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№40, 2019. Клинические рекомендации и алг оритмы для практикующих врачей

Pages 11-14. Демографические тенденции в борьбе с остеопорозом и его последствиями. Ершов В.Е., Родионова  С.С., Кривова А.В., Захаров В.П.

Pages 15-17. Роль однонуклеотидного полиморфизма гена CCR5 в развитии ревматоидного артрита. Чернова А.А., Никулина  С.Ю., Толстокорова Ю.А.

Pages 18-20. Лабораторные анализы у пациентов с эпилепсией. Клиническая лекция. Котов А.С., Фирсов К.В., Фролова В.М.

Pages 2-6. Обновление клинических рекомендаций по лечению больных остеоартритом 2019 года. Алексеева Л.И.

Pages 22-27. Регтайм для ацетилсалициловой кислоты в сосудистой неврологии. Широков Е.А.

Pages 28-31. Нестероидные противовоспалительные средства при скелетно-мышечных болях: преимущества трансдермальных терапевтических систем. Шестаков Н.В., Пятигорская Н.В.

Pages 32-37. Иммуногенность препаратов инсулинов: краеугольный камень в оценке безопасности. Мосикян А.А., Бабенко И А.Ю.

Pages 38-43. Возможности комбинированной сахароснижающей терапии у пожилых лиц с сахарным диабетом 2 типа. Дудинская Е.Н.

Pages 44-49. Влияние содержания таурина в плазме крови и генетической предрасположенности к диабету на изменение чувствительности к инсулину на фоне гипокалорийной диеты (реферат).

Pages 50-53. Тау протеин как маркер когнитивных нарушений при сахарном диабете. Матвеева М.В., Самойлова  Ю.Г., Жукова Н.Г., Кудлай Д.А.

Pages 54-58. Эффективность применения крема с бактериородопсином у больных псориазом. Олисова О.Ю., Максимов И.С., Алленова А.С.

Pages 59-61. Состояние вегетативной нервной системы у пациентов с хроническими дерматозами. Горшкова А.В., Русак Ю.Э., Русак С.Н., Ефанова Е.Н.

Pages 62-66. Клинические аспекты и трудности диагностики редких форм локализованной склеродермии. Тлиш М.М., Сычева Н.Л., Обломий А.В., Сорокина Н.В., Псавок Ф.А.

Pages 67-71. Оценка видового состава изолятов Сandida species, выделенных из различных биотопов, и их чувствительности к антифунгальным препаратам. Новикова В.В., Езов С.Г.

Pages 7-10. Локальная периартикулярная терапия при остеоартрите коленного сустава с использованием теноксикама. Гафаров И.Р., Мусина Ф.С., Глазунов С.Ю.

Pages 72-75. Подходы к профилактике рецидивов инфекций мочевыводящих путей у небеременных женщин. Гамидов С.И., Шатылко Т.В., Гасанов Н.Г.

Pages 76-79. Чрескожная криоабляция фиброаденомы молочной железы. Шачинов Е.Г., Балахнин П.В., Шмелев А.С., Малькевич В.И., Бит-Сава Е.М., Егоренков В.В., Моисеенко В.М.



№3, 2019. Аллергология. Иммунология

Pages 11-14. Клиническая эффективность иммунотерапии в лечении атопического дерматита у детей. Коков Е.А., Колесникова Н.В., Кокова Л.Н., Андронова Т.М.

Summary: Clinical efficacy of immunotherapy for atopic dermatitis in children

E.A. Kokov1, N.V. Kolesnikova1, L.N. Kokova1, T.M. Andronova2

1Kuban State Medical University, Krasnodar
2JSK “Peptek”, Moscow

Aim: to improve clinical efficacy of complex treatment for exacerbations of IgE-mediated atopic dermatitis in children using glucosaminylmuramyl dipeptide (GMPD) — Licopid, immunomodulator of microbial origin.
Patients and Methods: 85 children aged 6–9 years with exacerbations of moderate IgE-mediated atopic dermatitis without clinical manifestations of bacterial, viral, or fungal comorbidities by the time of examination were enrolled in the study. The patients were subdivided into three groups characterized by similar course and area of skin lesions but different treatment strategies. Group 1 (n=30) received complex treatment which included one course of GMPD (Licopid). Group 2 (n=25) received traditional treatment without immunotherapy. Group 3 (n=30) received complex treatment which included two courses of GMPD (Licopid) with a 2-month interval.
Results: complex treatment of exacerbations of IgE-mediated atopic dermatitis using GMPD (Licopid, course dosage 25 mg) reduces the area of skin lesions and the severity of clinical manifestations (subjective signs have totally disappeared after 2 months of the treatment). In addition, two courses of immunotherapy (a total dose of 50 mg) reduces the rate of atopic dermatitis exacerbations and comorbidities more significantly than traditional treatment.
Conclusions: GMPD (Licopid) should be recommended as the first choice drug in the complex immunotherapy due to its clinical efficacy as a part of complex treatment for exacerbations of erythematous squamous and lichenoid IgE-mediated atopic dermatitis with clinical manifestation.

Keywords: atopic dermatitis, traditional treatment, immunotherapy, muramyl peptides, clinical efficacy, glucosaminylmuramyl dipeptide, Licopid.
For citation: Kokov E.A., Kolesnikova N.V., Kokova L.N., Andronova T.M. Clinical efficacy of immunotherapy for atopic dermatitis in children. RMJ. 2019;3:11–14.

Pages 15-18. Клинико-диагностическое и прогностическое значение уровня интерлейкина-22 в сыворотке крови у детей с атопическим дерматитом. Башкина О.А., Самотруева М.А., Пахнова Л.Р.

Summary: Clinical diagnostic and predictive value of serum IL-22 in children with atopic dermatitis

O.A. Bashkina1, M.A. Samotrueva1, L.P. Pakhnova1, 2

1Astrakhan State Medical University
2 N.N. Silishcheva Regional Children’s Clinical Hospital, Astrakhan

Aim: to determine clinical diagnostic and predictive value of serum IL-22 levels in children with atopic dermatitis.
Patients and Methods: the study enrolled 95 children with atopic dermatitis. Mild atopic dermatitis was diagnosed in 22 children, moderate in 43 children, and severe in 30 children. Control group included 20 healthy children. Immunological examination (total and specific serum Ig E levels) and blood biochemistry were performed in a total of 95 children. Serum IL-22 level was measured by ELISA.
Results: significantly increased IL-22 levels were revealed in atopic dermatitis children as compared with the controls (median 175.2 pg/mL [158.9; 221.5] and 28.7 [25.6; 313] pg/mL, respectively; р=0.039). Strong direct correlation between IL-22 levels and SCORAD (scoring of atopic dermatitis) index was found (RS=0.774; р<0.05). The analysis of IL-22 levels has demonstrated that IL-22 median is 196.2 [145.1; 201.2] pg/mL in 80 children with atopic dermatitis and IgE overproduction and 173.9 [151.4; 316.2] pg/mL in 15 children with atopic dermatitis and normal IgE levels (p=0.197). Week correlation between total IgE and IL-22 levels was revealed in atopic dermatitis (RS=0.307; р<0.05).
Conclusion: considering increased serum IL-22 levels in a total of 95 children with atopic dermatitis and tendency to increased IL-22 leves along with the growing severity of dermatitis, IL-22 should be regarded as a predictive marker of dermatitis.

Keywords: children, atopic dermatitis, immunological examination, interleukin-22, immunoglobulin, prediction, marker.
For citation: Bashkina O.A., Samotrueva M.A., Pakhnova L.P. Clinical diagnostic and predictive value of serum IL-22 in children with atopic dermatitis. RMJ. 2019;3:15–18.

Pages 19-21. Пищевая анафилаксия у детей дошкольного возраста как фактор риска развития респираторной аллергии в будущем. Лепешкова Т.С., Бельтюков Е.К., Наумова В.В.

Summary: Nutritional anaphylaxis in preschool children as a risk factor for respiratory allergies development in the future

T.S. Lepeshkova1,2, E.K. Beltyukov1, V.V. Naumova1

1Ural State Medical University, Yekaterinburg
2City Children’s Outpatient Clinic No. 13, Yekaterinburg

Aim: to study the sensitization spectrum using comprehensive allergological diagnosis in children with persistent food allergy, who had experienced anaphylaxis episodes.
Patients and Methods: 14 children (11 (79%) boys and 3 (21%) girls) who experienced one or more food anaphylaxis episodes in early childhood and have persistent food allergy during the study (mean age — 6.8 years) underwent dynamic follow-up. The following allergic etiologies to severe life-threatening reactions were revealed: in 6 (43%) patients there were dairy products, in another 6 (43%) children — eggs, in 3 (21%) patients — kiwi, 2 (14%) patients had a reaction to fish, peanuts, sesame, and 1 (7%) — to walnuts and shrimps. All patients underwent a comprehensive allergological diagnosis, including the ImmunoCAP ISAC test.
Results: during the study, all children (100%) were confirmed with the true food allergy causing the anaphylactic reactions in history and the remaining etiologies of persistent food allergy at the present time. Sensitization to the major specific components of inhaled allergens was detected in all 14 children (100%) who experienced the food anaphylaxis. The highest hypersensitivity was observed to birch (rBet v1) — from 0.3 to 100.0 ISU-E (79%), to cypress (nCup a1) — from 0.3 to 1.2 ISU-E (36%), to cats (rFel d1) — from 1.6 to 90.0 ISU-E (64%), and to dogs (rCan f1) — from 1.1 to 40.0 ISU-E (50%). None of the patients showed sensitization to house dust mite molecules.
Conclusion: as a result of the study, the data were obtained on the sensitization formation to respiratory allergens in all children (100%) who experienced food anaphylaxis and who have persistent food allergy at the present time.

Keywords: children, food anaphylaxis, sensitization, allergen, persistent food allergy, respiratory allergy.
For citation: Lepeshkova T.S., Beltyukov E.K., Naumova V.V. Nutritional anaphylaxis in preschool children as a risk factor for respiratory allergies development in the future. RMJ. 2019;3:19–21.

Pages 2-2. Слово редактора. Федоскова Т.Г.

Pages 22-26. Влияние противопаразитарной терапии на течение бронхиальной астмы у детей. Файзуллина Р.М., Санникова А.В., Самигуллина Н.В., Гафурова Р.Р., Валеева Р.Н., Ханова А.К.

Summary: Antiparasitic therapy effect on the course of bronchial asthma in children

R.M. Fayzullina1, A.V. Sannikova1, N.V. Samigullina1, R.R. Gafurova1, R.N. Valeeva1, A.K. Khanova2

1Bashkir State Medical University, Ufa
2MMC Clinic of Allergology and Pediatrics LLC, Ufa

Bronchial asthma (BA) is a chronic inflammatory respiratory tract infection that ranks first among chronic bronchopulmonary diseases in childhood. Its heredity is of paramount importance, as well as environmental factors (e.g. parasitosis).
Aim: to study the BA clinical and immunological features in children with parasitic invasion before and after antiparasitic therapy.
Patients and methods: children with BA without parasitic invasion (n=45) and children with BA and parasitosis (n=30) underwent a prospective comparative study. Antiparasitic therapy with albendazole was administered to all patients with identified invasion. The study of BA clinical course and allergological examination results was performed before and after antiparasitic therapy.
Results: BA in children with parasitic invasion was characterized by the following: persistent course, increase in the exacerbations frequency and the basic anti-inflammatory therapy volume, uncontrolled course (p=0.0012), decrease in external respiration indices (p=0.004), significant increase eosinophils count (p=0.024), and total IgE level in blood. It was revealed that in children with combined BA and parasitosis course, most frequent allergy was to: house dust (p=0.007); dog hair (p=0.008) and guinea pigs (p=0.001) allergens; Aspergillus fumigatus fungi (p=0.036) and Candida albicans (p=0.024); as well as a number of food allergens. Also, antiparasitic therapy contributed to an increase in the number of patients with a mild intermittent course (p=0.0001) and control level (p=0.0072), a decrease in the exacerbations frequency (p<0.001), an absence of severe BA exacerbations, and a decrease in the blood eosinophils average level. Skin allergy test conducted at the end of observation showed an increase in the parameter of domestic and pollen allergens in children with BA. At the same time, positive results frequency of skin allergen tests decreased by epidermal and fungal allergens, with the significance of differences — by food allergens (p <0.05).
Conclusion: parasitic invasion in children with BA is a frequent comorbid condition. Antiparasitic therapy leads to an improvement in the clinical course of the disease and increases the allergic diagnosis objectivity.

Keywords: bronchial asthma, parasitosis, antiparasitic therapy, allergy testing, children.
For citation: Fayzullina R.M., Sannikova A.V., Samigullina N.V. et al. Antiparasitic therapy effect on the course of bronchial asthma in children. RMJ. 2019;3:22–26.

Pages 27-31. Ультразвуковая оценка динамики состояния органов иммунной системы у детей с гипертрофией небных миндалин при консервативной терапии с применением препарата комплексного действия азоксимера бромида. Возгомент О.В., Надточий А.Г., Карпова Е.П., Авальян Я.С., Аминова А.И., Акатова А.А.

Summary: Ultrasound of peripheral immune system in children with palatine tonsil hypertrophy who receive treatment with azoximer bromide

O.V. Vozgoment1,2, A.G. Nadtochiy1, E.P. Karpova2, Ya.S. Aval’yan2, A.I. Aminova3, A.A. Akatova4

1Central Research Institute of Dental and Maxillofacial Surgery, Moscow
2Russian Medical Academy of Continuous Professional Education, Moscow
3Sechenov University, Moscow
4Federal Scientific Center for Medical and Preventive Health Risk Management Technologies, Perm

Aim: to demostrate the importance of ultrasound examination of the peripheral immune system for treatment decision and monitoring of immunomodulatory therapy efficacy in children with palatine tonsil hypertrophy when using azoximer bromide.
Patients and Methods: 77 children aged 3–7 years with palatine tonsil hypertrophy and systemic lymphoid hyperplasia (study group) and 90 healthy children of the same age (control group) underwent clinical, ultrasound, and immunological examinations. Peripheral immune system status, immunological parameters, and changes in sonographic signs after intramuscular azoximer bromide were compared.
Results: significant differences in sonographic signs which demonstrate systemic lymphoid hyperplasia, i.e., maximum linear blood flow velocity in jugulodigastric lymph node artery (14.5±1.8 cm/sec and 11.7±1.6 cm/sec, respectively), splenic mass index (4.55 and 3.9, respectively), and splenic lymph follicle hyperplasia as well as in laboratory parameters (i.e., interleukins, cytotoxic lymphocytes, B cells, malondialdehyde, and plasma total antioxidant capacity) were revealed between the groups. After personalized treatment with azoximer bromide, decrease in palatine tonsil sizes, mean group splenic mass index, and reactive lymph follicle hyperplasia was reported in 60% of children.
Conclusions: ultrasound of peripheral immune system distinguishes between local and systemic lymphoid hyperplasia in children with palatine tonsil hypertrophy, determines baseline status of lymphoid organs, and monitors treatment efficacy.
Complex treatment using intramuscular injections of azoximer bromide reduces splenic mass index and splenic lymph follicle hyperplasia. This demonstrates total improvement of lymphoid hyperplasia in children with palatine tonsil hypertrophy.

Keywords: palatine tonsil hypertrophy, systemic lymphoid hyperplasia, peripheral immune system, spleen ultrasound, splenic mass index, azoximer bromide, Polyoxidonium.
For citation: Vozgoment O.V., Nadtochiy A.G., Karpova E.P. et al. Ultrasound of peripheral immune system in children with palatine tonsil hypertrophy who receive treatment with azoximer bromide. RMJ. 2019;3:27–31.

Pages 3-6. Клинико-патогенетическая роль рецепторов к комплементу у больных хронической спонтанной крапивницей. Мешкова Р.Я., Витчук А.В., Аксенова С.А., Ковригина Н.В.

Summary:

Clinical pathogenic role of complement receptors in chronic spontaneous urticaria

R.Ya. Meshkova, A.V. Vitchuk, S.A. Aksenova, N.V. Kovrigina

Smolensk State Medical University

Aim: to analyze clinical pathogenic value of soluble complement receptor (C1qR1) in patients with chronic spontaneous urticaria and to compare the findings with clinical characteristics of the disease.

Patients and Methods: the study enrolled 49 patients with chronic spontaneous urticaria. Group 1 included 36 patients with chronic spontaneous urticaria and angioedema (mean age 43.8±2.96 years). Group 2 included 13 patients with chronic spontaneous urticaria only (mean age 40.5±4.3 years). Control group included 34 healthy individuals (mean age 39.1±2.25 years). Serum C1qR1 concentration was measured by ELISA.

Results: in patients with chronic spontaneous urticaria and angioedema, C1qR1 level was significantly higher than in patients without angioedema (0.32±0.07 pg/mL and 0.17±0.05 pg/mL, respectively, p<0.05). In chronic spontaneous urticaria duration more than 5 years, C1qR1 concentration is significantly lower than in disease duration less than 5 years and 1 year to 5 years (0.09±0.02 pg/mL, 0.22±0.03 pg/mL, and 0.41±0.16 pg/mL, respectively, p<0.05). Neither gender differences (0.24±0.04 pg/mL in women and 0.41±0.20 pg/mL in men, p>0.05) nor age differences (0.24±0.04 pg/mL in 18–39 years, 0.18±0.04 pg/mL in 40–59 years, and 0.46±0.24 pg/mL over 60 years, p>0.05) in C1qR1 levels were found in patients with chronic spontaneous urticaria.

Conclusions: it was demonstrated for the first time that soluble receptors to C1q component are involved in the pathogenesis chronic spontaneous urticaria. In more severe disease with angioedema, significant increase in C1qR1 levels was found as compared with chronic spontaneous urticaria without angioedema. Non-sedating antihistamines initially available in two dosages (e.g., ESPA-BASTIN®) are the optimal choice for resistant chronic spontaneous urticaria.

Keywords: chronic spontaneous urticaria, receptor to C1q complement component, C1qR1, complement system, histamine, antihistamines, ebastine, ESPA-BASTIN.

For citation: Meshkova R.Ya., Vitchuk A.V., Aksenova S.A., Kovrigina N.V. Clinical pathogenic role of complement receptors in chronic spontaneous urticaria. RMJ. 2019;3:3–6.

Pages 32-35. Оптимизация концентрации аллергенов для использования в тесте активации базофилов. Бычкова Н.В., Учеваткина А.Е., Козлова Я.И., Фролова Е.В., Новик Г.А., Калинина  Н.М.

Summary: Allergen concentrations optimization for basophil activation test

N.V. Bychkova1,2, A.E. Uchevatkina3, Ya.I. Kozlova3, E.V. Frolova3, G.A. Novik4, N.M. Kalinina1,2

1Nikiforov All-Russian Center for Emergency and Radiation Medicine, Saint Petersburg
2Pavlov First St. Petersburg State Medical University
3North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg
4Saint Petersburg State Pediatric Medical University

Cell function testing, for which an optimal conditions selection has proceeded, has been recently proposed to improve the possibility of sensibilization detection to such allergen types as food, drug, inhalation. Basophil activation test is considered as a provocation in vitro test. It showed high sensitivity and specificity to a large range of allergens.
Aim: to study an allergen concentration impact on basophil activation in vitro in different patient groups.
Patients and Methods: 5 patients with allergic bronchopulmonary aspergillosis, 9 patients with atopic asthma without mycetogenic sensitization, 11 patients with atopic dermatitis (6 — with sensitization to wheat flour allergen, and 5 — without it) were examined. Laboratory examination included determination of the specific IgE level and basophil activation in vitro test by flow cytometry with allergen concentrations (Alkor Bio, Russia) from 0.5 to 100 µg/ml.
Results: the number of activated basophils expressing CD203c advanced with the allergens concentration increase in the samples. The value of choosing the optimal allergens concentration of Aspergillus fumigatus and wheat flour in the basophil activation test to exclude false positive and false negative results was demonstrated. The method accuracy improvement requires low activation index to increase sensitivity and low but sufficient allergen concentration used for the specificity increase to activate basophils. The optimal concentrations range for both allergens in the basophil activation test was from 2 to 10 µg/ml. It was shown that the cells activation degree in interaction with a mycotic allergen is higher than with food.
Conclusion: detection of patient sensitization in basophil activation test using the allergen optimal dosage coincides with the history data, skin test positive results and the level of specific IgE to allergens.

Keywords: allergic diseases, sensitization, basophil activation test, concentration, allergens, IgE, allergic bronchopulmonary aspergillosis, atopic dermatitis.
For citation: Bychkova N.V., Uchevatkina A.E., Kozlova Ya.I. et al. Allergen concentrations optimization for basophil activation test. RMJ. 2019;3:32–35.

Pages 36-39. Оценка напряженности популяционного иммунитета к вирусам кори, краснухи, эпидемического паротита и ветряной оспы у здоровых взрослых. Топтыгина А.П., Клыкова Т.Г., Смердова М.А., Зеткин А.Ю.

Summary: Herd immunity to measles, rubella, mumps, and chickenpox in healthy adults

A.P. Toptygina1,2, T.G. Klykova3, M.A. Smerdova1, A.Yu. Zetkin3

1G.N.Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow
2M.V. Lomonosov Moscow State University
3Main Center of State Sanitary and Epidemiological Supervision (of special purpose) of the Ministry of Defense of the Russian Federation, Moscow

Anthroponotic viral infections with aerosol transmission are a large nosologic group. Among them are measles, rubella, mumps, and chickenpox. Currently, these infections are common in adults who are more likely than children to have severe symptoms. Viral infections especially those involving skin may trigger or exacerbate allergic disorders.
Aim: to analyze herd immunity to measles, rubella, mumps, and chickenpox in 93 healthy individuals aged 18–30 years.
Patients and Methods: 93 accidentally enrolled healthy individuals aged 18–30 years were examined. Blood serums were examined for protective antibodies against measles, rubella, mumps, and chickenpox viruses by ELISA using relevant test systems.
Results: protective levels of antibodies against rubella, chickenpox, and mumps were detected in most individuals (96%, 87% and 87%, respectively) thus indicating the efficacy of vaccination or prior infection. Average levels of specific antibodies against rubella, mumps, and chickenpox were higher than protective levels. 56% of individuals were found to be seronegative for measles and 13% had residual specific antibodies less than protective levels. Therefore, 68% had no protection against measles. On average, 68% of individuals were susceptible to measles. This rate does not satisfy the criterion of epidemiological welfare.
Conclusion: our findings demonstrate that this group of individuals has low susceptibility to rubella, mumps, and chickenpox. Individuals without protection from measles have high risk of the infection and spread of the infection.

Keywords: incidence, measles, rubella, mumps, chickenpox, antibodies, vaccination, herd immunity, serological monitoring.
For citation: Toptygina A.P., Klykova T.G., Smerdova M.A., Zetkin A.Yu. Herd immunity to measles, rubella, mumps, and chickenpox in healthy adults. RMJ. 2019;3:36–39.

Pages 40-44. Особенности диагностики аллергии к яду перепончатокрылых насекомых. Шабанов Д.В., Лазаренко Л.Л., Федоскова Т.Г., Рыбникова Е.А.

Summary: Diagnostics of Hymenoptera venom allergy

D.V. Shabanov1, L.L. Lazarenko2, T.G. Fedoskova1, E.A. Rybnikova3

1National Research Center Institute of Immunology, Moscow
2I.I. Mechnikov North-Western State Medical University, St. Petersburg
3Children’s City Clinical Hospital № 9 named after G.N. Speransky, Moscow

Allergic reactions to Hymenoptera venom are characterized by great severity and rapidity of the development of life-threatening symptoms. In Russia, no diagnostic products for allergy skin tests are approved, therefore, laboratory tests are of special importance. This paper reviews the most common available methods for clinical and laboratory allergy diagnostics. The features and difficulties in clinical diagnosis as well as the relevance of in vitro tests are discussed using Hymenoptera venom allergy example. Current progress in molecular allergy testing (component-based IgE allergy testing) based on numerous European and Russian studies is addressed. The paper describes domestic advances in the development of molecular allergy testing in Hymenoptera venom allergy. The importance and significance of additional functional in vitro tests (i.e., basophil activation test) are discussed. Basophil activation test performance using various identification molecules (CD63 and CD203c) and their diagnostic potential in Hymenoptera venom allergy (in particular when clear clinical and anamnestic data are scarce and specific IgE levels are irrelevant) are highlighted.

Keywords: bee, wasp, allergy, venom, Hymenoptera, allergy diagnostics, molecular allergy testing, basophil activation test.
For citation: Shabanov D.V., Lazarenko L.L., Fedoskova T.G., Rybnikova E.A. Diagnostics of Hymenoptera venom allergy. RMJ. 2019;3:40–44.

Pages 45-50. Антигистаминные препараты 2-го поколения при аллергическом рините: опыт реальной клинической практики. Бодня О.С., Ненашева  Н.М.

Summary: Second generation antihistamines in allergic rhinitis: experience of real clinical practice

O.S. Bodnya, N.M. Nenasheva

Russian Medical Academy of Continuous Professional Education, Moscow

The results of recent research indicate an increase in allergic rhinitis (AR) morbidity. Rhinitis symptoms have a pronounced negative impact on the health-related quality of life of patients. Over the last 4 years, new international guidelines for the diagnosis and treatment of AR have been developed, which have helped to significantly improve the management of patients with this nosology. A new concept of step-by-step AR therapy has been developed based on the control of clinical symptoms of the disease. Practical rhinitis control has been proposed to evaluate treatment outcomes and simplify disease monitoring. Following the algorithm of AR therapy depending on the severity of symptoms, 2nd generation antihistamines should be administered as a starting therapy to all patients with mild AR symptoms, as well as patients with moderate and severe symptoms in the absence of dominance of “stuffy nose”.

Keywords: ARIA, phenotypes, allergic rhinitis, step-by-step therapy, rhinitis control, antihistamines, cetirizine, Zyrtec.
For citation: Bodnya O.S., Nenasheva N.M. Second generation antihistamines in allergic rhinitis: experience of real clinical practice. RMJ. 2019;3:45–50.

Pages 51-56. Роль и место интраназальных кортикостероидов в лечении аллергического ринита на современном этапе. Чурюкина Э.В.

Summary: Role and place of intranasal corticosteroids in the treatment of allergic rhinitis at the present stage

E.V. Churyukina

Rostov State Medical University, Rostov-on-Don

Allergic rhinitis (AR) — a widespread disease that significantly affects the quality of life. The issues of AR are considered taking into account the latest international and national conciliation documents. Emphasis is made on intranasal corticosteroids (ICS), which are recommended as the first line of therapy in the moderate and severe form of AR, as well as in the absence of therapy effects on the first stage of treatment. The mechanism of action, pharmacological peculiarities, therapeutic index of modern ICS are presented. The maximum therapeutic index showing the maximum efficacy and the minimum number of adverse events in the treatment of AR was revealed in the mometazone furoate (it is contained in the only domestic drug — nasal spray Nosefrin®). The data of the prospective open observational non-comparative study on the efficacy, tolerability and safety assessment of the nasal spray Nosefrin® in patients with seasonal AR (n=55) are described. Good clinical efficacy and safety of Russian nasal spray mometasone furoate Nozefrin® in monotherapy was established, confirmed both by objective data and subjective assessment of patients themselves.

Keywords: allergic rhinitis, intranasal corticosteroids, therapeutic index, mometasone furoate, Nosefrin®.
For citation: Churyukina E.V. Role and place of intranasal corticosteroids in the treatment of allergic rhinitis at the present stage. RMJ. 2019;3:51–56.

Pages 57-61. Антигистаминные препараты в лечении аллергического ринита: в фокусе внимания пациенты с коморбидной аллеpгопатологией. Надей Е.В., Нечаева Г.И.

Summary: Antihistamines for allergic rhinitis: focus on the patients with allergic comorbidities

E.V. Nadey, G.I. Nechaeva

Omsk State Medical University

Allergic rhinitis (AR) is one of the most common allergic disorders. AR is still an important medical social issue due to the unfavorable impact on health, mental status, and social life. Comorbidities (i.e., asthma, atopic dermatitis, urticaria, food and drug allergy) affect the course and severity of AR. Pharmacotherapy for AR, its duration and medication choice still remain a challenge. Second generation antihistamines for AR (in particular, when associated with other allergic disorders) are considered as basic treatment rather than symptomatic therapy which improves clinical signs. The authors report on the clinical efficacy of levocetirizine for allergic comorbidities. Their findings demonstrate high efficacy of Allerway for seasonal AR associated with atopic dermatitis or pollen polysensitization. Both AR and atopic dermatitis benefit from Allerway.

Keywords: allergic disorders, rhinitis, itching, nasal congestion, second-generation antihistamines, levocetirizine, Allerway.
For citation: Nadey E.V., Nechaeva G.I. Antihistamines for allergic rhinitis: focus on the patients with allergic comorbidities. RMJ. 2019;3:57–61.

Pages 62-64. Хроника научной жизни.

Pages 7-10. Анализ роли аллергокомпонентов в комплексной диагностике поллиноза и прогнозировании эффективности аллерген-специфической иммунотерапии. Хабибулина Л.Р., Власова Н.В., Манжос М.В., Кавеленова  Л.М.

Summary: The role of allergen components in the complex diagnosis of pollinosis and prediction of allergen-specific immunotherapy efficacy

L.R. Khabibulina1, N.V. Vlasova2, M.V. Manzhos1, L.M. Kavelenova2

1 Medical University “Reaviz”, Samara
2 Samara University

Aim: to determine the profile of specific IgEs in patients with weed pollen sensitization in Samara and to identify the causes of poor efficacy of allergen-specific immunotherapy (ASIT) by means of component-based allergy diagnostic testing.
Patients and Methods: specific IgEs to the major allergens of Ambrosia and Artemisia (Amb a 1 and Art v 1, respectively), minor allergen of Artemisia (Art v 3), and native allergenic extract of Ambrosia trifida were tested in 50 patients with weed pollen sensitization and poor efficacy of ASIT with Artemisia allergen. The testing was performed using ImmunoCAP ISAC system (Sweden).
Results: 74% of patients (n=37) were sensitized to Art v 1, 18% (n=9) to Art v 3, 34% (n=17) to Аmb а 1, and 78% (n=39) to the allergenic extract of Ambrosia trifida. In 26 patients with poor efficacy of ASIT, 11.5% (n=3) required ASIT with Artemisia allergen only, 65.4% (n=17) required ASIT with Artemisia and Ambrosia allergens, 11.5% (n=3) required ASIT with Ambrosia allergen, and 11.5% (n=3) did not require ASIT.
Conclusion: ASIT with Artemisia allergen without considering additional sensitizing factor (Ambrosia trifida) results in poor efficacy of ASIT. The diagnosis of true allergy and medication choice for ASIT should be based on careful allergy history, clinical manifestations, skin testing, and ImmunoCAP ISAC testing.

Keywords: pollinosis, Ambrosia trifida, immunotherapy, ASIT, component-based allergy diagnostic testing, aeropalinology, Artemisia.
For citation: Khabibulina L.R., Vlasova N.V., Manzhos M.V., Kavelenova L.M. The role of allergen components in the complex diagnosis of pollinosis and prediction of allergen-specific immunotherapy efficacy. RMJ. 2019;3:7–10.



№1(II), 2019. Имунный ответ

Pages 42-46. Влияние азоксимера бромида на формирование внеклеточных нейтрофильных ловушек. Пинегин Б.В., Дагиль Ю.А., Воробьева Н.В., Пащенков М.В.

Summary: Azoximer bromide effect on the neutrophil extracellular traps formation
B.V. Pinegin1, Yu.A. Dagil2, N.V. Vorobieva3, M.V. Pashchenkov1

1National Research Center — Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow
2 LLC “Petrovax Pharm”, Moscow
3Lomonosov Moscow State University

In 2004, a new immunological process, consisting of DNA strands release framed with cationic proteins and peptides during neutrophil activation, was presented. These structures were called neutrophil extracellular traps (NETs). Along with the presence of NETs positive properties, it was shown that NETs have a serious negative effect associated with their protein composition, consisting of 70% of positively charged histones and 20–30% of cationic proteins such as α-defensins and peptide LL-37 (which in the same manner as histones have a toxic effect on human tissue outside the cellular space) in relation to the infection protection. Currently, it is proved that NETs are involved in numerous pathological conditions, including those with respiratory infections, significantly aggravating the course of the disease.
Aim: to study the effect of azoximer bromide (under «Polyoxidonium» trade name) on the NETs formation in vitro.
Patients and Methods: neutrophils of healthy donors were isolated by centrifugation in one-step Ficoll-Hypaque density gradient. Polyoxidonium in 10, 100, 500, or 1000 μg/ml dosages was added to neutrophils 1 hour before the phorbol myristate acetate (PMA) introduction into the wells. Fluorescence microscopy was used to detect NETs. The preparations were stained with Syber Green.
Results: a new effect of the Polyoxidonium drug has been identified. It consisted in reducing the activated neutrophils ability to secrete macromolecular complexes including DNA, granular, nuclear and cytoplasmic proteins, and antimicrobial proteins as well, which are equally toxic for both prokaryotic and eukaryotic cells. A decrease in the NETs formation and release has made a significant contribution to the therapeutic and prophylactic effect of Polyoxidonium. Also, it explained its high clinical efficacy in the treatment and prevention of acute and chronic respiratory viral infections along with the immunomodulating and detoxifying properties.
Conclusion: conducted researches revealed fundamentally new therapeutic properties of Polyoxidonium, namely, its ability to reduce the NETs formation by activated neutrophils with full preservation of its immunostimulating and detoxifying properties.

Keywords: neutrophil extracellular traps, NETosis, respiratory diseases, ARVI, human neutrophils, azoximer bromide, Polyoxidonium.
For citation: Pinegin B.V., Dagil Yu.A., Vorobieva N.V., Pashchenkov M.V. Azoximer bromide effect on the neutrophil extracellular traps formation. RMJ. 2019;1(II):42–46.

Pages 47-50. Исследование гистаминолиберирующих свойств мелиттина, полученного из отечественного пчелиного яда. О.В. Миславский, Т.Г. Федоскова, Д.В. Шабанов, А.И. Мартынов, С.Р. Маштакова, Е.Д. Головкина

Summary: Study of melittin histamine-liberating properties, obtained from the domestic bee venom
O.V. Mislavsky1, T.G. Fedoskova1,2, D.V. Shabanov1,3, A.I. Martynov1, S.R. Mashtakova1, E.D. Golovkina1

1National Research Center — Institute of Immunology, Moscow
2Pirogov Russian National Research Medical University, Moscow
3Yevdokimov Moscow State University of Medicine and Dentistry

Aim: to study melittin histamine-liberating properties, obtained from bee venom of the domestic manufacturer.
Patients and Methods: the study of melittin histamine-liberating properties, obtained from bee venom purified extracts — the raw of the company “Apis” LLC, was carried out according to the method for determining the histamine release from rat mast cells. The work was carried out using the mast cells received from the peritoneal fluid of male Wistar rats. Melittin was tested at concentrations of 0.1, 0.25, 0.5, 1, 2.5, 5 and 10 mg/ml. Melittin obtained from the bee venom of the company Sigma was taken as a reference drug. The melittin samples used in the work were received using chromatographic separation, gel filtration by FPLC Pharmacia Biotech medium pressure chromatographic system, and Superdex 75HR column calibrated by molecular weight.
Results: it was revealed that melittins, obtained from the bee venoms of the “Apis” LLC and Sigma companies, did not significantly differ among themselves by their dose-dependent effect on the histamine release from mast cells. It has been established that melittin causes the histamine release from mast cells of less than 10% in concentrations from 0.1 to 0.25 mg/ml. Conducted study tests revealed that the melittin concentrations 5 and 10 mg/ml are the most toxic for mast cells. The ninhydrin inhibitory effect study on the histamine release from mast cells, caused by melittin, showed the ability to reduce the melittin toxic effect on mast cells under the inhibitor action of free NH2-groups. The ninhydrin inhibitory effect on the histamine release from mast cells was detected in concentrations of 0.001 and 0.0001 M.
Conclusion: the authors of the study showed the same dose dependence of the melittin histamine-liberating action from domestic raw bee venom and melittin from Sigma bee venom, which will allow us to investigate melittin from the bee venom of the domestic manufacturer.

Keywords: insect allergy, honey bee, Apis mellifera, bee venom, melittin, target cells, allergy, mast cells, histamine, ninhydrin.
For citation: Mislavsky O.V., Fedoskova T.G., Shabanov D.V. et al. Study of melittin histamine-liberating properties, obtained from the domestic bee venom. RMJ. 2019;1(II):47–50.

Pages 51-55. Ингибиторный эффект препарата на основе масляного экстракта водорослей на репродукцию вируса герпеса в культуре клеток in vitro. Н.Д. Львов, Мельниченко А.В., Л.М. Алимбарова, А.А. Никитина

Summary: Drug inhibitory effect, based on algae oil extract, on the herpes virus reproduction in cell culture in vitro

N.D. Lvov, A.V. Melnichenko, L.M. Alimbarova, A.A. Nikitina

Gamalei National Research Center for Epidemiology and Microbiology, Moscow

Aim: to study the drug based on the algae oil extract (AOE) for the herpes simplex virus (HSV 1, 2) reproduction in an in vitro experiment on the sensitive model — the cell culture.
Patients and Methods: the study included the following actions: determination of the drug cytotoxicity on cell culture, determination of the drug antiviral action directly in the cells, determination of virus reproduction inhibition after drug exposure and the HSV infectious activity in enzyme immunoassay (ELISA).
Results: the concentrations, at which the drug does not have the cytotoxic effect on the sensitive cell line culture, were determined — 50% tissue cytopathic dose (TCD50/ml) was 0.0055% AOE solution. 0.001% drug concentration is TCID50/ml — the dose inhibiting the virus replication by 50%, giving a maximum decline by 2 lg TCID50/ml for HSV-1 («L2») and by 1.75 lg TCID50/ml for HSV-2 («VN») of virus infectious activity through the prophylactic regimen (1 hour before virus exposure).
Conclusion: the AOE drug inhibitory effect was established — chemotherapeutic index for AOE drug was 5.5, which indicates the drug antiviral activity. AOE is a new promising drug with another mechanism of action, different from the generally accepted drugs such as acycloguanosine drugs, for the HSV infection treatment.

Keywords: herpes simplex virus, HSV, cell culture, algae oil extract, antiviral effect, in vitro.
For citation: Lvov N.D., Melnichenko A.V., Alimbarova L.M., Nikitina A.A. Drug inhibitory effect, based on algae oil extract, on the herpes virus reproduction in cell culture in vitro. RMJ. 2019;1(II):51–55.

Pages 56-61. Современные возможности лабораторной аллергодиагностики. Бала А.М., Клещенко А.Б., Чурсинова Ю.В.

Summary: Current possibilities of an allergy laboratory diagnosis

A.M. Bala, A.B. Kleschenko, Yu.V. Chursinova

Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirskiy

Allergic diseases are a global epidemiological problem: 10–30% of the planet population has any allergic diseases’ manifestations. In this regard, early diagnosis and prevention of allergic diseases are extremely relevant. Current allergy diagnosis is a wide range of effective tools that allow maximally personalizing the diagnosis and predicting treatment effectiveness. Mainly, IgE are involved in allergic reactions development, as they are responsible for the manifestation of immediate-type allergy and are detected by using various diagnostic tools.
Polysensitization is an important clinical characteristic, as it affects about 70–80% of the world’s allergic population. The diagnostic pathway requires an adequate and detailed methodology based on the compliance demonstration of medical history with documented sensitization. The patient management with polysensitization should rely on a careful examination, mainly, based on the possibilities of allergy molecular diagnostics. Multiplex systems are the most breakthrough method, which gives a complete sensitization profile picture (a key aspect of the allergic diseases’ diagnosis).

Keywords: allergic diseases, IgE, allergy diagnosis, polysensitization, biochip, component diagnosis, molecular diagnostics, ACIT.
For citation: Bala A.M., Kleschenko A.B., Chursinova Yu.V. Current possibilities of an allergy laboratory diagnosis. RMJ. 2019;1(II):56–61.

Pages 62-65. Оптимизация диагностики герпес-вирусной инфекции 8 типа. Н.Д. Львов, Е.М. Панюкова, М.В. Мезенцева

Summary: Diagnosis optimization for the human herpesvirus type 8

N.D. Lvov, E.M. Panyukova, M.V. Mezentseva

National Research Center for Epidemiology and Microbiology named after N.F. Gamaleya, Moscow

Aim: to study an association of immunological parameters with human herpesvirus type 8 (HHV-8) markers for the laboratory variants determination of viral reproduction and human immunity condition in patients with Kaposi’s sarcoma (KS) and prognostic markers selection of the disease exacerbation.
Patients and Methods: 22 patients with KS underwent a comprehensive study. The following methods were applied in this study: ELISA for the HHV-8 small capsid protein (SCP) IgG determination in human serum and polymerase chain reaction for the HHV-8 DNA determination in human peripheral blood mononuclear cells (PBMC) and in a biopsy sample from the KS focus. The production of interferon α (IFN-α), interleukins IL-1β, IL-6, IL-8, IL-1 receptor antagonist (IL-1 RA).
Results: a correlation between the HHV-8 SCP IgG detection and reduced IFN-α values, as well as between the HHV-8 DNA detection and increased IL-1 RA values, were found. The highest IFN-α levels in patients with KS were observed in the absence of HHV-8 antibodies. The IL-1 RA median value in patients with detected HHV-8 DNA was 838 pg/ml, and in patients without detected DNA — 187.5 pg/ml (p=0.0015). The proinflammatory IL-1β level increase in the patients’ serum with the HHV-8 IgG presence (p=0.0016) was shown. It was also shown that the HHV-8 DNA detection in the PBMC revealed higher IL-6 values and lower IL-8 values in patients’ serum with KS.
Conclusion: prognostic markers determination of the HHV-8 exacerbation and 4 KS laboratory variants selection were conducted, which can improve the HHV-8 diagnosis effectiveness to carry out a set of prophylactic measures for KS progression prevention.

Keywords: human herpesvirus type 8, Kaposi’s sarcoma, enzyme immunoassay, polymerase chain reaction, immunoglobulin G, interferon α, interleukin, IL-1 receptor antagonist.
For citation: Lvov N.D., Panyukova E.M., Mezentseva M.V. Diagnosis optimization for the human herpesvirus type 8. RMJ. 2019;1(II):62–65.

Pages 66-70. Острые аллергические реакции у детей: в фокусе провоцирующие факторы. Барденикова С.И., Снитко С.Ю., Довгун О.Б., Лобанова Е.А., Дроздова Н.И.

Summary: Acute allergic reactions in children: initiating agents in focus

S.I. Bardenikova1, S.Yu. Snitko1, O.B. Dovgun2, E.A. Lobanova2, N.I. Drozdova2

1A.I. Yevdokimov Moscow State University of Medicine and Dentistry
2Children’s City Clinical Hospital of St. Vladimir, Moscow

Acute allergic reactions (AARs) can develop at any age for the first time or repeatedly in response to contact with allergens (foreign protein substances carrying genetic information) as a protective immune response by one of the four hypersensitivity types. Food products are the most common cause of AARs (food allergy). Food allergy is more common in young children than in adults due to intestinal high permeability and insufficient enzyme activity, so foodborne AARs are usually manifested in early childhood. In these circumstances, the presence of specific antibodies in the patient can be detected in the blood or proven by skin tests. In clinical practice, children are more likely to have localized manifestations of both true and pseudoallergic reactions in the following forms: skin rash, urticaria, angioedema, toxicoderma, and allergic dermatitis exacerbation. For instance, laryngeal (subglottic space) edema refers to localized, but life-threatening AAR. Thus, an elimination of causative allergen is extremely important. Symptomatic drug therapy is used mainly in the treatment of patients with allergic reactions. Everyone is regularly prescribed with second-generation antihistamines during the acute manifestation period.

Keywords: acute allergic reaction, pseudoallergy, food allergy, urticaria, rash, angioedema, antihistamines, ebastine, Espa-Bastin.
For citation: Bardenikova S.I., Snitko S.Yu., Dovgun O.B. et al. Acute allergic reactions in children: initiating agents in focus. RMJ. 2019;1(II):66–70.

Pages 71-76. Особенности клинической картины и течения острых аллергических реакций (крапивницы и отека Квинке) у детей. С.И. Барденикова, С.Ю. Снитко, О.Б. Довгун, Е.А. Лобанова, Н.И. Дроздова

Summary: Provoking factors influence on the course of acute allergic reactions (urticaria and angioedema) in children

S.I. Bardenikova1, S.Yu. Snitko1, O.B. Dovgun2, E.A. Lobanova2, N.I. Drozdova2

1Evdokimov Moscow State University of Medicine and Dentistry
2St. Vladimir Children’s City Clinical Hospital, Moscow

Aim: to determine the provoking factors (drugs or food) effect on the clinical picture and course of acute allergic (AAR) and pseudoallergic reactions (PAR).
Patients and Methods: 192 children’s medical histories with «urticaria» and «angioedema» (patients were hospitalized) underwent a retrospective analysis. The following comparison groups were formed: group 1 — 46 children with drug hypersensitivity (DH); group 2 — 77 children with AAR/PAR, developed in response to food intake. Adding that, the next clinical and laboratory examinations were conducted — differential blood cell count, eosinophil count, and liver function tests. Other studies have also been performed (as indicated).
Results: there were a 2-fold decrease in the food factors significance (from 60.6% in infants to 28.8% in children over the age of 12 years) and a 3-fold increase in the role of medicines (from 9.1 to 28.8%, respectively) in the AAR/PAR progression as the child grows up. In group 1, the AAR/PAR cause was antibiotics in 30.4% of cases (of which aminopenicillins — in 86%). In group 2, AAR/PAR food factors were products of animal origin in 30% of cases, vegetable food — in 40.3%, and sweets — in 20.8%. In group 1, there was a prevalence of urticaria (in 52%) and a combination of urticaria with angioedema (in 26.1%). In group 2, angioedema without urticaria was found in 16.9% of cases, in combination with urticaria — in 53.2%.
Conclusion: in this study, the features of the AAR/PAR course and clinical picture in children were established. This can provide practical guidelines in the differential diagnosis and tactics for further patient management.

Keywords: acute allergic/pseudoallergic reactions, provoking factors, children, food allergy, drug allergy, urticaria, angioedema.
For citation: Bardenikova S.I., Snitko S.Yu., Dovgun O.B. et al. Provoking factors influence on the course of acute allergic reactions (urticaria and angioedema) in children. RMJ. 2019;1(II):71–76.

Pages 77-80. Возможности этиотропной терапии в снижении рисков развития тяжелого или осложненного течения ОРВИ и гриппа. О.А. Паевская, С.Н. Зуевская, В.В. Никифоров,  О.Ф. Белая, Н.В. Колаева, Е.А. Немилостива, Н.Н. Каншина, К.А. Туркадзе

Summary: Etiotropic therapy possibilities for risk reduction during severe or complicated ARVI and influenza courses

O.A. Paevskaya1, S.N. Zuevskaya1, V.V. Nikiforov2, O.F. Belaya1, N.V. Kolaeva1, E.A. Nemilostiva1, N.N. Kashina1, K.A. Turkadze1

1Sechenov University, Moscow
2Pirogov Russian National Research Medical University, Moscow

Viral respiratory infections have a common nature and take up to 90% of all infectious diseases in Russia. Of these, about 20% are influenza viruses. Acute respiratory viral infections (ARVI) and influenza usually cause exacerbation of concomitant chronic diseases such as asthma, chronic obstructive pulmonary disease, chronic hepatitis or kidney failure, diabetes or cardiovascular disorders. In addition, these pathologies can cause severe complications. Thus, this requires an effective therapy to reduce the risk of chronic diseases complications and their exacerbations. Currently, there are a large number of marketed drugs recommended for ARVI treatment and prevention, which indicates the difficulties of creating highly effective drugs.
In this regard, the possibility of using Nobazit® (enisamium iodide) in high-risk patients with developing complications (during or after the influenza course) is considered at the time of searching for new drugs. Nobazit® has a number of advantages over the other preparation groups. It has not only a direct antiviral effect but also an anti-inflammatory, immunostimulating, analgesic effect.

Keywords: acute respiratory viral infections, ARVI, influenza, prophylaxis, antiviral drugs, enisamium iodide, Nobazit.
For citation: Paevskaya O.A., Zuevskaya S.N., Nikiforov V.V. et al. Etiotropic therapy possibilities for risk reduction during severe or complicated ARVI and influenza courses. RMJ. 2019;1(II):77–80.



№20, 2019. Хирургия. Урология

Pages 12-15. Экспериментально-клиническое обоснование механизмов многоцелевого терапевтического действия комплексного биорегуляционного препарата. Жернов В.А., Фролков  В.К., Зубаркина М.М., Агасаров  Л.Г.

Summary: Experimental and clinical justification of mechanisms of multi-purpose therapeutic action of a complex bioregulatory preparation
V.A. Zhernov1, V.K. Frolkov1, M.M. Zubarkina1, L.G. Agasarov2

1 Peoples’ Friendship University of Russia, Moscow
2 National medical research center for rehabilitation and balneology of the Ministry of Health of the Russian Federation, Moscow

Inflammatory processes in the musculoskeletal system develop in athletes after injuries, in the treatment of which the use of drugs may be limited.
Aim: study of the therapeutic effects of the preparation Traumeel S in the conditions of modeling the inflammatory process in experimental animals and in athletes with diseases of the musculoskeletal system of inflammatory genesis.
Patients and Methods: studies were carried out on white Wistar line rats with adjuvant arthritis model and in athletes with post-traumatic inflammation (bursitis, tendovaginitis, periarthritis). Dynamics of inflammatory process, immunocompetent and nociceptive systems at two-week application of ointment form containing Traumeel S was analyzed.
Results: it was established that the experimental model of chronic inflammatory process (adjuvant arthritis) reproduces the main pathogenetic reactions of the disease, including suppression of the immune system, activation of biochemical pain markers (substances P and histamine) and reduction of the level of antinociceptive indices (serotonin and beta-endorphin). Course application of Traumeel S ointment leads to regression of inflammatory process (reduction of lower limb edema in experimental animals, reduction of leukocytosis), reduction of phagocytosis completion rate, as well as increase of serotonin and beta-endorphin production. Almost the same results were obtained in athletes with inflammation of the musculoskeletal system, with almost twofold decrease in pain syndrome. Simultaneously, the concentration of cytotoxic T-lymphocytes decreased and natural killer cells increased. A decrease in pain syndrome was statistically significantly associated with an increase in serotonin and beta-endorphin production.
Conclusion: complex bioregulatory drug Traumeel S confirmed its clinical efficacy in the treatment of inflammatory diseases of the musculoskeletal system in athletes and experimental simulation of joint inflammation in experimental animals.

Keywords: inflammatory process, musculoskeletal system, sportsmen, experimental animals, rats, bioregulatory drug Traumeel S, immune system, nociceptive system.
For citation: Zhernov V.A., Frolkov V.K., Zubarkina M.M., Agasarov L.G. Experimental and clinical justification of mechanisms of multi-purpose therapeutic action of a complex bioregulatory preparation. RMJ. 2019;2:12–15.

Pages 16-20. Роль тромболитической и антикоагулянтной терапии в снижении риска развития хронической легочной гипертензии после перенесенной тромбоэмболии легочных артерий. Кузнецов М.Р., Орлов Б.Б., Марченко И.П., Хотинский А.А., Несходимов Л.А.

Summary: The role of thrombolytic and anticoagulant therapy in reducing the risk of chronic pulmonary hypertension after pulmonary embolism
M.R. Kuznetsov1,2, B.B. Orlov1, I.P. Marchenko2, A.A. Khotinsky1,3, L.A. Neskhodimov1

1Pirogov Russian National Research Medical University, Moscow
2Bauman City Clinical Hospital No 29, Moscow
3First N.I. Pirogov City Clinical Hospital, Moscow

Aim: to determine the role of thrombolytic and anticoagulant therapy in reducing the risk of chronic pulmonary hypertension after PE.
Patients and Methods: 210 patients diagnosed with submassive and massive PE from 2013 to 2017 were included in the study. The control examination was conducted within 1 to 3 years after the initial hospitalization. Patients were divided into two groups: Group 1 was represented by 45 patients, in whom the control examination revealed signs of chronic thromboembolic pulmonary hypertension (CTEPH); the second group included 165 patients without CTEPH signs. To detect venous thrombosis in the inferior vena cava system ultrasound angioscanning was used, estimation of the degree of lung vascular lesion was carried out by means of multihelix computer tomoangiography and lung scintigraphy, echocardiography was performed, and associated diseases were evaluated.
Results: the following risk factors for the development of CTEPH after PE were revealed: duration of thrombotic anamnesis (1 group 13.70±2.05 days, 2 group 8.16±1.13 days, p=0.015), localization of venous thrombosis in the lower limbs (the most favorable — the veins of the thigh, popliteal vein and common femoral veins, unfavorable — the superficial femoral vein). The choice of the preparation for thrombolytic and anticoagulant therapy: streptokinase and urokinase were much more effective than alteplase, Rivaroscaban surpassed the combination of unfractionated or low molecular weight heparins with warfarin. Also risk factors for CTEPH were the initial degree of pulmonary hypertension and tricuspidal insufficiency, as well as the positive dynamics of these indicators against the background of thrombolytic or anticoagulant therapy.Among the concomitant diseases, the significant risk factors for the development of CTEPH were the diseases of the abdominal cavity, especially splenectomy, hypertension of the 3rd degree, diabetes mellitus, postinfarction cardiosclerosis. On the other hand, age, sex, severity at the moment of admission, presence of heart attack pneumonia, surgical prophylaxis of PE relapse, number of pregnancies and births in the history, traumatological and oncological history, heart rhythm disorders did not have a reliable influence on the possible development of CTEPH.

Conclusion: the results of the study allow to identify with a high degree of reliability the patients predisposed to the development of CTEPH after the PE, which creates the basis for the timely implementation of measures aimed at reducing the risk of this complication and improving the long-term results of PE treatment.
Keywords: pulmonary embolism, chronic thromboembolic pulmonary hypertension, risk factors, predictors of development, streptokinase, urokinase, alteplase, warfarin, rivaroxaban, MDCT-angiography, lung scintigraphy, echocardiography.
For citation: Kuznetsov M.R., Orlov B.B., Marchenko I.P. et al. The role of thrombolytic and anticoagulant therapy in reducing the risk of chronic pulmonary hypertension after pulmonary embolism. RMJ. 2019;2:16–20.

Pages 21-25. Комплексная оценка эффективности генно-терапевтического лечения пациентов с хронической ишемией нижних конечностей. Шабунин А.В., Кузнецов М.Р., Матвеев Д.В., Федоров Е.Е., Матвеев А.Д.

Summary: Comprehensive assessment of the effectiveness of gene therapy in patients with chronic ischemia of the lower limbs
A.V. Shabunin1, M.R. Kuznetsov2,3, D.V. Matveev1, E.E. Fedorov3, A.D. Matveev1

1Russian Medical Academy of Continuous Professional Education, Moscow
2Pirogov Russian National Research Medical University, Moscow
3Bauman City Clinical Hospital No. 29, Moscow

Aim: to evaluate the efficacy of conservative treatment of patients with chronic lower limb ischemia (CLLI) using genetically engineered therapy (Neovasculgen).
Patients and Methods: 49 patients with different degrees of arterial damage to the lower limbs participated in the study. Patients were divided into 2 groups: patients of the 1st group received standard conservative therapy, drug treatment of the 2nd group patients was supplemented with Neovasculgen, which was injected intramuscularly into the calf muscles of the affected limb by 1.2 mg at intervals of 14 days twice. The effectiveness of the treatment was assessed both on the basis of subjective (pain-free walking distance – PFWD) and objective (VEGF-A (vascular endothelial growth factor A) in peripheral blood, BNIP3 (BCL2/adenovirus E1B 19 kDa protein-interacting protein 3, proapoptosis protein of the B-cell lymphoma 2 family (BCL2) in the biopsy of the calf muscle affected limb) criteria.
Results: after 6 months, no significant dynamics, both positive and negative, were observed in 1st group patients for any of the indicators. Patients of the 2nd group had a significant increase in PFWD, an increase in VEGF-A in peripheral blood flowing directly from ischemic muscles, and a decrease in BNIP3 levels, especially in patients with intermittent claudication, corresponding to the II stage of ischemia according to the Fontaine-Pokrovsky classification.
Conclusion: the results of the study have shown that gene therapy should be recommended as part of a conservative treatment regimen for CLLI, primarily in patients with IIA and IIB ischemia. In addition, it is worth emphasizing the importance of using objective evaluation criteria (determination of the endothelial growth factor VEGF-A in peripheral blood, determination of the proapoptosis protein BNIP3 of the BCL2 family): it is the introduction of histochemical and biochemical criteria that can make the next step towards the creation of a «golden standard» of conservative treatment of CLLI.

Keywords: chronic ischemia of the lower limbs, morphological criteria, biochemical criteria, apoptosis, VEGF-A, BNIP3, gene therapy, therapeutic angiogenesis.
For citation: Shabunin A.V., Kuznetsov M.R., Matveev D.V. et al. Comprehensive assessment of the effectiveness of gene therapy in patients with chronic ischemia of the lower limbs. RMJ. 2019;2:21–25.

Pages 25-30. Реканализация проксимального тромбоза глубоких вен на фоне длительной антитромботической терапии. Петриков А.С., Дудин Д.В., Шойхет Я.Н., Белых В.И., Простов И.И.

Summary: Recanalization of deep vein proximal thrombosis against a background of prolonged antiplatelet therapy
A.S. Petrikov1,2, D.V. Dudin1,3, Y.N. Shoikhet1,3, V.I. Belykh1, I.I. Prostov4

1Altai State Medical University, Barnaul
2Altai Krai Diagnostic Center, Barnaul
3City hospital No 5, Barnaul
4Rostov State Medical University, Rostov-on-Don

Aim: to study recanalization of deep veins in patients with proximal thrombosis against the background of prolonged antiplatelet therapy (APT) with warfarin, dabigatran etexilate and sulodexide during the year.
Patients and Methods: 210 patients were included in the study. Group 1 includes 68 patients treated with vitamin K antagonists (VKA). Group 2 consisted of 78 patients who were prescribed dabigatran etexilate after standard heparin therapy for 5 days. Group 3 consisted of 64 patients, who were prescribed sulodexide after 3 months after the course of standard ACT (heparin in the acute period with transition to VKA). US-angioscanning of the lower limbs venous system was performed at the hospitalization of the patient and on the eve of discharge for 
10–14 days against the background of APT by standard common methods. Later on, outpatients underwent a study of vein recanalization on Envisor C and Acuson Antares scanners (Germany) during a year after 1, 3, 6 and 12 months from the beginning of randomization.
Results: the frequency of patients with occlusion forms in the proximal segment against the background of prolonged therapy with warfarin during the year is statistically significantly higher by 20.7% and 18.3%, respectively, than on dabigatran etexilate and sulodexide. At the same time, no cases of residual thrombotic occlusions of the main veins were detected in patients taking dabigatran etexilate during the year, and only in 2.4% of patients taking dabigatran etexilate.
Conclusion: prolonged use of dabigatran etexilate and sulodexide for a year in patients with deep vein proximal thrombosis exceeds warfarin safety and is accompanied by the development of early recanalization in the proximal segments of the venous channel.

Keywords: thrombosis, proximal deep vein thrombosis, recanalization, antiplatelet therapy, warfarin, dabigatran etexilate, sulodexide.
For citation: Petrikov A.S., Dudin D.V., Shoikhet Y.N. et al. Recanalization of deep vein proximal thrombosis against a background of prolonged antiplatelet therapy. RMJ. 2019;2:25–30.

Pages 3-7. Послеоперационная боль: предотвращение или лечение последствий?. Страхов М.А., Загородний Н.В., Егиазарян К.А., Плужникова М.Н., Овчаренко Н.В., Гаев Т.Г.

Summary: Postoperative pain: prevention or treatment of consequences?
M.A. Strakhov1,2, N.V. Zagorodniy3,4, K.A. Yeghiazaryan1, M.N. Pluzhnikova2, N.V. Ovcharenko1, T.G. Gaev2

1Pirogov Russian National Research Medical University, Moscow
2Federal Research and Clinical Center of the FMBA of Russia, Moscow
3Peoples’ Friendship University of Russia, Moscow
4National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, Moscow

Postoperative pain remains an important problem for both surgeons and their patients. Optimization of postoperative analgesia is an important issue in terms of achieving clinical goals as soon as possible and minimizing complications and side effects of medication support. At present, the concept of multimodal analgesia is relevant, based on the combination of several drugs that differ in terms of their application points, but have an unidirectional effect on the mechanisms of pain realization and reduction of local hormonal response to the injury. This approach allows to achieve maximum analgesic effect at lower doses of specific drugs. At the same time, the dose-dependent frequency and severity of side effects of drugs decrease.
Medicines that implement the mechanisms of influence on both the peripheral and the central link of the pain pattern are now drugs of choice. The main component in the schemes of multimodal anesthesia are non-steroidal anti-inflammatory drugs. As an example, we can cite Ketonal® (SJSC “Sandoz”), which in combination with other analgesic drugs, as well as in monotherapy, is able to quickly relieve severe pain syndrome and minimal side effects, which makes it an important component of various schemes of postoperative management.

Keywords: postoperative pain, chronization of pain, psychophysiology of pain, ketoprofen, Ketonal.
For citation: Strakhov M.A., Zagorodniy N.V., Yeghiazaryan K.A. et al. Postoperative pain: prevention or treatment of consequences? RMJ. 2019;2:3–7.

Pages 32-38. Современное представление о роли инфекции, передаваемой половым путем, в развитии урогенитальной патологии у мужчин. Винник Ю.Ю.

Summary: A modern understanding of the role of sexually transmitted infections, in the development of urogenital pathology in men
Yu.Yu. Vinnik

Krasnoyarsk State Medical University named after prof. V.F. Voino-Yasenetsky

The article highlights the modern concepts of the role of sexually transmitted infection in the development of urogenital pathology in men: inflammation of urethra, additional genital glands and scrotum organs. Despite numerous studies on their prevention and treatment, it has not yet been possible to reduce these diseases due to their tendency to chronic relapsing current. The variety of subjective and objective symptoms associated with urethral lesions, glandular supplements and scrotal organs makes diagnosis difficult, and common clinical and laboratory methods do not always confirm the presence of inflammatory processes.
Infectious agents affecting the urogenital tract and their role in the determination of the inflammatory process are still under discussion. The most common complication of sexually transmitted infection in men of reproductive age is chronic prostatitis. Historical, epidemiological and etiological aspects of the disease are examined. One of the priority theories of prostatitis development is penetration into the prostate of urinary tract infection.
The argument in favour of the infectious theory is the detection of E. coli, Klebsiella, Proteus, Serratia, C. trachomatis, T. vaginalis, 
M. genitalium and other microorganisms in prostate tissue and secretion. In addition, the article, along with other diagnostic methods, gives a detailed description of the highly informative complex of the study of microflora of the urogenital tract by molecular-biological method with the quantitative determination of microorganisms.

Keywords: sexually transmitted infections, prostatitis, urogenital tract, molecular-biological method.
For citation: Vinnik Yu.Yu. A modern understanding of the role of sexually transmitted infections, in the development of urogenital pathology in men. RMJ. 2019;2:32–38.

Pages 39-41. Последствия избыточного формирования фиброза у больных хроническим простатитом. Филимонов П.Н., Кульчавеня Е.В.

Summary: Consequences of excessive fibrosis formation in patients with chronic prostatitis
P.N. Filimonov1, E.V. Kulchavenya1,2

1Novosibirsk Scientific Research Institute of Tuberculosis
2Novosibirsk State Medical University

One of the reasons for chronic recurrent prostatitis is the hyperproduction of fibrous tissue. Tissue sclerosis aggravates the clinical picture of prostatitis and reduces the effectiveness of treatment.
Aim: to determine the influence of the degree of severity of inflammatory phenomena and prostate fibrosis on urodynamics and local microcirculation.
Patients and Methods: an open, retrospective case-control comparative study included 18 patients who had been biopsied by a prostate biopsy. Indicators of urofluometry and the degree of microcirculation disorder were compared between the group of patients with severe fibrosis (the 1st group, 9 people) and the 2nd group (also 9 patients) — with insignificant fibrosis changes of the prostate gland. The degree of fibrosis and inflammation was indicated: from 0 (no change) to 3 points (expressed changes).
Results: structural changes in the prostate gland were revealed in all of them according to the ultrasound examination data, mainly — echogenic heterogeneity, regions of increased and decreased echodensity. In the 1st group, the degree of fibrosis averaged 2.7 points, and the degree of inflammation — 2.5 points. In the 2nd group fibrosis and inflammation were insignificant: 0.2 and 0.3 points, respectively. Urination indexes in the 1st group were 1.5 times worse than in the 2nd group, and microcirculation indexes were 1.7 times worse than in the 2nd group.
Conclusion: chronic prostatitis complicated by excessive development of fibrous tissue leads to statistically significant deterioration of urinary parameters and local microcirculation. The degree of microcirculation disorder and urodynamics indirectly indicates the level of prostate fibrosis.

Keywords: chronic prostatitis, fibrosis, hardening, impaired microcirculation, impaired urodynamics.
For citation: Filimonov P.N., Kulchavenya E.V. Consequences of excessive fibrosis formation in patients with chronic prostatitis. RMJ. 2019;2:39–41.

Pages 42-46. Антимускариновые препараты в лечении гиперактивного мочевого пузыря: фармакотерапевтические свойства и фармакоэкономическая оценка. Филиппова О.В.

Summary: Antimuscarine drugs in the treatment of overactive bladder: pharmacotherapeutic properties and pharmacoeconomic evaluation

O.V. Filippova

Sechenov University, Moscow

Overactive bladder has an extremely negative effect on the quality of life of patients. In 2018, 546 million people worldwide were reported to be suffering from OAB, accounting for 20.1% of the population. Its symptoms are present in 17% of the adult population of Europe. The main goals of OAB pharmacological therapy are to alleviate symptoms and improve quality of life. The main task of treatment is to restore the lost control over the accumulation capacity of the bladder. The most effective and frequently used method of treatment of patients with OAB is the use of M-cholinergic antagonists, which differ in efficiency and safety of use. Fesoterodine (Toviaz®) improves urinary control and is a choice for patients with OAB, especially the elderly and at risk of cognitive or cardiovascular complications. Fesoterodine is available as prolonged action tablets, which allows you to prescribe it once a day. Good ratio of efficacy and price, good tolerability, accessibility, and ease of administration of fesoterodine ensure a high level of patient adherence to treatment, which helps to achieve good clinical results.

Keywords: overactive bladder, OAB, urinary incontinence, cost of treatment, M-cholinergic antagonist, antimuscarin drug, fesoterodine, Toviaz.
For citation: Filippova O.V. Antimuscarine drugs in the treatment of overactive bladder: pharmacotherapeutic properties and pharmacoeconomic evaluation. RMJ. 2019;2:42–48.

Pages 48-52. Терапия инфекции мочевыводящих путей на фоне уратного нефролитиаза. Гамидов С.И., Шатылко Т.В., Гасанов Н.Г.

Summary: Urinary tract infection therapy with uric acid nephrolithiasis
Gamidov S.I., Shatylko T.V., Gasanov N.G.

Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Moscow

Urinary stone disease (USD) and urinary tract infections are the most common diseases in general urological practice. Typical examples of infected urinary stones are struvite stones with a prothetic infection. However, urolithiasis can also be combined with other pathogens and, thus, has a different chemical composition. Microbes may persist on the surface and inside urate concrements, which is not always reflected in the indicators of general and bacteriological culture of urine, causing a number of unforeseen difficulties in conservative therapy and surgical treatment of urolithiasis. The article describes the role of citrate therapy in infected nephrolithiasis, as well as the possibility of using fosfomycin trometamol in infections associated with urolithiasis and in the framework of antibiotic prophylaxis before endourological interventions. Preoperative and perioperative antibiotic therapy is mandatory for patients with signs of urinary tract infection, as it helps prevent the development of septic complications associated with surgical intervention.

Keywords: urinary tract infections, urinary stone disease, struvite stones, urate nephrolithiasis, citrate therapy, fosfomycin, Fosfomycin Esparma, Blemaren.
For citation: Gamidov S.I., Shatylko T.V., Gasanov N.G. Urinary tract infection therapy with uric acid nephrolithiasis. RMJ. 2019;2:48–52.

Pages 52-55. Анализ психологических нарушений у больных местно-распространенным раком предстательной железы. Солодкий В.А., Павлов А.Ю., Цыбульский А.Д., Дзидзария А.Г., Гафанов Р.А., Пчелинцев А.С.

Pages 56-60. Современные вопросы молекулярной диагностики рака мочевого пузыря. Дзидзария А.Г., Павлов  А.Ю., Гафанов Р.А., Фастовец С.В., Кравцов И.Б.

Pages 61-64. Фотодинамическая тераностика отечественной флуоресцентной видеосистемой немышечно-инвазивного рака мочевого пузыря. Бабаев А.Б., Лоран  О.Б.

Pages 8-11. Опыт местного медикаментозного лечения раневой инфекции у больных с синдромом диабетической стопы с учетом патогенетического варианта. Осинцев Е.Ю., Мельситов В.А.

Summary: Experience of local medical treatment of wound infection in patients with diabetic foot syndrome, taking into account the pathogenetic variant
E.Yu. Osintsev, V.A. Melsitov

Saratov State Medical University named after V.I. Razumovsky

Wound infection complicates diabetes mellitus (DM) in 15–34% of patients. Standard schemes of local medical therapy of wound infection used in everyday practice do not provide satisfactory results in the treatment of purulonecrotic complications of DM. The emergence of new classes of bandages and modern interactive bandages on the pharmaceutical market requires a comprehensive assessment of the results of their use as means of local treatment of chronic wound infection in DM patients.
Numerous clinical studies prove the high efficacy of drugs based on ionized silver in the treatment of purulonecrotic complications of DM. The article presents the own experience of local therapy of puruonecrotic complications of diabetes mellitus with participation of 104 patients. It is shown that the therapy should be based on the complex influence on the infectious process and stimulation of regenerative and reparative mechanisms in wounds. Optimal results were obtained in the group of patients with neuropathic form of diabetic foot syndrome using sulfathiazole silver (Argosulfan®).

Keywords: diabetes mellitus, diabetic foot, wound infection, chronic wound, biofilm, granulation, epithelialization, amputation, local treatment, sulfathiazole silver, Argosulfan.
For citation: Osintsev E.Yu., Melsitov V.A. Experience of local medical treatment of wound infection in patients with diabetic foot syndrome, taking into account the pathogenetic variant. RMJ. 2019;2:8–11.



№1(I), 2019. Клинические рекомендации и алгоритмы для практикующих врачей

Pages 10-14. Стратегия выбора дифференциальной терапии у пациентов с болью в спине: новые данные и возможности. П.Р. Камчатнов,  А.В. Чугунов, А.Ю. Казаков

Summary: Choosing differential therapy strategy in patients with back pain: new data and opportunities

P.R. Kamchatnov, A.V. Chugunov, A.Yu. Kazakov

Pirogov Russian National Research Medical University, Moscow

Low back pain (LBP) is one of the most common in outpatient musculoskeletal pain syndromes. LBP problem has been turned from exceptionally medical to socio-economic, since the presence of this syndrome is associated with high temporary disability and direct/indirect material costs. Patient treatment with LBP is aimed at pain syndrome relief in order to ensure the highest possible level of daily activity and improve the patient’s life quality. Non-steroidal anti-inflammatory drugs are in most common use for the patient treatment with LBP. In this regard, the drug choice is determined not only by its effectiveness but also by the pain syndrome nature and properties, as well as by additional therapy effects that contribute to the patient early recovery. Besides, it is necessary to consider the range of possible therapy adverse events. The article describes an individualized therapy approach to the patient with LBP exemplified by Ketonal® and Kostarox® drugs. The article also provides information justifying the prescription appropriateness of a muscle relaxant Sirdalud to the patients with LBP. This preparation has the ability to eliminate the striated muscles’ excessive tension.

Keywords: low back pain, ketoprofen, Ketonal, etoricoxib, Kostarox, tizanidine, Sirdalud.
For citation: Kamchatnov P.R., Chugunov A.V., Kazakov A.Yu. Choosing differential therapy strategy in patients with back pain: new data and opportunities. RMJ. 2019;1(I):10–14.

Pages 15-20. Роль кальция, витамина D и остеотропных минералов в профилактике и лечении остеопороза. П.И. Новиков

Summary: Role of calcium, vitamin D and osteotropic minerals in the osteoporosis prevention and treatment

P.I. Novikov

Sechenov University, Moscow

Osteoporosis (OP) is a multifactorial disease, the occurrence and progression of which, along with genetic predisposition, sex and age are influenced by modifiable factors, the most important of which is nutrition. The article discusses the OP prevention associated with rational nutrition and the use of supplements containing calcium, vitamin D and osteotropic minerals. The article also shows the data of observational cohort and randomized studies and meta-analyses devoted to the impact study of increasing calcium intake from food or drug (containing calcium) administration on the OP fractures risk. A positive association between dairy products consumption and bone mineral content and bone mineral density (BMD) is shown. The increase in calcium intake from food sources contributes to BMD maintenance. Nowadays, the need for calcium is difficult to compensate for the diet, so the use of additional drugs is justified. The drug Calcemin® Advance contains magnesium, zinc, copper, manganese, and boron along with calcium and vitamin D. The use of Calcemin® Advance allows to stabilize BMD, helps to reduce pain in the spine, has good tolerability and safety, which makes it possible to recommend this drug for a wide clinical practice according to the study results.

Keywords: calcium deficiency, fractures, calcium supplements, vitamin D, osteotropic minerals, osteoporosis, Calcemin Advance, prevention.
For citation: Novikov P.I. Role of calcium, vitamin D and osteotropic minerals in the osteoporosis prevention and treatment. RMJ. 2019;1(I):15–20.

Pages 2-9. Хемотранскриптомный анализ молекулы глюкозамина сульфата в контексте постгеномной фармакологии. И.Ю. Торшин, Громова О.А., Наумов  А.В.,  А.М. Лила

Summary: Chemical transcriptome analysis of glucosamine sulfate molecule in the context of post-genomic pharmacology
I.Yu. Torshin1,2, O.A. Gromova1,2, A.V. Naumov3, A.M. Lila4

1FRC CSC RAS, Moscow
2Lomonosov Moscow State University
3Pirogov Russian National Research Medical University, Moscow
4Nasonova Research Institute of Rheumatology, Moscow

Aim: to study a glucosamine sulfate (GS) molecule effect on transcription in human fibroblasts of the FIBRNPC line.
Patients and Methods: chemotranscriptome analysis of the GS molecule effect on transcription in human fibroblasts of the FIBRNPC line was conducted during incubation of cells with GS for 24 hours.
Results: reliable dose-dependent effects of GS impact on transcription (on average, 5% or more changes in transcription per 1 μmol of GS) were shown for 4,431 of the 12,700 human genome annotation. Analyzes using functional genome annotation showed that GS substantially reduced the gene expression encoding inflammatory factors (100 genes) and genes involved in cell division (66 genes). Reducing the gene expression of these groups corresponds to the cell preparation to reduce inflammation and transition to a state of energy saving. GS modulated the gene expression involved in the restoration of cartilage and bone (reduced expression of 133 genes and increased expression of 188 genes). GS contributed to a predominant increase in the transcription of gene groups involved in maintaining cardioprotection (134 genes), neuroprotection (110 genes), detoxification processes (91 genes), and antiviral/antibacterial immunity (58 genes).
Conclusion: GS significantly reduced the pro-inflammatory gene expression, contributed to the cell transition to a state of energy saving, increased gene expression involved in the restoration of cartilage and bone, and, in general, increased fibroblast survival. Estimates of gene transcription changes correspond to an increase in the effectiveness of GS and indicate the prospects for using GS in patients suffering from both cartilage pathology and other comorbid diseases (coronary heart disease, arrhythmias, cerebrovascular pathology, infectious, liver and kidney diseases, and others).

Keywords: chemical transcriptomics, chemical transcriptome analysis, glucosamine sulfate, Sustaguard Artro, data mining, molecular pharmacology, comorbidity, cartilage, chondrocytes, chondroprotection.
For citation: Torshin I.Yu., Gromova O.A., Naumov A.V., Lila A.M. Chemical transcriptome analysis of glucosamine sulfate molecule in the context of post-genomic pharmacology. RMJ. 2019;1(I):2–9.

Pages 21-25. О «различиях» дженериков урсодезоксихолевой кислоты на отечественном рынке. Е.Ю. Плотникова, А.С. Сухих, Т.Ю. Грачева, К.А. Краснов

Summary: About the «differences» of ursodeoxycholic acid generics in the domestic market

E. Yu. Plotnikova, A.S. Sukhikh, T. Yu. Gracheva, K.A. Krasnov

Kemerovo State Medical University

The article deals with the issues of different equivalence types of generic drugs and with the evidence of the original and generic product therapeutic effectiveness as well. The authors compared several currently existing definitions of «therapeutic equivalence». This article lists the qualitative generic features.
Ursodeoxycholic acid (UDCA) is one of the drugs that demonstrate adequate quality in generic forms. This bile acid is found in bear bile in large amounts, as well as in human bile in small amounts. UDCA production and market, drug substance pharmacokinetics and pharmacodynamics issues, the study results on the UDCA effectiveness and safety in patients with biliary sludge are described by the authors. The studied UDCA preparations showed a very high similarity of more than 99% during infrared spectrography and high-performance liquid chromatography. The data obtained indicated almost identical pharmaceutical equivalence of all the drugs described in this article. These drugs have demonstrated full pharmaceutical equivalence, thus, this implies their pharmacokinetic and therapeutic equivalence. A detailed analysis of the study results was carried out with the participation of an internist, a lawyer and a specialist in pharmaceutical chemistry.

Keywords: generics, pharmaceutical equivalence, pharmacokinetic equivalence, therapeutic equivalence, ursodesoxycholic acid.
For citation: Plotnikova E.Yu., Sukhikh A.S., Gracheva T.Yu., Krasnov K.A. About the «differences» of ursodeoxycholic acid generics in the domestic market. RMJ. 2019;1(I):21–25.

Pages 26-27. Стратегия лечения аллергических заболеваний. Белан Э.Б.

Pages 28-32. Гипокалиемия. В.С. Лукьянчиков

Summary:

Hypokalemia

V.S. Lukianchikov

Xema-Medica LLC, Moscow

Hypokalemia is the most common form of electrolyte imbalance. The article contains the etiological and pathogenetic hypokalemia classification, which includes more than 20 categories and reflects a wide range of conditions, accompanied by a decrease in the level of potassium in the blood to 3.5 mmol/l and below. A significant part of the hypokalemia etiopathogenetic variants is considered in detail in terms of causes and mechanisms of its development. Particular attention is paid to iatrogenic hypokalemia, which is an intensive therapy complication, as well as hypokalemia in the setting of relatively rare conditions and diseases, little known to practitioners. The main part of the article is devoted to the definitions of hypokalemia syndrome and its clinical and laboratory diagnosis. The article also shows exceptional variability and nonspecific nature of syndrome clinical manifestations, simulating a variety, usually acute pathology, which in fact makes it almost impossible to diagnose hypokalemia clinically. At the same time, hypokalemia syndrome verification by the level of potassium in the blood is also associated with a number of objective and subjective limitations and difficulties. Methods, means, and ways to overcome diagnostic difficulties are specified. A scheme-algorithm for the main hypokalemia types diagnosis is proposed. The risks accompanying dietary and medical correction of hypokalemia are analyzed. Safe approaches to hypokalemia elimination are discussed.

Keywords: hypokalemia, intensive care complications, infusion therapy, electrolyte imbalance, aldosteronism, arterial hypertension, renal tubular pathology, arrhythmia, heart failure, kidney failure.
For citation: Lukianchikov V.S. Hypokalemia. RMJ. 2019;1(I):28–32.

Pages 33-36. Организация акушерской помощи в структуре многопрофильного стационара. А.С. Шкода, А.Д. Подтетенев, И.В. Бахарева, А.Б. Доброва, К.А. Покровский, С.Г. Ведяшкина, М.А. Лоскутников

Summary: Obstetric care organization in the multidisciplinary hospital structure

A.S. Shkoda1, A.D. Podtetenev1, I.V. Bakhareva2, A.B. Dobrova1, K.A. Pokrovskii1, S.G. Vediashkina1, M.A. Loskutnikov1

1City Clinical Hospital No. 67, Moscow
2Pirogov Russian National Research Medical University, Moscow

The article presents new opportunities for obstetric and gynecological service in a large multidisciplinary hospital — City Clinical Hospital No. 67. Quality improvement of the health care delivery became possible due to Moscow healthcare system modernization, handled between 2014 and 2017. Structural reforms have made it possible to increase the economic efficiency of the medical facility, to optimize the logistical patient flows of the obstetric and gynecological area, and to make health care delivery more accessible and patient-oriented. A clinical case of a patient, hospitalized in 28–29 weeks of pregnancy in critical condition, is presented in this article. Within CT angiography, she was diagnosed with acute intraventricular hemorrhage in consequence of the arteriovenous malformation (AVM) rupture of the vertebrobasilar basin. Conservative treatment was conducted after operative delivery (cesarean section) in the Department of Neurological Resuscitation of the City Clinical Hospital No. 67 with the subsequent radiosurgical treatment of AVM in the N.V. Sklifosovsky Scientific Research Institute of First Aid. The parturient was discharged in a satisfactory condition. Comprehensive health care delivery for patients with the severe condition is carried out in close collaboration of all the clinical centers of the City Clinical Hospital No. 67 with the use of new medical technologies and multidisciplinary approach, as well as the hospital work coordination with other Moscow medical facilities.

Keywords: obstetric and gynecological service, medical emergencies, intraventricular hemorrhage, ACVA, arteriovenous malformation, pregnancy, CT angiography, new medical technologies, patient-orientation.
For citation: Shkoda A.S., Podtetenev A.D., Bakhareva I.V. et al. Obstetric care organization in the multidisciplinary hospital structure. RMJ. 2019;1(I):33–36.

Pages 37-40. Определение отношения российских студентов к проведению генетического тестирования и фармакогенетического анализа. Я.В. Киричук, С.С. Царьков, А.С. Орлова,  Е.В. Силина, К.С. Керимова, В.А. Дадаева, Е.С. Акарачкова

Summary: Study of the Russian student’s attitude to genetic testing and pharmacogenetic analysis

Ya.V. Kirichuk1, S.S. Tsarkov2, A.S. Orlova1, E.V. Silina1, K.S. Kerimova3, V.A. Dadaeva4, E.S. Akarachkova5

1Sechenov University, Moscow
2Privolzhsky Research Medical University, Nizhny Novgorod
3MediSPA LLC, Moscow
4National Medical Research Center for Preventive Medicine, Moscow
5International Association for the Study and Effective Control of the Stress and Related Disorders, Moscow

Genetic testing is one of the main studies of personalized medicine with a considerable impact on diagnosis of genetic and multifactorial diseases. The results of pharmacogenetic analysis give an opportunity for the precise selection of drugs with optimal dosing range and time of administration. Nevertheless, people are not aware of the real-life implications of such studies.
Aim: to evaluate the awareness and attitude about genetic testing and its implementation of students of various (medical and non-medical students) educational institutions.
Patients and Methods: a total of 982 respondents — 539 and 443 medical and non-medical students, respectively, participated in a survey. The survey was performed in different regions of the Russian Federation and was anonymous. The questionnaire was available on the Internet on the basis of the Google Forms service and contained 14 questions concerning different aspects of genetic testing. All basic concepts were explained to the participants during the survey.
Results: it was revealed that medical students are more likely to be aware of personalized medicine (75.6%, against 49% of non-medical students, p=0.0002). A substantial part (81.2%) among all participants reacted positively to undergo genetic testing; 84.6% expressed a desire to undergo pharmacogenetic analysis; 84.1% were ready for lifestyle changes in case of a high risk of disease development. 73.1% of the respondents were in favor of universal genetic testing. Furthermore, the majority of respondents stated that genetic testing in pregnancy planning (58.9%) and genetic testing of children (70.9%) are reasonable to conduct. Only 42.9% of respondents were ready to participate in a clinical trial of an unregistered drug in case of a relevant disease. There were no significant differences in the responses between medical and non-medical students.
Conclusion: obtained results showed that it is essential to continue the genetic testing development, to study bioethical aspects and to inform the population on its benefits.

Keywords: personalized medicine, genetic testing, genetic disease, multifactorial disease, survey, students, pregnancy planning, pharmacogenetic analysis, bioethics.
For citation: Kirichuk Ya.V., Tsarkov S.S., Orlova A.S. et al. Study of the Russian student’s attitude to genetic testing and pharmacogenetic analysis. RMJ. 2019;1(I):37–40.



№12(II), 2018. Ревматология

Pages 103-106. Оптиконевромиелит (синдром Девика) — редкий вариант поражения нервной системы при системной красной волчанке. Виноградова Е.С., Новиков П.И., Моисеев С.В.

Summary: Neuromyelitics optica (Devic’s syndrome) is a rare variant of the nervous system impairment in systemic lupus erythematosus
E.S. Vinogradova1, P.I. Novikov2, S.V. Moiseev1,2

1 Faculty of Fundamental Medicine of the Moscow State University, Moscow
2 Tareev Clinic of Nephrology, Internal and Occupational Diseases, University Clinical Hospital No.3, 

 Sechenov University, Moscow

Neuromyelitics optica or Devic’s syndrome is an inflammatory demyelinating disease of the central nervous system, affecting mainly the optic nerve and spinal cord. In 50–70% of cases, association with systemic diseases of the connective tissue, such as systemic lupus erythematosus, Sjogren disease, and others, is determined. In this case, the question of the secondary nature of the disease remains open. The clinical picture is characterized by a combination of optic neuritis syndromes and/or longitudinal-transverse myelitis. Imaging methods are used for diagnostics, such as optical coherence tomography, event-related potentials method, magnetic resonance imaging. At present, the key method of making the correct diagnosis is the detection of a specific serological marker — antibodies to aquaporin-4 (NMO-IgG), the titer of which correlates with disease activity and helps the differential diagnosis. Detection of Devic’s syndrome in combination with rheumatic diseases determines the tactics of more active immunosuppressive treatment. The article describes the clinical case of a young patient with systemic lupus erythematosus and Devic’s syndrome. The prognosis and severity of the disease determined the presence of neuromyelitics optica. As induction therapy, ultrahigh doses of glucocorticosteroids, cyclophosphamide replaced with azathioprine as a supportive treatment with a positive clinical and laboratory response were used.

Key words: neuromyelitics optica, Devic’s syndrome, autoimmune pathology, systemic lupus erythematosus, antibodies to aquaporin-4, aquaporin-associated syndromes, demyelinating diseases of the central nervous system.
For citation: Vinogradova E.S., Novikov P.I., Moiseev S.V. Neuromyelitics optica (Devic’s syndrome) is a rare variant of the nervous system impairment in systemic lupus erythematosus // RMJ. 2018. № 12(II). P. 103–106.

Pages 107-109. Системный амилоидоз, ассоциированный с множественной миеломой: клиническое наблюдение. Загребнева А.И., Потешкина Н.Г., Кузнеченко Д.И., Бабак В.В.

Summary: Systemic amyloidosis associated with multiple myeloma: clinical observation
A.I. Zagrebneva1,2, N.G. Poteshkina2, D.I. Kuznechenko1, V.V. Babak3

1 City Clinical Hospital, Moscow
2 Pirogov Russian National Research Medical University, Moscow
3 Nasonova Research Institute of Rheumatology, Moscow

An amyloidosis is a group of diseases characterized by the deposition in the organs and tissues of a particular protein of the amyloid fibrillar structure. The clinical picture of amyloidosis is diverse, the clinic depends on the involvement of a particular organ in the pathological process, and the determining factor in the choice of treatment tactics is to establish the cause of its development. The article presents a clinical case of amyloidosis associated with multiple myeloma. The features of this clinical case are presented as an initially uncertified nosological form of heart disease with the leading syndrome of cardiac insufficiency, a relapsing course of pleurisy and an absence of kidney damage under conditions of proven amyloidosis. Diagnosis of secondary AL-amyloidosis in multiple myeloma is challenging and is based on histological and immunohistochemical studies of the bone marrow, secretion of Bens-Jones λ-protein. The most effective treatment method in young patients is the protocols for the therapy of multiple myeloma (VCD courses) for patients-candidates for autologous transplantation of hematopoietic stem cells (auto-THSC) with its subsequent implementation.

Key words: AL-amyloidosis, multiple myeloma, heart disease in amyloidosis, cardiac insufficiency.
For citation: Zagrebneva A.I., Poteshkina N.G., Kuznechenko D.I., Babak V.V. Systemic amyloidosis associated with multiple myeloma: clinical observation // RMJ. 2018. № 12(II). P. 107–109.

Pages 110-112. Клинический случай лихорадки денге, осложненной вторичной тромбоцитопенией. Сергеева И.В.

Summary: Clinical case of dengue fever, complicated by secondary thrombocytopenia
I.V. Sergeeva

Voyno-Yasenetsk Krasnoyarsk State Medical University, Krasnoyarsk

The article presents a clinical case of severe dengue hemorrhagic fever, accompanied by articular syndrome, complicated by secondary thrombocytopenia in a 26-year-old young man who returned from a holiday in Thailand. The above clinical case is of professional interest for physicians of various specialties, since dengue fever is not a typical disease for residents of the Russian Federation, especially the Siberian region. The course of the disease was complicated by secondary thrombocytopenia and articular syndrome. It should be noted that the patient’s articular syndrome had a pronounced symmetric pain syndrome, swelling and stiffness for 15 minutes in the morning, against the background of a pronounced intoxication syndrome, however, an ultrasound examination of the joints did not reveal any pathology. The absence of any pathognomonic symptoms of the disease in the initial period creates difficulties in the diagnosis of dengue fever. Timely laboratory diagnosis, based on identifying immunoglobulins of classes M and G to the dengue virus, not only helps to make a differential diagnosis with other hemorrhagic fevers, but also to save the patient’s life. Clinicians and physicians of hospitals should be wary of patients with febrile syndrome and pay more attention to the epidemiological history.

Key words: dengue fever, tourists, Southeast Asia, thrombocytopenia, clinic, complication, diagnosis, treatment.
For citation: Sergeeva I.V. Clinical case of dengue fever, complicated by secondary thrombocytopenia // RMJ. 2018. № 12(II). 
P. 110–112.

Pages 73-73. Слово редактора. Лила А.М.

Pages 74-81. Оценка комбинированного применения препарата неомыляемых соединений авокадо и сои и кетопрофена лизиновой соли у больных остеоартритом коленного сустава. Предварительные данные открытого многоцентрового наблюдательного исследования ПАРАЦЕЛЬС. Каратеев А.Е., Лила А.М., Погожева Е.Ю., Алексеева Л.И., Амирджанова В.Н., Филатова Е.С.

Summary: Evaluation of the effectiveness and tolerability of the combined use of the drug with non-saponifying compounds of avocado and soy and ketoprofen lysine salt in patients with osteoarthritis of the knee. Preliminary data of an open multicenter observational study PARACELS*

A.E. Karateev, A.M. Lila, E.Yu. Pogozheva, L.I. Alexeeva, V.N. Amirdzhanova, E.S. Filatova

Nasonova Research Institute of Rheumatology, Moscow

Long-delayed anti-inflammatory drugs (LDAIDs) — the basis of pharmacotherapy of osteoarthritis (OA). However, the effect of LDAIDs does not occur immediately, therefore, when treating patients with OA who are experiencing severe pain, it is advisable to combine them with fast-acting analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
Aim: to evaluate the effectiveness of the preparation combination of non-saponifying compounds of avocado and soy (NSCAS) and ketoprofen lysine salt (KLS) in patients with OA of the knee.
Patients and Methods: a study group consisted of 6448 patients with OA, 70.9% of women and 29.1% of men, average age –57.8±10.2 years, with severe pain (≥40 mm by the visual analog scale (VAS)). Of these, 1638 (25.4%) were under 50 years old and had a radiological stage ≤ 1 according to Kellgren-Lawrence (conditionally, “early” OA (EOA)). All patients were prescribed NSCAS (Piascledine) 300 mg/day. During the first 2 weeks, patients received KLS (Artrosilene capsules) 320 mg/day. They could also use KLS topically (Artrosilene spray). At a later stage, with increased pain, patients could take KLS with or without a topical form of KLS with short courses or “on demand”. The main criterion of effectiveness was the dynamics of pain during movement (according to VAS) after 2 weeks and 3 months of therapy.
Results: an average duration of oral administration of KLS at the beginning of treatment was 12.4±3.4 days. In the future, 44% of patients received KLS in short courses (3–5 days), and 24.3% in the “on demand” mode (1–2 times per week during pain). 70.1% also used KLS spray in short courses or “on demand”. In 4.3% of patients, intra-articular administration of glucocorticoids was required.
The severity of pain initially amounted to 63.7±12.0 mm, after 2 weeks — 32.6±16.2 mm, after 3 months — 14.2±11.7 mm. The vast majority of patients (81.7%) rated the outcome of the treatment as “good” or “excellent”. The pain dynamics did not differ in the EOA group and in patients ≥50 years of age with a radiological stage ≥2 according to Kellgren-Lawrence: pain reduction after 2 weeks amounted to 30.4±15.1 and 31.4±14.9, after 3 months — 50.5±18.7 and 49.1±19.1 mm according to VAS (the difference is not significant).
The main adverse events were dyspepsia (3.5%), arterial hypertension (2.3%) and skin allergic reactions (0.2%). No information on serious adverse events has been received.
Conclusion: the combined administration of NSCAS and KLS allows for fast and long-term pain control in OA, regardless of the stage of the disease.

Key words: osteoarthritis, treatment, long-delayed anti-inflammatory drugs, non-saponifying compounds of avocado and soy, Piascledine, NSAIDs, ketoprofen lysine salt, Artrosilene.
For citation: Karateev A.E., Lila A.M., Pogozheva E.Yu. et al. Evaluation of the effectiveness and tolerability of the combined use of the drug with non-saponifying compounds of avocado and soy and ketoprofen lysine salt in patients with osteoarthritis of the knee. Preliminary data of an open multicenter observational study PARACELS // RMJ. 2018. № 12(II). P. 74–81.

*PARACELS: Piascledine and Artrosilene Regular administration for osteoarthritis: Feasibility of an Integrated Treatment Regimen

Pages 82-86. Механизм-направленная терапия боли при остеоартрите. Филатова Е.С., Каратеев А.Е., Филатова Е.Г.

Summary: Mechanism-directed therapy for pain in osteoarthritis
E.S. Filatova1, A.E. Karateev1, E.G. Filatova2

1 Nasonova Research Institute of Rheumatology, Moscow
2 Sechenov University, Moscow

About 30% of patients with osteoarthritis (OA) have a mixed nature of pain: inflammatory pain combined with central sensitization (CS). Pain in CS is determined by the ineffectiveness of therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), the presence of neuropathic descriptors, the absence of the somatosensory nervous system impairment and clinically significant depression or anxiety, as well as the effectiveness of using drugs with the central mode of action (antiepileptic agents).
Aim: evaluation of the effectiveness of the antiepileptic agent pregabalin in the treatment of chronic pain syndrome of a mixed nature in patients with OA of the knee.
Patients and Methods: 60 patients with OA of the knee were involved in the study. The median age was 59.82±4.46 years. The patients were divided into two groups of 30 people. Groups were randomly formed. Group I received NSAIDs + pregabalin therapy and group II only NSAIDs monotherapy. Clinical neurological status, functional index WOMAC, pain intensity during movement, pain diagnosis (DN4 questionnaire and Pain DETECT), emotional-affective sphere assessment (HADS questionnaire), pain intensity assessment on a visual analogue scale (VAS) at rest, quality of life assessment (questionnaire EQ-5D).
Results: the clinical neurological study did not reveal a pathology of the peripheral or central nervous system capable of explaining the occurrence of neuropathic pain in the patients. In this regard, the presence of neuropathic pain descriptors, detected using DN4, was regarded as a CS. A study of the treatment of patients with OA with a mixed mechanism of pain (inflammatory + CS) showed a more pronounced and long-lasting effect of therapy, aimed at both mechanisms compared with anti-inflammatory monotherapy. In the group receiving pregabalin and NSAIDs, a stable and significantly greater decrease in the intensity of pain on VAS and a more pronounced change in the functional activity of the WOMAC test were observed compared with NSAIDs monotherapy.
Conclusion: the study confirms the need to determine the signs of CS in patients with OA and conduct in this subgroup a complex mechanism-directed therapy, including NSAIDs and drugs with the central mode of action.

Key words: osteoarthritis, central sensitization, NSAIDs, pregabalin, chronic pain syndrome.
For citation: Filatova E.S., Karateev A.E., Filatova E.G. Mechanism-directed therapy for pain in osteoarthritis // RMJ. 2018. № 12(II). P. 82–86.

Pages 87-90. Клинические аспекты применения гиалуроновой кислоты при патологии вращательной манжеты плеча. Шестерня П.А., Юрин Д.В.

Summary: Clinical aspects in the treatment of rotator cuff disorders with hyaluronic acid

P.A. Shesternya, D.V. Yurin

Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk

Pain in the shoulder region is one of the most common causes of health encounter. The clinician needs to identify the most common forms of shoulder lesions: tendinitis/myositis of the rotator cuff muscles, impingement-syndrome, adhesive capsulitis, bursitis. Experience with the use of hyaluronates in this category of patients is quite limited, clinical recommendations and generally accepted approaches to treatment are lacking.
Aim: to evaluate the efficacy and safety of intra-articular injections of sodium hyaluronate in the rotator cuff disorders.
Patients and Methods: a retrospective analysis of 27 patients (11 men and 16 women) with verified diagnosis impingement-syndrome of the shoulder. Patients who had arthritis of the shoulder joint or previous injury, rotator cuff tear or adhesive capsulitis were excluded. The average age was 52.8±10.5 years. All patients received three intra-articular injections of 2 ml —1% sodium hyaluronate in the shoulder joint weekly: group 1 — monotherapy, group 2 — advanced single injection of betamethasone 7 mg/1 ml in the subacromial bursa. Within 2.5 months follow-up pain on a visual analogue scale (VAS); the active range of motion (ROM) and requirement of non-steroidal anti-inflammatory drugs (NSAIDs) were assessed.
Results: initially patients of group 2 had higher pain intensity in comparison with group 1 — 84.3±8.6 vs 71.2±10.2 (p=0.004) and lower ROM — 79.5±8.2 vs 88.5±11.8 (p=0.059), respectively. Both treatment strategies were high effective. Groups 1 and 2 did not differ after 6 and 10 weeks: pain scale were 24.6±7.6 vs 18.1±8.9 (p=0,194) and 18.2±8.2 vs 15.6±8.5 (p=0,527); range of motion — 128.3±16.4 vs 139.2±9.2 (p=0.059) and 142.6±16.0 vs 145.2±8.7 (p=0.527), respectively. There were 4 (22.2%) patients refused and 12 (66.7%) reduced dosage of NSAID in the group 1, received injection of hyaluronate only.
Conclusion: intra-articular administration of sodium hyaluronate is an effective and safe treatment strategy of the rotator cuff disorders. An important component of the hyaluronate application is the lack of metabolic effects, which is extremely important for comorbid patients.

Key words: hyaluronic acid, hyaluronate, rotator cuff, impingement-syndrome, shoulder, Fermathron.
For citation: Shesternya P.A., Yurin D.V. Clinical aspects in the treatment of rotator cuff disorders with hyaluronic acid // RMJ. 2018. № 12(II). P. 87–90.

Pages 92-98. Иммунологические исследования в ревматологической клинике. Путь длиной в семь десятилетий. Головизнин М.В., Тимофеев В.Т., Лахонина Н.С., Булдакова Ю.Р.

Summary: The immunological studies in rheumatology. Seven-decade journey
M.V. Goloviznin1, V.T. Timofeev2, N.S. Lakhonina1, Yu.R. Buldakova1

1 Moscow State University of Medicine and Dentistry
2 Pirogov Russian National Research Medical University, Moscow

Since the formation «non-infectious immunology», systemic connective tissue diseases became an important model for immune disorders study and laboratory immunological methods were included in clinical rheumatology practice. Rheumatology was the place of the origin of «immunomodulating therapy» concept. At the same time, the «explosive development” of immunology last decades led to significant disproportions in the morphofunctional approach to the disease and produced the «declination» towards the immune periphery (immune cells and their products) and some disregard of central organs of immunity (thymus). Over the past 30–40 years, clinical immunology three times has completely updated the complex of research methods and approaches. Such situation greatly complicated the contact between immunologists and clinicians. The emergence of «targeted» therapy with genetically engineered biological means in rheumatology again actualizes the use of immunological methods in the clinic and poses new challenges to immunologists and clinicians.

Key words: immune system, rheumatology, autoantibodies, thymus, targeted therapy, immunogram.
For citation: Goloviznin M.V., Timofeev V.T., Lakhonina N.S., Buldakova Yu.R. The immunological studies in rheumatology. Seven-decade journey // RMJ. 2018. № 12(II). P. 92–98.

Pages 99-102. Принципы ведения пациентов с глюкокортикоидным остеопорозом. Башкова И.Б., Мадянов И.В.

Summary: Principles of management of patients with glucocorticoid osteoporosis
I.B. Bashkova1, I.V. Madyanov1,2

1 Ulyanov Chuvash State University, Cheboksary
2 Republican Clinical Hospital, Cheboksary

Osteoporosis (OP) and related bone fractures are one of the serious complications of oral glucocorticoid (GC) therapy. GCs have a direct effect on bone tissue cells. The loss of bone mass is most pronounced in the first 3–6 months fr om the start of the GC regimen, in the future its decline occurs more slowly, but it continues during the entire period of hormonal therapy. A decrease in bone mineral density inevitably leads to an increased risk of osteoporotic fractures. The article reflects the modern approaches to the prevention and treatment of glucocorticoid OP. Detection criteria among patients receiving GCs, persons with a high risk of developing glucocorticoid OP are presented for the purpose of timely and adequate primary prevention of osteoporotic fractures. The first-line drugs are bisphosphonates and teriparatide. Considering that GSs contribute to the metabolic disturbance of vitamin D, in particular, to the reduction of calciferol hydroxylation processes, an emphasis is placed on the expediency of using active vitamin D metabolites in a comprehensive treatment of OP, wh ere the preference is given to alfacalcidol. It has been shown that alfacalcidol has demonstrated its effectiveness as a therapy of glucocorticoid OP.

Key words: glucocorticoids, glucocorticoid osteoporosis, fractures, vitamin D, active metabolites of vitamin D, alfacalcidol.
For citation: Bashkova I.B., Madyanov I.V. Principles of management of patients with glucocorticoid osteoporosis // RMJ. 2018. № 12(II). P. 99–102.



№6(II), 2018. Ангиология. Гемостаз

Pages 49-49. Слово редактора. Кузнецов М.Р.

Pages 50-53. Термография как метод обследования пациентов с венозной патологией нижних конечностей. Яровенко Г.В.

Summary: Thermography as an examination method in patients with venous pathology of the lower extremities
G.V. Yarovenko

Samara State Medical University

Aim: to study the change of infrared radiation for the examination of patients with phlebothrombosis, post-thrombophlebitic disease, and lower limb varicose vein disease.
Patients and Methods: thermography in patients with venous pathology was performed in conjunction with the evaluation of the clinical picture and data of Color Flow Mapping (CFM). The thermograms of the lower extremities of 25 healthy persons and 32 patients with deep vein thrombosis of the lower extremities were studied. Thermographic studies of the lower extremities were performed in 50 patients with post-thrombophlebitic disease at the stage of occlusion and recanalization and 142 patients with varicose disease at the stage of decompensation.
Results: on thermograms with phlebothrombosis, a zone of severe hyperthermia was visualized on the lower leg if the pathological process was in the popliteal vein and the entire limb if the process was localized in the iliofemoral segment. The hyperthermia level ranged from 39 to 40.8 °C. In patients with phlebothrombosis, there was a slowdown in lymph flow, to the extent of a blockade of regional lymph node basins. Indicators of the extremities’ minimum temperature in patients with lower extremity post-thrombophlebitic disease significantly increased compared with those in healthy people. On thermograms in patients with the varicose disease, changes in the maximum temperature were noted in all segments of the extremities. On thigh, on either side of the lower and upper half of the lower leg, the maximum temperature increased by more than 2 °C, in the lower half of the thigh on either side — more than 1.7 °C.
Conclusion: thermography makes it possible to identify not detected by visual examination or ill-defined pathological changes, which is of great importance for the examination in patients with the vein disease of the lower extremities.

Key words: thermographic study, thermography, thermogram, phlebothrombosis, post-thrombophlebitic disease, varicose 
disease.
For citation: Yarovenko G.V. Thermography as an examination method in patients with venous pathology of the lower extremities // RMJ. 2018. № 6(II). P. 50–53.

Pages 54-60. Состояние системы иммунитета у пациентов с варикозной болезнью вен нижних конечностей. Васильев И.М., Рыкова М.П., Богданец Л.И., Пономарев С.А., Антропова Е.Н., Калинин С.А., Тагирова С.К., Селезнев В.В., Марченко И.П.

Summary: Immune system condition in patients with lower limb varicose vein disease
I.M. Vasiliev1,2, M.P. Rykova2, L.I. Bogdanets3, S.A. Ponomarev2, E.N. Antropova2, S.A. Kalinin2, S.K. Tagirova1,2
V.V. Seleznev1, I.P. Marchenko1

1 Bauman City Clinical Hospital No.29, Moscow
2 Institute of Medical and Biological Problems of the Russian Academy of Sciences, Moscow
3 Pirogov Russian National Research Medical University, Moscow

Aim: to study the state of innate and adaptive immunity in patients with lower limb varicose vein disease (LLVVD) of C4 and C6 clinical class according to CEAP classification.
Patients and Methods: the study involved 34 patients with LLVVD who were on outpatient treatment in phlebological center of the Pirogov City Clinical Hospital No.1. The control group consisted of 17 healthy volunteers. In the peripheral blood were assessed by the absolute and relative count of:
1) monocytes and granulocytes, expressing receptors TLR2, TLR4, TLR6, CD11b, CD16, CD18, CD24, CD36, CD54, CD206;
2) lymphocytes, expressing receptors on its surface CD16, CD56, CD3, CD4, CD8, CD19, CD25, СD45RA, CD45RO.
Results: an analysis of the receptor repertoire of cellular factors of natural resistance in patients with LLVVD of C4–C6 classes of changes in the system of pattern recognition receptors associated with a significant increase (p<0.05) of granulocytes and/or monocytes in the peripheral blood, expressing signal Toll-like receptors — TLR2, TLR4 and TLR6, on their surface, compared with healthy volunteers.
The study of the relative and absolute count in the peripheral blood of cellular factors of the natural cytotoxicity system — mature circulating NK-cells — in patients with LLVVD showed that these indicators did not significantly differ from those in healthy persons.
Analysis of the T-lymphocyte subpopulations level in the peripheral blood allowed noting some features of the T-cells phenotype of adaptive immunity depending on the severity of CVI.
Conclusion: this study of systemic immunity in patients with lower limb varicose vein disease of various clinical classes has shown that patients with LLVVD of C4 clinical class, as well as patients with LLVVD of C6 clinical class, have changes in the subpopulation count of immune competent cells and their functional activity.

Key words: lower limb varicose vein disease, venous trophic ulcer, innate immunity, adaptive immunity.
For citation: Vasiliev I.M., Rykova M.P., Bogdanets L.I. et al. Immune system condition in patients with lower limb varicose vein disease // RMJ. 2018. № 6(II). P. 54–60.

Pages 61-65. Современная терапия хронических заболеваний вен нижних конечностей: в фокусе — трансдермальные флеботропные препараты. Богачев В.Ю., Болдин Б.В., Туркин П.Ю.

Summary: Modern therapy of chronic venous disorders of the lower limbs: transdermal phlebotropic medications in focus
V.Yu. Bogachev, B.V. Boldin, P.Yu. Turkin

Pirogov Russian National Research Medical University, Moscow

Aim: to evaluate the efficacy and safety of an application of the drug Detragel.
Patients and Methods: 1734 patients were included in the study (mean age 50.6±15.7 years) with various stages and forms of chronic venous disorders of the lower limbs (CVDLL), accompanied by venospecific symptoms: a sense of heaviness and fatigue in the legs, pain, swelling and nocturnal cramps. All patients used Detragel daily for 14 days. Permitted therapy included Detralex, acetylsalicylic acid, compression therapy. The severity of each of the CVDLL venospecific symptoms was assessed in points (0 points — absence, 3 points — maximum severity) initially and 14 days after the start of therapy. Satisfaction with the results of treatment of the patient and the physician and the frequency of adverse events were also assessed.
Results: Detragel monotherapy was used by 58% of patients, in the remaining cases, the combination of Detragel + Detralex (1000 mg/day) was recommended. Patients were statistically significantly younger in the monotherapy group than in the combination therapy group (p<0.001). Also in the monotherapy group, there was a significantly higher percentage of patients younger than 40 years of age with CVDLL of C0s and C1 clinical classes according to CEAP and a significantly lower percentage of patients older than 65 years with more severe forms of CVDLL than in the combination therapy group. Compression therapy was recommended for 4.5% of patients in the Detragel group and for 21.5% of patients receiving comprehensive treatment (p<0.0001). Acetylsalicylic acid was prescribed in 0.7% and 6.8% of cases in the Detragel and Detragel+Detralex groups, respectively (p<0.0001). A significant decrease in the severity of venospecific symptoms was noted in patients who received Detragel in both monotherapy and comprehensive therapy. 86.5% of patients and 89.9% of physicians characterized treatment as good and excellent, respectively. 2 (0.12%) patients noted minor skin reactions.
Conclusion: Detragel is an effective and safe drug for the treatment of patients with various clinical classes of CVDLL according to the CEAP classification.

Key words:
chronic venous disorders, Detragel, liposomes, essential phospholipids, topical medications.
For citation: Bogachev V.Yu., Boldin B.V., Turkin P.Yu. Modern therapy of chronic venous disorders of the lower limbs: transdermal phlebotropic medications in focus // RMJ. 2018. № 6(II). P. 61–65.

Pages 65-69. Тазовое венозное полнокровие усугубляет симптомы хронической венозной недостаточности. Гаврилов С.Г., Москаленко Е.П., Ефремова О.И.

Summary: Pelvic congestion syndrome exacerbates the symptoms of chronic venous insufficiency
S.G. Gavrilov, E.P. Moskalenko, O.I. Efremova

Pirogov Russian National Research Medical University, Moscow

Aim: to study an effect of pelvic congestion syndrome (PCS) on the clinical manifestations of chronic venous insufficiency (CVI) in patients with compound pelvic varicose veins (PVV) and lower limb varicose vein disease (LEVVD).
Patients and Methods: an analysis of the study results of 95 patients with LEVVD and CVI of class C2, C3 according to CEAP was carried out. Of these, 65 women were diagnosed with PVV, accompanied by PCS. The patients were divided into three groups: the first (control) group included 30 patients with LEVVD without pathology of pelvic veins; the second — 35 patients with combined LEVVD and PVV, PCS. The third group consisted of patients with LEVVD and latent form of PVV. The severity of the most common and characteristic symptoms of LEVVD (pain and heaviness in the lower limbs and pelvis, edema of the lower limbs, varicose syndrome) was evaluated.
Results: the combination of LEVVD and PCS significantly increases the frequency and intensity of clinical manifestations of CVI. The severity of varicose syndrome prevailed in the second group (group 1 — 1 point; group 3 — 1.06±0.08 points; group 2 — 2.3±0.2 points, p=0.000001), pain in the lower limbs also significantly differed in patients of group 2 (group 1 — 2.2±0.6 points; group 3 — 1.3±0.5 points; group 2 — 4.9±0.4 points; p=0.003). Pain, edema and severity in the lower limbs in patients of group 2 were found much more often in comparison with groups 1 and 3: pain in the lower limbs — 7 times; edema — 6 times, heaviness — 2 times.
Conclusion: PCS contributes to the deterioration of venous outflow from the lower limbs, exacerbates the clinical manifestations of CVI among patients with compound LEVVD and PCS.

Key words: lower limb and pelvis varicose disease, pelvic congestion syndrome, chronic venous insufficiency, venous pain, diagnosis.
For citation: Gavrilov S.G., Moskalenko E.P., Efremova O.I. Pelvic congestion syndrome exacerbates the symptoms of chronic venous insufficiency // RMJ. 2018. № 6(II). P. 65–69.

Pages 70-73. Периферическая нейропатия при критической ишемии нижней конечности. Кудыкин М.Н., Шейко Г.Е., Белова А.Н.

Summary: Peripheral neuropathy in critical limb ischemia
M.N. Kudykin, G.E. Sheiko, A.N. Belova

Volga Research Medical University, Nizhny Novgorod

Critical limb ischemia (CLI) is an actual problem of modern medicine due to the increasing incidence, severity of outcomes and the presence of comorbidities. At the present moment, the features of the development of peripheral neuropathy (PN) in patients with CLI remain poorly studied, the contribution of chronic ischemia to the development of PN is not determined.
Aim: to study the frequency and nature of a lesion of peripheral nerve trunks in patients with critical limb ischemia, and to evaluate the role of ischemia in the development of peripheral neuropathy in patients with critical ischemia.
Patients and Methods: the study included 36 patients with the popliteal-tibial artery segment occlusion of the lower extremity (type D according to TASC II classification) in the stage of critical ischemia to assess the nature and frequency of PN. The average age of patients was 62±7.8 years. Patients were divided into two groups depending on the presence of type 2 diabetes mellitus (DM2) to assess the role of ischemia in the development of PN. Group 1 — 10 (28%) patients without DM2, group 2 — 26 (72%) with DM2. Subjective and clinical signs of PN were evaluated in all patients, and electroneuromyography (ENMG) of the tibial and peroneal nerves was also performed.
Results: peripheral nerve trunks lesion of the tibia was detected in 100% of patients with CLI. Disfunction was detected by at least one nerve of the tibia and was characterized by both clinical symptoms and a decrease in the nerve conduction velocity along the motor fibers of the affected nerve. The clinical symptoms and results of ENMG in groups with and without DM2 did not statistically significantly differ (p>0.05), which may indicate the leading role of ischemia in the development of peripheral nerve trunks lesions of the tibia.
Conclusion: PN predominantly of demyelinating character is an obligate manifestation of CLI. Ischemia plays a key role in the development of PN in patients with CLI.

Key words: critical limb ischemia, peripheral neuropathy, obliterating atherosclerosis of the lower extremities vessels, electroneuromyography, diabetes mellitus.
For citation: Kudykin M.N., Sheiko G.E., Belova A.N. Peripheral neuropathy in critical limb ischemia // RMJ. 2018. № 6(II). P. 70–73.

Pages 74-79. Современные принципы фармакотерапии хронических заболеваний вен. Богачев В.Ю., Болдин Б.В., Родионов С.В.

Summary: Modern principles of pharmacotherapy of chronic venous diseases
V.Yu. Bogachev, V.B. Boldin, S.V. Rodionov

Pirogov Russian National Research Medical University, Moscow

At the 19th annual congress of the European Venous Forum, which was held in Athens in June 28–30, 2018, the long-awaited updated recommendations on the diagnosis and treatment of chronic venous diseases (CVD) were presented, the full text of which can be found in the June issue of the International Angiology publication. This publication aims to familiarize the practitioners with one of the key sections of the new European recommendations on pharmacotherapy for CVD. The primary agents of medical treatment of CVD remain venoactive drugs (phleboprotectors). Along with the venoactive drugs, pentoxifylline and sulodexide are widely used in the pharmacotherapy of venous trophic ulcers. In recent years, a personalized approach has been approved to treating a particular patient and optimizing the choice of a pharmacological drug, depending on the presence of specific symptoms and syndromes. For this purpose, an NNT (number-needed-to-treat) indicator is used — the number of patients who need to be treated to obtain a positive result in one patient. Thus, the ideal NNT should be equal to one. Modern and adequate phlebotropic therapy, taking into account new recommendations at all stages of the pathological process from C0s to C6, regardless of the key pathogenetic mechanism — reflux or occlusion, expands our capabilities in control of CVD.

Key words: chronic venous diseases, pharmacotherapy, venoactive drugs.
For citation: Bogachev V.Yu., Boldin V.B., Rodionov S.V. Modern principles of pharmacotherapy of chronic venous diseases // 
RMJ. 2018. № 6(II). P. 74–79.

Pages 79-84. Поздние осложнения имплантации кава-фильтров. Иванов В.В., Андрияшкин В.В.

Summary: Late complications of vena cava filter implantation
V.V. Ivanov, V.V. Adriyashkin

Pirogov Russian National Research Medical University, Moscow

The author tried to generalize and systematize information about the late complications of vena cava filter implantation, to describe the symptoms and methods of treatment of its complications. The databases PubMed MEDLINE, Web of Sciences, OVID, eLIBRARY, LILACS, FDA MAUDE were analyzed on a key word. This review includes works describing the complications of vena cava filter implantation, their causes, clinical symptoms, results of surgical, endovascular and conservative treatment. An urgency of the problem is shown; types of late complications of vena cava filters implantation, a dependence of the mechanism of their development and clinical symptoms on the structure of the implantable device, a length of stay in the vein lumen are discussed. Many of the late complications of vena cava filter implantation, such as its thrombosis, syndrome of the inferior vena cava, walls damage of the inferior vena cava by elements of the filtering device with their penetration into the adjacent anatomical structures, fragmentation of the vena cava filter, filter migration or its fragments in the venous heart and pulmonary arteries, with the possible development of myocardial rupture and cardiac tamponade, pose a threat to the patient’s life. In the long-term period, the weaknesses of the vena cava filter implantation may dominate their therapeutic role. The article describes the options for treatment tactics in the development of complications of the cava filter implantation and their results. The necessity of creating a diagnostic and treatment algorithm in this category of patients is substantiated.

Key words: inferior vena cava, vena cava filter, post-thrombotic disease, complication, venous thromboembolic event.
For citation: Ivanov V.V., Adriyashkin V.V. Late complications of vena cava filter implantation // RMJ. 2018. № 6(II). P. 79–84.

Pages 85-88. Возможности и собственный опыт применения ривароксабана в комплексном лечении больных с синдромом критической ишемии нижних конечностей. Кательницкий И.И., Зорькин А.А., Дрожжин Е.В., Мазайшвили К.В., Ивченков Д.С.

Summary: Possibilities of rivaroxaban application in combination therapy in patients with critical limb ischemia
I.I. Katelnitskii1, A.A. Zorkin2, E.V. Drozhin2, K.V. Mazaishvili2, D.S. Ivchenkov3

1 Rostov State Medical University, Rostov-on-Don
2 Surgut State University
3 Surgut City Clinical Hospital

The article is devoted to the possibilities of using rivaroxaban peroral anticoagulant as a component of the combined disaggregating and anticoagulant therapy of the perioperative period in the treatment of critical limb ischemia (CLI).
An analysis of a few literature data on this issue is presented; the intermediate results of ongoing multicenter clinical studies are reviewed. Own experience of using rivaroxaban in 25 patients with obliterative arterial disease of the lower limbs (OADLL) and CLI in comparison with the traditional prescription of warfarin is generalized. The immediate results of limb revascularization and the nature of hemorrhagic complications were compared.
In patients with CLI using rivaroxaban in the combination therapy of the perioperative period, compared with the warfarin administration, there was a tendency to a decrease in the frequency of revascularization zone thrombosis. Thus, the application of rivaroxaban is an alternative to the traditional use of warfarin. The total frequency of hemorrhagic complications during rivaroxaban application was significantly lower when using warfarin (16% vs. 24%, respectively). The need for the use of blood products didn’t increase. An increase in the ratio of endovascular revascularizing interventions can reduce the incidence of local hemorrhagic complications in patients with OADLL and CLI who receive combined anti-platelet and anticoagulant therapy. The clinical and economic aspects of rivaroxaban in patients with OADLL and CLI require focused researches.

Key words: critical limb ischemia, obliterative arterial disease of the lower limbs, critical ischemia treatment, anticoagulant therapy, warfarin, NOAC, rivaroxaban.
For citation: Katelnitskii I.I., Zorkin A.A., Drozhin E.V. et al. Possibilities of rivaroxaban application in combination therapy in patients with critical limb ischemia // RMJ. 2018. № 6(II). P. 85–88.



№10(II), 2018. Оториноларингология

Pages 102-104. Клиническое наблюдение гистиоцитоза у ребенка 1 месяца 3 недель, протекавшего под маской наружного диффузного отита. Молчанова М.В., Алексеенко С.И., Артюшкин С.А.

Summary: Clinical observation of histiocytosis, proceeding under the mask of an acute otitis externa, in a child of 1 month 3 weeks
M.V. Molchanova1,2, S.I. Alexeenko1,2, S.A. Artyushkin1

1 Mechnikov Northwestern State Medical University, Saint Petersburg
2 Raukhfus Children City Multi-Profile Clinical Center of High Medical Technologies, Saint Petersburg

A histiocytosis is a group of diseases that combine the proliferative process in the monocyte-macrophage system with the accumulation of pathological histiocytes in the lesions and a formation of specific granulomas.
There is a possibility of an immunopathological and tumor nature of the disease. A high incidence of spontaneous remission, low mortality and an absence of chromosomal abnormalities in cells from lesions are in favor of the immunopathological nature of histiocytosis. In favor of the tumor nature — the clonal nature of the Langerhans cells proliferation in the lesions.
Clinical manifestations of histiocytosis are very diverse, which determines the difficulty of diagnosis. Various organs and tissues can be involved in the pathological process: skin, lymph nodes, external and middle ear, flat bones, bone marrow, liver, spleen, lungs, endocrine glands, gastrointestinal tract, brain.
The article presents a clinical case of histiocytosis diagnosed in a child of 1 month 3 weeks, the clinical manifestations of which were masked under the symptoms of an acute otitis externa.
The description of this clinical case is intended to draw attention to the peculiarities of the course of recurrent otitis externa and otitis media in infants, as the “mask” of these diseases may be histiocytosis.

Key words: acute otitis externa and otitis media, infants, histiocytosis, computerized tomography.
For citation: Molchanova M.V., Alexeenko S.I., Artyushkin S.A. Clinical observation of histiocytosis, proceeding under the mask of an acute otitis externa, in a child of 1 month 3 weeks // RMJ. 2018. № 10(II). P. 102–104.

Pages 49-49. Слово редактора. Рязанцев С.В.

Pages 50-53. Возможности комбинированной ингаляционной терапии инфекционно-воспалительных заболеваний верхних отделов дыхательных путей. Морозова С.В., Биданова Д.Б.

Summary: Possibilities of combined inhalation therapy of infectious and inflammatory diseases of the upper respiratory tract
S.V. Morozova, D.B. Bidanova

Sechenov University, Moscow

Unreasonable prescription of systemic antibacterial drugs in the treatment of infectious and inflammatory diseases of the upper respiratory tract leads to increased levels of antibiotic resistance. In the overwhelming majority of cases, systemic antibacterial therapy for acute rhinosinusitis is not indicated, since acute rhinosinusitis is viral in 90% of cases. In chronic rhinosinusitis, the prescription of systemic antibiotic therapy should be strictly justified. An alternative to the systemic administration of antibiotics for rhinosinusitis is topical antimicrobial application. The combination drug Fluimucil®-antibiotic IT, which includes the N-acetylcysteine mucolytic and thiamphenicol, broad-spectrum antibiotic, is highly effective in treating inflammatory diseases of the upper respiratory tract. The use of the drug Fluimucil®-antibiotic IT for rhinosinusitis allows you to accelerate the onset of convalescence, to avoid systemic antibiotic therapy and invasive procedures.

Key words: rhinosinusitis, inhalation therapy, topical therapy, antibiotic therapy, thiamphenicol glycinate acetylcysteine, Fluimucil®-antibiotic IT.
For citation: Morozova S.V., Bidanova D.B. Possibilities of combined inhalation therapy of infectious and inflammatory diseases of the upper respiratory tract // RMJ. 2018. № 10(II). P. 50–53.

Pages 54-58. Патогенетические аспекты медикаментозной терапии у пациентов с болью в горле. Мальцева Г.С., Захарова Г.П., Артемьева Е.С., Рязанцев С.В.

Summary: Pathogenetic aspects of drug therapy in patients with sore throat
G.S. Maltseva, G.P. Zakharova, E.S. Artemieva, S.V. Ryazantsev

St. Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg

At the present stage, the problem of pain and its relief is one of the priority tasks of the healthcare service. The frequency of this pathological condition development is steadily increasing, and the intensity has a direct negative impact on vital activity, leading to a decrease in efficiency and quality of life.
The article provides general concepts and generally accepted classifications of pain. The pathophysiological processes of sore throat and the principles of patient management are considered in detail, depending on the etiology of the pain. An application of topical nonsteroidal anti-inflammatory drugs in the treatment of nociceptive sore throat has been substantiated. The results of clinical studies on the efficacy and safety of topical application of flurbiprofen 8.75 mg (various dosage forms) for sore throat are presented.
Strepsils® Intensive is an effective drug to relieve pain and discomfort in the throat. It can be used as a first-line drug for the symptomatic treatment of infectious and inflammatory diseases of the pharynx. As different benefits to meet the needs of patients, it is offered to use Strepsils® Intensive dosage forms as a spray and lozenges. Besides, they have proven equal efficacy in the treatment of pain syndrome, a good safety profile and tolerability.

Key words: sore throat, pathogenesis of pain, nonsteroidal anti-inflammatory drugs, flurbiprofen, Strepsils® Intensive.
For citation: Maltseva G.S., Zakharova G.P., Artemieva E.S., Ryazantsev S.V. Pathogenetic aspects of drug therapy in patients with sore throat // RMJ. 2018. № 10(II). P. 54 –58.

Pages 59-63. Анализ кардиореспираторной координации у больных с заиканием. Корнеенков А.А., Бахилин В.М., Абдурахманов М.А., Сердюков С.В.

Summary: Analysis of cardiorespiratory coordination in patients with stuttering
A.A. Korneenkov, V.M. Bakhilin, M.A. Abdurakhmanov, S.V. Serdyukov

Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech

Respiratory distress and heart rhythm disorder accompany many diseases. This article proposes a method to visually assess their interaction during stuttering. Synchronous records of the electrocardiogram and respiration were used for the calculations. The moments of R-peaks were determined in a cardiogram record, and the moments of the inspiratory cycle beginning — in a respiration record.
Aim: to analyse a cardiorespiratory communication in patients with stuttering based on the proposed indicators of cardiorespiratory coordination.
Patients and Methods: electrocardiogram (ECG, II standard lead) and data on uncalibrated airflow from the nose, obtained using a thermistor sensor, were recorded simultaneously in 12 healthy subjects and in 23 stuttering patients using a portable device VNS-Spectr. The data for each test were recorded during rest in a sitting position for 5 minutes. The sampling frequency of ECG signals and nasal airflow was 200 Hz.
Analysis of cardiorespiratory coordination was carried out in the following areas:
– calculation of indicators related by the ratio of m:n (where m: number of heartbeats, n: number of inspiratory cycles);
– calculation of the time distances between the event markers of two time series;
– building of synchrograms for descriptive model and visualization of “phase repeats”, on which the time scale values of relative distance jiof each R-peak registration were noted. If in the sequence the relative distance ji of each m R-peak does not exceed the specified error ε=0.025, then horizontal lines are formed from individual point values of ji. Otherwise, parallel horizontal lines will not appear.
Results and Discussion: the study revealed a loss of cardiorespiratory coordination in patients with stuttering.
Conclusion: the study showed that the quantitative characterization of the cardiorespiratory interaction in patients with stuttering may well be used to identify differences in the degree of its manifestation in different groups of patients with respiratory rhythm disturbances.

Key words: cardiorespiratory communication, cardiorespiratory coordination, stuttering, synchrogram, synchronization theory, inspiratory cycle.
For citation: Korneenkov A.A., Bakhilin V.M., Abdurakhmanov M.A., Serdyukov S.V. Analysis of cardiorespiratory coordination in patients with stuttering // RMJ. 2018. № 10(II). P. 59–63.

Pages 63-67. Особенности этиологической диагностики лимфопролиферативного синдрома у детей. М.В.Дроздова, Ю.С.Преображенская, Е.В.Тырнова, С.Н.Ларионова

Summary: Features of etiological diagnosis of lymphoproliferative syndrome in children
M.V.Drozdova, Yu.S. Preobrazhenskaya, E.V.Tyrnova, S.N.Larionova

Saint Petersburg Research Institute of Ear, Throat, Nose and Speech

Aim: to analyse the features of etiological diagnosis of lymphoproliferative syndrome in children-candidates for surgical treatment.
Patients and Methods: 233 children aged from 3 to 16 years with acute lymphoproliferative syndrome, 157 children aged from 3 to 16 years with chronic lymphoproliferative syndrome, 100 children aged from 1 to 7 years with a high degree of hearing loss were examined in Saint Petersburg Research Institute of Ear, Throat, Nose and Speech. In addition to a general examination, hematological examination was carried out, including verification of the diagnosis of herpes infection.
Results: it was established that the acute form of lymphoproliferative syndrome in 33.5% of cases was caused by beta-hemolytic streptococcus. In 30.9% of the examined children, heterophilic antibodies associated with infectious mononucleosis were detected in the serum. In 16% of children, the acute lymphoproliferative syndrome of mixed etiology was diagnosed: infectious mononucleosis and streptococcal infection. Chronic lymphoproliferative syndrome was detected in 157 children from among those who applied to decide on the need for surgical treatment. It was established that in most cases (more than 74%) the Epstein-Barr virus (EBV) is the etiological factor in the development of lymphoid proliferation. Cytomegalovirus infection in most cases was detected in combination with other pathogens — in 34.39% of cases with EBV, and in 14.65% — with EBV and beta-hemolytic streptococcus.
Conclusion: for verification of the diagnosis, it is now advisable to introduce modern methods of laboratory diagnostics, which will increase the level of patient care in connection with the etiological diagnosis. Clarification of the etiology of lymphadenopathy of infectious origin is a necessary condition for adequate etiotropic therapy. The emergence of information about new etiological agents of lymphoproliferative syndrome in children and modern laboratory and diagnostic technologies gives some hope for the development of effective measures to prevent and treat these diseases and reduce the burden of economic load on the state.

Key words: cytomegalovirus, Epstein-Barr virus, children, lymphoproliferative syndrome, high degree of hearing loss.
For citation: Drozdova M.V., Preobrazhenskaya Yu.S., Tyrnova E.V., Larionova S.N. Features of etiological diagnosis 
of lymphoproliferative syndrome in children // RMJ. 2018. № 10(II). P. 63–67.

Pages 70-74. Выбор топических препаратов в комплексном лечении острого тонзиллита. Мальцева Г.С., Дроздова М.В., Потапова П.Д.

Summary: Selection of topical preparations in the comprehensive treatment of acute tonsillitis
G.S. Malceva, M.V. Drozdova, P.D. Potapova

Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech

The proportion of acute tonsillitis in the overall morbidity structure of the population has always remained and still remains high. Needless to say, this nosology can be accompanied by complications, including life-threatening ones, leading to partial or complete disability.
The article covers the issues of nosology of acute tonsillitis and aspects of the drugs selection for the topical treatment of this disease. Much attention is paid to the effectiveness of the drug’s use of the nitrofuran group (in particular, their representative — nitrofural).
Acute tonsillitis will always occupy a leading position in the overall structure of otorhinolaryngological diseases. Without a doubt, the treatment of acute tonsillitis come down to a combination of systemic and topical therapy. In the comprehensive treatment of acute tonsillitis, an important role is played by gargling repeatedly during the day as the pathogenetic component of therapy. When choosing a drug for topical treatment, it is necessary to consider its efficacy, bioavailability, safety, low cost compared to other drugs and ease of use. FURACILIN AVEXIMA on the basis of nitrofural has all the necessary benefits over alternative preparations of various antiseptic groups. A convenient, soluble form and a reasonable price will allow patient compliance.

Key words: otorhinolaryngology, acute tonsillitis, gargling, conservative treatment, nitrofurans, nitrofural, FURACILIN AVEXIMA.
For citation: Malceva G.S., Drozdova M.V., Potapova P.D. Selection of topical preparations in the comprehensive treatment of acute tonsillitis // RMJ. 2018. № 10(II). P. 70–74.

Pages 75-78. Биорегуляционная терапия в лечении острых и хронических ринитов. Карпищенко С.А., Колесникова О.М.

Summary: Bioregulatory therapy in the treatment of acute and chronic rhinitis
S.A. Karpishchenko, O.M. Kolesnikova

Pavlov First St. Petersburg State Medical University, Saint Petersburg

Acute respiratory viral infections (ARVI) — the common pathology that occurs regardless of age, place of residence and social status of a person. The entrance gates of the body for the virus — an upper respiratory tract, most often through the nasal mucous membranes. With long-term acute inflammation of the nasal mucous membranes, complications may develop with the formation of chronic processes: irreversible changes of the paranasal sinuses and nasal mucous membranes develop in addition to bacterial inflammation and persistence of mucosal edema. Therefore, it is advisable to carry out not only symptomatic, but also anti-inflammatory and antimicrobial therapy of rhinitis in a timely manner. The article reviewed the studies evaluating the effectiveness of the components of the nasal spray Euphorbium compositum Nasentropfen S®. Due to the wide range of a complex effect, this drug can be recommended for the treatment of various forms of rhinitis. Euphorbium compositum Nasentropfen S® has antiedematous, antiviral, immunomodulatory and antibacterial action, suitable for irrigation therapy during the epidemiological risk of ARVI. To achieve the best result, the drug should be used at the first signs of incipient ARVI.ё

Key words: rhinitis, antiviral effect, symptomatic therapy, bioregulatory medicine, Euphorbium compositum Nasentropfen S®.
For citation: Karpishchenko S.A., Kolesnikova O.M. Bioregulatory therapy in the treatment of acute and chronic rhinitis // RMJ. 2018. № 10(II). P. 75–78.

Pages 79-83. Вертикальный нистагм: диагностическое значение и требования к проведению оценки по данным литературы. А.А.Вавилова

Summary: Vertical nystagmus: diagnostic value and requirements for evaluation according to the literature data
A.A.Vavilova

Nikiforov All-Russian Center for Emergency and Radiation Medicine, Saint Petersburg

The article is devoted to the study of vertical nystagmus as a sign of central vestibular disorders in neurological and otorhinolaryngological practice. Vertical nystagmus is believed to indicate central vestibular disorders. The modern models that explain its mechanism are outlined. Based on the literature data, the requirements for the evaluation of this pathology are discussed.
Own observations of vertical nystagmus in 5 patients, obtained during the examination of 60 patients with complaints of dizziness, which were conducted in the departments of otorhinolaryngology and maxillofacial surgery of Nikiforov All-Russian Center for Emergency and Radiation Medicine, are given. Registration of spontaneous nystagmus in the course of an otoneurological examination was carried out using video-oculography.
It is noted that vertical nystagmus was rarely detected in the examined patients (in 5 out of 60), which can be explained by the fact that patients with peripheral vestibular pathology dominate in otorhinolaryngological practice. It was detected only in the dark and was detected in patients with central vestibular disorders. It is discussed that the common factors of its change in positional samples (when placed on the back, turning in this position of the head to the side, etc.) for problems of topical diagnosis require further study. The article is addressed to the attention of neurologists and otorhinolaryngologists.

Key words: vertical nystagmus, vestibular dysfunction, vestibuloocular reflex, videooculography, central vestibular disorders.
For citation: Vavilova A.A. Vertical nystagmus: diagnostic value and requirements for evaluation according to the literature data // RMJ. 2018. № 10(II). P.79 –83.

Pages 84-91. Медикаментозные и немедикаментозные методы реабилитации детей с респираторными инфекциями. Гончарова О.В., Камелденова Д.Б., Потапов В.Н., Богова О.Т., Сатыго Е.А.

Summary: Drug and non-drug methods of rehabilitation of children with respiratory infections
O.V. Goncharova1, D.B. Kameldenova1, V.N. Potapov2, O.T. Bogova2, E.A. Satigo3

1 Sechenov University, Moscow
2 Russian Medical Academy of Continuous Professional Education, Moscow
3 Mechnikov Northwest State Medical University, Saint Petersburg

The article shows the clinical manifestations of acute respiratory infections in children, depending on the type of pathogen and describes the characteristics of a cough, its duration in various diseases. Also, it provides general characteristics of drugs for the treatment of the cough, including their features directly acting on cough: drugs of central action, peripheral action (expectorant, mucolytic drugs, combination drugs), as well as drugs characteristics of an indirect effect on cough and features of combined drugs of different pharmacological groups. The indications in children and determined efficacy of the expectorant syrup Eucabal®, consisting of liquid extracts of plantain and thyme, emulsion Eucabal® Balsam S, consisting of eucalyptus oil and pine needles oil, and ESPA-NAC® mucolytic, based on acetylcysteine, are presented in more detail. Considering that in the treatment of respiratory infections, great attention is paid to drug therapy and, to a lesser extent, the importance of nutrition, proper care and rehabilitation of children during the recovery period; recommendations on nutrition in the acute period and recovery period, care for children are given and physical methods of rehabilitation (drainage massage, physical therapy, breathing exercises depending on age), increasing the effectiveness of drug therapy, are described. Only a comprehensive approach to the treatment of children with respiratory pathology contributes to successful recovery and allows the children to avoid complications.

Key words: respiratory infections in children, rehabilitation of children, expectorant drugs, mucolytics, Eucabal®, Eucabal® Balsam S, ESPA-NAC®.
For citation: Goncharova O.V., Kameldenova D.B., Potapov V.N. et al. Drug and non-drug methods of rehabilitation of children with respiratory infections // RMJ. 2018. № 10(II). P. 84–91.

Pages 92-96. Перспективы применения препаратов на основе серебра при ринитах. Карпищенко С.А., Шумилова Н.А.

Summary: Prospects for the use of silver-based drugs for rhinitis
S.A. Karpishenko, N.A. Shumilova

Pavlov First Saint Petersburg State Medical University

In recent years, silver-based drugs are rarely used in the treatment of various forms of rhinitis. Review of foreign scientific studies over the past years indicates the return of preparations with silver ions to the pharmaceutical market and the prospects for their application in various branches of medicine. Review on scientific studies on the biological effects of silver ions has been carried out, and modern ideas on the mechanisms of action on bacterial cells have been described. The article digs into the question of the safety of silver in medicine. Antibacterial, antiviral and antifungal effects of drugs with silver are proven. Besides, it has been established that silver ions have the ability to potentiate the action of a number of antibiotics, increasing their activity, against microorganisms with polyvalent resistance as well. In connection with the growth of antibiotic resistance of microorganisms and the lack of prerequisites for the emergence of new antibiotics in the coming decades, preparations with silver ions can be used topically in combination with antibiotics to increase the spectrum of their antimicrobial activity. Due to the wide range of the biological action of silver ions, the use of drugs based on it (e.g., the drug Sialor®) is justified both in viral and in bacterial forms of rhinitis.

Key words: rhinitis, antibacterial activity, antibiotics synergism, silver ions, silver proteinate, Sialor®.
For citation: Karpishenko S.A., Shumilova N.A. Prospects for the use of silver-based drugs for rhinitis // RMJ. 2018. № 10(II). P. 92–96.

Pages 97-102. Возможности топических этиотропных препаратов в лечении больных острым тонзиллофарингитом. Свистушкин В.М., Никифорова Г.Н., Топоркова Л.А., Карпова О.Ю.

Summary: Possibilities of topical etiotropic drugs in the treatment of patients with acute tonsillopharyngitis
V.M. Svistushkin, G.N. Nikiforova, L.A. Toporkova, O.Yu. Karpova 

Sechenov University, Moscow

Acute tonsillopharyngitis is a general term used to describe any acute inflammation of the mucous membrane and oropharynx lymphoid formations. Administration of topical drugs (mouthwashes, sprays, lozenges) is the main treatment method for most patients with inflammatory pathology and streptococcal tonsillopharyngitis. Most often, local dosage forms are represented by a combination of various drugs, which helps them to quickly and effectively interact on the main manifestations of the disease.
The article highlights the possibility of using local antibacterial and antiseptic drugs for the topical treatment of acute tonsillopharyngitis. Data are given on the use of the drug Grammidin®, based on a local broad-spectrum antibiotic gramicidin S and antiseptic cetylpyridinium chloride. The drug showed high efficacy and safety of use in adults and children, due to the combination of active substances and their synergism. The strength of the drug Grammidin® is in its effectiveness against microbial associations — biofilms, which is confirmed, in particular, with data on the use of the drug in patients with exacerbation of chronic infectious-inflammatory diseases of the oropharynx. Grammidin® in the pharmaceutical form of «metered dose spray» provides additional benefits in the treatment of patients with infectious and inflammatory diseases of the pharynx.

Key words: acute tonsillopharyngitis, microbial associations, metered dose spray, gramicidin S, cetylpyridinium chloride, Grammidin®.
For citation: Svistushkin V.M., Nikiforova G.N., Toporkova L.A., Karpova O.Yu. Possibilities of topical etiotropic drugs in the treatment of patients with acute tonsillopharyngitis // RMJ. 2018. № 10(II). P.97 –102.



№8(II), 2018. Дерматология

Pages 102-103. Применение физиотерапевтических методов при лечении больных псориазом. Баткаев Э.А., Чистякова И.А.

Summary: Application of physiotherapeutic methods in the treatment of patients with psoriasis
E.A. Batkaev, I.A. Chistyakova

RUDN University, Moscow

Modern treatment methods of severe forms of psoriasis include so-called genetically engineered biologic drugs containing monoclonal antibodies that neutralize crucial cytokines. Most drugs for biologic therapy have a good therapeutic effect already after 3–6 months from the start of treatment, however, in some patients, an “effect escape” may develop, which is mainly due to the appearance of neutralizing antibodies to monoclonal antibodies contained in these drugs, and leads to the use of cytostatics. The effectiveness of the treatment of psoriasis increases significantly with the co-use of drugs and physiotherapy methods. One of the most active methods is an ultraviolet therapy of various spectral ranges.
Photochemotherapy (PUVA therapy) is one of the most effective modern methods of psoriasis phototherapy. Clinical recovery is achieved in 75–92% of cases. The article presents the successful experience of 5-year-long use of the drug Ammifurin® in almost twice increased doses (1.5 mg/kg). We believe that the PUVA therapy method should be applied more widely for patients with psoriasis in the conditions of our country, preferring it over corticosteroids, with which relapses are more common.

Key words: physiotherapy, ultraviolet therapy, genetic engineered biologic drugs, cytostatics, psoriasis, photochemotherapy, Ammifurin®.
For citation: Batkaev E.A., Chistyakova I.A. Application of physiotherapeutic methods in the treatment of patients with psoriasis // RMJ. 2018. № 8(II). P. 102–103.

Pages 104-108. Обоснование применения сосудистых препаратов в комплексной терапии псориаза. Мильдзихова Д.Р., Дениева М.И., Балабекова Ф.Г., Корсунская И.М.

Summary: Rationale for use of vascular drugs in the treatment of psoriasis
D.R. Mildzihova1, M.I. Denieva2,3, F.G. Balabekova3, I.M. Korsunskaya1

1 Academy of Sciences, Moscow
2 Chechen State University, Grozny
3 Republican Dermatovenerologic Dispensary, Grozny

Psoriasis is a multifactorial disease, which is manifested not only by skin changes, but also by the vascular system changes. Due to this, there is often a comorbidity of psoriasis with cardiovascular diseases, and in patients with severe forms of psoriasis, there is an increase in the level of a number of cytokines, vascular endothelial growth factor (VEGF), endothelin-1, etc. This, in turn, provokes the development of pathological angiogenesis. Many foreign studies have demonstrated the relationship of an inflammatory process in psoriasis and the inflammatory process in the vascular wall, which is a sufficient justification for the inclusion of phlebotropic drugs in the comprehensive therapy. In dermatology, calcium dobesilate (for example, Doxi-Hem®) is often used in nosologies such as chronic venous insufficiency, rosacea, and etc. Calcium dobesilate is an inhibitor of endothelin-1 and VEGF. The drug improves the function and integrity of the capillary walls and veins, reduces the extravasation of blood and fluids and the formation of edema, and normalizes the physiology of lymph. Foreign data shows the effectiveness of both topical calcium dobesilate, approved by the FDA, and the experience of using the oral form of the drug in patients with pigmented purpuric dermatosis, but on the Russian market calcium dobesilate is presented only in forms for systemic use. The drug administration in these forms in the comprehensive therapy of psoriasis requires further clinical studies.

Key words: psoriasis, comorbidity, vascular disorders, calcium dobesilate, Doxi-Hem®.
For citation: Mildzihova D.R., Denieva M.I., Balabekova F.G., Korsunskaya I.M. Rationale for use of vascular drugs in the treatment of psoriasis // RMJ. 2018. № 8(II). P. 104–108.

Pages 109-112. Клинический опыт применения системного изотретиноина в лечении тяжелых форм акне. Матушевская Е.В., Антонова Л.А., Матушевская Ю.И., Петрова К.С.

Summary: Clinical experience of using systemic isotretinoin in the treatment of severe forms of acne
E.V. Matushevskaya1, L.A. Antonova2,3, Yu.I. Matushevskaya4, K.S. Petrova5

1 Institution of Advanced Training, Federal Medical and Biological Agency, Moscow
2 Krasnoyarsk Interdistrict Outpatient Department
3 Epilation and Cosmetology Center «Electra» LLC, Krasnoyarsk
4 Lyubertsy Dermatovenerologic Clinic, Moscow Region
5 Volga Research Medical University, Nizhny Novgorod

For the treatment of medium and severe forms of acne, the prescription of systemic drugs as antibiotics, hormonal drugs, synthetic retinoids is indicated. The article presents data on the effectiveness and safety of systemic isotretinoin (SI) in the practice of a dermatologist in the treatment of acne. Issues of the acne pathogenesis, a formation of the phenotypic heterogeneity of the Cutibacterium acnes bacterium are considered, an exposome analysis and its effect on the severity and persistence of acne is carried out. Recommendations are given on the management of patients with acne, depending on the form and severity of the pathological process using SI based on current domestic and foreign recommendations. Data of the clinical use of the drug Verocutane® (based on SI) for the treatment of severe forms of acne are presented.
The SI application in the treatment of medium and severe forms of acne is effective and safe and meets the requirements of modern principles of treatment. A new drug Verocutane® is registered on the Russian pharmaceutical market. The experience of its use in the treatment of patients with acne has demonstrated a high therapeutic efficacy and low risk of serious adverse events. High efficacy, safety, and an optimal pharmacoeconomic index increase patient compliance with acne therapy.

Key words: acne, exposome, synthetic retinoids, systemic therapy, efficacy, safety, isotretinoin, Verocutane®.
For citation: Matushevskaya E.V., Antonova L.A., Matushevskaya Yu.I., Petrova K.S. Clinical experience of using systemic isotretinoin in the treatment of severe forms of acne // RMJ. 2018. № 8(II). P. –112.

Pages 113-117. Клинический случай: лечение пожилого пациента с распространенным вульгарным псориазом тяжелого течения генно-инженерным биологическим препаратом секукинумаб. Свечникова Е.В., Жуфина С.Е.

Summary: Clinical case: treatment of an elderly patient with a common severe psoriasis vulgaris of the with a genetically engineered biological drug secukinumab
E.V. Svechnikova, S.E. Zhufina

Central State Medical Academy, Moscow

Psoriasis is one of the most common chronic severe skin diseases. According to S.K. Kurd, J.M. Gelfand (2009), about 3.5% of the world’s population suffers from psoriasis. According to the Ministry of Health in the Russian Federation in 2017, a total of 346,978 patients with psoriasis were registered, which corresponds to 236.4 cases per 100 thousand of the population.
The article presents the latest statistical data on the incidence of psoriasis and psoriatic arthritis in the Russian Federation — the current information on the pathogenesis and genetic engineering biological therapy of psoriasis is reviewed. The clinical case of effective treatment with secukinumab of an elderly patient with common severe psoriasis vulgaris is presented.
The presented clinical case demonstrates the high clinical efficacy of the drug Cosentyx (secukinumab) in the treatment of severe psoriasis vulgaris. A quick and stable result was achieved — a decrease in the PASI index by 97% over 12 weeks. An elderly patient with the presence of comorbidities, as well as poor tolerability of basic therapy with methotrexate, had well-tolerated secukinumab treatment, no adverse events were detected during 12 weeks of therapy, which confirms such characteristics of the drug as safety, high efficacy and no adverse effects.

Key words: common psoriasis vulgaris, psoriatic arthritis, genetically engineered biological therapy, secukinumab, Cosentyx.
For citation: Svechnikova E.V., Zhufina S.E. Clinical case: treatment of an elderly patient with a common severe psoriasis vulgaris of the with a genetically engineered biological drug secukinumab // RMJ. 2018. № 8(II). P. 113–117.

Pages 118-118. Новые возможности и перспективы терапии псориаза.

Pages 67-67. Слово редактора. Баткаев Э.А.

Pages 68-71. Сравнительная оценка дерматологического индекса качества жизни у больных хроническими воспалительными дерматозами. Баткаева Н.В., Баткаев Э.А., Гитинова М.М.

Summary: Comparative assessment of the Dermatology Life Quality Index in patients with chronic inflammatory dermatoses
N.V. Batkaeva, E.A. Batkaev, M.M. Gitinova

RUDN University, Moscow

Aim: to evaluate and compare the quality of life of patients with various chronic dermatoses according to the Dermatology Life Quality Index questionnaire (DLQI).
Patients and Methods: main groups consisted of patients suffering from severe forms of psoriasis (Ps), psoriatic arthritis (PsA) and other chronic dermatoses who were hospitalized at the Korolenko Branch of the Moscow Research and Practical Center for Dermatovenerology and Cosmetology in 2017. The quality of life of patients was assessed by the DLQI questionnaire in points. For statistical analysis, M and σ±m, Chi-square were calculated.
Results: the average DLQI value in patients of the main group was 15.8±5.2 points, that is, the disease had a very strong impact on the patient’s life. In patients with only skin manifestations of Ps, the mean value of DLQI was 12.2±3.6 points, in PsA patients — 22.3±5.0 points, in patients with other chronic dermatoses — 10.1±6.7 points (p<0.05). The mean DLQI value in patients with comorbidities was 16.1±5.3 points (n=112).
Conclusion: all patients with chronic inflammatory dermatoses had a high mean DLQI value, which indicates a very strong influence of dermatological disease and comorbid pathology on the patient’s quality of life. Among them, the highest rates were in patients with Ps and PsA. In patients with PsA, the mean DLQI value was significantly higher than in patients with cutaneous form of Ps and other dermatoses of the skin. Among comorbid pathology, the highest rates were observed in patients suffering from PsA with concomitant cardiovascular pathology and intestinal diseases. Thus, PS patients require an integrated approach and dynamic observation by dermatologists and doctors of related specialties in order to early diagnose PsA and comorbid pathology and timely therapy, which will significantly increase the quality of life of such patients and their ability to work.

Key words: Dermatology Life Quality Index of patients, psoriasis, psoriatic arthritis, chronic inflammatory dermatosis.
For citation: Batkaeva N.V., Batkaev E.A., Gitinova M.M. Comparative assessment of the Dermatology Life Quality Index in patients with chronic inflammatory dermatoses // RMJ. 2018. № 8(II). P. 68–71.

Pages 72-74. Ретроспективное изучение анамнестических данных больных вульгарным псориазом. Олисова О.Ю., Гаранян Л.Г.

Summary: Retrospective study of anamnestic data on patients with vulgar psoriasis
O.Yu. Olisova, L.G. Garanyan

Sechenov University, Moscow

Aim: developing an algorithm for managing patients with the vulgar psoriasis based on severity and prevalence of the disease, pruritus, comorbidity, and the mental and socioeconomic status of patients
Patients and Methods: a retrospective study of medical histories of 150 patients with the vulgar psoriasis (68 men and 82 women) was conducted, during which causes of psoriasis development, the psoriasis severity and prevalence, presence of the comorbid conditions and itch were analyzed. The comorbid conditions were observed in 50 (33.3%) patients, of which 22 (44%) had polymorbidity. The duration of dermatosis was 15.7 ± 3.8 years on the average.
Results: comorbid conditions were noted in 50 (33.3%) patients, of which 22 (44%) had polymorbidity. In the endocrine system diabetes mellitus type 2 (compensated) was taken in 11 (22%) patients, nodular goiter in anamnesis — in 2 (4%), hypothyroidism — in 2 (4%), and thyroiditis — in 2 (4%). 10 (20%) patients suffered from coronary artery disease and exertional angina; 18 (36%) had arterial hypertension stage II, risk 2. Two (4%) patients in the past suffered a myocardial infarction, atherosclerosis was observed in 4 (8%) patients. Liver diseases were noted in 7 (14%) patients, among them non-alcoholic fatty liver disease — in 3 (43%), chronic hepatitis — in 4 (57%).
Conclusion: the data obtained in the course of retrospective study should be taken into account in a personalized approach to the treatment of patients with vulgar psoriasis, and an assessment of the severity of each comorbid state and its impact on course of the disease and patient’s quality of life should influence the choice of anti-psoriatic therapy. In addition to taking into account the severity of the psoriatic process, stage, comorbid conditions, one should also consider the attitude to the disease of patient.

Key words: psoriasis, multicenter study, retrospective study, itch, comorbidity, polymorbidity.
For citation: Olisova O.Yu., Garanyan L.G. Retrospective study of anamnestic data on patients with vulgar psoriasis // RMJ. 2018. № 8(II). P. 72–74.

Pages 76-81. Коррекция нарушенного микробиоценоза кожи у детей с атопическим дерматитом. Баткаев Э.А., Попов И.В.

Summary: Disturbed skin microbiocenosis correction in children with atopic dermatitis
E.A. Batkaev, I.V. Popov

RUDN University, Moscow

Disturbed skin microbiocenosis plays a special role in maintaining skin inflammation in atopic dermatitis (AD). In this case, most often, there is a contamination of the skin of patients with microorganisms: S. aureus, Candida spp., Malassezia spp., antigens of which acquire properties of triggers of the disease.
Aim: to create an algorithm for assessing a degree of disturbance of the skin microbiocenosis and treatment scheme in its deterioration.
Patients and Methods: 120 patients aged from 3 to 15 years were included in the study. Severity of AD was determined by a clinical picture of the disease, the SCORAD index and serum total IgE level. A degree of skin dissemination by the conditionally pathogenic flora was assessed by determination of colony-forming units (CFU) in bacteriological study and by specific IgE level. In complex treatment for correction of disturbed skin microbiocenosis Sanguiritrin (in a form of liniment, alcohol solution, tablets), having a wide spectrum of antimicrobial and antifungal activity, was included.
Results and Discussion: in mild AD, only external treatment with Sanguiritrin liniment displayed a significant reduction in the SCORAD index by 50% in all patients (p <0.05). After 1 year, the SCORAD index was only 55% of the initial level.
In patients with moderate and severe AD, only external treatment with Sanguiritrin liniment showed a significant decrease of the SCORAD index by 60% (p <0.05). However, 1 year after the treatment, the SCORAD index was restored to 94% of the initial level. In patients receiving, in addition to the external treatment, systemic therapy with Sanguiritrin (in tablets), a decline in the SCORAD index by 56% was found (p <0.05). After 1 year of the treatment, the index was 75% of the initial level. These data is also confirmed by results of cultural and allergological examination.
Conclusion: for the treatment of AD complicated by the skin microbiocenosis deterioration, the drug Sanguiritrin is effective: in the mild severity of microbiocenosis deterioration, only external treatment is required; in the moderate and severe AD, the addition of systemic therapy with the tablet form of Sanguiritrin is demanded.

Key words: atopic dermatitis, skin microflora, disturbed skin microbiocenosis, IgE, SCORAD index, Sanguiritrin.
For citation: Batkaev E.A., Popov I.V. Disturbed skin microbiocenosis correction in children with atopic dermatitis // RMJ. 2018. № 8(II). P. 76–81.

Pages 83-86. Новое в терапии акне легкой степени тяжести. Олисова О.Ю., Вертиева Е.Ю.

Summary: New in the treatment of mild acne
O.Yu. Olisova, E.Yu. Vertieva

Sechenov University, Moscow

Acne is a chronic inflammatory disease of the sebaceous glands. According to literary data, 80–85% of adolescents and young people are at risk of dermatosis. The highest rate of incidence is accounted for by the age of 15–16 years. In addition to skin lesions, the disease leads to the development of problems in the psycho-emotional sphere. All over the world, similar treatment regimens have been developed depending on the severity of the process.
Aim: to study the effectiveness of a new patch SERACIN COMEDOCID in the treatment of mild acne.
Patients and Methods: 20 patients with mild acne vulgaris at the age of 17–27 years old. A dermatologic examination was conducted visually with a simple count of eruption elements: open and closed comedones, papules, pustules and nodes, by which the severity of acne was determined. All patients underwent sebumetry based on photometric analysis of sebaceous spots, in order to objectively evaluate the clinical data. The study was performed with CUTOMETER MPA 580 CK Electronic (Germany) device with the adjutages for sebumetry.
Results: all patients had regression of inflammatory elements by the 3rd–4th day of application. As a result of the therapy (usually, it took only 2–3 days), the number of inflammatory elements (pustules) decreased from 9.5±1.4 to 0.6±0.3, i.e., in 10 (50%) patients with acne, complete skin cleansing was achieved, in other 10 (50%) patients — a significant improvement.
Conclusion: SERACIN COMEDOCID topical patches in combination with SERACIN cleansing gel of the company Librederm for the treatment of mild acne are the effective remedies, which is confirmed by the results of sebumetry and dermatoscopy. Patches are well tolerated by patients with acne and do not cause the development of adverse events and allergic reactions. Patches are also recommended to be used as SOS-agents in the presence of single elements, which ensures their regression by 2–3 days of use.

Key words: mild acne, SERACIN cleansing gel, SERACIN COMEDOCID patch.
For citation: Olisova O.Yu., Vertieva E.Yu. New in the treatment of mild acne // RMJ. 2018. № 8(II). P. 83–86.

Pages 87-91. Применение сертаконазола в амбулаторной практике. Хамаганова И.В., Кашеваров Д.Ф., Маляренко Е.Н., Максимова М.В.

Summary: Sertaconazole administration in outpatient practice
I.V. Khamaganova1, D.F. Kashevarov1, E.N. Malyaremko2, M.V. Maximova2

1 Pirogov Russian National Research Medical University, Moscow
2 Moscow Center of Dermatovenerology and Cosmetology

A dual antifungal drug sertaconazole (a derivative of imidazole and benzothiophene) allows to solve the problem of resistance to antimicotic therapy. The azol structure of imidazole provides a fungistatic effect, benzothiophene has a fungicidal effect. The drug is active against yeasts (Candida albicans, С. tropicalis, С. pseudo-tropicalis, С. krusei, С. parapsilosis, С. neoformans), dermatophytes (Trichophyton, Microsporum and Epidermophyton, Torulopsis, Trichosporon and Malassezia), filamentous opportunistic fungi (Scopulariopsis, Altermania, Acremonium, Aspergillus и Fusarium), gram-positive (staphylococci and streptococci, L. monocytogenes) and gram-negative bacteria (E. faecium, E. faecalis, Corynebacterium spp., Bacteroides spp., P. acnes), of the Trichomonas genus.
Aim: to study the efficacy and safety of sertaconazole in outpatient practice.
Patients and Methods: 53 patients (39 with glabrous skin rubromycosis, 14 with glabrous skin microsporia) received Zalain® cream 2 times a day for 6 weeks. An experimental group consisted of 12 patients (7 with glabrous skin rubromycosis, 5 with glabrous skin microsporia), who received 1% clotrimazole cream 2 times a day for 6 weeks.
Results and Discussion: on the first day of applying Zalain® cream, 4 patients showed erythema and itching intensification, which were resolved without any additional prescriptions by the end of the 3rd day of therapy. In the experimental group, the tolerability of the treatment was good; on the first day of treatment, no patients had any exacerbations. There was no adverse effect on the blood or urine parameters as a result of therapy in either the first or the second group. Patients who received Zalain® had recovered in all cases, patients who received clotrimazole had a slight improvement in their condition. Observations confirm previously reported information about the high efficacy of Zalain® cream.
Conclusion: observations allow us to recommend the use of Zalain® cream for rubromycosis and microsporia of glabrous skin.

Key words: rubromycosis, microsporia, skin lesions, antimicotic therapy, resistance, clotrimazole, sertaconazole, Zalain®.
For citation: Khamaganova I.V., Kashevarov D.F., Malyaremko E.N., Maximova M.V. Sertaconazole administration in outpatient practice // RMJ. 2018. № 8(II). P. 87–91.

Pages 92-96. Структура, функции и значение микробиома кожи в норме и при патологических состояниях. Силина Л.В., Бибичева Т.В., Мятенко Н.И., Переверзева И.В.

Summary: Structure, function and value of the skin microbiome under normal and pathological conditions
L.V. Silina1, T.V. Bibicheva1, N.I. Mjatenko2, I.V. Pereverzeva1

1 Kursk State Medical University
2 Belgorod State National Research University

Skin is a kind of ecosystem, closely connected with the body internal environment, its external environment, and is an ecological niche for many microorganisms. A balanced state of the skin microbiocenosis ensures the colonization resistance of this biotope. Application of antibacterial drugs, working in hazardous areas, sites of chronic infection, etc., can disrupt the skin microflora.
It has been shown that the high microorganism contamination of the skin (and its microbiome disorder) is facilitated by the structure and function of the epidermal barrier in chronic dermatoses: increased transepidermal water loss, changes in the function of the acid mantle, impaired desquamation and other factors.
The most effective as a topical therapy of chronic dermatoses are combined drugs, which, in addition to topical glucocorticosteroids, include antibacterial and antimycotic drugs, which allows acting simultaneously on all the links of the pathological process. Numerous studies have shown that the combined drug Akriderm GK has a high therapeutic efficacy in the treatment of chronic dermatosis, complicated by bacterial and mycotic infection, makes it possible to notice the reduction in the duration of therapy, lengthening of remission periods and reduction in the number of exacerbations, improving the prognosis of diseases in the absence of side effects.

Key words: chronic dermatosis, epidermal barrier, skin microflora, skin microbiome, Akriderm GK.
For citation: Silina L.V., Bibicheva T.V., Mjatenko N.I., Pereverzeva I.V. Structure, function and value of the skin microbiome under normal and pathological conditions // RMJ. 2018. № 8(II). P. 92–96.

Pages 97-101. Атопический дерматит: современные возможности профилактики. Колерова А.В., Криницына Ю.М.

Summary: Atopic dermatitis: modern possibilities of prevention
A.V. Kolerova1, Yu.M. Krinicina1,2

1 Novosibirsk State University
2 Institute of Molecular Pathology and Pathomorphology, Novosibirsk

Defects of the epidermis are the entrance gate for potential allergens of the external environment, which can lead to the development of a type I hypersensitivity reaction, which underlies atopic dermatitis, asthma, allergic rhinitis, etc. Therefore, the basic method for the prevention and treatment of exacerbations of the disease and an increase in the duration of the remission period is the regular use of emollients, daily application of which to the skin of newborns reliably reduces the risk of atopic dermatitis in the future twice.
The active ingredient of the drug D-Panthenol (EGIS Pharmaceuticals PLC) — dexpanthenol, helps to compensate for the subclinical dysfunction of the skin barrier, and also prevents the development of an inflammatory reaction by replenishing skin hydration and reducing skin permeability to allergens. Lanolin and white beeswax, which are part of the drug, contribute to the restoration of the lipid composition of the skin, thereby enhancing the action of the main substance. The drug is available in two dosage forms: cream and ointment. D-Panthenol is the basic step in the treatment of atopic dermatitis according to the Federal Clinical Guidelines for the treatment of this disease, which indicates that the drug is used for any degree of severity of the pathology.

Key words: prevention of atopic dermatitis, epidermis defects, skin barrier, emollients, dexpanthenol, D-Panthenol.
For citation: Kolerova A.V., Krinicina Yu.M. Atopic dermatitis: modern possibilities of prevention // RMJ. 2018. № 8(II). P.97 –101.



№12(I), 2018. Неврология

Pages 10-15. Рациональная фармакотерапия депрессии, осложненной неврологической симптоматикой: хронической болью и инсомнией. Кучаева А.В., Максимов М.Л.

Summary: Rational pharmacotherapy of depression, complicated by neurological symptoms: chronic pain syndrome and insomnia
A.V. Kuchaeva, M.L. Maximov

Kazan State Medical Academy

Aim: to study the effect of psycholeptics in patients with depression complicated by neurological symptoms for psychopharmacotherapy optimization.
Patients and Methods: 50 patients were involved in the retrospective study with a diagnosis of non-psychotic recurrent depressive disorder, current episode of moderate severity, with neurological symptoms (F33.11 ICD-10), hospitalized in SAHI (State Autonomous Healthcare Institution) «Behterev Republican Clinical Psychiatric Hospital of the Ministry of Health of the Republic of Tatarstan» (Kazan), 2018. Dosing of neuroleptics was analyzed using Defined Daily Doses (DDD), certain Anatomical Therapeutic Chemical (ATC) Classification. Patients received the following treatment: antidepressant drugs, tranquilizers, neuroleptics, bromides, non-steroidal anti-inflammatory drugs or combinations thereof. Hamilton Depression Rating Scale (HDRS) was used to determine the severity of depression in follow-up, to measure pain intensity — Wong-Baker Faces Pain Scale, to evaluate sleep quality — Leeds Sleep Questionnaire, to assess the treatment of depression with chronic pain syndrome and insomnia — Cost Minimization Method.
Results: the most effective in depression, with chronic pain syndrome and insomnia, is the combination of amitriptyline, sulpiride and bromkamphora (Dobrocam) at the Defined Daily Doses (DDD) according to neurologists.
Hospital treatment of patients with chronic insomnia with amitriptyline, phenazepamum and bromkamphora (Dobrocam) reduced the average time duration of hospitalization, improved the quality of patients’ life, reduced frequency of seeking neurological care. Administering of bromocamphora reduced the heart rate in the treatment of insomnia in patients with the studied depression, while with the use of other studied sedatives (amitriptyline, sulpiride, phenazepamum) it was increasing.
Monotherapy of insomnia with bromkamphora (Dobrocam) was cheaper than other drugs in studied depression with neurological symptoms.
Conclusion: the results of the study allow us to recommend the following studied drugs: amitriptyline, sulpiride, phenazepamum, bromkamphora (Dobrocam) in the treatment of depression, complicated by neurological symptoms.

Key words: depression, chronic pain, age, occupational adaptation, insomnia, sedatives, rational pharmacotherapy.
For citation: Kuchaeva A.V., Maximov M.L. Rational pharmacotherapy of depression, complicated by neurological symptoms: chronic pain syndrome and insomnia // RMJ. 2018. № 12(I). P. 10–15.

Pages 16-20. Роль цереброваскулярной патологии в развитии деменции смешанного генеза. Табеева Г.Р.

Summary: Role of cerebrovascular disease in the development of mixed dementia
G.R. Tabeeva

Sechenov University, Moscow

The prevalence of severe cognitive impairment in the population is quite high and is increasing every year. Ordinary, it is difficult to classify these disorders, which is associated with a high diversity of the clinical performance and the complex genesis of neuropathological forms of inhibition of cognitive functions. Currently, dementia of mixed type ranks third among the most common causes of cognitive impairment. Cerebrovascular dysfunction plays an important and integral role in the development of not only vascular dementia, but neurodegenerative genesis, emphasizing the common of both processes and the high importance of registration of vascular factor in the practical management of patients. In addition to the pathomorphological changes that underlie various types of cognitive disorders, the similarity of risk factors for the development of various dementia types has been repeatedly pointed out. Control of these risk factors remains the key strategy for the prevention of all dementia types. In the absence of clinical guidelines for the management of patients with mixed dementia, it seems reasonable to use medications that have proven a high level of effectiveness in patients with various disorders of cognitive functions.

Key words: dementia, vascular-degenerative dementia, cognitive impairment, risk factors, Cerebrolysin.
For citation: Tabeeva G.R. Role of cerebrovascular disease in the development of mixed dementia // RMJ. 2018. № 12(I). P. 16–20.

Pages 21-24. Актуальные проблемы травмы периферических нервов. Маргасов А.В.

Summary: Actual problems of peripheral nerve injuries
A.V. Margasov

Kirov Military Medical Academy, Saint-Petersburg

Nerve injury in the structure of traumatic pathology is not as common as injuries of other organs and tissues. However, if not timely conduct a diagnosis and radical treatment, an injured limb may lose its function, despite the efforts made to restore the injured bones, muscles and vessels. Despite the development of medical science, the treatment of nerve injury has not been improved for several decades. In addition to the treatment of nerve injuries, it is necessary to revise the set of organizational and methodological approaches, as well as to improve the surgical technique and apply modern materials for surgical treatment. It should be noted that in the event of disability in case of a nerve injury, the patient is doomed to long-term rehabilitation, permanent disability, which has a negative social and economic effect both for the victim and for the state. The author has studied the existing algorithms for the treatment of nerve injury and clarified the most pressing problems. During the analysis of pathological features of nerve injury and evaluation of existing methods of surgical treatment, a summary of the results of many different studies was made as well as suggestions to solve the problems of surgical treatment of nerve injury at all levels.

Key words: nerve injury, neurotraumatology, neuroimplant, nerve treatment, treatment standards, nerve tubulization.
For citation: Margasov A.V. Actual problems of peripheral nerve injuries // RMJ. 2018. № 12(I). P. 21–24.

Pages 25-31. Тревожные нарушения у больных с онкологическими заболеваниями: влияние на течение онкологического процесса и возможности коррекции. Левин О.С., Чимагомедова А.Ш., Арефьева А.П.

Summary: Anxiety disorders in patients with cancer: influence on the course of the cancer disease and the possibility of its correction
O.S. Levin1, A.Sh. Chimagomedova2, A.P. Arefieva1

1 Russian Medical Academy of Continuing Professional Education, Moscow
2 City Clinical Hospital named after S.P. Botkin, Moscow

Anxiety disorders are the most common group of mental illnesses that often accompany severe somatic diseases, including oncologic pathology. Approximately 30% of patients with cancer suffer from any form of mental disorder, most often — anxiety or depression. The risk of anxiety disorders among both persons with present cancer and recovered from these diseases is higher than the average for the population. Meanwhile, anxiety disorders are often not recognized as a specific pathology that requires special attention and long-term adequate treatment, which leads not only to chronicity of mental disorders, but also may adversely affect the prognosis of cancer. This article discusses the features of anxiety disorders in patients with cancer, diagnostic methods and their correction.

Key words: anxiety, depression, affective disorders, cancer, tofisopam, buspirone.
For citation: Levin O.S., Chimagomedova A.Sh., Arefieva A.P. Anxiety disorders in patients with cancer: influence on the course of the cancer disease and the possibility of its correction // RMJ. 2018. № 12(I). P. 25–31.

Pages 3-9. Умеренное когнитивное расстройство при цереброваскулярных заболеваниях: возможности профилактики дальнейшего прогрессирования. Колоколов О.В., Малеина А.Ю., Лукина Е.В.

Summary: Moderate cognitive disorder in cerebrovascular diseases: ways to prevent further progression
O.V. Kolokolov, A.Yu. Maleina, E.V. Lukina

Saratov Razumovsky State Medical University

The article discusses the actual problem of the timely detection and adequate therapy of a moderate cognitive disorder (MCD) and a sleep disorder, which onset impinge on patients of young and middle age with hypertension and other circulatory system diseases. Criteria for clinical diagnosis, neuropsychological approaches, neuroimaging methods and biomarkers are listed to determine the type of MCD and etiology of the disease. Special attention is paid to cognitive disorder associated with cerebrovascular diseases (CVD) — vascular cognitive disorder. There are data on the relationship between the sleep disorders, depression and MCD. It was emphasized that the correction of sleep disorders and depression in some cases allows achieving the recovery of cognitive functions. It was stated that the treatment of MCD, which onset is in young- and middle-aged patients, largely depends on the etiology of the disease. The data on the use of the drug Divaza in patients younger than 65 years old with CVD are presented. The use of the drug Divaza, which has an antihypoxant, antioxidant, nootropic and angioprotective effect, in combination with basic therapy allows to restore the quality of night sleep and reduce the severity of MCD.

Key words: cognitive functions, dementia, cognitive disorder, cerebrovascular disease, chronic cerebral ischemia, discirculatory encephalopathy, neuroimaging, biomarkers, protein S-100, Divasa.
For citation: Kolokolov O.V., Maleina A.Yu., Lukina E.V. Moderate cognitive disorder in cerebrovascular diseases: ways to prevent further progression // RMJ. 2018. № 12(I). P. 3–9.

Pages 32-37. Когнитивные нарушения — актуальная междисциплинарная проблема. Екушева Е.В.

Summary: Cognitive impairment — relevant interdisciplinary problem
E.V. Ekusheva

Federal Medical and Biological Agency, Moscow

Cognitive impairment (CI) is one of the most urgent problems of modern medicine. According to projections of specialists, by 2030 the number of people with dementia will double, and by 2050 — triple, and will be more than 130 million people. Patients with dementia require significant costs, and there is a trend to their further growth. In clinical practice, a patient with CI, as a rule, is a tough call for physicians of various specialties in both the diagnosis and selection of effective therapy. Far from every decrease in cognitive functions is steadily progressive and leads to the development of dementia. Timely manifestation and pathogenetically reasonable treatment administration are of crucial importance, because they contribute to the functional recovery of cerebral structures, and leads to reversible consequences. In recent years, the importance of differentiated and timely use of drugs of neuroprotective and metabolic action, the need for prolonged, possibly continuous use of drugs of this pharmacological direction, as well as the advisability of combinations of vasoactive and nootropic drugs with synergistic and additive effects, have been increasingly discussed.

Key words: cognitive impairment, dementia, aging, neuroprotective therapy, choline alphoscerate, Cerepro, idebenone, Neiromet.
For citation: Ekusheva E.V. Cognitive impairment — relevant interdisciplinary problem // RMJ. 2018. № 12(I). P. 32–37.

Pages 39-43. Возможности применения пирибедила с точки зрения доказательной медицины. Пилипович А.А., Голубев В.Л.

Summary: The possibilities of using piribedil in terms of evidence-based medicine
A.A. Pilipovich, V. L. Golubev

Sechenov University, Moscow

The article reviews the data of modern foreign and domestic literature on the use of piribedil as one of the dopamine agonists for the main indications: Parkinson’s disease, moderate cognitive impairment and sensory deficiency in elderly patients. Such a multiple use of this drug is due to its unique mechanisms of action that distinguish it from other dopamine agonists. The mechanisms of action of the drug are discussed. The data of the main clinical studies of the efficacy and safety of piribedil are given. The Movement Disorder Society (MDS-EBM) estimates that pyribedil is «effective» and «clinically useful» for the symptomatic treatment of patients at the early stages of Parkinson’s disease both as monotherapy and in combination with levodopa. The drug reduces the main motor symptoms of parkinsonism, and also has a positive effect on non-motor disorders: depression, apathy, cognitive decline. The positive effect of piribedil on cognitive function has been shown in more than 10 foreign clinical trials involving about 7000 patients and in a significant number of domestic works. This effect is successfully used in various types of cognitive disorders, both neurodegenerative and vascular, of mild to moderate severity.

Key words: moderate cognitive impairment, Parkinson’s disease, dopamine agonists, piribedil, Pronoran.
For citation: Pilipovich A.A., Golubev V. L. The possibilities of using piribedil in terms of evidence-based medicine // RMJ. 2018. № 12(I). P. 39–43.

Pages 44-48. Применение ипидакрина у пациентов с заболеваниями периферической нервной системы. Камчатнов П.Р., Дзугаева Ф.К., Чугунов А.В., Казаков А.Ю.

Summary: Use of ipidacrine in patients with peripheral nervous system diseases
P.R. Kamchatnov1, F.K. Dzugaeva2,3, A.V. Chugunov1, A.Yu. Kazakov1

1 Pirogov Russian National Research Medical University, Moscow
2 North-Caucasian multidisciplinary medical center, Beslan
3 North Ossetian State Medical Academy, Vladikavkaz

Peripheral nervous system lesions are caused by a wide heterogeneous group of diseases. The most frequent clinical manifestations of them are peripheral paresis and pain syndromes. Adequate choice of drugs and non-drug treatment can achieve sufficient effectiveness in treatment of patients with peripheral nervous system diseases. One of directions of the treatment of such patients is use of acetylcholinesterase inhibitors (AChEI), and Axamon (ipidacrine) is a representative of this class of drugs. It has a stimulating effect on neuromuscular transmission and conduction of excitation through nerve fibers due to inhibition of AChEI activity and potassium channel blockade, which causes an elongation of the excitation period in a presynaptic fiber during a passage of nerve impulse and allows a large amount of acetylcholine to escape into a synaptic cleft. Due to inhibition of sodium channel activity, the use of drug provides a moderate analgesic effect. Possibilities of using the drug Axamon (ipidacrine) in mono- and polyneuropathies mainly with motor disorders — peripheral paresis, treatment of patients with facial nerve neuropathy are considered.

Key words: peripheral nervous system, peripheral paresis, nociceptive pain, neuropathic pain syndrome, treatment, ipidacrine, Axamon.
For citation: Kamchatnov P.R., Dzugaeva F.K., Chugunov A.V., Kazakov A.Yu. Use of ipidacrine in patients with peripheral nervous system diseases // RMJ. 2018. № 12(I). P. 44–48.

Pages 49-52. Эффективность теноксикама в терапии дорсалгии. Шавловская О.А.

Summary: The effectiveness of tenoxicam in the treatment of dorsalgia
O.A. Shavlovskaya

Sechenov University, Moscow

Lower-back pain (LBP) remains an urgent problem due to its widespread. LBP is one of the most common among chronic pain syndromes, and the fifth most common cause of seeing a doctor.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered to be a gold standard in relieving back pain. Parenteral forms of administration NSAIDs (tenoxicam) to patients with dorsalgia reduces the duration of treatment, provides greater regression of pain and longer remissions. Tenoxicam belongs to the group of oxicams, non-selective inhibitors of cyclooxygenase. It is rapidly absorbed since the maximum plasma concentration is reached within 2 hours after intramuscular injection (the concentration is 90% or higher). Bioavailability of the drug by oral administration reaches 100%. Tenoxicam has a number of advantages in terms of speed and duration of the effect over other oxycams. It has been shown that tenoxicam therapy is quite equal to corticosteroid one. 

Key words: pain, lower-back pain, dorsalgia, nonsteroidal anti-inflammatory drugs, oxicam, tenoxicam, Texared.
For citation: Shavlovskaya O.A. The effectiveness of tenoxicam in the treatment of dorsalgia // RMJ. 2018. № 12(I). P. 49–52.

Pages 54-60. Терапевтический потенциал ацетил-L-карнитина в лечении когнитивных и депрессивных расстройств у пациентов пожилого возраста. Гаврилова С.И.

Summary: The therapeutic potential of acetyl-L-carnitine in the treatment of cognitive and depressive disorders in elderly patients
S.I. Gavrilova

Mental Health Research Center, Moscow

A literature review is given on the evaluation of the therapeutic potential of acetyl-L-carnitine (ALC) (Carnicetine) in the treatment of cognitive and depressive disorders in elderly patients. ALC is a brain-specific derivative of L-carnitine, it is an easily accessible substrate for triggering volatile metabolic processes in the mitochondries, supplying the acetyl group directly to the mitochondrial matrix to synthesize acetyl coenzyme A without consuming ATP and oxygen. By improving the energy supply of neurons in conditions of reduced oxygen consumption, ALC protects neurons from ischemic hypoxia. A number of experimental studies have also established the antioxidant effect of ALC. ALC reduces free radicals formation and promotes the preservation of ATP.
Due to structural similarity with acetylcholine, it has a cholinomimetic effect, and also modulates the activity of dopaminergic and serotonergic systems. Pharmaceutic preparations based on L-carnitine and ALC refer to energy-consuming agents that can restore the damaged cellular energy metabolism. This article describes the mechanisms of action of the drug, assessed the effectiveness and safety of its use in gerontological practice. Analysis of the results of preclinical and clinical studies of ALC in the world medical practice is given.

Key words: late age, dementia, cognitive disorders, Alzheimer’s disease, depression, treatment, acetyl-L-carnitine, Carnicetine.
For citation: Gavrilova S.I. The therapeutic potential of acetyl-L-carnitine in the treatment of cognitive and depressive disorders in elderly patients // RMJ. 2018. № 12(I). P. 54–60.

Pages 61-65. Физиологические основы восприятия и воспроизведения ритма в неврологии. Ковалева А.В.

Summary: Physiological basis of rhythm perception and reproduction in neurology
A.V. Kovaleva

P.K. Anokhin Research Institute of Normal Physiology, Moscow

The processes of perception and reproduction of rhythm affect the vast areas of the auditory, motor cortex, prefrontal cortical areas, and also subcortical structures such as the basal ganglia, the cerebellum and others. Perception and rhythm reproduction are most often investigated by the results of a person’s sensomotor synchronization task performance, when a person needs to synchronize his/her movements with sound or visual stimulus. The review examines approaches to the study of perception and reproduction of rhythm, describes the current understanding of the role of various brain structures in this process, as well as the connection of rhythmic praxis to cognitive functions. The emphasis is on the role of the cerebellum and basal ganglia in the processes of auditory-motor synchronization. The last part of the review is devoted to the consideration of approaches to the rehabilitation of patients with various neurological pathologies (autism, strokes, parkinsonism, Huntington’s chorea, brain tumors) with the help of music, rhythmic sound stimulation and performing tasks for synchronization with rhythm. Motor rehabilitation, including with the use of music and rhythmic influences, is widely used to develop coordination and regulation of sensory and motor information processing, which is a necessary condition for social interaction, voice communication and, in general, for integration with the environment.

Key words: rhythm, tapping, auditory-motor synchronization, rhythmic praxis, cerebellum, cognitive functions, rehabilitation, autism, stroke, Parkinson’s disease, Huntington’s chorea, brain tumor.
For citation: Kovaleva A.V. Physiological basis of rhythm perception and reproduction in neurology // RMJ. 2018. № 12(I). P. 61–65.

Pages 66-72. Современный взгляд на патогенетические механизмы прогрессирования болезни Паркинсона. Гапонов Д.О., Пригодина Е.В., Грудина Т.В., Доросевич А.Е.

Summary: Modern view on the pathogenetic mechanisms of Parkinson’s disease progression
D.O. Gaponov1, E.V. Prigodina1, T.V. Grudina1, A.E. Dorosevich1,2

1 Smolensk State Medical University
2 Smolensk Regional Institute of Pathology

The article discusses the modern aspects of Parkinson’s disease development in light of the latest scientific data on the mechanisms that are triggering in the presence of relevant factors of genetic predisposition. Special attention is paid to the preclinical stage of Parkinson’s disease since this stage is crucial in the cascade of pathogenetic reactions of the pathology under consideration. Thus, the article discusses immuno-inflammatory, neurohumoral, dysbiotic, and metabolic factors in the development of Parkinson’s disease, at the preclinical stage causing structural changes in both the central and peripheral nervous systems. The so-called enteral nervous system and biochemical changes in a-synuclein metabolism, which is pivotal in the pathogenesis of both Parkinson’s disease and Alzheimer’s disease and multiple sclerosis, occupy a special place in this issue. A special role in this review is given to the role of the «gut-brain» axis as only the role of intestinal microflora and imbalance of the intestinal microbiota is considered by many authors to be underestimated in the mechanism of development of this pathology. This article is constructed in the form of a comparative analysis of the research of various authors in order to systematize the new aspects of the development of Parkinson’s disease that are currently being considered.

Key words: Parkinson’s disease, synucleinopathy, pathogenesis of Parkinson’s disease, alpha-synuclein, gut-brain axis, neurodegenerative diseases, Alzheimer’s disease.
For citation: Gaponov D.O., Prigodina E.V., Grudina T.V., Dorosevich A.E. Modern view on the pathogenetic mechanisms of Parkinson’s disease progression // RMJ. 2018. № 12(I). P.66 –72.



№11(II), 2018. Эндокринология

Pages 101-104. Ведение пациентов с амиодарон-ассоциированной дисфункцией щитовидной железы. Новости Европейской тиреоидологической ассоциации 2018 г.. Демидова Т.Ю., Кишкович Ю.С., Ладыгина Д.О.

Summary: Patient management with amiodarone-associated thyroid dysfunction. News of the European Thyroid Association 2018
T.Yu. Demidova, Yu.S. Kishkovich, D.O. Ladigina

Pirogov Russian National Research Medical University, Moscow

Treatment with amiodarone is associated with the development of thyroid dysfunction and changes in laboratory parameters of its functions. There are amiodarone-induced hypothyroidism (AIH) and amiodarone-induced thyrotoxicosis (AIT). There are also mixed/undifferentiated forms. Although AIH can develop in patients with normal thyroid and absence of an autoimmune reaction, it most often develops in patients with latent chronic autoimmune thyroiditis, prevails in women as well as in iodine-saturated areas.
All patients treated with amiodarone had early (<3 months) or late (>3 months) changes in serum thyroid hormone levels in the analyzes. The high content of iodine in amiodarone increases the inorganic iodine of the blood plasma and the excretion of iodine with urine. Due to the Wolff-Chaikoff effect, a thyroid gland adapts to iodine overload by suppressing the organification of iodine and reducing the levels of thyroid hormones. The latter effect is the main cause of an increase in serum thyrotropic hormone concentration.
While AIH is easily treated, AIT represents itself as the diagnostic and therapeutic difficulty. Most patients with AIT 2 (destructive thyroiditis) are successfully treated with glucocorticosteroids, and may not need to cancel amiodarone. Treatment of AIT 1 (mixed/undifferentiated forms) is a much more difficult task due to the resistance of the iodine-saturated gland to antithyroid drugs. Taking into account the difficulties in the diagnostic differentiation between AIT 1 and mixed/undifferentiated forms, the combined treatment is often used.

Key words: thyroid dysfunction, iodine, amiodarone-induced hypothyroidism, amiodarone-induced thyrotoxicosis, thyroidectomy, amiodarone.
For citation: Demidova T.Yu., Kishkovich Yu.S., Ladigina D.O. Patient management with amiodarone-associated thyroid dysfunction. News of the European Thyroid Association 2018 // RMJ. 2018. № 11(II). P. 101–104.

Pages 105-109. Роль ожирения в развитии репродуктивных нарушений и возможности преодоления рисков. Демидова Т.Ю., Грицкевич Е.Ю.

Summary: Role of obesity in development of reproductive disorders and possibilities of risk management
T.Yu. Demidova, E.Yu. Gritskevich

Pirogov Russian National Research Medical University, Moscow

Obesity is associated with many adverse reproductive events, including ovarian failure, disorder of menstrual function, deterioration in the quality of oocytes, negative impact on the receptor apparatus of the endometrium, increase in the risk of relative sterility and inevitable miscarriage. In the development pathogenesis of these disorders, a significant role is played by the pathological effect of free fatty acids, lipotoxicity, impaired insulin sensitivity and insulin resistance.
In this review, we discuss the unfavorable effects of obesity on reproductive function, studies concerning the mechanisms of their development and preventive treatment of infertility and adverse outcomes of pregnancy by enhancement of body mass and coping with insulin resistance.
Weight loss in women with overweight or obesity is required during the preconception period as an effective measure to enhance fertility and improve pregnancy outcomes. Drug administration for the obesity treatment contributes not only to the efficiency improvement of weight loss, but also affects the pathogenetic triggers such as lipotoxicity and insulin resistance. Combination drug Reduxin®Met, on the basis of metformin and sibutramine, can effectively deal with these negative factors.

Key words: obesity, fertility, reproduction, preconception period, preventive treatment of infertility, sibutramine, metformin, Reduxin®Met.
For citation: Demidova T.Yu., Gritskevich E.Yu. Role of obesity in development of reproductive disorders and possibilities of risk management // RMJ. 2018. № 11(II). P. 105–109.

Pages 110-115. Роль заместительной терапии тестостероном при сахарном диабете 2 типа. Демидова Т.Ю., Скуридина Д.В.

Summary:

Role of testosterone replacement therapy in type 2 diabetes mellitus

T.Yu. Demidova, D.V. Skuridina

Pirogov Russian National Research Medical University, Moscow

As the large-scale Russian epidemiological study NATION has shown, the actual number of patients with type 2 diabetes mellitus (DM2) in Russia is at least 8–9 million people (about 6% of the population). Hypogonadism in men is a clinical and biochemical syndrome associated with a low level of testosterone, as well as insensitivity of the receptor apparatus to androgens. It was shown that testosterone levels in men with DM2 are lower than in healthy people by an average of 2.5 nmol/L, and the prevalence of hypogonadism DM2 patients is higher than in the general population by 50%. Therefore, it is now recommended for all patients with DM2 and obesity to determine the level of testosterone and to decide on the appointment of testosterone replacement therapy (TRT), one of the modern representatives of which is gel Androgel. Since testosterone takes an active part in the regulation of fat and carbohydrate metabolism, the question of improving the parameters of carbohydrate and fat metabolism against the background of TRT in men with DM2 and confirmed hypogonadism remains topical.

Key words: type 2 diabetes, testosterone, substitution therapy, metabolic syndrome, insulin resistance, Androgel.
For citation: Demidova T.Yu., Skuridina D.V. Role of testosterone replacement therapy in type 2 diabetes mellitus // RMJ. 2018. № 11(II). P. 110–115.

Pages 116-121. Синдром множественных эндокринных неоплазий 2-го типа. Демидова Т.Ю., Кишкович Ю.С.

Summary:

Multiple endocrine neoplasia syndrome type 2

T.Yu. Demidova, Yu.S. Kishkowich

Pirogov Russian National Research Medical University, Moscow

Multiple endocrine neoplasia syndrome type 2 (multiple endocrine tumors syndrome, MEN 2) combines a group of diseases characterized by the development of a tumor and/or hyperplasia (diffuse, nodular) of the cells of neuroectodermal origin in two endocrine organs and more. The combination of medullary thyroid cancer, pheochromocytoma and lesions of the parathyroid glands is referred to MEN 2A (Sipple syndrome). The combination of medullary thyroid cancer, pheochromocytoma and multiple ganglioniomas of the mucous membrane of the gastrointestinal tract is referred to 
MEN 2B (Gorlin syndrome). To prove that relatives have a family form of medullary thyroid cancer, it is necessary to confirm the absence of a pheochromocytoma or primary hyperparathyroidism in two or more generations of the family. With the incidence in only one generation, caution is needed regarding the risk of developing pheochromocytoma (MEN 2A). In 
MEN 2A, most authors note the changes in the type of recombination in chromosome 10, in a region located near the centromere in the locus region of 10q11.2. This part contains the RET proto-oncogene, so all sporadic observations of medullary thyroid cancer should be checked for a RET mutation. The review deals with the classification, description of the diagnosis and treatment of this pathology, and gives an example of a clinical case of this disease.

Key words: multiple endocrine neoplasia syndrome type 2, Sipple syndrome, Gorlin syndrome, medullary thyroid cancer, pheochromocytoma, hyperparathyroidism, RET mutation.
For citation: Demidova T.Yu., Kishkowich Yu.S. Multiple endocrine neoplasia syndrome type 2 // RMJ. 2018. № 11(II). P. 116–121.

Pages 122-125. Длительно протекающий рецидив инсулиномы в клинической практике. Демидова Т.Ю., Титова В.В.

Summary: Long-standing relapse of insulinoma in clinical practice
T.Yu. Demidova, V.V. Titova

Pirogov Russian National Research Medical University, Moscow

Insulinoma is the most frequent neuroendocrine tumor (up to 70–75% of the total), originating from β-cells of the Langerhans islets, secreting insulin into the bloodstream uncontrollably, which turn up as the cause of spontaneous hypoglycemia. Insulinomas are rare (1–4 cases per 1 million population per year) and in most cases (up to 90%) are benign, malignant insulinomas occur in 5–10% of cases. Diagnosis of insulinoma may be delayed for several years since the onset of the disease as the symptoms of the disease are nonspecific and may be similar to the symptoms of mental, cardiovascular and neurological diseases. Surgical resection is the main treatment of insulinoma. In benign single insulinoma, small in size, located in the corpus or cauda pancreatis, laparoscopic surgery, enucleation, partial or middle pancreatectomy are possible, which preserve the healthy tissue of the pancreas, thus reducing the risk of pancreatic function insufficiency.
The article presents a clinical case of relapse of insulinoma in a patient after an open treatment of long-term insulinoma without adequate therapy. The authors provide brief information about the endogenous hyperinsulinism as the manifestation of insulinoma.

Key words: endogenous hyperinsulinism, hypoglycemia, neuroendocrine tumor, insulinoma, pancreatectomy, laparoscopic surgery, clinical case.
For citation: Demidova T.Yu., Titova V.V. Long-standing relapse of insulinoma in clinical practice // RMJ. 2018. № 11(II). P. 122–125.

Pages 126-130. Целесообразность использования витамина-гормона D с профилактической и лечебной целью (обзор литературы). Пестрикова Т.Ю., Юрасова Е.А., Князева Т.П., Шматкова А.С.

Summary: Feasibility of using vitamin D hormone with preventive and curative purposes (Literature review)
T.Yu. Pestrikova, E.A. Yurasova, T.P. Knyazeva, A.S. Shmatkova

Far Eastern State Medical University, Khabarovsk

Disorders of hormones production and hormones deficiency are important causes of many human diseases. D-hormone deficiency has negative consequences and causes a number of pathological conditions and diseases, which worsen in a menopause period.
A low level of D-hormone is found in overweight and obese individuals, along with arterial hypertension, peripheral arterial disease, coronary heart disease, myocardial infarction, heart failure and stroke. Low levels of 25(ОН)D3 in the blood serum seem to be associated with hypertriglyceridemia, insulin resistance and metabolic syndrome in obese people, low level of high-density cholesterol. Many studies confirm the relationship between vitamin D deficiency and depression, obesity, polycystic ovary syndrome, infertility, etc.
In Russia, vitamin D is used mainly in two forms: aqueous and oil solutions. The aqueous solution is absorbed better because of the micellar form. This is due to the fact that it consists of micelles — nanoparticles with a “fat falling” and an aqueous membrane. The natural mechanism of vitamin D assimilation requires the formation of a micellar solution in the human body, which depends on the state of the digestive system, the meal and the food. The aqueous form of vitamin D (Aquadetrim®) is ready for assimilation when entering the human body, so its assimilation does not depend on a number of additional factors.

Key words: vitamin- D hormone, D-hypovitaminosis, D-vitamin deficiency, cholecalciferol, Aquadetrim®.
For citation: Pestrikova T.Yu., Yurasova E.A., Knyazeva T.P., Shmatkova A.S. Feasibility of using vitamin D hormone with preventive and curative purposes (Literature review) // RMJ. 2018. № 11(II). P. 126–130.

Pages 131-136. Антибиотики как модуляторы кишечной микробиоты: между добром и злом. Плотникова Е.Ю., Захарова Ю.В.

Summary: Antibiotics as modulators of intestinal microbiota: between the good and the bad
Plotnikova E.Yu., Zakharova Yu.V.

Kemerovo State Medical University

Obesity is progressing in a number of countries around the world with a real epidemic speed. Microbiomas play an important role in maintaining health, immunity and metabolism. Today antibiotics are invaluable drugs used in the treatment of many serious infections and they continue to save countless number of lives. Side effects from antibiotic treatment on the intestinal microflora range from a self-limited «functional» diarrhea to a life-threatening pseudomembranous colitis. New epidemiological studies have shown that the use of antibiotics is associated with an increased risk of overweight and obesity. But it is not only antibiotic therapy that may cause the disturbance of intestinal microflora. Antibiotics are widely used as growth stimulators in agriculture, they are accumulated in the meat of animals and poultry that we eat. Probiotics are agents that can modulate and improve the intestinal microflora during antibiotic therapy. Probiotics not only prevent and treat antibiotic-associated diarrhea, but also contribute to weight loss and reduce overweight, they can improve immunity, prevent colds and atopic diseases, and also have many other effects.

Key words: obesity, antibiotics, antibiotic therapy, probiotics, Maxilac.
For citation: Plotnikova E.Yu., Zakharova Yu.V. Antibiotics as modulators of intestinal microbiota: between the good and the bad // RMJ. 2018. № 11(II). P. 131–136.

Pages 83-83. Слово редактора. Демидова Т.Ю.

Pages 84-85. К юбилею кафедры эндокринологии лечебного факультета РНИМУ им. Н.И. Пирогова.

Pages 86-90. Современные технологии непрерывного мониторинга гликемии: развивающиеся возможности контроля и управления. Демидова Т.Ю., Ушанова Ф.О.

Summary: Modern technologies for continuous monitoring of glycemia: developing opportunities for check-up and control
T.Yu. Demidova, F.O. Ushanova

Pirogov Russian National Research Medical University, Moscow

In modern endocrinology, devices for continuous monitoring of glycemia have become an important tool for managing diabetes. In addition to the fact that they become more accurate and convenient in use, new options appear for estimating the glycemic profile, such as information on the trend of the glycemic curve, quantification of the duration and amplitude of glucose fluctuations. Obtained information, during long-term monitoring, about the current level of glucose and retrospective data about the level of glucose can be used to build an outpatient glycemic profile. The outpatient glycemic profile of the patient is an individual and easy-to-use graph reflecting a complete picture of the compensation of diabetes due to the fact that, despite the level of glucose in the blood, such important indicators as glycemia variability and the duration of episodes of hypo- and hyperglycemia are also recorded. This technique helps to establish the causes of changes in the level of glycemia and resolve the issue of the correction advisability of therapy.
Continuous measurement of glucose concentration with determination of the duration of normal, hypo- and hyperglycemia (e. g., using the Abbott FreeStyle Libre) can significantly complement the level of glycated hemoglobin (HbA1c) as the integrated evaluation of glycemic control.

Key words: continuous glucose monitoring, ambulatory glycemic profile, diabetes mellitus, FreeStyle Libre.
For citation: Demidova T.Yu., Ushanova F.O. Modern technologies for continuous monitoring of glycemia: developing opportunities for check-up and control // RMJ. 2018. № 11(II). P. 86–90.

Pages 91-94. Клинико-патогенетические аспекты поражения малых нервных волокон у пациентов с сахарным диабетом 1 типа и возможности их коррекции. Бреговская А.В., Гринева Е.В., Бабенко А.Ю., Жарова Е.Н., Деминская И.В.

Summary: Clinical and pathogenetic aspects of the lesion of small nerve fibers in patients with type 1 diabetes mellitus and possibility of their correction
A.V. Bregovskaya1, E.V. Grineva1, A.Yu. Babenko1, E.N. Zharova1, I.V. Deminskaya2

1 Almazov National Medical Research Center, Saint Petersburg
2 Municipal Polyclinic № 34, Saint Petersburg

Aim: to study the features of small nerve fibers lesion of the cornea in diabetic neuropathy (DN) in patients with type 1 diabetes mellitus (DM), as well as the possibility of evaluating the dynamics of the nerve fibers state with the help of confocal microscopy of the cornea (CMC) in the course of the DM treatment.
Patients and Methods: 40 healthy patients aged 18–45 years (the control group) were involved in the study, as well as 50 patients aged 18–45 years with type 1 DM and with clinical and/or electrophysiological (electroneuromyography, ENMG) criteria for sensory and/or sensorimotor form of DN.
Results and Discussion: there were significant differences in the nerve fibers structure of the cornea between the control group and patients with DM: the number of nerve fibers in patients with type 1 DM was reduced by 30%, the thickness of nerve fibers was 25% less than in healthy persons (p<0.001). When comparing the results of CMC and ENMG data, a significant negative correlation (p<0.005) was found between the severity of sensory deficit by the NDS scale and morphological changes of the corneal nerves. During evaluation of CMC and ENMG data in the course of the DN treatment with alpha-lipoic acid drugs (Thioctacid® 600 T, Thioctacid® HR), positive dynamics of structural changes of small nerve fibers (p<0.005) were determined, as well as an increase in amplitude values according to ENMG (p<0.01), however, the accuracy in the change of ENMG velocity parameters was not achieved.
Conclusion: structural changes in small nerve fibers are manifested in patients with type 1 DM already at the preclinical stage of DN with effects enhancement as the DN severity increases, however, there is a possibility of morphological changes regression of corneal nerves in the course of early pathogenetic DN treatment. CMC is a non-invasive and objective research, it can serve not only for the early diagnosis of DN, but also to assess the morphological changes in the dynamics during therapy.

Key words: diabetes mellitus, diabetic neuropathy, confocal microscopy of corneal, alpha-lipoic acid, Thioctacid® 600 T, 
Thioctacid® HR.
For citation: Bregovskaya A.V., Grineva E.V., Babenko A.Yu. et al. Clinical and pathogenetic aspects of the lesion of small nerve fibers in patients with type 1 diabetes mellitus and possibility of their correction // RMJ. 2018. № 11(II). P. 91–94.

Pages 95-100. ИДПП-4: 10 лет эффективного и безопасного управления сахарным диабетом 2 типа. Демидова Т.Ю., Томилова Е.Н.

Summary: iDPP-4: 10 years of effective and safe management of type 2 diabetes mellitus
T.Yu. Demidova, E.N. Tomilova

Pirogov Russian National Research Medical University, Moscow

Traditional medications of sulfonylurea (SU), which stimulate insulin secretion, have been edged out by incretin drugs, primarily dipeptidyl peptidase-4 (iDPP-4) inhibitors, due to their unique physiological glucose-dependent effect on insulin and glucagon secretion, allowing for effective control of type 2 diabetes mellitus (DM) without significant side effects. Drugs of iDPP-4 class are recommended for use at all stages of DM development, starting from the onset, both in monotherapy and in combination with oral antidiabetic drugs (OAD) and insulin. Cardiovascular safety, the possibility of admission at the tardive stages of chronic kidney disease (CKD), a neutral effect on body weight, ease of application are indisputable benefits. The combination of iDPP-4 (for example, vildagliptin) with metformin is the most popular, covers the vast majority of pathophysiological defects in type 2 DM, is available in a fixed form (for example, Galvus Met®). The admission of drugs of the iDPP-4 class in clinical practice for more than 10 years (e.g., Galvus®) allows to consider that their main clinical effects are finally identified, they can be systematized and the established benefits and disadvantages in managing of type 2 DM can be discussed.

Key words: diabetes mellitus, incretins, iDPP-4, vildagliptin, metformin, Galvus®, Galvus Met®.
For citation: Demidova T.Yu., Tomilova E.N. iDPP-4: 10 years of effective and safe management of type 2 diabetes mellitus // RMJ. 2018. № 11(II). P. 95–100.



№11(I), 2018. Кардиология

Pages 12-17. Ишемическое прекондиционирование миокарда у больных ишемической болезнью сердца и сахарным диабетом 2-го типа: опыт применения никорандила. Сизова Ж.М., Захарова В.Л., Козлова Н.В.

Summary: Ischemic preconditioning of myocardium in patients with coronary artery disease and type 2 diabetes mellitus: the experience of using nicorandil
Zh.M. Sizova, V.L. Zaharova, N.V. Kozlova

Sechenov University, Moscow

Coronary artery disease (CAD) is a complex of disorders caused by known risk factors and concomitant diseases that can affect the development of ischemic injuries and the severity of the response to cardioprotective interventions. Ischemic preconditioning (IP) of the myocardium is considered as the gold standard of cardioprotection. The ability of drugs to initiate IP processes and protect the myocardium from possible future injuries, especially in patients with CAD with concomitant type 2 diabetes mellitus (DM2), deserves special attention.
Aim: to evaluate comparatively the possibilities of coronary reserve pharmacological correction and effect on IP of the myocardium in patients with CAD and DM2 with traditional nitro-based preparations and the activator of potassium channels, nicorandil.
Patients and Methods: 54 patients with stable angina pectoris of 2–3 functional classes (FC) and DM2 were under study. Dynamics of the frequency of angina pectoris attacks, angina pectoris middle FC, exercise tolerance and Holter ECG monitoring under the effect of 24-week therapy with nicorandil, isosorbide dinitrate (ISDN) and isosorbide-5-mononitrate (I5MN) were analyzed.
Results: therapy with nicorandil, ISDN and I5MN for 12 weeks leads to a significant decrease in the number of attacks per week, a decrease of the middle angina pectoris FC, an increase in exercise tolerance and a reduction in the number of episodes of pain and painless myocardial ischemia with some bonus of nitrates over nicorandil. With continued treatment for up to 24 weeks, an increase in antianginal and anti-ischemic efficacy is observed only in the nicorandil group.
Conclusion: in patients with CAD and DM2, the selected drug for long-term therapy is nicorandil, which is more effective than traditional nitro-based drugs and has the ability to initiate IP of the miocardium. Nicorandil effectively corrects endothelial dysfunction, without causing the development of tolerance and without reducing its effectiveness while simultaneous administration of glucose-lowering therapy.

Key words: coronary artery disease, type 2 diabetes mellitus, ischemic preconditioning, endothelial dysfunction, nicorandil, Cordinik.
For citation: Sizova Zh.M., Zaharova V.L., Kozlova N.V. Ischemic preconditioning of myocardium in patients with coronary artery disease and type 2 diabetes mellitus: the experience of using nicorandil // RMJ. 2018. № 11(I). P. 12–17.

Pages 18-26. Эффективность лечения аритмий иммунно-воспалительного генеза с помощью плазмафереза. Куликова В.А., Недоступ А.В., Благова О.В., Зайденов В.А., Куприянова А.Г., Нечаев И.А., Рагимов А.А.

Summary: Treatment efficiency of arrhythmias of immune-inflammatory genesis by plasmapheresis
V.A. Kulikova1, A.V. Nedostup1, O.V. Blagova1, V.A. Zaydenov2, A.G. Kupriyanova3, I.A Nechaev4, A.A. Ragimov4

1 Sechenov University, Moscow
2 Shumakov National Medical Research Center of Transplantology and Artificial Organs, Moscow
3 Veltishchev Research Clinical Institute of Pediatrics, Moscow
4 Sechenov University Blood Center, Moscow

Aim: to study the effectiveness of plasmapheresis as the main type of pathogenetic treatment or in combination with immunosuppressive therapy in patients with arrhythmias of immune-inflammatory genesis.
Patients and Methods: 48 patients with an arrhythmic variant of myocarditis (with supraventricular/ventricular premature beats, atrial fibrillation) were included in the study. The inclusion criterion was an increase in ≥2 times of titers of at least 2 types of anti-cardiac antibodies. Myocarditis was diagnosed using myocardial biopsy, coronary angiography, a non-invasive diagnostic algorithm including anamnestic data, magnetic resonance imaging and multispiral computed tomography of the heart, myocardial scintigraphy. All patients underwent standard cardiotropic and anti-arrhythmic therapy. An additional course of discrete plasmapheresis was performed in 22 patients (the main group) with the removal of the thrombo-leukocyte layer and the total circulating plasma volume. The remaining 26 patients entered the experimental group. Dynamics of clinical and laboratory parameters were evaluated after 6 and 12 months.
Results: in the plasmapheresis group, a significant decrease in anti-cardiac antibody titers was observed immediately after plasmapheresis and during control studies (p<0.05). A good clinical response (decrease in the number of extrasystoles and atrial fibrillation frequency ≥75%) was observed in 81.2% of patients of the plasmapheresis group and 57.7% of the experimental group. In 32% of patients of the main group, it was possible to completely cancel the anti-arrhythmic therapy due to the persistent suppression of myocarditis activity, which was not achieved in the experimental group. The most significant effect was observed in patients with ventricular premature beats. The good response of plasmapheresis was associated with a shorter duration of the disease and younger patients. The predictor of plasmapheresis efficiency was the titer of a specific antinuclear factor (antibodies to the nuclei of cardiomyocytes) 1:40-1:80 and more. More aggressive therapy of myocarditis with methylprednisolone in patients of the main group was conducted significantly less frequently (46%) than in patients of the experimental group (73%), p<0.05. Methylprednisolone doses were also lower in the plasmapheresis patient group than in the experimental group (7[3.5; 16] vs. 16[10; 24] mg per day, respectively, p=0.055).
Conclusion: good clinical response to plasmapheresis was observed in 81.8% of patients with arrhythmias of immune-inflammatory genesis. In patients with the arrhythmic variant of myocarditis, plasmapheresis conduction increases the effectiveness of anti-arrhythmic and immunosuppressive therapy and makes it possible to refrain from aggressive immunosuppression regimens.

Key words: myocarditis, ventricular premature beats, supraventricular premature beats, atrial fibrillation, plasmapheresis, immunosuppressive therapy.
For citation: Kulikova V.A., Nedostup A.V., Blagova O.V. et al. Treatment efficiency of arrhythmias of immune-inflammatory genesis by plasmapheresis // RMJ. 2018. № 11(I). P. 18–26.

Pages 2-6. Антигипертензивная эффективность монотерапии кандесартаном у пациентов с неосложненной артериальной гипертонией. Кобалава Ж.Д., Шаварова Е.К., Хромова И.А.

Summary: The antihypertensive efficacy of candesartan monotherapy in patients with uncomplicated arterial hypertension
Zh.D. Kobalava, E.K. Shavarova, I.A. Khromova

RUDN University, Moscow

Aim: to evaluate the antihypertensive effect and safety of the drug Angiakand (“Canonpharma Production”, Russia) in patients with uncomplicated uncontrolled arterial hypertension (AH).
Patients and Methods: 54 patients (median of age 55 years, 37% of men) with uncomplicated previously untreated or uncontrolled monotherapy AH of 1–2 st., who applied for ambulatory care were included in an open, single-center study of the efficacy and safety of a 4-week candesartan therapy. All patients before and after the study had their clinical blood pressure (BP) and heart rate measured, also biochemical blood test, ambulatory BP monitoring (ABPM), applanation tonometry, echocardiography were made.
Results: the observation period was 4 weeks. There was a decrease in the median of systolic/diastolic blood pressure from 153/95 to 138/89 mm Hg. (p<0.001) according to the clinical measurement and from 134/79 to 125/74 mm Hg. (p<0.001) according to the ABPM data. Target values of clinical BP were achieved in 33 (61%), and daily mean BP in 36 (68%) patients. Central systolic blood pressure decreased from 141 to 129 (p<0.001), central diastolic blood pressure — from 92 to 84 (p<0.001), central pulse BP — from 48 to 41 mm Hg. (p<0.05). Accurate changes in pulse wave velocity, indices of left ventricular diastolic function, functional state of the kidneys, electrolyte level were not established. 1 (2%) patient had a transient headache, which was not the reason for drug withdrawal. No other adverse reactions were reported.
Conclusion: a four-week monotherapy with the Russian medication called candesartan (Angiakand) at a dose of 16 mg/day in middle-aged patients with uncomplicated uncontrolled AH of 1–2 st. is accompanied by a significant decrease in both peripheral and central systolic and diastolic blood pressure and pulse pressure, differing in the high safety profile.

Key words: cardiovascular diseases, arterial hypertension, arterial stiffness, renin-angiotensin-aldosterone system, RAАS, RAAS blockers, Angiakand.
For citation: Kobalava Zh.D., Shavarova E.K., Khromova I.A. The antihypertensive efficacy of candesartan monotherapy in patients with uncomplicated arterial hypertension // RMJ. 2018. № 11(I). P. 2–6.

Pages 27-30. Анализ уровней цитокинов у больных атеросклерозом периферических сосудов в условиях техногенного загрязнения. Суранова Г.Ж., Майназарова Э.С., Тухватшин Р.Р.

Summary: Analysis of cytokine levels in patients with atherosclerosis of peripheral vessels under conditions of technological pollution
G.Zh. Suranova1, E.S. Maynazarova2, R.R. Tuhvatshin3

1 International School of Medicine, Bishkek
2 Research Institute of Molecular Biology and Biophysics, Bishkek
3 Ahunbayev Kyrgyz State Medical Academy, Bishkek

Aim: to study the levels of pro-and anti-inflammatory cytokines of interleukins 6, 10 (IL-6, IL-10) in patients with atherosclerosis of peripheral vessels living in mountainous conditions near uranium tailing dumps.
Patients and Methods: 73 patients were included in this study: main group (MG) — 27 patients living near uranium tailing dumps and suffering from obliterating atherosclerosis of vessels of the lower extremities and hypertension (H), control group 1 (CG-1) — 31 patients with H, control group 2 (CG-2) — 20 healthy persons.
The following actions were conducted: filling in of a specially designed case record, determination of a state of peripheral arteries, study of cytokine levels.
Results and Discussion: a statistically significant increase of IL-6 values in the blood of patients with obliterating atherosclerosis of vessels of the lower extremity with concomitant hypertension, living on the territory contaminated with uranium radionuclides, was found in the group with triglyceridemia, hypercholesterolemia and normolipidemia, which mechanisms should be investigated further. Registration of IL-10 at the level of reference values indicates the suppression of anti-inflammatory immune response mechanisms under conditions of hypoxia and radionuclide load. However, a high content of IL-10 (11.3±1.0) with an increase in the concentration of total cholesterol (C) above 6.2 mmol/l may indicate a reactive stimulation of T-lymphocytes responsible for the production of cytokines, by increasing the disturbing etiological factors such as an excess of total С, С–LDL, high systemic arterial pressure, radionuclide load and hypoxia. In patients with obliterating atherosclerosis of vessels of the lower extremities, affected by hypertension, the cytokine ratio is significantly higher than in healthy persons and patients with hypertension.
Conclusion: patients with obliterating atherosclerosis of the lower extremity vessels with concomitant hypertension living on the territory contaminated with uranium radionuclides, having a high content of pro-inflammatory cytokines, even with hemodynamically insignificant forms of obliterating atherosclerosis without occlusion and stenosis, should be considered to a high-risk group of the atherosclerotic process progression.

Key words: cytokines, interleukin-6, interleukin-10, atherosclerosis, peripheral vessels, middle mountains, uranium tailing dumps.
For citation: Suranova G.Zh., Maynazarova E.S., Tuhvatshin R.R. Analysis of cytokine levels in patients with atherosclerosis of peripheral vessels under conditions of technological pollution // RMJ. 2018. № 11(I). P. 27–30.

Pages 32-34. Изменения психоэмоционального статуса и сердечно-сосудистые заболевания: что первично?. Курушина О.В., Барулин А.Е., Друшлякова А.А.

Summary: Changes in psychoemotional status and cardiovascular diseases: what is primary?
O.V. Kurushina, A.E. Barulin, A.A. Drushlyakova

Volgograd State Medical University

The article is dedicated to the problem of comorbidity of changes of psychoemotional status and cardiovascular pathology. The role of risk factors for the formation of both anxiety-depressive and cardiovascular disorders is considered. The main pathophysiological mechanisms supporting the formation of comorbid disorders in modern life conditions are singled out. The relationship between anxiety-depressive states and disorders of vegetative regulation, endocrine disorders and pathology of the circulatory system was demonstrated. Particular attention is paid to the authors’ consideration of the mechanisms of the influence of such a common risk factor, as chronic stress, on the processes of the emergence and maintenance of all links in the pathological process, leading to a high incidence of various pathologies of the cardiovascular system. The data of modern studies on the problem of preventing the development of diseases of the circulatory system, the therapy of the already existing cardiovascular pathology, and the correction of comorbid conditions in this category of patients are presented. On the example of domestic research, in which the effectiveness and safety of the use of antibodies to the brain-specific protein S-100 in the correction of psychoemotional disorders in patients with cardiovascular pathology of varying severity was demonstrated.

Key words: psychoemotional status, cardiovascular diseases, anxiety disorders, complex therapy.
For citation: Kurushina O.V., Barulin A.E., Drushlyakova A.A. Сhanges in psychoemotional status and cardiovascular diseases: what is primary? // RMJ. 2018. № 11(I). P. 32–34.

Pages 36-40. Измерение артериального давления: метод, прошедший испытание временем. Дроботя Н.В., Гусейнова Э.Ш., Пироженко А.А.

Summary: Blood pressure measurement: method that stood the test of time
N.V. Drobotya, E.Sh. Guseynova, A.A. Pirozhenko

Rostov State Medical University, Rostov-on-Don

Auscultatory method for determining blood pressure (BP), proposed at the beginning of the last century by a Russian surgeon and scientist N.S. Korotkov, is widely used now in clinical practice. It is the basis for the diagnosis of hypertension (H). To obtain reliable BP values, it is necessary to comply with a number of mandatory requirements and conditions, which are set out in the relevant recommendations. In the light of national recommendations for the diagnosis and treatment of hypertension and European recommendations of 2018, the article discusses current views on the classification of BP levels, the algorithm for screening and diagnosis of hypertension, as well as target levels of BP in various patient populations. In conditions of inadequate control of BP in the population, the importance of self-monitoring of blood pressure (SMBP) at home is emphasized, which can significantly improve patient compliance and, accordingly, the effectiveness of therapeutic interventions. This method of BP control has a number of additional benefits over the traditional clinical measurement of BP. In turn, the information content of the SMBP results is predetermined by the correct measurement technique and reliability of used sphygmomanometers. Main requirements for modern sphygmomanometers are discussed.

Key words: BP measurement, hypertension, self-monitoring of blood pressure, varieties of sphygmomanometers, sphygmomanometer.
For citation: Drobotya N.V., Guseynova E.Sh., Pirozhenko A.A. Blood pressure measurement: method that stood the test of time // RMJ. 2018. № 11(I). P. 36–40.

Pages 42-46. Алгоритм подбора антигипертензивной терапии, место бета-блокаторов пролонгированного действия. Смирнова М.Д., Агеев Ф.Т.

Summary: An algorithm for selection of antihypertensive therapy, a place of long-acting beta-blockers
M.D. Smirnova, F.T. Ageev

National Medical Research Center of Cardiology, Moscow

The article is devoted to reassessment of the role of beta-blockers (BB) in the arterial hypertension (AH) treatment, reflected in the new version of joint recommendations on AH of the European Society of Cardiology and the European Society of Hypertension 2018. BB can be prescribed as antihypertensive drugs in presence of specific clinical situations such as chronic heart failure (CHF), angina pectoris, a previous myocardial infarction (MI), need for rhythm control, pregnancy or its planning. In addition, they can be used as a third-step drug in resistance to the therapy. As absolute contraindications to BB included bradycardia (heart rate less than 60 beats per minute) and excluded chronic obstructive pulmonary disease. Prerequisites of this reassessment are considered and analyzed, a data of the last meta-analyzes devoted to drugs of the first line of AH treatment is presented. Indications for use of different BB are considered. Features of pharmacokinetics, pharmacodynamics of clinical application of various salts of metoprolol (succinate and tartrate) are presented. A data on efficacy and safety of metoprolol succinate use in AH in combination with coronary heart disease, CHF is presented.

Key words: beta-adrenoblockers, metoprolol, metoprolol succinate, Betaloc® ZOK, arterial hypertension, chronic heart failure, coronary heart disease, cardiovascular diseases.
For citation: Smirnova M.D., Ageev F.T. An algorithm for selection of antihypertensive therapy, a place of long-acting beta-blockers // RMJ. 2018. № 11(I). P. 42–46.

Pages 47-53. Оптимизация лечения отечного синдрома у больных с хронической сердечной недостаточностью. Евдокимова А.Г., Коваленко Е.В., Евдокимов В.В., Михайлова И.М.

Summary: Optimization of the treatment of edema syndrome in patients with chronic heart failure
A.G. Yevdokimova, E.V. Kovalenko, V.V. Yevdokimov, I.M. Mikhailova

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

The article considers the mechanisms of the fluid retention syndrome in patients with chronic heart failure (CHF). The classification of diuretics is given depending on the points of application of their action in the nephron. Particular attention is paid to the negative role of hyperaldosteronism in CHF and the possibility of its control when using torasemide and eplerenone. Based on numerous, multicenter clinical studies, the advantage of using a loop diuretic with an antialdosterone effect — torasemide and an antagonist of mineral corticoid receptors — eplerenone in the complex therapy of CHF is shown. It is emphasized that after intaking the initial dose of torasemide, diuretic and antihypertensive effects appear immediately, and the antifibrotic effect requires a certain time, which is due to a change in collagen occurring during 6-9 months of continuous drug therapy. In connection with this, it is necessary to take into account the long-term, sometimes lifelong, use of torasemide in the management of patients with CHF, arterial hypertension and defeat of target organs. The article presents data, within the framework of evidence-based medicine, on the high clinical efficacy of eplerenone in patients with CHF and a reduced ejection fraction with or without myocardial infarction. Thus, the use of torasemide and eplerenone helps not only to improve the quality of life of serious patients, but also the prognosis.

Key words: chronic heart failure, edema syndrome, torasemide, Trigrim, eplerenone, Espiro.
For citation: Yevdokimova A.G., Kovalenko E.V., Yevdokimov V.V., Mikhailova I.M. Optimization of the treatment of edema syndrome in patients with chronic heart failure // RMJ. 2018. № 11(I). P. 47–53.

Pages 54-58. Дезагрегантная терапия — вторичная профилактика ишемической болезни сердца. Трошина А.А.

Summary: Disaggregant therapy — secondary prevention of coronary heart disease
A.A. Troshina1,2

1 Pirogov Russian National Research Medical University, Moscow
2 City Clinic No. 52, Moscow

Cardiovascular diseases (CVD) are the leading cause of death in most countries of the world, they lead to an increase in the disability of the adult population, which is accompanied by an increase in economic costs. It is not accidental that CVD is nowadays called the «epidemic of the XXI century». According to epidemiological data in the Russian Federation — coronary heart disease (СHD) is one of the main causes of death and disability of patients. The prevalence of СHD in our country is 13.5%, in the US — almost 2 times lower — 7%. It is expected that by 2030 from СHD and stroke, about 23.6 million people will die. According to forecasts, these diseases will remain the main individual causes of death. Understanding the causes of the development of these diseases, as well as expanding opportunities in their prevention, diagnosis and treatment is one of the key priorities of today’s cardiology. To a patient with СHD, the clinician should prescribe pathogenetic therapy not only for the purpose of correcting the quality of life, but also for improving the prognosis and reducing the risk of cardiovascular mortality. The article fully presents the role of acetylsalicylic acid in secondary prevention of CVD, in particular СHD and myocardial infarction.

Key words: cardiovascular diseases, coronary heart disease, myocardial infarction, acetylsalicylic acid, secondary prevention.
For citation: Troshina A.A. Disaggregant therapy — secondary prevention of coronary heart disease // RMJ. 2018. № 11(I). P. 54–58.

Pages 59-64. Эффективность, безопасность и изученность как основа выбора антигипертензивного препарата в контексте современных тенденций в лечении артериальной гипертонии. Гиляревский С.Р., Голшмид М.В., Кузьмина И.М., Синицина И.И.

Summary: The efficacy, safety, and background as the basis of selection of antihypertensive drug in terms of current trends in the hypertension treatment
S.R. Gilyarevsky1, M.V. Golsсhmid1, I.M. Kuzmina2, I.I. Sinitcina1

1 Russian Medical Academy of Continuing Professional Education, Moscow
2 Sklifosovsky Scientific Research Institute of First Aid, Moscow

The article discusses the up-to-date requirements for antihypertensive drugs in relation to the adoption of new recommendations on the therapeutic approach of patients with hypertension. This article represents the evidence base of the effective administration of angiotensin receptor blocker, candesartan. The selection algorithm of the antihypertensive drug in patients with hypertension and the efficacy of candesartan in case of hypertension and pre-hypertension are described. Special attention is given to the probative effectiveness of candesartan administration in patients with chronic cardiac insufficiency. In addition, there are pharmacological characteristics of the drug, contributing to its high clinical effectiveness. In light of new clinical practice guidelines for the treatment of patients with hypertension, they can be the basis for revision of the optimal antihypertensive drugs or components of antihypertensive therapy. Taking into account the evidence data on the effectiveness and safety of candesartan administration, it can be considered that this drug establishes itself as a leading choice both among renin-angiotensin system blockers and antihypertensive drugs, as a whole. Clinically significant benefits of candesartan were confirmed during the conduction of a large number of randomized clinical trials. The administration of candesartan in patients with hypertension and chronic cardiac insufficiency leads to the prognosis improvement.

Key words: hypertension, chronic cardiac insufficiency, clinical practice guidelines, treatment of hypertension, angiotensin receptor blockers, candesartan, Hyposart.
For citation: Gilyarevsky S.R., Golsсhmid M.V., Kuzmina I.M., Sinitcina I.I. The efficacy, safety, and background as the basis of selection of antihypertensive drug in terms of current trends in the hypertension treatment // RMJ. 2018. № 11(I). P. 59–64.

Pages 65-70. Эффективность применения каптоприла в клинической практике. Евдокимова А.Г., Коваленко Е.В., Маркова Л.И.

Summary: The efficacy of captopril in clinical practice
A.G. Yevdokimova, E.V. Kovalenko, L.I. Markova

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

The article gives a brief description, classification and mechanisms of action of angiotensin-converting enzyme (ACE) inhibitors. Particular attention is paid to captopril, as the most popular ACE inhibitor, its relevance in real clinical practice is considered. Captopril differs from other representatives of this class by the presence of an additional mechanism of antioxidant protection due to the content of the sulfhydryl group in the chemical structure of the preparation. Captopril promotes inhibition of lipid peroxidation, which is mediated by direct activation of superoxide anion, an increase in nitric oxide and a content inside magnesium cells, which contributes to the expressed cardioprotective, antiischemic effects, and decreases the tolerance to nitrates in patients with ischemic heart disease. Antihypertensive effect of the drug begins in 15–30 minutes, which allows to prescribe it for relieving the acute elevation of blood pressure. Thanks to the increase in the production of prostaglandin E2, the improvement of the binding of insulin to the receptors, captopril positively affects the parameters of carbohydrate metabolism, reducing insulin resistance. Numerous clinical studies has proved its high efficacy in patients with arterial hypertension and hypertensive crises, acute myocardial infarction, chronic heart failure and diabetic nephropathy.

Key words: angiotensin-converting enzyme inhibitors, captopril, arterial hypertension, hypertensive crises, acute myocardial infarction, chronic heart failure, diabetic nephropathy.
For citation: Yevdokimova A.G., Kovalenko E.V., Markova L.I. The efficacy of captopril in clinical practice // RMJ. 2018. № 11(I). P. 65–70.

Pages 7-11. Антигипертензивная и церебропротективная эффективность бисопролола у больных артериальной гипертонией, ассоциированной с сахарным диабетом 2-го типа. Фальковская А.Ю., Мордовин В.Ф., Белокопытова Н.В., Усов В.Ю., Сухарева А.Е., Рябова Т.Р., Шарыпова Н.Г.

Summary: Antihypertensive and cerebral protective efficacy of bisoprolol in patients with hypertension combined with type 2 diabetes mellitus
A.Yu. Falkovskaya1, V.F. Mordovin1, N.V. Belokopytova2, Yu.V. Usov1, A.E. Suhareva1, T.R. Ryabova1, N.G. Sharypova1

1 Research Institute for Cardiology, Tomsk National Research Medical Center
2 Bureau of Medical and Social Expertise in the Tomsk Region

Aim: to study the interaction of the long-term therapy with bisoprolol on blood pressure, early structural brain damage and wall thickness of carotid arteries in patients with hypertension (H) combined with type 2 diabetes mellitus (DM).
Patients and Methods: 21 patients with H combined with type 2 DM (15 women, mean age 50±6 years) were included in the open controlled trial. Ambulatory blood pressure monitoring (ABPM), laboratory tests (glycosylated hemoglobin (HbA1C), blood lipid spectrum), magnetic resonance imaging (MRI) of the brain and sonography of carotid arteries were conducted to all patients initially and after 6 months of treatment. After the initial examination, the patients received selective beta-blocker bisoprolol at a starting dose of 5 mg, which was increased to 10–15 mg/day. The average doses of bisoprolol amounted to 7.25 mg (5–15 mg/day, n=21).
Results: a significant decrease in blood pressure was manifested in both office measurements (17/8.7 mm Hg, p<0.0001) and ABPM results (-17.5/-12.1 mm Hg, p<0.0001) after six months of treatment with bisoprolol. The increased blood pressure load (systolic/diastolic) decreased by an average of 38.2/37.7%, respectively. Target blood pressure values were achieved in 71% of patients. Besides, a significant decrease in the thickness of intima-media complex of carotid arteries (from 0.75±0.06 to 0.68±0.14 mm, p=0.02) was determined, and the MRI results showed an essential decrease in the linear dimensions of the ventricular system of the brain and subarachnoid spaces, the severity of which depended on the degree of average values reduction of the ABPM parameters. Relevant changes in HbA1C level and lipid spectrum parameters were not manifested.
Conclusion: a 6-month therapy with bisoprolol for patients with hypertension combined with type 2 DM is followed by a pronounced antihypertensive effect, decrease in the wall thickness of the carotid arteries and involution of non-clinical MRI indications of structural brain damage in the form of reduced severity of liquor-dynamic disturbances.

Key words: hypertension, diabetes mellitus, ambulatory blood pressure monitoring, brain MRI, liquor-dynamic disturbances, carotid arteries, bisoprolol, Concor.
For citation: Falkovskaya A.Yu., Mordovin V.F., Belokopytova N.V. et al. Antihypertensive and cerebral protective efficacy of bisoprolol in patients with hypertension combined with type 2 diabetes mellitus // RMJ. 2018. № 11(I). P. 7–11.

Pages 71-75. Оптимальная медикаментозная терапия хронической сердечной недостаточности: роль антагонистов минералокортикоидных рецепторов. Сумин А.Н.

Summary: Optimal medical therapy for chronic heart failure: a role of mineralocorticoid receptor antagonists
A.N. Sumin

Research Institute for Complex Issues of Cardiovascular Disease, Kemerovo

Chronic heart failure (CHF) remains a significant health problem associated with high hospitalization rates, mortality and treatment costs, despite the advances in therapy for CHF and the management of risk factors associated with it. In the INTER-CHF study, there were significant differences in the mortality of patients with CHF in countries with different levels of income. That is, an opportunity to receive modern medical care plays a significant role in outcome of CHF treatment. Studies of recent years have shown that the optimal drug therapy for CHF is a small number of patients, and most often due to non-prescription of mineralocorticoid receptor antagonists (MCRA) when it is necessary. This review deals with causes of this situation, and also discusses how to overcome it. In particular, necessity to use selective MCRA (eplerenone) instead of non-selective (spironolactone) in order to reduce the number of possible side effects. Also, use of eplerenone in early stages of development of the disease, in particular, in patients who underwent myocardial infarction, possible mechanisms of action, as well as possibility of using eplerenone generics to increase compliance of patients to this therapy are handled.

Key words: chronic heart failure, optimal medical therapy for chronic heart failure, mineralocorticoid receptor antagonists, eplerenone.
For citation: Sumin A.N. Optimal medical therapy for chronic heart failure: a role of mineralocorticoid receptor antagonists // RMJ. 2018. № 11(I). P. 71–75.

Pages 76-80. Симпозиумы «2018: Новые возможности снижения сердечно-сосудистого риска в РФ» и «Пациенты высокого и очень высокого риска: актуальные вопросы первичной и вторичной профилактики».



№10(I), 2018. Болезни дыхательных путей

Pages 11-14. Клинико-диагностическое значение исследования полиморфизма гена NAT2 при хронической обструктивной болезни легких. Кудряшева И.А., Новикова Н.Е., Полунина Е.А.

Summary: Clinical and diagnostic value of the study of NAT2 gene polymorphism in chronic obstructive pulmonary disease
I.A. Kudryashova1, N.E. Novikova2, E.A. Polunina1

1 Astrakhan State Medical University
2 Private Clinic “MSCh”, Astrakhan

Aim: To study the contribution of NAT2 gene alleles and genotypes frequency to the character of chronic obstructive pulmonary disease (COPD) and the frequency of relapse and exacerbation of the disease.
Patients and Methods: the total of 120 people were examined, including 90 patients with COPD and 30 somatically healthy individuals as a control group. We analyzed the frequencies of genotypes and alleles of the NAT2 gene, depending on the stage of the disease, the frequency and duration of exacerbations and forms of COPD.
Results and Discussion: It was found that the most common genotype among the subjects was S/S genotype, F/F genotype was the least common among patients with COPD, with the differences between patients with COPD and somatically healthy individuals in the frequency of genotypes (S/S, S/F, F/F) and alleles (S, F) being statistically insignificant. Statistically significant differences were found in the comparison of the NAT2 gene and allele frequencies between patients with different degrees of COPD severity and somatically healthy subjects. A statistically significant increase in carriers of the S/F, F/F and S allele genotypes was found in patients with COPD with bronchitis compared to emphysema.
Conclusions: distribution of the NAT2 gene genotypes and alleles in patients with COPD depends on severity of the disease; the analysis of the combined genotypes made it possible to identify the association of some polymorphisms of the NAT2 genes with the development and progression of COPD; the relationship between the frequency of polymorphic alleles of the NAT2 gene with the frequency of relapses and the nature of COPD exacerbation; an increase in the carriers of the S/F, F/F and S allele genes among patients COPD with bronchitis compared with emphysema.

Key words: chronic obstructive pulmonary disease, NAT2 gene, genotypes (S/S, S/F, F/F), alleles (S, F), bronchitis, emphysema.
For citation: Kudryashova I.A., Novikova N.E., Polunina E.A. Clinical and diagnostic value of the study of NAT2 gene polymorphism in chronic obstructive pulmonary disease // RMJ. 2018. № 10 (I). P. 11–14.

Pages 16-20. Сравнение вновь выявленных больных саркоидозом молодого и старшего возраста. Визель И.Ю., Шмелев Е.И., Визель А.А., Ганибаева Г.С.

Summary: Comparison of the young and elderly patients with newly revealed sarcoidosis
I.Yu. Vizel1, E.I. Shmelev2, A.A. Vizel1, G.S. Ganibaeva3

1 Kazan State Medical University
2 Central Research Institute of Tuberculosis, Moscow
3 Republican Clinical Antituberculosis Dispensary, Kazan

Sarcoidosis is an epitheliocellular polyorganic granulomatosis of unknown nature, the prevalence of which has increased significantly over the past three decades. In all areas of medicine, older patients are a problem, primarily associated with polymorbidity.
Aim: compare patients with histologically confirmed sarcoidosis of a young (18–35 years) and older (55–75 years) age at the time of diagnosis (primary detection, before treatment).
Patients and Methods: the study consisted of a retrospective analysis of the database of patients observed by the authors of this publication in real clinical practice. The database was created in the SPSS-18 program. Statistical processing included the verification of the variation series for the normal distribution, the calculation of the mean, the error of the mean and standard deviation, the calculation of the conjugacy criterion CI-square (χ2), and the odds ratio.
1210 patients with sarcoidosis were examined during the primary detection between 1976 and 2017 (817 women and 393 men, 67.5% / 32.5%), the age ranged from 12 to 76 years, an average of 42.36 ± 0.35 (12.1) years. A comparison of 190 patients with histologically confirmed sarcoidosis of a young age (18–35 years old) and 110 patients of the older age group (55–75 years) was made during the diagnosis (primary detection, before treatment).
Results: no differences were found in the radial stages of sarcoidosis, there was a slight tendency towards a greater number of cases of Löfgren’s syndrome in older patients. Complaints were more pronounced and were more frequent in patients of the senior group — 60% weakness vs. 45.1% in young patients (p<0.01), cough — 47.2% vs. 31.1% (p<0.01), dyspnea — 40.9% vs. 24.4% (p<0.01), whereas the frequency of articular syndrome, fever, pain and discomfort in the chest did not differ. 60.6% of young patients were detected during fluorographic examination (vs. only 36.4%, p<0.001, in the elderly group). Diagnosis of sarcoidosis in young people was almost 2 times more often in TB dispensaries (40.9% vs 22.7%, p<0.001), in older patients — 
in oncology dispensaries (31.8% vs. 18.1%, p<0, 01). The treatment of patients did not differ, but in patients of the older age group the use of systemic glucocorticosteroids caused the adverse effects more often, and their effectiveness was lower.
Conclusion: the study showed that the age did not affect the frequency of occurrence of different radial stages of intrathoracic sarcoidosis and the nature of the therapy. The probability of revealing sarcoidosis when handling complaints is higher in older patients due to the greater frequency of complaints, disturbances in the function of external respiration and external manifestations (sarcoidosis of the skin), they have a worse tolerance to the hormone therapy. Sarcoidosis in young patients was more often detected during preventive examinations and their diagnostic pathway often passed through anti-tuberculosis institutions.

Key words: sarcoidosis, age, diagnosis, radiation stages, comorbidity, treatment, adverse effects.
For citation: Vizel I.Yu., Shmelev E.I., Vizel A.A., Ganibaeva G.S. Comparison of the young and elderly patients with newly revealed sarcoidosis // RMJ. 2018. № 10 (I). P. 16–20.

Pages 22-25. Кашель: в фокусе протуссивная терапия. Зайцев А.А.

Summary: Cough: in the focus of protous therapy
A.A. Zaicev

The main military clinical hospital named after Acad. N. N. Burdenko, Moscow

In Russia, about 40 million cases of respiratory infections are registered every year, and it can be assumed that the actual number of people suffering from acute respiratory illness is much higher, and it is obvious that a significant number of patients seek medical help also with complaints of cough. In Russia, based on the results of a study carried out in Ryazan, 14.8% of respondents complained of a chronic cough.
Mucolytic therapy is the safest in the treatment of patients with productive cough. The most widely spread in clinical practice is acetylcysteine. The mucolytic effect of the drug is realized in the bronchi lumen and is based on the presence of sulfhydryl SH-groups in its molecule, which break the disulfide bonds of mucopolysaccharides of sputum, making it less viscous. In addition, acetylcysteine has an antioxidant effect. Acetylcysteine has oral, parenteral and inhalation forms.
Depending on the etiology, pathogenesis and nature of the course of the disease, each type of cough requires appropriate therapy. In this case, the first stage in the treatment of productive cough comes protous therapy, including more modern and safe mucolytic drugs, a bright and reliable representative among which is acetylcysteine (ESPA-NAC®) in a convenient dosage form.

Key words: productive cough, respiratory infection, protous therapy, mucolytic therapy, acetylcysteine, ESPA-NAC®.
For citation: Zaicev A.A. Cough: in the focus of protous therapy // RMJ. 2018. № 10 (I). P. 22–25.

Pages 28-35. Лекарственное обеспечение при заболеваниях органов дыхания: возможности и решения. Елисеева Е.В., Невзорова В.А., Манеева Е.С., Гончарова Р.К.

Summary: Medicine provision in case of diseases of the respiratory system: opportunities and solutions
E.V. Eliseeva, V.A. Nevzorova, E.S. Maneeva, R.K. Goncharova

FGBOU IN TSMU Russian Ministry of Health, Vladivostok

Stable drug provision for patients with socially significant diseases as part of the program of state guarantees of free medical care to citizens, as well as a part of state social assistance in the form of a set of social services, is one of the domestic health care priorities. Chronic obstructive pulmonary disease (COPD) and asthma are a significant burden for society due to the continuously increasing disease incidence, the need for continuous lifelong therapy with expensive drugs and, at the same time, not the highest adherence of patients to treatment. One of the ways to increase the availability and effectiveness of drug provision for patients with asthma and COPD, as well as adherence to therapy, is the implementation of the import phase-out program. The key requirements for reproduced drugs are quality, safety, good tolerability, the availability of optimal devices for inhalation delivery, ease of use, low cost. Such requirements are met by the domestic manufacturer of medicines «Nativa». Successful implementation of the import phase-out program in the production of a full cycle of domestic medicines will allow us to confidently implement all key destinations of drug provision for all patients in need.

Key words: bronchial asthma, chronic obstructive pulmonary disease, drug supply, import phase-out, Nativa.
For citation: Eliseeva E.V., Nevzorova V.A., Maneeva E.S., Goncharova R.K. Medicine provision in case of diseases of the respiratory system: opportunities and solutions // RMJ. 2018. № 10 (I). P. 28–35.

Pages 36-39. Сердечно-сосудистая патология у больных хронической обструктивной болезнью легких: как мы лечим?. Овчаренко С.И.

Summary: Cardiovascular pathology in patients with chronic obstructive pulmonary disease: how do we treat it?
Ovcharenko S.I.

Sechenov University, Moscow

Cardiovascular pathology in patients with chronic obstructive pulmonary disease (COPD) is one of the most frequent comorbid conditions in the clinic of internal diseases. Its high frequency is caused by both genetic disposition and general risk factors (smoking, old age, male sex, sedentary lifestyle, obesity, etc.). The COPD patients often suffer from arterial hypertension (AH), ischemic heart disease (IHD), including myocardial infarction and angina pectoris, arrhythmias and heart failure (HF). AH in patients with COPD has a number of significant features, referring mainly to the night period, which requires the intensification of antihypertensive therapy in the evening and night hours. This understanding is especially important in the development of treatment programs for hypertension in this category of patients. Taking into account the fact that the basis of cardiovascular pathology should be considered as a result of endothelial dysfunction and its consequences, in the treatment of such patients it is necessary to use drug therapy, including medications that positively influence the state of the endothelium. Indapamide with prolonged action is used for the treatment of hypertension.
To date, we have already accumulated a certain positive experience, including our personal one, of the use of highly selective adrenoblockers in patients suffering from cardiovascular diseases (IHD, AH + IHD, HF) in combination with COPD, which indicate their safety in effecting the respiratory function in this category of patients. The GOLD program postulates, that the treatment of cardiovascular disease in COPD patients should be carried out in the same way as without COPD, and, in turn, the treatment of COPD in patients with a combined cardiovascular pathology should be carried out in the same way as in COPD patients without this pathology. When treating this category of patients, it is necessary to use such medications that do not worsen the course of each of them, and in some cases improve. The article substantiates the use of such medications in patients with COPD who have combined cardiovascular pathology.

Key words: chronic obstructive pulmonary disease, cardiovascular diseases, arterial hypertension, ischemic heart disease, heart failure, drug therapy for cardiovascular disease in COPD.
For citation: Ovcharenko S.I. Cardiovascular pathology in patients with chronic obstructive pulmonary disease: how do we treat it? // RMJ. 2018. № 10 (I). P. 36–39.

Pages 40-43. Кашель у детей. Диагностика и подходы к терапии. Колосова Н.Г.

Summary: Cough in children. Diagnosis and approaches to therapy
N.G. Kolosova

Sechenov University, Moscow

Cough is one of the most frequent symptoms of respiratory tract diseases and is a protective reflex aimed at cleansing the airways in conditions of insufficient mucociliary clearance. In accordance with some characteristics of cough, doctors can often determine the localization, and sometimes even the nature of the disease that causes it. Cough can be productive and not productive by nature (depending on the presence of sputum, cough can be acute, subacute or chronic depending on its duration). The cause of acute cough is usually upper and lower respiratory tract infections, in addition, cough may indicate a disease that the doctor can not miss, such as bronchial asthma, bronchiolitis, whooping cough, pneumonia and aspiration of foreign bodies. Subacute coughing can be caused by hyperreactivity of the airways after an infection, whooping cough, bronchial asthma. The effectiveness of cough treatment largely depends on a correctly and timely diagnosed disease and is aimed at diluting sputum, reducing its adhesiveness (viscosity) and increasing the effectiveness of coughing. If it is necessary to prescribe antibacterial therapy, the drug of choice in this case is tiamphenicol glycinate acetylcysteinate (TGA), which is used in the form of inhalation.

Key words: children, cough, respiratory diseases, mucolytic therapy, antibacterial therapy, inhalation therapy, thiamphenicol glycinate acetylcysteinate (TGA).
For citation: Kolosova N.G. Cough in children. Diagnosis and approaches to therapy // RMJ. 2018. № 10 (I). P. 40–43.

Pages 44-48. Высокодозный режим терапии левофлоксацином в лечении внебольничных инфекций нижних дыхательных путей. Синопальников А.И., Романовских А.Г., Смирнов И.П.

Summary: High-dose regimen of levofloxacin therapy in the treatment of community-acquired infections of the lower respiratory tract
A.I. Sinopalnikov, A.G. Romanovskikh, I.P. Smirnov

Russian Medical Academy of Continuous Professional Education, Moscow

Currently, levofloxacin is one of the most popular antimicrobial drugs. A huge experience has been accumulated in the practical use of the antibiotic, which indicates its high efficacy and safety in the treatment of infections of various localizations. One of the priority indications for the levofloxacin prescription are community-acquired infections of the lower respiratory tract (LRTI).
Despite its long history, levofloxacin remains a reliable antibiotic used for the treatment of community-based LRTIs. Advantages of levofloxacin include high activity with respect to respiratory pathogens, proven efficacy, good tolerability, convenient dosing regimen (1p / day), availability in oral dosage forms and parenteral administration. At the same time, it should be noted that the future of the drug, the preservation of its antimicrobial activity depends on a rational approach to prescribing an antibiotic. The high-dose regimen of prescribing levofloxacin (750 mg / day), which allows to create higher antibiotic concentrations, has been successfully used in short courses of antibiotic therapy in patients with community-acquired pneumonia, as well as in patients with complicated exacerbation of chronic obstructive pulmonary disease and is considered as one of the options for optimizing the approach to the use of the drug.

Key words: community-acquired lower respiratory tract infections, antibacterial therapy, pneumonia, antibiotics, levofloxacin.
For citation: Sinopalnikov A.I., Romanovskikh A.G., Smirnov I.P. High-dose regimen of levofloxacin therapy in the treatment of community-acquired infections of the lower respiratory tract // RMJ. 2018. № 10 (I). P. 44–48.

Pages 5-5. Слово редактора. Лещенко И.В.

Pages 6-10. Идиопатический легочный фиброз: современный взгляд на патогенез и роль биомаркеров. Лещенко И.В., Жеребцов А.Д.

Summary: Idiopathic pulmonary fibrosis: modern view of pathogenesis and the role of biomarkers
I.V. Leshchenko1,2, A.D. Zherebtsov1

1 Ural State Medical University, Yekaterinburg
2 Medical Association “Novaya Bolnitsa”, Yekaterinburg

The article is devoted to the pathogenesis of idiopathic pulmonary fibrosis (IPF) and the role of biomarkers in the diagnosis and asssessing of the severity of the disease. IPF is a special form of chronic progressive fibrosing interstitial pneumonia of unknown etiology. It is shown that IPF is a disease of the pulmonary epithelium, which manifests itself as fibrosis, i. e.it is caused by dysfunction of the pulmonary epithelium. The theory of the three-stage development of the IPF is considered. From a diagnostic and differential diagnostic point of view, at suspicion on IPF it is important to determine the level of serum SP-A. The diagnostic role of other biomarkers (evaluated in these studies) is not established. When determining the prognosis, IPF can have the value of IL-8, the level of which correlates with the severity of the disease. Studies have shown that the serum biomarkers SP-A, MMP-7 and KL-6 can play a diagnostic and prognostic role for IPF patients. An inverse relationship was found between the concentration of biomarkers MMP-7 and KL-6 and the prognosis of 5-year survival in patients with IPF. Diagnostic and prognostic significance of biomarkers in IPF patients can be established only taking into account clinico-anamnestic, radiological and, in some cases, morphological methods of investigation.

Key words: idiopathic pulmonary fibrosis, pathogenesis, biomarkers.
For citation: Leshchenko I. V., Zherebtsov A. D. Idiopathic pulmonary fibrosis: modern view of pathogenesis and the role of biomarkers // RMJ. 2018. № 10 (I). P. 6–10.



№9, 2018. Педиатрия

Pages 13-17. Уменьшение лекарственной нагрузки на детский организм: опыт использования эфирных масел для профилактики и лечения острых респираторных инфекций. Старостина Л.С.

Summary: Reducing the drug load on children: the experience of using essential oils for the prevention and treatment of acute respiratory infections
L.S. Starostina

Sechenov University, Moscow

The problem of acute respiratory infections (ARI), especially during seasonal outbreaks, is relevant all over the world. The first target organ is the mucous membrane of the upper respiratory tract, and the most frequent manifestations of ARI are rhinitis, rhinosinusitis and other diseases of the respiratory system. The article discusses the features of the ARI course in children of different ages, the possibilities of preventing the development of ARI, their complications and reducing of their duration with the help of various methods, including such a trusted method as aromatherapy. The advantages of using essential oils for the treatment of ARI, in particular, their passive inhalation, are noted. Details of the composition of the essential oil Dyshi Oil, the results of clinical studies of this product are given. It has proved its effectiveness as a means for prevention or as a part of complex ARI therapy in children of different ages: it helps to reduce the duration of the disease, facilitates its course and reduces the need for antibiotics and nasal vasoconstrictors.

Key words: pediatrics, clinical studies, inhalation, ARI prevention, essential oils, aromatherapy, Dyshi Oil.
For citation: Starostina L.S. Reducing the drug load on children’s body: the experience of using essential oils for the prevention and treatment of acute respiratory infections // RMJ. 2018. № 9. P. 13–17.

Pages 17-19. Оценка возможности внедрения международного протокола по ведению детей с энтеровирусным везикулярным стоматитом на амбулаторном этапе оказания педиатрической помощи. Царькова С.А., Мороз Г.А., Бируля Н.И.

Summary: Possibilities of introducing the international protocol for the management of children with hand, foot and mouth disease on the ambulatory stage of pediatric care
S.A. Tsarkova1, G.A. Moroz2, N.I. Birulya2

1 Ural State Medical University, Ekaterinburg
2 Children`s City Clinical Hospital № 11, Ekaterinburg

The article considers the possibility of introducing an international protocol for the management of children with hand, foot and mouth disease on the ambulatory stage of providing pediatric care in the Russian Federation. The wide prevalence of this disease and the high resistance of the pathogen in the environment gives reasons to admit its epidemiological danger, especially for organized children’s groups, and the need to review and finalize the legislative measures taken to prevent and treat hand, foot and mouthh disease. The WHO (World Health Organization) protocol for the treatment and prevention of hand, foot and mouth disease in children contains a list of indications for ambulatory treatment, hospitalization, recommendations for symptomatic therapy. At the example of a clinical case, the orders and standards of Russian regulatory legal documents were assessed for compliance with the WHO protocol for the treatment and prevention of hand, foot and mouth disease in children. The possibility of using the international protocol in the conditions of the district pediatric service in the territory of the Russian Federation is shown. In this regard, there is a need for additional improvement of pediatricians’ qualification and ability to diagnose the “hand, foot and mouth” syndrome and bringing their knowledge in line with international standards to avoid an unreasonable treatment.

Key words: enteroviruses, vesicular exanthema, WHO protocol, “hand, foot and mouth”, aciclovir, outpatient clinic.
For citation: Tsarkova S.A., Moroz G.A., Birulya N.I. Possibilities of introducing the international protocol for the management of children with hand, foot and mouth disease on the ambulatory stage of pediatric care// RMJ. 2018. № 9. P. 17–19.

Pages 2-7. Алгоритм диагностики и лечения железодефицитных состояний у детей. Васильева Т.М., Захарова И.Н., Заплатников А.Л., Лазарева С.И., Мачнева Е.Б.

Summary: Algorithm for diagnosis and treatment of iron deficiency in children
T.M. Vasilyeva1,2, I.N. Zakharova1, A.L. Zaplatnikov1, S.I. Lazareva2, E.B. Machneva1

1 Russian Medical Academy of Continuous Professional Education, Moscow
2 Children’s City clinic № 133 of the Moscow City Health Department

Iron deficiency disorders (IDD) are the most common deficiency conditions in the human population, most common in children and women of reproductive age. Depending on the degree of severity of iron deficiency in the body, the latent iron deficiency state (LID) and iron deficiency anemia (IDA) are identified. The clinical manifestations of IDD are non-specific, and therefore their diagnosis is based on the identification of characteristic laboratory changes, which include: a decrease in the serum concentration of iron, ferritin and a decrease in the saturation index of transferrin by iron. In this case, if these laboratory markers are detected at a normal level of hemoglobin, the LID is diagnosed. In the same cases, when hypochromic, microcytic anemia takes place simultaneously with laboratory signs of iron deficiency (the criteria of which are reduction of hemoglobin concentration, decrease in the values of «blood color indices» and average volume of erythrocytes), the IDA diagnosed. At the same time, irrespective of the form of iron deficiency, the main method of therapy is the use of iron preparations. The choice of specific iron-containing drugs, as well as the way they are administered, the duration of the course of treatment and the dosage regimen depend on the initial degree of severity of iron deficiency, the age of the child and the state of the health in general.

Key words: anemia, children, iron deficiency, iron deficiency anemia, latent iron deficiency.
For citation: Vasilyeva T.M., Zakharova I.N., Zaplatnikov A.L. et al. Algorithm for diagnosis and treatment of iron deficiency in children // RMJ. 2018. № 9. P. 2–7.

Pages 22-28. Аллергический ринит: подходы к диагностике и лечению. Чотчаева А.А., Колотилина А.И., Корсунский И.А., Смирнова Г.И., Асманов А.И., Мунблит Д.Б.

Summary: Allergic rhinitis: approaches to diagnostics and management
A.A. Chotchaeva1, A.I. Kolotilina1, I.A. Korsunskiy1,2, G.I. Smirnova1, A.I. Asmanov3, D.B. Munblit1

1 Sechenov University, Moscow
2 Dmitry Rogachev National Research Center of Paediatric Hematology, Oncology and Immunology, Moscow
3 Pirogov Russian National Research Medical University, Moscow

Allergic rhinitis (AR) is one of the most common chronic conditions in children, however, it is still frequently underdiagnosed and undertreated. AR is not a life-threatening condition but lack of good control over AR symptoms results in a significant decrease in quality of life and affects school performance and work. AR is considered the most important risk factor for asthma development.
AR diagnostics are built around clinical history and allergy testing. The AR therapy is based on the use of intranasal corticosteroids and second-generation antihistamines. Both drug groups are highly effective and have good safety profile. First-generation antihistamines, in contrast, have a significant sedative effect, associated with reduced academic performance, and should not be routinely used in AR patients. Specific immunotherapy is highly effective in patients with well-established cause of symptoms.
Importance of standartised, evidenced-based approach to AR diagnosis and management is highlighted in both National and International guidelines. This review considers the current approaches to diagnosis and management of AR.

Key words: allergy, allergic diseases, allergic rhinitis, hay fever.
For citation: Chotchaeva A.A., Kolotilina A.I., Korsunskiy I.A. et al. Allergic rhinitis: approaches to diagnostics and management // RMJ. 2018. № 9. P. 22–28.

Pages 29-32. Целесообразность неонатального скрининга первичных иммунодефицитных состояний. Корсунский И.А., Гордукова М.А., Смирнова А.С., Мунблит Д.Б., Давыдова Н.В., Козлов И.Г., Продеус А.П., Корсунский А.А., Румянцев А.Г.

Summary: Feasibility of neonatal screening in primary immunodeficiency diseases
I.A. Korsunskiy1–3, M.A. Gordukova1, A.S. Smirnova1, D.B. Munblit2, N.V. Davydova1, I.G. Kozlov3, A.P. Prodeus1,3, A.A. Korsunskiy1,2, A.G. Rumyantsev3

1 Children’s City Hospital № 9, Moscow
2 Sechenov University, Moscow
3 Dmitry Rogachev National Research Center of Paediatric Hematology, Oncology and Immunology, Moscow

Primary immunodeficiency states are a heterogeneous group of congenital defects in the cells of the immune system, which are most often clinically manifested in recurrent infectious and autoimmune diseases of various severity, as well as malignant neoplasms. Severe forms of primary immunodeficiency lead to death in the first two years of life. Moderate forms lead to irreversible changes in the body, which significantly reduce the quality of a human life. The average age of setting an immunological diagnosis in developed countries is about 4–5 months. Most often, PIDs can be characterized by reduced functional ability of leukocytes to fight infections, however, some disorders are associated with limited differentiation of lymphoid cells or their increased apoptosis. Neonatal screening of primary immunodeficiencies helps to identify moderate to severe immune system defects prior to clinical manifestation. The outcomes of screening programs launched in different countries in recent years show high sensitivity and specificity of analysis aimed at detecting reduced TREC and KREC levels. Early detection of immunocompromised infants allows for modern approaches to treatment, improving survival rates. Early screening and intervention programmes in children with primary immunodeficiencies has also demonstrated high cost effectiveness.

Key words: primary immunodeficiencies, PIDs, neonatal screening, TREC, KREC. 
For citation: Korsunskiy I.A., Gordukova M.A., Smirnova A.S. et al. Feasibility of neonatal screening in primary immunodeficiency diseases // RMJ. 2018. № 9. P. 29–32.

Pages 33-38. Функциональные гастроинтестинальные расстройства у детей раннего возраста: современный взгляд на механизмы развития и возможности терапии. Казюкова Т.В., Котлуков В.К.

Summary: Functional gastrointestinal disorders in young children: a modern view of the mechanisms of development 
and the possibility of therapy
T.V. Kazyukova, V.K. Kotlukov

Pirogov Russian National Research Medical University, Moscow

Functional gastrointestinal disorders (FGD) are well known throughout the centuries. However, the concept of FGD has appeared recently, and now they are considered as the most common pathology of the gastrointestinal tract (GIT), which is most often registered in young children, bringing the sufferings and a decrease in the quality of life not only to the kid but also to his parents and to all family members. To date, many aspects of the etiology and pathogenesis of various forms of functional disorders of the GIT have a serious evidentiary basis, which is reflected in the Roman criteria IV (2016). Such disorders are caused by combined morphological and physiological abnormalities associated with violations of motility of the gastrointestinal tract, protective mucous barrier, immune function, intestinal microbiota, visceral hypersensitivity, and disorders of the central nervous system. In the Roman criteria (2016), many aspects of the FGD are specified, an algorithm for diagnosing and managing such patients is given, taking into account modern views on pathogenesis and the current possibilities of drug therapy.

Key words: functional gastrointestinal disorders, children of early age, infantile colic, approaches to therapy, simethicone, Bobotiс.
For citation: Kazyukova T.V., Kotlukov V.K. Functional gastrointestinal disorders in young children: a modern view of the mechanisms of development and the possibility of therapy// RMJ. 2018. № 9. P. 33–38.

Pages 39-44. Кишечная микробиота и иммунитет: иммуномодулирующие эффекты Lactobacillus rhamnosus GG. Оганезова И.А.

Summary: Intestinal microbiota and immunity: immunomodulatory effects of Lactobacillus rhamnosus GG
I.A. Oganezova

North-Western State Medical University named after I. I. Mechnikov, St. Petersburg

Intestinal microbiota is a complex formed by a large number of microorganisms, which make a kind of symbiosis with the human body, where everyone gets benefits for his existence and influences the partner. It can be confidently said, that there are no such functions of the body, which are not effected by the intestinal microbiota in one way or another.
The intestine is the largest immune organ of the human body, while the effectiveness of local immunity depends on the colonization of the intestine by an indigenous microflora. Lactobacilli take a special place in the process of formation and functioning of the immune system.
The aim of this review was to provide the most complete information about the composition and functions of the intestinal microbiota, its role in the formation of immunity and the therapeutic possibilities of Lactobacillus rhamnosus GG. The established mechanisms of molecular action, the detailed structural and genetic characteristics, the data of randomized studies and meta-analyzes, and the great experience of effective practical use of LGG make this strain the means of choice for the prevention and relieving a number of conditions caused by immune system dysfunction.

Key words: intestinal microflora, immunity, probiotic, Lactobacillus rhamnosus GG, LGG.
For citation: Oganezova I.A. Intestinal microbiota and immunity: immunomodulatory effects of Lactobacillus rhamnosus GG // 
RMJ. 2018. № 9. P. 39–44.

Pages 45-51. Стресс у детей: как активировать адаптационные резервы у ребенка. Акарачкова Е.С., Блинов Д.В., Котова О.В., Кадырова Л.Р., Лебедева Д.И., Мельникова И.М., Сорокина А.С., Травникова Е.В., Царева Е.В.

Summary:

Stress in children: how to activate adaptive reserves in children
E.S. Akarachkova1, D.V. Blinov2, O.V. Kotova1, L.R. Kadyrova3, D.I. Lebedeva4, I.M. Melnikova5, A.S. Sorokina6, E.V. Travnikova7, E.V. Tsareva8

1 International Society of Stress “Stress Under Control»
2 “Lapino” Clinic, Odintsovo
3 Kazan State Medical Academy — a branch of Russian Medical Academy of Continuous Professional Education
4 “Regional Treatment and Rehabilitation Center”, Tyumen
5 Yaroslavl State Medical University
6 Sechenov University, Moscow
7 Russian Presidential Academy of National Economy and Public Administration, Moscow
8 “Unison” Medical Center, Moscow

The child’s physical health is inseparable from his emotional state. Stresses actively interfere in the life of children and adolescents, reduce their ability to self-control, interfere with normal psychological and social development, and can also lead to negative consequences already at an older age. The adaptation mechanisms to stress of children and adolescents are imperfect. In the clinical practice, the application of therapeutic and prophylactic methods with the aim of increasing the stress-resistance in childhood and adolescence remains relevant. The article presents drug and non-drug methods, including the regimen of work and rest, motor conditions and adequate nutrition in conditions of stress. Methods for group activities (self-control techniques, relaxation, visualization, art therapy, exercises for removing «internal» blocks, communication skills, as well as working with metaphor and exercises for relieving anxiety) are recommended. Based on the literature, the conclusion is drawn that the healthy lifestyle of a child (full and proper nutrition, regular physical activity combined with rest, training in skills of overcoming difficulties) allows not only to increase the adaptive capacity, but also to substantially minimize the effects of chronic stress.

Key words: children, adolescents, adaptation, stress, prevention, treatment, bioorganic magnesium, magnesium pidolate, magnesium citrate, Magne B6, sleep, sleep disorders, physical activity, nutrition, psychological adaptation.
For citation: Akarachkova E.S., Blinov D.V., Kotova O.V. et al. Stress in children: how to activate adaptive reserves in children // RMJ. 2018. № 9. P. 45–51.

Pages 52-56. Послеоперационная когнитивная дисфункция у детей (обзор литературы). Пантелеева М.В., Овезов А.М., Котов А.С., Луговой А.В., Князев А.В.

Summary: Postoperative cognitive dysfunction in children (Literature review)
M.V. Panteleeva, A.M. Ovezov, A.S. Kotov, A.V. Lugovoy, A.V. Knyazev

Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy, Moscow

General anesthetics are one of the greatest medical discoveries, allowing to carry out diagnostic procedures and surgical interventions even in the very young patients, reducing the adverse effects of hemodynamic reactions in response to pain and stress stimulation. However, there are data on the ability of anesthetics to have a neurotoxic effect on the brain. Studies conducted on animals have shown a negative effect of general anesthetics on the developing brain, causing a widespread apoptotic neurodegeneration, impaired synaptogenesis and persistent memory and learning deficits. The clinical data, which testify to the development of postoperative cognitive dysfunction and the long-term learning disabilities in the pediatric population, remain conflicting. One of the main aims of the research in children is to determine the effect of anesthesia on cognitive function in early and delayed periods. The review presents data on the pathogenetic mechanisms of the effect of general anesthesia on the developing brain, occurring of delayed cognitive deficits in children, and possible approaches to their drug and non-drug prevention.

Key words: postoperative cognitive dysfunction, general anaesthesia, children, neuroprotection, hopantenic acid, Pantogam.
For citation: Panteleeva M.V., Ovezov A.M., Kotov A.S. et al. Postoperative cognitive dysfunction in children (Literature review) // RMJ. 2018. № 9. P. 52–56.

Pages 57-61. Опыт применения релиз-активных препаратов в лечении психических нарушений у детей раннего возраста. Козловская Г.В., Калинина М.А., Иванов М.В., Кремнева Л.Ф., Крылатова Т.А.

Summary: Experience in use of release-active drugs in mental disorders treatment in young children
G.V. Kozlovskaya, M.A. Kalinina, M.V. Ivanov, L.F. Kremneva, T.A. Krylatova

Mental Health Research Center, Moscow

A search for new forms and approaches in medicopsychological correction of revealed mental abnormalities during an early childhood period is very actual.
Aim: an effectiveness evaluation of Tenoten for children application in child psychiatric practice on the example of young patients.
Patients and Methods: a cohort of 80 children (60 boys and 20 girls) aged 1–4 years was selected. The cohort included children with asthenia, anxiety-phobic, subdepressive, psychovegetative disorders in forms of sleep disorders, eating behavior disorders, gastrointestinal disorders, and other neurotic (neurosis-like) and psychotic disorders. A procedure of Tenoten for children prescription: the study continued throughout one year, with regularity of inspection once a month. Tenoten for children was used in a form of 1–2 absorbable tablets (or in a form of crumbled tablet with an addition of a half teaspoonful of water) on an empty stomach under the tongue in the morning for 2–3 months, followed by a break of 6 months and a repeated course of taking that of the same duration, and in a number of cases was combined with complex homeopathic drugs.
Results: the greatest effect in using of Tenoten for children was noted for the asthenic syndrome, anxiety-phobic syndrome, and psychovegetative disorders, with an exception of dissomnia, as well as in states of a mental deviation risk. A negative result was obtained in the Tenoten for children therapy of catatonic disorders, speech disorders, severe autistic disorders. There were no cases accompanied by complications in the Tenoten for children treatment. In single cases (patients with schizotypal disorders), side effects of the drug were noted in a form of disease symptom intensification, which was associated with an activating action of the drug.
Conclusion: Tenoten for children can be recommended for wide use in the child psychiatric practice.

Key words: children, early age, medicopsychological correction, allopathic drugs, release-active drugs, Tenoten for children.
For citation: Kozlovskaya G.V., Kalinina M.A., Ivanov M.V. et al. Experience in use of release-active drugs in mental disorders treatment in young children // RMJ. 2018. № 9. P. 57–61.

Pages 62-68. К вопросу о патогенезе атеросклероза и коррекции атерогенных нарушений у детей. Неудахин Е.В., Морено И.Г.

Summary: Revisiting the pathogenesis of atherosclerosis and correction of atherogenic disorders in children
E.V. Neudakhin1, I.G. Moreno2

1 Scientific and Practical Center of Specialized Medical Care for Children named after V.F. Voino-Yasenetskiy, Moscow
2 Pirogov Russian National Research Medical University, Moscow

Atherosclerosis is the most common among the population and the most controversial pathology. The issues concerning the etiology and pathogenesis, prevention and treatment of its manifestations need further discussion. Based on the analysis of literature data, own observations and studies, the article proves the stressful character of atherogenic disorders in children with hypotrophy and obesity. At the same time, the development of atherogenesis emphasizes the starting role of oxidative stress, triggering energy disorders in cells, destabilization of cell membranes, damage to the vascular endothelium, initiation of inflammatory and autoimmune processes, as well as metabolic, endocrine and other disorders. It is noted that the course of the pathological process is undulating, progressive, characterized by a change in stages and phases. These changes indicate the need for early correction of the atherogenic shifts. The use of L-carnitine preparations is justified.

Key words: children, hypotrophy, obesity, pathogenesis, atherosclerosis, chronic stress, oxidative stress, L-carnitine.
For citation: Neudakhin E.V., Moreno I.G. Revisiting the pathogenesis of atherosclerosis and correction of atherogenic disorders in children // RMJ. 2018. № 9. P. 62–68

Pages 69-72. Эффективность синбиотиков у детей с атопическим дерматитом. Маланичева Т.Г., Зиатдинова Н.В., Сердинская И.Н.

Summary: Effectiveness of synbiotics in children with atopic dermatitis
T.G. Malanicheva, N.V. Ziatdinova, I.N. Serdinskaya

Kazan State Medical University

Aim: to improve methods of atopic dermatitis (AD) treatment in children on a basis of Maxilac® Baby synbiotic effectiveness study in children of the first years of life as part of complex therapy of this pathology.
Patients and Methods: 65 children with AD at the age from 4 months to 2 years, who are divided into two groups, were examined. A main group consists of 35 children receiving Maxilac® Baby synbiotic as a part of the complex therapy 1 sachet per day for 20 days. A comparison group — 30 children receiving only traditional antiallergic therapy, which in the compared groups did not differ. Clinical examination methods were performed with an assessment of AD severity on a SCORAD scale, as well as laboratory-instrumental and specific allergological methods.
Results: Against the background of ongoing therapy in children of the main group, overall therapeutic effect was 91.4±5.1%, and in the comparison group — 80.0±4.3%, p <0.05. This was manifested by a reduction of exacerbation period by 1.5 times — from 13.8±1.4 to 9.1±2.3 days, p <0.05. A high individual therapeutic effect (HIE) was observed by 2 times more often in the main group of children, and a low HIE was by 2.3 times less frequent than in the comparison group. In the main group of children, the SCORAD index decreased by 5 times — from 29.0±4.8 to 5.6±1.8, and in the comparison group by 3 times — from 29.3±4.7 to 9.8±1,9 points, p <0.05. Long-term positive effects were characterized by a prolongation of remission by 3 times, and in 62.8% of patients in the main group there was stable remission during an observation period against the background of a 3-fold decrease in a total IgE level and more than 1 class decrease of allergen-specific IgE level, as well as normalization of intestinal microbiota.
Conclusion: the obtained results open new possibilities for using Maxilac® Baby synbiotic in children with AD.

Key words: atopic dermatitis, food allergy, children, complex therapy, microbiota, synbiotic, Maxilac® Baby.
For citation: Malanicheva T.G., Ziatdinova N.V., Serdinskaya I.N. Effectiveness of synbiotics in children with atopic dermatitis // RMJ. 2018. № 9. P. 69–72.

Pages 8-12. Современный подход к терапии острых респираторных вирусных инфекций у детей с применением инозина пранобекса. Краснова Е.И., Хохлова Н.И., Проворова В.В., Панасенко Л.М., Куимова И.В.

Summary: Current approach to the therapy of acute respiratory viral infections in children with the use of inosine pranobex
E.I. Krasnova, N.I. Khokhlova, V.V. Provorova, L.M. Panasenko, I.V. Kuymova

Novosibirsk State Medical University

The high incidence of acute respiratory diseases (ARD) in children, relapses and reinfections, which form the category of frequently ill children (FIC) with long-lasting symptoms and complications, the possibility of deaths, especially in children of the first 3 years of life, make the timely diagnosis and rational therapy one of the most relevant problem in pediatric practice.
The highest incidence of ARD is observed in pre-school children attending organized groups. The list of effective and safe chemotherapeutic agents of etiotropic therapy for ARVI in children is very limited. The following direct antiviral agents are used in children: from the age of 1 year — oseltamyvir (recommended by WHO for severe and moderate forms of influenza), from 2 years — umifenovir (for mild and moderate forms of influenza and other acute respiratory viral infections), from 3 years — inosine pranobex (Isoprinosine). The most promising direction in the treatment of FIC is the prevention of polypharmacy, i. e. prescription the drug, which combines both antiviral and immunotropic effects, e. g., inosine pranobex.

Key words: inosine pranobex, isoprinosine, acute respiratory viral infections, antiviral therapy, frequently ill children.
For citation: Krasnova E.I., Khokhlova N.I., Provorova V.V. et al. Current approach to the therapy of acute respiratory viral infections in children with the use of inosine pranobex // RMJ. 2018. № 9. P. 8–12.



№8(I), 2018. Аллергология / иммунология

Pages 14-18. Опыт применения сублингвальной иммунотерапии у больных с сенсибилизацией к клещам домашней пыли. Костина Е.М., Молотилов Б.А.

Summary: Experience with sublingual immunotherapy in patients with sensitization to house dust mites
E.M. Kostina, B.A. Molotilov

Penza Physicians’ Continuing Education Institute — Branch of “Russian Medical Academy of Continuous Professional 
Education"

Allergen-specific immunotherapy (ASIT) is a modern method of treatment of allergic diseases (AD). Sublingual allergen administration is considered to be the most convenient, safe and promising. Sensitization to house dust mites (HDM) Dermatophagoides farinae (D. farinae) and Dermatophagoides pteronyssinus (D. pteronyssinus) is detected in more than 50% of patients with allergic rhinitis (AR) and bronchial asthma (BA). The importance of the molecular proteins Der p 1, Der p 2, Der p 23, Der f 1, and Der f 2 in development of clinical symptoms of asthma and rhinitis with household sensitization has been established. The ASIT, which based on major allergens, significantly improves treatment effectiveness. An introduction of new standardized allergens into practice enhances the ASIT capacity and makes it safer and more successful.
Aim: to evaluate effectiveness of sublingual allergen-specific immunotherapy (SLASIT) with a drug «Mixture of mites» 
in patients with bronchial asthma with the household sensitization.
Patients and Methods: 47 patients with a diagnosis of allergic form of bronchial asthma (ABA) caused by house dust mites 
(D. farinae and D. pteronyssinus) atopy were under supervision. Clinical laboratory, allergic-immunological examination has been provided. 30 subjects with the diagnosis of ABA were on sublingual ASIT with the drug «Allergens of mites», a control group was 17 subjects who received standard therapy with inhaled glucocorticosteroids (ICS).
Results: the SLASIT is a highly effective pathogenetic method of AD therapy. During treatment, there was a significant decrease of levels of total IgE, asIgE to the Der p 1 and Der p 2, and a significant diminution of intensity of skin tests with HDM allergens. A good tolerability of the SLASIT has been registered. There were side reactions in local reactions form in only 5 patients (16.5%). Efficacy of the SLASIT was 83.3% after the first year of treatment, 86.6% after the second year and 93.3% after the third year of therapy. Reduction of clinical symptoms and asthma recurrence frequency, and decrease of anti-inflammatory therapy quantity has been registered clinically.
Conclusion: the SLASIT is a safe, highly effective method of immunotherapy for AD. Clinical efficacy of the SLASIT is expressed in the decrease in intensity of allergic inflammation, changes in clinical symptoms of the ABA and AR, diminution in frequency of recurrences and lessening in volume of anti-inflammatory therapy.

Key words: bronchial asthma, home dust mites, allergen-specific immunotherapy, molecular diagnostics, Allergens of mites.
For citation: Kostina E.M., Molotilov B.A. Experience with sublingual immunotherapy in patients with sensitization to house dust mites // RMJ. 2018. № 8(I). P. 14–18.

Pages 19-27. Микробиота, мукозальный иммунитет и антибиотики: тонкости взаимодействия. Козлов И.Г.

Summary: Microbiota, mucosal immunity and antibiotics: the fineness of the interaction
I.G. Kozlov

D. Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow

There is a multi-level system for protecting the body from foreign infectious and chemical agents, known as «mucosa-associated lymphoid tissue» (MALT), in the barrier tissues (mucosa and skin). It includes humoral factors and cells of congenital and adaptive immunity, as well as non-immune defense mechanisms. One of the important components of protecting barrier tissues is the microbiota, whose commensals, on the one hand, carry out metabolic function and direct anti-pathogenic activity, and, on the other hand, constantly stimulate MALT at different levels and, thus, support the immunity of barrier tissues in the state of «smoldering activation” and readiness for a rapid response to the invasion of foreign organisms or substances. Antibiotics, being one of the most frequently prescribed medications, disrupt the number, composition and activity of symbiotic microorganisms. As a consequence, the immunity of barrier tissues is weakened, which contributes to the colonization of mucous and skin by pathogenic microorganisms and, in particular, their antibiotic-resistant strains. Awareness of this fact requires a change in the tactics of prescribing antibiotics and the introduction of additional medications to maintain MALT activity. Candidate drugs to supplement etiotropic anti-infective therapy are microbial-associated molecular patterns (MAMP) or, that is more real from the pharmacologycal point of view, their minimal biologically active fragments (MBAF).

Key words: mucosal immunity, microbiota, antibiotics, immunosuppression, infections, antibiotic resistance, immunomodulation, replacement therapy.
For citation: Kozlov I.G. Microbiota, mucosal immunity and antibiotics: the fineness of the interaction // RMJ. 2018. № 8(I). P. 19–27.

Pages 28-32. Диагностика лекарственной аллергии: современный взгляд на проблему. Мясникова Т.Н., Романова Т.С., Хлудова Л.Г., Латышева Т.В.

Summary: Diagnosis of drug allergy: a current view of the problem
T.N. Myasnikova, T.S. Romanova, L.G. Khludova, T.V. Latysheva

“National Research Center — Institute of Immunology” Federal Medical-Biological Agency of Russia, Moscow

Doctors of various specializations examine the patients with a burdened pharmacological history. The treatment of such patients requires an individual approach, taking into account the drug hypersensitivity. Such patients should be examined by allergist-immunologist to identify the offending drugs and select the alternative medications. Doctors of other specialties suggest that there are tests in vitro, which can be used by the allergist for accurate identification of the offending drug. But this is an erroneous opinion. Unfortunately, today there is no completely reliable method for diagnosis of drug allergy. This is due to heterogenous mechanisms of drug hypersensitivity, a wide range of medicines, a reaction on metabolites, individual features. The article describes a set of diagnostic methods, used for testing the drug hypersensitivity. The authors emphasize that in vivo testing is associated with certain risks of adverse reactions, and in vitro tests are safe, but unfortunately, they are not informative, which complicates the examination of patients with drug allergy.

Key words: drug allergy, drug hypersensitivity, diagnosis, in vitro tests, in vivo tests, skin testing, graded challenge test.
For citation: Myasnikova T.N., Romanova T.S., Khludova L.G., Latysheva T.V. Diagnosis of drug allergy: a current view of the problem // RMJ. 2018. № 8(I). P. 28–32.

Pages 3. Слово редактора.

Pages 33-38. Антигистаминные препараты в терапии хронической крапивницы. Ненашева Н.М.

Summary: Antihistamines in the treatment of chronic urticaria
N.M. Nenasheva

Russian Medical Academy of Continuous Professional Education, Moscow

Urticaria has a large medical and social significance due to its high prevalence. In 15–23% of adults in the stream of life there is at least one episode of acute urticaria, and the prevalence of chronic urticaria (CU) varies from 0.5 to 5%. Incidence of the urticaria often comes in working age and patients note a marked decrease in quality of life. Mast cells are key cells in pathogenesis of the urticaria, they express a variety of receptors, activation of which leads to cell degranulation and release of a multitude of mediators, the main one, with respect to the urticaria, is histamine. Many symptoms of the urticaria are mediated by an action of the histamine on H1-receptors, and prolonged continuous treatment with H1-antihistamines (H1-AH) is advisable in the treatment of CU. The main principle of pharmacological treatment of the CU is control or complete reduction of symptoms. Modern H1-AH of 2nd generation in licensed doses is a first-line treatment for the CU, but therapy with high doses of the H1-AH of 2nd generation is a second line. One of the H1-AH, most fully satisfying requirements for efficiency and safety, is levocetirizine. Pharmacological and clinical studies demonstrate a rapid onset of effect and a prolonged therapeutic action of the drug.

Key words: urticaria, blister, angioedema, mast cells, antihistamines, levocetirizine, Allerway.
For citation: N.M. Nenasheva. Antihistamines in the treatment of chronic urticaria // RMJ. 2018. № 8(I). P. 33–38.

Pages 39-45. Герпесвирусные инфекции человека: клинические особенности и возможности терапии. Щубелко Р.В., Зуйкова И.Н., Шульженко А.Е.

Summary: Human herpesviruses infections: clinical features and opportunities of therapy
R.V. Shubelko1, I.N. Zuykova2, A.E. Shulzhenko2

1 JSC "K+31", Moscow
2 “National Research Center — Institute of Immunology” Federal Medical-Biological Agency of Russia, Moscow

Herpesviruses are widely spread among the human population. After the primary infection, the herpesviruses become latent and persistent in the human body for life. Adverse conditions and a low local or systemic immunity may reactivate the infection, which causes the inflammation, usually at the local level. The variety of clinical forms of herpesviruses infections constantly supports scientific interest both in the field of studying their pathophysiology and in the search for effective antiviral therapy. This is especially important for β- and γ-herpesviruses, since the α-herpesvirus group has been studied rather well.
Aim: to determine the efficacy of valacyclovir for replication of the Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV-6), cytomegalovirus (CMV) in the oropharynx in frequently ill adults with chronic inflammatory diseases of the upper respiratory tract.
Patients and Methods: 80 patients with frequent recurrences of chronic inflammatory diseases of the upper respiratory tract were examined outpatiently. All patients underwent microbiological examination of swabs from the oropharynx and the viral load in mixed saliva and whole blood not in exacerbation period was assessed. Patients received valacyclovir therapy according to the scheme 500 mg x 3 times a day for 14 days. Control of viral load in the biomaterial was carried out after the end of treatment.
Results and Discussion: out of the period of exacerbation the oropharynx microflora in frequently ill adults is represented mainly by a normal or conditionally pathogenic microflora. EBV DNA, HHV-6, but not CMV DNA, were detected in the mixed saliva. The DNA of the herpesvirus was not detected in the blood samples of these patients. The use of valacyclovir in a dose 
of 500 mg 3 times a day significantly reduces the replication of EBV in the oropharynx in frequently ill adults.
Conclusions: it is advisable to conduct further studies to determine the dosage regimen and evaluate the clinical efficacy of acyclic nucleosides in the treatment of EBV infection.

Key words: herpes viruses, Epstein-Barr virus, human herpes virus, cytomegalovirus, frequently ill adults, viral load, valacyclovir.
For citation: Shubelko R.V., Zuykova I.N., Shulzhenko A.E. Human herpesviruses infections: clinical features and opportunities of therapy // RMJ. 2018. № 8(I). P. 39–45.

Pages 4-8. Ожирение и бронхиальная астма: клинико-аллергологическая характеристика. Глушкова Е.Ф., Шартанова Н.В., Лусс Л.В.

Summary: Obesity and bronchial asthma. Clinical and allergological characteristics
E.F. Glushkova, N.V. Shartanova, L.V. Luss

“National Research Center — Institute of Immunology” Federal Medical-Biological Agency of Russia, Moscow

Obesity, which is considered one of the risk factors for the development of bronchial asthma (BA), and the reasons for its insufficient control, can probably influence the inflammation of the respiratory tract. However, the nature of these relationships needs to be clarified.
Aim: to give a clinico-functional allergological and endocrinological characteristic, to highlight the features of the course and to determine the tactics of treating patients suffering from bronchial asthma in combination with obesity.
Patients and Methods: the study was conducted on the basis of the National Research Center — Institute of Immunology of Federal Medical-Biological Agency of Russia, both in the outpatient and inpatient conditions. A statistical analysis of 367 patients with different body mass index (BMI), who received an inpatient treatment for the exacerbation of asthma of varying severity, was performed. Forty patients with asthma, who met all entry criteria and did not have exclusion criteria, were examined on an outpatient basis.
Results: the analysis of the data showed, that the prevalence of obesity among the 367 patients, suffering from asthma and treated on inpatient basis in 2013–2015, was 44.9%, which is comparable to the prevalence of obesity in the general population. Thus, at the age of 18–30 the prevalence of obesity was 30%, 31–40 years — 37.93%, 41–50 years — 45.78%, 51–60 years — 55.88%. The severity of asthma in patients with normal, excessive body mass and obesity did not have statistically significant differences in patients of these groups. The structure of phenotypes of bronchial asthma was also comparable among patients with different BMI.
The present study found that the severity of BA in patients with obesity increases with the age, that is, the older the patient, the more severe clinical course of asthma.
Conclusion: when analyzing the data of the study in inpatient and outpatient patients suffering from asthma and obesity, it was established that obesity does not affect the severity of the clinical course of asthma. It is shown that obesity does not affect the control of symptoms of asthma.

Key words: bronchial asthma, metabolic syndrome, obesity, body mass index, VRI diagnostics.
For citation: Glushkova E.F., Shartanova N.V., Luss L.V. Obesity and bronchial asthma. Clinical and allergological characteristics // RMJ. 2018. № 8(I). P. 4–8.

Pages 46-52. Аллергический ринит. Проблемы ведения пациентов. Никифорова Г.Н., Федоскова Т.Г., Свистушкин В.М.

Summary: Allergic rhinitis. Challenges of patients mangement
G.N. Nikiforova1, T.G. Fedoskova2, V.M. Svistushkin1

1 Sechenov University, Moscow
2 “National Research Center — Institute of Immunology” Federal Medical-Biological Agency of Russia, Moscow

The article describes the challenges of managing patients with allergic rhinitis. Allergic rhinitis (AR) is a disease that characterized by IgE-mediated inflammation of the nasal mucosa developing after contact with the allergen. The late diagnosis of AR is the most common problem among patients, which is due to a number of aspects — low appealability on the background of a mild illness, no recognition of allergic symptoms by primary care doctors, lack of possibility to conduct specific allergodiagnostics in most of polyclinics.
In addition, the article describes the main principles of AR therapy — the pathogenetic approach, complexity, step-by-step treatment and prevention of the disease. It is emphasized, that the role and place of different therapy methods should be determined by the efficacy of their use for the treatment of the symptoms and the disease as a whole, the risk of side effects and complications, and the cost of treatment. The article describes antihistamines, or H1-histamine blockers, as the preparations of the first choice in the therapy of AR. Thus, an ideal approach to the treatment of patients with AR should be individualized, with special attention given to identifying and excluding the AR triggers in all cases.

Key words: allergic rhinitis, histamine, H1-histamine blockers, anti-inflammatory effect, cetirizine, Cetrine.
For citation: Nikiforova G.N., Fedoskova T.G., Svistushkin V.M. Allergic rhinitis. Challenges of patients mangement // 
RMJ. 2018. № 8(I). P. 46–52.

Pages 53-58. Краткосрочная профилактика проявлений наследственного ангионевротического отека. Латышева Т.В., Латышева Е.А., Манто И.А.

Summary: Short-term prophylaxis of hereditary angioedema
T.V. Latysheva, E.A. Latysheva, I.A. Manto

“National Research Center — Institute of Immunology” Federal Medical-Biological Agency of Russia, Moscow

Hereditary angioedema (HAE) due to the deficiency of the C1-inhibitor is an orphan disease characterized by derma deep layers’ and membrane mucosa’s edema development. Edema can be debilitating, it can significantly reduce patient’s quality of life and often lead to disability and even to death. Edema can occur both for no apparent reason, and under the influence of various trigger factors. Injury is one of the most common causes of edema, while there is a special group of triggers, which most often provoke life-threatening edema: various medical interventions such as diagnostic, dental and surgical. That is why patients with HAE are often denied the necessary examination or treatment due to the fear of edema, or, vise versa, medical interventions are provided without proper preparation, which leads to resuscitation, including tracheostomy. In addition, patients themselves are afraid of the edema development and reject the necessary medical care. Low awareness of medical staff about this rare disease worsens the situation. For today, there are some recommendations which have been developed to reduce the risk of edema. The introduction of these recommendations into practice allows not only to perform the required intervention without complications, but also to improve the quality of patient’s life.

Key words: hereditary angioedema, HAE, short-term prophylaxis, C1-inhibitor, Berinert, danazol, angioedema, bradykinin.
For citation: Latysheva T.V., Latysheva E.A., Manto I.A. Short-term prophylaxis of hereditary angioedema // RMJ. 2018. 
№ 8(I). P. 53–58.

Pages 59-63. Терапия антигистаминными препаратами при аллергическом рините и крапивнице у пациентов с атопией. Шабанов Д.В.

Summary: Therapy with antihistamine medications with allergic rhinitis and urticaria in patients with atopia
D.V. Shabanov

“National Research Center — Institute of Immunology” Federal Medical-Biological Agency of Russia, Moscow

Relevance of study of allergic diseases (AD) is conditioned by a tendency to increase in prevalence both in developed and developing countries. The prevalence of AD in most countries of the world is from 10 to 30% of urban and rural populations. In various regions of Russia, the prevalence of AD ranges from 19 to 40% among adult population and over 27% in children and adolescents. This article highlights a concept of atopy, genetic mechanisms and environmental factors of its implementation. Main aspects of pathogenesis of allergic rhinitis are considered as the most common pathology in patients with the atopy. And a problem of urticaria — an allergic dermatosis with a lot of etiological factors, is shown that presence of the atopy in patients with the urticaria certainly has an effect on its course and severity of inflammatory process. Features of antihistamine therapy with modern drugs of the second generation, and their influence on links of the inflammatory process are considered. Data studies on efficacy and safety of various antihistamines, including ebastine in increased dosage, is presented.

Key words: allergic rhinitis, urticaria, atopy, histamine, antihistamines, ebastine, Espa-Bastin.
For citation: Shabanov D.V. Therapy with antihistamine medications with allergic rhinitis and urticaria in patients with atopia // RMJ. 2018. № 8(I). P. 59–63.

Pages 9-13. Клиническая и цитокин-модулирующая эффективность композиции трех мурамилпептидов, содержащих остаток мезо-диаминопимелиновой кислоты, при хронической пиодермии. Летяева О.И., Зиганшин О.Р., Маркеева Д.А., Блохина Ю.В., Алексеева Н.Ю., Баранова Н.И., Калюжин О.В.

Summary: Clinical and cytokine-modulating efficacy of a composition of three muramylpeptides containing a meso-diaminopimelic acid residue in the treatment of chronic pyoderma
O.I. Letyaeva1,2, O.R. Ziganshin1, D.A. Markeeva2, Yu.V. Blokhina3, N.Yu. Alekseeva4, N.I. Baranova4, O.V. Kalyuzhin5

1 South Ural State Medical University, Chelyabinsk
2 Multidisciplinary Professorial Clinic CityMed of the Center of “Ecology of Health”, Chelyabinsk
3 Chelyabinsk Regional Clinical Dermatovenerologic Dispensary
4 Penza Physicians’ Continuing Education Institute — Branch of “Russian Medical Academy of Continuous Professional 
  Education”
5 Sechenov University, Moscow

Insufficiency of anti-infectious defense is one of the main causes of onset and recurrences of skin infections. In this regard, immunomodulators can be a useful option for complex treatment of chronic forms of these diseases. Special attention should be paid to low molecular weight fragments of peptidoglycan of bacterial cell wall, muramylpeptides.
Aim: to evaluate the clinical efficacy of a standardized composition of three muramylpeptides containing a meso-diaminopimelic acid residue (Polymuramyl) and the effect of this immunomodulator on the delayed dynamics of the concentration of proinflammatory and regulatory cytokines in patients with chronic recurrent pyoderma.
Patients and Methods: 35 men aged 23-55 years with recurrence of chronic pyoderma (ostiofolliculitis, folliculitis, sycosis, furunculosis) were included in the study. Patients were randomized into two groups: the patients in the group of comparison (n=17) received standard treatment for recurrence of the disease; the patients in the main group (n=18), in addition to the standard treatment, received intramuscular injections of Polymuramyl at a dose of 200 mg daily from day 1 to 5 of the study. Clinical symptoms of pyoderma were assessed on days 0-7, 14, and then after 1 and 6 months of the study. The level of cytokines (TNF-α, IFN-γ, IL-1β, IL-4, IL-8, IL-10) in blood plasma was determined by enzyme-linked immunosorbent assay on days 0 and 14, and then after 6 months of follow-up.
Results: the inclusion of Polymuramyl in the complex treatment of recurrence of chronic pyoderma in men accelerated the regression of the main clinical manifestations of the disease and provided the induction of persistent remission. Clinical efficacy of Polymuramyl correlated with a decrease in the level of pro- and anti-inflammatory cytokines in blood plasma on the day 14 and at 6 months of follow-up. The adverse effects associated with the treatment and cases of intolerance to the immunomodulator have not been recorded.
Conclusion: the effectiveness and safety of Polymuramyl in the treatment of recurrence of chronic pyoderma have been confirmed. The ability of this immunomodulator to induce persistent remission of this disease has been revealed.

Key words: chronic pyoderma, skin infection, muramylpeptides, meso-diaminopimelic acid, Polymuramyl, immunomodulator, symptom regression, remission induction, cytokines.
For citation: Letyaeva O.I., Ziganshin O.R., Markeeva D.A. et al. Clinical and cytokine-modulating efficacy of a composition of three muramylpeptides containing a meso-diaminopimelic acid residue in the treatment of chronic pyoderma // 
RMJ. 2018. № 8(I). P. 9–13.



№7, 2018. Неврология

Pages 10-14. Современные представления о патогенезе, диагностике и лечении синдрома Сусака. Чухловина М.Л., Вознюк И.А., Полушин А.Ю.

Summary: Contemporary view of the pathogenesis, diagnosis and treatment of Susac syndrome
Chukhlovina M.L.1, Voznyuk I.A.2, Polushin A.Yu.3,4

1 Almazov National Medical Research Centre, Saint-Petersburg
2 Medical Military Academy named after S.M. Kirov, Saint-Petersburg
3 Pavlov First Saint Petersburg State Medical University
4 Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, Saint-Petersburg

Susaс syndrome is an immune-mediated disease of the nervous system. In the clinical picture, it is represented by a triad of the main symptoms: subacute encephalopathy, occlusion of the retinal artery branches and neurosensory hearing loss. One of the main symptoms, in addition to visual impairment, may be a severe headache. These symptoms are based on microangiopathy. The immune-associated endotheliopathy in the microvascular channel leads to hypertrophy of endothelial cells with the subsequent occlusion of arterioles. As a result, there is perivascular inflammation followed by ischemia of the brain and retina. Differential diagnosis of the syndrome should be carried out with demyelinating diseases, vasculitis, toxic leukoencephalopathy. Blood and cerebrospinal fluid tests in most cases are not informative. The main role in diagnosing Susaс syndrome belongs to magnetic resonance imaging, according to which changes in the type of «snow balls» mainly in the central part of the corpus callosum are detected. The use of pulse therapy with methylprednisolone usually does not lead to the proper effect. This involves, along with the introduction of corticosteroids, the use of cytostatics and intravenous immunoglobulins. The scheme of therapy escalation of Susaс syndrome is presented in this article.

Key words: Susac syndrome, RED-M, SICRET, autoimmune diseases, microangiopathy, vasculitis, subacute encephalopathy, occlusion of the retinal artery branches, neurosensory hearing loss.
For citation: Chukhlovina M.L., Voznyuk I.A., Polushin A.Yu. Contemporary view of the pathogenesis, diagnosis and treatment of Susac syndrome // RMJ. 2018. № 7. P. 10–14.

Pages 15-22. Терапия когнитивных нарушений при хронической ишемии головного мозга в общеврачебной практике. Сметнева Н.С., Голобородова И.В., Попкова А.М., Самойлова Н.В., Игонина Н.П., Шатрова Г.В., Паневин Т.С.

Summary: Therapy of cognitive disorders in chronic cerebral ischemia in general medical practice
Smetneva N.S.1, Goloborodova I.V.1, Popkova A.M.1, Samoylova N.V.1, Igonina N.P.1, Shatrova G.V.2, Panevin T.C.3

1 A.I. Yevdokimov Moscow State University of Medicine and Dentistry
2 City Polyclinic No. 5, Moscow
3 National medical Research Center of Endocrinology, Moscow

The problem of population aging and widespread prevalence of comorbidity with the presence of chronic cerebral ischemia (CCI) requires a multidisciplinary approach, involving physicians, general practitioners and neurologists. CCI is one of the most common diseases leading to a serious decrease in the quality of life and severe disability of older patients. The article presents data on the etiology, diagnostic possibilities and basic principles of CCI therapy. Treatment of CCI, accompanied by cognitive disorders, includes the treatment of the underlying disease, non-drug therapy and the use of neuroprotective drugs. Among the drugs with neuroprotective properties, Actovegin is a unique preparation of biological origin that can provide multiple effects on both microcirculation and cellular metabolic processes and the regulation of neuronal apoptosis, and ultimately improve the cognitive function of patients with cerebral vascular diseases. This drug has an extensive evidence base in both experimental and clinical trials. Due to its low influence on blood pressure and a high safety profile, Actovegin can be recommended for a wide use in the therapy of patients with CCI.

Key words: chronic cerebral ischemia, dyscirculatory encephalopathy, dementia, cognitive disorders, neuroprotective drugs, Actovegin.
For citation: Smetneva N.S., Goloborodova I.V., Popkova A.M. et al. Therapy of cognitive disorders in chronic cerebral ischemia in general medical practice // RMJ. 2018. № 7. P. 15–22.

Pages 2-3. Заключение cовета экспертов по эпилептологии «Пролонгированные формы противоэпилептических препаратов как фактор достижения ремиссии».

Pages 23-27. Анализ болевого синдрома у больных ревматоидным артритом и остеоартритом коленных суставов. Филатова Е.С.

Summary:

Analysis of pain syndrome in patients with rheumatoid arthritis and osteoarthritis of the knee

Filatova E.S.

Scientific Research Institute of Rheumatology named after V. A. Nasonova, Moscow

Pain syndrome in rheumatoid arthritis (RA) and osteoarthritis (OA) was considered as a manifestation of a nociceptive pain. However, a number of Russian and foreign studies have shown the involvement of the central nervous system in the pathogenesis of chronic pain syndrome in RA and OA. A common mechanism that supports all types of pain in a chronic condition is central sensitization (CS) — the increased reactivity of central nociceptive neurons, finally resulting in the intensification of pain.
Aim: of the study was to assess pain in patients with RA and osteoarthritis of the knee (OAk).
Patients and Methods: all patients with RA (183 people) and OAk (89 people) were examined according to a single design. The examination included clinical-neurological, clinical-rheumatological examination, diagnosis of neuropathic pain by DN4 and Pain DETECT questionnaires, as well as the emotional-affection assessment (HADS).
Results: the study showed that in these articular pathologies the mechanisms of chronic pain syndrome had a mixed nature. In 43% of RA patients, along with the inflammation (nociceptive pain), a neuropathic component was revealed, represented by disorders of the peripheral nervous system and neuropathic descriptors. In OAk patients no pathology of the somatosensory nervous system was revealed, however, together with neuropathic descriptors, primary and secondary hyperalgesia was determined in the study of the sensitive sphere, which indicated the presence of a dysfunctional pain component in 37% of OAk patients.
Conclusion: the study of the pain phenotypes in various articular pathologies makes it possible to determine both the nociceptive component in the RA and the neuropathic and dysfunctional pain components in OAk, which opens the ways to pathogenetically-directed therapy.

Key words: rheumatoid arthritis, osteoarthrosis, ankylosing spondylitis, neuropathic pain, dysfunctional pain, central sensitization, B vitamins.
For citation: Filatova E.S. Analysis of pain syndrome in patients with rheumatoid arthritis and osteoarthritis of the knee // RMJ. 2018. № 7. P. 23–27.

Pages 28-32. Мультидисциплинарный подход к пациенту с хронической болью. Кадырова Л.Р., Акарачкова Е.С., Керимова К.С., Котова О.В., Лебедева Д.И., Орлова А.С., Ткачев А.М., Травникова Е.В., Царева Е.В.

Summary: A multidisciplinary approach to a patient with chronic pain
Kadyrova L.R.1, Akarachkova E.S.2, Kerimova K.S.3, Kotova O. V.1, Lebedeva D.I.4,5, Orlova A.S.6, Tkachev A.M.7,8, Travnikova E.V.9, Tsareva E.V.10

1 Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuing Professional Education
2 International society of stress «Stress under control», Moscow
3 Medi SPA Technology, Moscow
4 Tyumen State Medical University
5 Regional Treatment and Rehabilitation Center, Tyumen
6 Sechenov University, Moscow
7 Medical Institute named after Berezin Sergey (MIBS), Moscow
8 Ltd “TMM-Clinic”, Volgograd
9 The Russian Presidential Academy of National Economy and Public Administration (RANEPA), Moscow
10 Ltd “Unison”, Moscow

Chronic pain is a frequent manifestation of joints and spine diseases, requiring an interdisciplinary approach to diagnostics and treatment. In patients with long-term pain syndromes, many comorbid conditions are formed, which significantly affects the course of the disease. Within the framework of comorbidity bone and muscle diseases occupy a special place. In prevalence, osteoarthrosis (OA) is a leader among other rheumatic diseases. A variety of pathogenetic mechanisms, involved in formation and progression of the OA, leads to development of various pain syndromes by origin. The treatment of OA is a difficult complex task, requiring joint efforts of physicians of different specialties: rheumatologists, orthopedists, neurologists, and surgeons. More and more attention is paid to a group of drugs called time-delayed drugs (SySADOA — symptomatic slow acting drugs for osteoarthritis), which have a symptomatic and possible structural and modifying effect. Alflutop is an effective and safe drug from the SySADOA group, with a wide spectrum of chondroprotective, anti-inflammatory, and analgesic properties, that allows it to be used also in neurological practice in complex therapy of patients with various musculoskeletal diseases (spondylarthrosis, tendonitis, enthesitis), including comorbid patients, if prolonged therapy and limiting nonsteroidal anti-inflammatory drugs intake are necessary.

Key words: back pain, osteoarthrosis, facet joint, spine, comorbidity, school of health.
For citation: Kadyrova L.R., Akarachkova E.S., Kerimova K.S. et al. A multidisciplinary approach to a patient with chronic pain // RMJ. 2018. № 7. P. 28–32.

Pages 33-36. Нарушение сна и болевой синдром при грыжах межпозвонковых дисков поясничного отдела позвоночника: возможности терапии. Ткачев А.М., Акарачкова Е.С., Смирнова А.В., Илюшин А.В., Арчаков Д.С.

Summary: Sleep disturbance and pain syndrome in herniated intervertebral discs: treatment opportunities
Tkachev A.M.1, Akarachkova E.S.2, Smirnova A.V.1, Ilyushin A. V.1, Archakov D.S.3

1 Dr.Berezin Medical Institute, Volgograd
2 International society of stress «Stress under control», Moscow
3 LLC «TMM-Klinik», Volgograd

Sleep disturbance often accompanies pain syndrome associated with herniated intervertebral disc (HIVD). Studies demonstrate a two-way relationship between sleep disorders and pain intensification.
Aim: to evaluate the efficacy of combined gabapentin and melatonin therapy of pain syndrome in patients with HIVD.
Patients and Methods: the study included 39 patients with acute low back pain. The first group included 21 patients who received conventional therapy, the second group — 18 patients who received additionally 3 mg of melatonin before sleep. 
All patients received gabapentin 300–900 mg/day and rehabilitation. Treatment efficacy was assessed using VAS, Pittsburgh Sleep Quality Index and Oswestry Disability Index on 1, 2, 3 and 4 weeks of the treatment and 3 months after the treatment.
Results: patients in the second group had a faster and more pronounced regression of pain syndrome with improved sleep quality during the acute period. No significant differences between groups at 3 months after treatment were observed.
Conclusion: inclusion of melatonin into the treatment plan of patients with pain syndrome associated with HIVD increases the treatment efficacy and can be recommended as a part of multimodal treatment of these patients.

Key words: pain syndrome, sleep disturbance, herniated intervertebral disc, lumbar spine, melatonin, gabapentin.
For citation: Tkachev A.M., Akarachkova E.S., Smirnova A.V. et al. Sleep disturbance and pain syndrome in herniated intervertebral discs: treatment opportunities // RMJ. 2018. № 7. P. 33–36.

Pages 37-40. Перспективы практического применения методов клинической нейрофизиологии. Паломар Х., Исайкин А.И., Свет М.С., Алексеев А.В.

Summary: Perspectives: practical application of clinical neurophysiology
Palomar H.1, Isaikin A.I.2, Svet M.S.1, Alekseev A.V.3

1 “P-DTR Rehabilitation and research center”, Geneva, Switzerland
2 Sechenov State Medical University, Moscow
3 LLC “Med-UrConsult”, Moscow

The practical healthcare during recent decades has been marked by the growing popularity of evidence-based medicine when determining methods or means of treatment and/or medical examination. At the same time, however, expenses on non-drug methods of treatment applied in neurology, orthopedics and rehabilitation medicine continue to increase. In recent years, there has been a tendency towards the growing use of osteopathy and applied kinesiology, which have slightly supplanted exercise therapy, manual therapy and physiotherapeutic methods of treatment. Among the methods practiced more and more often over the last years, there is a proprietary method stemmed from applied kinesiology and osteopathy, but based on the classical principles of neurophysiology — the method of proprioceptive deep tendon reflex (P-DTR), elaborated by Jose Palomar. The following article provides the theoretical evidence underlying the method and verified by the results of the neurophysiological research.

Key words: clinical neurophysiology, rehabilitation, proprioceptive deep tendon reflex.
For citation: Palomar H., Isaikin A.I., Svet M.S., Alekseev A.V. Perspectives: practical application of clinical neurophysiology // 
RMJ. 2018. № 7. P. 37–40.

Pages 4-8. Синдром недостаточности кровотока в артериях вертебробазилярной системы. Максимова М.Ю., Пирадов М.А.

Summary: Syndrome of insufficiency of blood flow in arteries of vertebrobasilar system
Maximova M.Yu., Piradov M.A.

Research Center of Neurology, Moscow

Disorders of blood flow in the arteries of the vertebrobasilar system account for about 70% of all transient ischemic attacks (TIA). Stroke with localization of focal changes in areas of the brain that receive blood along the arteries of this system develops 2.5 times less often than in the carotid system. The diagnosis of insufficient blood flow in the arteries of the vertebrobasilar system is based on a characteristic symptom complex, which combines several groups of clinical symptoms that occur in patients with atherosclerosis (AS) and arterial hypertension (AH). These are visual and oculomotor disorders, violations of statics and coordination of movements, vestibular disorders. At various stages of vertebrobasilar insufficiency, patients often complain of memory loss, impaired cognitive functions, which significantly reduces the quality of life, and also affects the progression of cerebral vascular insufficiency. Treatment of vertebrobasilar insufficiency is aimed at preventing its progression, improvement of blood supply to the brain, correction of individual syndromes and symptoms. Citicoline (Neipilept) can be used to improve memory and cognitive functions, as one of the most promising neuroprotective drugs in terms of evidence-based medicine.

Key words: vertebrobasilar system, blood flow disturbance, transient ischemic attack, atherosclerosis, arterial hypertension, Neipilept.
For citation: Maximova M.Yu., Piradov M.A. Syndrome of insufficiency of blood flow in arteries of vertebrobasilar system // RMJ. 2018. № 7. P. 4–8.



№6(I), 2018. Кардиология

Pages 14-18. Влияние никорандила на дисперсию интервала QT у пациентов со стабильной стенокардией, нуждающихся в плановой ангиопластике: тройное слепое рандомизированное плацебо-контролируемое исследование (реферат).

Summary: Effect of nicorandil on QT dispersion in patients with stable angina pectoris undergoing elective angioplasty: a triple-blind, randomized, placebo-controlled study (abstract)

Nicorandil causes relaxation of the smooth muscle cells of the heart vessels and has a vasodilating effect on the coronary vessels. In addition, it has antiarrhythmic and cardioprotective effects by improving reperfusion, and leads to a reduction in microvascular damage associated with percutaneous coronary intervention (PCI).
Aim: to determine the effect of nicorandil on QT interval dispersion (QTd) in patients with stable angina pectoris during elective angioplasty.
Patients and Methods: the triple-blind randomized clinical trial was performed on the patients with stable angina pectoris, which were candidates for elective coronary angiography between January and October 2016. Patients were randomly divided into 2 groups: the main group, which received nicorandil (60 mg divided into three doses: 20 mg before 12 and 3 hours and 20 mg after PCI), and the control group, which received placebo. All patients underwent electrocardiography 12 hours before and 12 hours after PCI. The values of the maximal corrected QT interval (QTc max) and QTd were compared, as well as the degree of QTd change (QTd difference before and after angiography).
Results: 90 patients — 55 men and 35 women (mean age 58.6±10.8 years) were divided into two groups of 45 people. Both groups were comparable in the main clinical data.
The QTd before angiography had no statistically significant difference between the patients of both groups (control 77.7±17 ms, main 80.7±14.2 ms, p=0.371). The QTd after PCI in the nicorandil group was lower than in the control group (48.1±14.2 and 59.2±15.6 ms, respectively, p<0.05). The decrease rate of QTd had a statistically significant difference between the two groups (control: 18.9±11.0, vs. nicorandil: 33.5±9.5 ms, p<0.05).
Conclusions: the results of this study showed that oral administration of nicorandil around the PCI could further reduce QTd following the PCI, compared to the control group.

Key words: nicorandil, QT-dispersion, percutaneous coronary intervention, angioplasty, ischemic heart disease, atherosclerosis, cardiovascular diseases.
For citation: Effect of nicorandil on QT dispersion in patients with stable angina pectoris undergoing elective angioplasty: 
a triple-blind, randomized, placebo-controlled study (abstract) // RMJ. 2018. № 6(I). P. 14–18.

Pages 19-24. Оценка ранних результатов реваскуляризации у больных с острым коронарным синдромом без подъема сегмента ST с поражением проксимальной трети передней нисходящей артерии, включая изолированные и мультисосудистые стенозы. Колупаев А.Н., Мальчикова С.В.

Summary: Evaluation of early results of revascularization in patients with non-ST elevation acute coronary syndrome with proximal left anterior descending coronary artery disease, including isolated and multivessel stenoses
Kolupaev A.N., Malchikova S.V.

Kirov State Medical University

Aim: to evaluate and compare the immediate results of percutaneous coronary intervention (PCI) and aortic coronary artery bypass graft (CABG) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) with proximal left anterior descending (LAD) coronary artery disease.
Patients and Methods: 103 patients with NSTE-ACS with proximal LAD coronary artery disease were included in the study on a prospective basis. The patients received the invasive treatment: coronary artery bypass grafting (CABG) — 63 patients (61.2%) and percutaneous coronary intervention (PCI) — 40 patients (38.8%). They were divided into two groups, respectively. Revascularization was carried out on the basis of the Kirov Regional Clinical Hospital. Prior to invasive / operative treatment, the clinical course of the disease, comorbidity, total cardiovascular risk before NSTE-ACS, scores on scales Euroscore II, SYNTAX, and echocaridioscopic parameters were evaluated. The endpoints of the study were death, myocardial infarction associated with СABG/PCI, acute cerebrovascular accident / transient ischemic attack, postoperative complications. Endpoints were evaluated during the period from hospitalization to the regional vascular center until the end of the period of treatment in the rehabilitation center.
Results: there was no difference between the groups by sex and age. Statistically significant differences were in the SYNTAX scale (p <0.05), the time of surgical treatment (p <0.01). There were no statistically significant differences between the groups by end points (p> 0.05). When it was technically possible, in patients with isolated stenoses of the proximal LAD coronary artery disease of 50–80%, PCI was preferred. With stenoses from 90% or more, the decision was made based on the clinical condition of the patient — repeated recurrence of pain syndrome, unstable hemodynamic parameters.
Conclusions: CABG (р<0.01) is prefferable in patients with proximal LAD disease with ostial lesion of LAD, hemodynamically significant multivessels defeat, stenosis of trunk of left coronary artery of more than 50%, extended stenosis of LAD.
The choice of the revascularization method in this category of patients should be determined by a cardio team based on the application of stratification scales in the aggregate, and integrated approach.

Key words: coronary heart disease, atherosclerosis, coronary arteries, stenting, aortic coronary artery bypass graft, anterior descending artery, cardiovascular diseases.
For citation: Kolupaev A.N., Malchikova S.V. Evaluation of early results of revascularization in patients with non-ST elevation acute coronary syndrome with proximal left anterior descending coronary artery disease, including isolated and multivessel stenoses // RMJ. 2018. № 6(I). P. 19–24.

Pages 25-28. Ацетилсалициловая кислота в практике врача-терапевта. Кашталап В.В., Барбараш О.Л.

Summary: Acetylsalicylic acid in the practice of a therapist
Kashtalap V.V.1,2, Barbarash O.L.1.2

1 Kuzbass Cardiology Center, Kemerovo
2 Kemerovo State Medical Univesity

The article presents the current state of the use of acetylsalicylic acid (ASA) in the practice of a physician based on current clinical recommendations and the results of randomized clinical trials. The advantage of using enteric forms of the drug is shown. The mechanism of antiplatelet action of ASA is described. The possibilities of using ASA for primary and secondary prevention of atherothrombotic complications of ischemic heart disease are discussed in detail. The evidence base for the long-term use of aspirin for the prevention of such repeated cardiovascular events as myocardial infarction, unstable angina, ischemic stroke, and associated mortality is now undoubted. Long-term use of ASA for primary prevention of cardiovascular events by persons without clinical manifestations of atherosclerosis does not provide a reduction in cardiovascular mortality and at the same time increases the incidence of large gastrointestinal and extracranial bleeding. The issues of safety of ASA and the possibility of reducing the risk of gastropathy are considered. Additional effects of acetylsalicylic acid on the prevention of certain forms of oncopathology are shown. So the daily use of aspirin in a dosage of 75–100 mg is associated with a decrease in the risk of colorectal cancer and other types of oncology.

Key words: atherothrombosis, ischemic heart disease, cardiovascular diseases, cardiovascular mortality, acute coronary syndrome, acetylsalicylic acid, aspirin, Sanovasc.
For citation: Kashtalap V.V., Barbarash O.L. Acetylsalicylic acid in the practice of a therapist // RMJ. 2018. № 6(I). P. 25–28.

Pages 29-32. Актуальные вопросы взаимозаменяемости лекарственных препаратов: оригинальный бисопролол или воспроизведенные лекарственные средства (дженерики)?. Максимов М.Л., Ермолаева А.С.

Summary: Topical issues of interchangeability of medicinal preparations: original bisoprolol or reproduced drugs (generics)? 
Maksimov M.L.1, Ermolaeva A.S.2

1 Kazan State Medical University, branch of the Russian Medical Academy of Continuous Professional Education
2 Sechenov University, Moscow

The article discusses the topical issues of the drugs interchangeability. It is believed, that the use of generic drugs significantly reduces the cost of health care. However, if the patient buys a low-quality generic instead of an original drug, he at best receives a less effective remedy, but most often — significant undesirable drug reactions, for which the money, time and efforts of the patient and his family are spent. Bioequivalent reproduced medicines (generics) are not always similar in effectiveness and safety to original drugs. The relatively low cost of generics is their main and the only advantage over the original drugs. The reasons for the low cost of generics may be obsolete or simplified production technologies, use of low-quality substances, lack of comparative clinical studies with the original drugs; absence of multi-year studies of the long-term consequences of therapy. The article gives examples of the non-equivalence of reproduced drugs, presented in the domestic pharmaceutical market, in particular, generic preparations of bisoprolol, which differ from the original drug both in efficiency and safety.

Key words: original preparations, reproduced drugs, generics, bisoprolol, interchangeability, bioequivalence, therapeutic equivalence, safety, efficacy.
For citation: Maksimov M.L., Ermolaeva A.S. Topical issues of interchangeability of medicinal preparations: original bisoprolol or reproduced drugs (generics)? // RMJ. 2018. № 6(I). P. 29–32.

Pages 3-3. Слово редактора.

Pages 33-40. Современные принципы снижения периоперационных кардиальных осложнений при внесердечных хирургических вмешательствах. Джиоева О.Н., Орлов Д.О., Резник Е.В., Никитин И.Г., Родоман Г.В.

Summary: Current principles of decreasing perioperative cardial complications in extracardiac surgical interventions
Dzhioeva O.N.1,2, Orlov D.O.1, Reznik E.V.2, Nikitin I.G.2, Rodoman G.V.1

1 Municipal Clinical Hospital No. 24, Moscow
2 Pirogov Russian National Research Medical University, Moscow

Throughout the world, the rate of complications in extracardiac surgeries ranges from 7 to 11%, the lethality ranges from 0.8 to 1.5%. Cardiovascular complications in the perioperative period are the main interdisciplinary problem. The comorbid background is much more common among elderly and senile patients than in middle-aged patients, that increases the number of surgical interventions performed in elderly patients with a burdened cardiac anamnesis, which cannot and should not be a reason for a refusal from surgical treatment. Therefore, the problem of stratification and modification of perioperative risk factors, the systematization of schemes and methods for perioperative and intraoperative cardiac monitoring is very important and urgent, which makes it possible to predict the probability of postoperative complications and optimize the therapeutic regimens of postoperative cardiac support in the hospital and outpatient stage. The main aim of a competent perioperative monitoring is to improve patient outcomes and reduce economic costs. The article considers the current provisions on the stratification of cardiac perioperative risk in extracardiac interventions, and identifies the problems requiring further study.

Key words: cardiac risk, extracardiac surgical intervention, perioperative complications.
For citation: Dzhioeva O.N., Orlov D.O., Reznik E.V. et al. Current principles of decreasing perioperative cardial complications in extracardiac surgical interventions // RMJ. 2018. № 6(I). P. 33–40.

Pages 42-46. Роль антиагрегантов и статинов в снижении сердечно-сосудистого риска: возможности фиксированных комбинаций. Карпов Ю.А.

Summary: Role of antiaggregants and statins in cardiovascular risk reduction: opportunities for fixed combinations
Karpov Yu.A.

National Medical Research Center for Cardiology, Moscow

Cardiovascular risk reduction with decreasing morbidity and mortality from cardiovascular diseases is considered as one of the main tasks of modern cardiological practice and should contribute to an increase in life expectancy in our country. Efficacy and safety of statins and acetylsalicylic acid (ASA) have been confirmed in a large number of randomized trials. The use of statins and ASA in patients with a very high cardiovascular risk to reduce incidence of myocardial infarction, stroke, and vascular death is beyond doubt. In this category of patients, the usage of fixed combinations of statins and ASA opens up new opportunities for improving efficacy through better compliance to treatment. However, the use of the same technologies for primary prevention in people with a relatively low risk of cardiovascular events raises certain doubts. The prescription of ASA and statins to patients without clinical manifestations of atherosclerosis in accordance with modern clinical recommendations should be strictly individual.

Key words: statins, acetylsalicylic acid, prevention of cardiovascular complications, compliance, fixed combinations.
For citation: Karpov Yu.A. Role of antiaggregants and statins in cardiovascular risk reduction: opportunities for fixed combinations // RMJ. 2018. № 6(I). P. 42–45.

Pages 46-48. Редкий клинический случай болезни Хагемана у пациентки кардиологического отделения. Ахмедов В.А., Шадевский В.М., Судакова А.Н., Гаус О.В., Гудалов С.О., Шустов А.В.

Summary:

Rare clinical case of Hageman disease in the patient of the cardiological department

Akhmedov V.A.1, Shadevsky V.M.1, Sudakova A.N.1, Gaus O.V.1, Gudalov S.O.2, Shustov A.V.2

1 Omsk State Medical University
2 “Clinical Cardiology Hospital”, Omsk

Hageman’s disease is an extremely rare disorder of hemostasis, characterized by a significant decrease in the activity of plasma blood coagulation factor XII. The presented case reports the identification of rare Hageman disease in the woman of 58 years old with cardiac pathology. The patient repeatedly admitted to the cardiology department for treatment of ischemic heart disease, arterial hypertension. During one of the visits, an elongation of the activated partial thromboplastin time (APTT) was revealed, which was the cause for further follow-up. Conducting the examination in the conditions of the hematological scientific center revealed a rare pathology of coagulation — Hageman’s disease, based on the absence of factor XII in the coagulogram, prolongation of the APTT and retardation of fibrinolysis. The feature of this case is that the disease has been asymptomatic for a long time, aggravating the course of cardiovascular pathology. Particularly interesting is the fact that the patient was found to have a complete absence of blood coagulation factor XII, whereas in previously published observations only the deficiency of this factor was described.

Key words: rare case, Hageman’s disease, absence of factor XII, coagulating blood system, hemostasis, coagulogram, APTT.
For citation: Akhmedov V.A., Shadevsky V.M., Sudakova A.N. et al. Rare clinical case of Hageman disease in the patient of the cardiological department // RMJ. 2018. № 6(I). P. 46–48.

Pages 5-8. Высокая комплаентность как фактор эффективного лечения артериальной гипертонии. Агеев Ф.Т.

Pages 9-12. Алгоритм диагностики и терапии психоэмоциональных расстройств у больных с артериальной гипертензией. Дадашева М.Н., Дадашева К.Н., Каравашкина Е.А., Тараненко Н.Ю., Горенков Р.В., Круглов В.А., Агафонов Б.В.

Summary: Algorithm of diagnostics and therapy of psychoemotional disorders in patients with arterial hypertension
Dadasheva M.N.1, Dadasheva K.N.1, Karavashkina E. A.2, Taranenko N.Yu.2, Gorenkov R.V.2, Kruglov V.A.1, Agafonov B.V.1

1 Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy
2 A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Diseases of the cardiovascular system have actual medical, social and economic importance. Arterial hypertension (AH) is the most common disease among them. AH is a risk factor for the development of cerebrovascular disease, as well as premature death.
Aim: to study the clinical features of the course and the effectiveness of correction of psychoemotional disorders in patients with chronic cerebral ischemia, depending on the severity and duration of hypertension.
Patients and Methods: 150 people with AH were under observation, the duration of hypertension averaged 12.0±3.6 years. The study included patients with a stable value of blood pressure not higher than 140/90 mm Hg, who received antihypertensive therapy. 
Patients with anxiety disorders and increased variability of blood pressure were treated with a 4-week course of anxiolytic therapy: Group 1 included 30 patients, who received tofisopam at a dose of 50 mg twice a day; Group 2 included 30 people, who received affinely purified antibodies to the brain-specific protein S-100 in release-active form (Tenoten) 1 tablet 3 times a day.
The examination algorithm included: physical and neurological examination, including 24-hour BP monitoring. A study of cognitive functions was carried out. To assess the psychoemotional state, the Spielberger-Hanina anxiety scale and the Hamilton anxiety and depression scale were used.
Results: the main symptoms in patients with chronic cerebral ischemia on the background of AH are cognitive and psychoemotional disorders. These patients are characterized by anxiety, phobias, and expressed autonomic disorders. Affinely purified antibodies to the brain-specific protein S-100 in release-active form (Tenoten) proved to be effective for the correction of psychoemotional disorders.
Conclusion: the development of methods for treating psychoemotional disorders in AH patients seems to be an extremely important task, the earliest possible start of treatment allows stabilizing blood pressure and improving the quality of life of patients. The experience of using the preparation Tenoten shows that it has a significant anti-anxiety effect and allows to stabilize blood pressure and reduce the risk of complications of hypertension.

Key words: arterial hypertension, increased diurnal variability of arterial hypertension, chronic cerebral ischemia, cognitive disorders, psychoemotional disorders, antibodies to the brain-specific protein S-100 in release-active form.
For citation: Dadasheva M.N., Dadasheva K.N., Karavashkina E.A. et al. Algorithm of diagnostics and therapy of psychoemotional disorders in patients with arterial hypertension // RMJ. 2018. № 6(I). P. 9–12.



№5(II), 2018. Педиатрия

Pages 104-112. Внебольничная пневмония у подростка с впервые выявленными бронхоэктазами. Барденикова С.И., Зайцева О.В., Снитко С.Ю., Довгун О.Б.

Summary: Community-acquired pneumonia in a teenager with the first revealed bronchiectasis
Bardenikova S.I.1, Zaytseva O.V.1, Snitko S.Yu.1, Dovgun O.B.2

1 A. I. Yevdokimov Moscow State University of Medicine and Dentistry
2 Children’s City Clinical Hospital of St. Vladimir, Moscow

The article presents a clinical case of bronchiectasis diagnosed for the first time with pneumonia in a boy at the age of 13 years. The severe course of the disease with severe respiratory insufficiency, subcutaneous emphysema, infectious-toxic cardiomyopathy, pulmonary edema, was accompanied by an x-ray picture of multi-focal (multilobar, bilateral) pulmonary lesion and did not correspond to community-acquired infection and the safe premorbid background of the child. Multispiral computed tomography, performed when local symptomatology in the lungs after resolving acute inflammation returned, revealed structural changes in the bronchial tree — cylindrical bronchiectasis. With the resolution of pneumonia, the boy showed a clinical picture of bronchial obstructive syndrome, as a result, probably, of intrahospital superinfection with atypical pathogens (mycoplasmas, pneumocysts) against the background of a decrease in immune resistance. The article notes that the frequent cause of bronchial obstructive syndrome in patients without atopic heredity is atypical infections occurring in the form of obstructive bronchitis. The article discusses the following issues: congenital genesis of multiple bronchiectasis, possible causes of their late verification, the role of the severe course of the present disease with the successive change of infectious agents, algorithms for treating the patient with the importance of active drainage and anti-relapse antibacterial therapy. Issues for discussion are the potential risks of exacerbation of the disease, rational ways of rehabilitation, including active immunization with bacterial pneumococcal vaccines and hemophilic rod, palliative surgical intervention — capable of improving the prognosis of the disease and the quality of life of a teenager with bronchiectatic disease.

Key words: community-acquired pneumonia, pulmonary edema, broncho-obstructive syndrome, superinfection, bronchiectatic disease, rehabilitation, prognosis.
For citation: Bardenikova S.I., Zaytseva O.V., Snitko S.Yu., Dovgun O.B. Community-acquired pneumonia in a teenager with the first revealed bronchiectasis // RMJ. 2018. № 5(II). P.104 –112.

Pages 67. Слово редактора.

Pages 68-71. Синдром прорезывания зубов у младенцев: новый взгляд на старую проблему. Заплатников А.Л., Касьянова А.Н., Майкова И.Д.

Summary: Teething syndrome in infants: a new look at the old problem
Zaplatnikov A.L.1,2, Kasyanova A.N.1, Maikova I.D.2

1 Russian Medical Academy of Сontinuous Professional Education, Moscow
2 Children’s City Clinical Hospital named after Z.A. Bashlyaeva, Moscow

Primary teeth eruption is the greatest challenge for children and their parents, as well as for a pediatrician. It’s a false belief, that the milk teeth are only temporary organs, which will be replaced by permanent teeth, and that their diseases and loss do not have any consequences. This article presents an analysis of the literature devoted to the problem of teething. It is emphasized, that teething syndrome should be the diagnosis of exclusion. The clinical symptoms, detected during the primary teeth eruption, are not specific. The article presents current data, revealing the pathogenetic mechanisms of development of local and systemic manifestations in this case. The leading role of pro-inflammatory cytokines in the clinical manifestation of such symptoms of teething as hyperemia, tenderness and swelling of the gums, increased body temperature and sleep disturbance, is shown. The issues of the safe and effective use of topical medications to reduce discomfort during teething are discussed. The characteristics of Kamistad® Baby, which is successfully used for relief of local manifestations of the teething syndrome, are presented.

Key words: children, teeth, teething, Kamistad® Baby, medicines used to reduce local symptoms of primary teeth eruption, pro-inflammatory cytokines.
For citation: Zaplatnikov A.L., Kasyanova A.N., Maikova I.D. Teething syndrome in infants: a new look at the old problem // RMJ. 2018. № 5(II). P. 68–71.

Pages 72-76. Метабиотики — комплексное решение дисбиотических проблем при различных заболеваниях. Плотникова Е.Ю., Грачева Т.Ю.

Summary: Metabiotics — the complex solution of dysbiotic problems at various diseases
Plotnikova E.Yu., Gracheva T.Yu.

Kemerovo State Medical University

In any age group, disorders of intestinal microflora are among the causes of various pathological conditions. To correct those disorders, probiotics (products of active microorganisms) and prebiotics (oligosaccharides that stimulate the growth of beneficial microflora) are utilized. These days, the use of metabolic extracts from probiotic bacteria, which being similar to oligosaccharide prebiotics in that they stimulate the growth of beneficial bacteria, attracts more attention. The metabolites from such microflora representative species as Escherichia coli, Enterococcus faecalis, Lactobacillus acidophilus, Lactobacillus helveticus facilitate the growth of beneficial intestinal microflora, and can act as antagonists of pathogenic microflora. A great experience of using Hylak forte with various pathological conditions in patients of different ages has been accumulated. There are specific uses of this drug in certain clinical situations. The works devoted to the use of Hylak forte in practical medicine are published both in Russia and abroad. As a result of studies of the effectiveness of the drug it was found that its prebiotic properties are aimed not only at optimizing the functional state of the intestine, but they also participate in the regulation of important homeostatic mechanisms at the level of the macroorganism.

Key words: dysbiosis, gastrointestinal tract, metabiotic, Hylak forte.
For citation: Plotnikova E.Yu., Gracheva T.Yu. Metabiotics — the complex solution of dysbiotic problems at various diseases // RMJ. 2018. № 5(II). P. 72–76.

Pages 77-80. Фармакотерапия острых респираторных инфекций у детей: возможности снижения лекарственной нагрузки. Булгакова В.А.

Summary: Pharmacotherapy of acute respiratory infections in children: the possibility of reducing the drug load
Bulgakova V.A.

National Medical Research Center of Children’s Health, Moscow

Acute respiratory infections are the most common cause of application for medical help. Repeated respiratory viral infections and their complications in children are a significant problem for both the family and society. Often, especially in young children, a viral infection of the respiratory tract leads to the development of serious complications, the attachment of a bacterial infection, which contributes to a more severe course and a change in the clinical picture of the disease. Acute respiratory infections with their variety of clinical manifestations may cause an unreasonable drug prescription, polypragmasy and polypharmacy. The problem of effective and safe treatment and prevention of acute respiratory infections is one of the most urgent issues in clinical pediatrics. The article considers the possibility of using Isoprinosine (Inosine pranobex), an antiviral agent with the immunostimulating action, in the therapy of acute respiratory viral infections (ARVI). The author presents an overview of scientific data on the efficacy and tolerability of this drug. It is shown that its mechanism of action with a dual therapeutic effect (antiviral and immunostimulating) makes it possible to reduce the need for additional prescription of other drugs for ARVI treatment. The use of Isoprinosine can reduce the duration and severity of symptoms of acute respiratory viral infection, the need for prescribing other medicines (including antibiotics), and restore the immunity suppressed by viral infection.

Key words: acute respiratory infections, viruses, immune response, antiviral drugs, inosine pranobex, Isoprinosine.
For citation: Bulgakova V.A. Pharmacotherapy of acute respiratory infections in children: the possibility of reducing the drug load // RMJ. 2018. № 5(II). P. 77–80.

Pages 82-85. Младенческие колики: от патогенеза к лечению. Руженцова Т.А.

Summary: Baby colics: from pathogenesis to treatment
Ruzhentsova T.A.

«Central Research Institute of Epidemiology» of The Federal Service on Customers’ Rights Protection and Human Well-being Surveillance, Moscow

Baby colics are the most common cause of the parents’ appeals to pediatricians in the first year of a child’s life. In most cases, colic appear on the 2–4th week of the baby’s life and ends by the end of the 4–5th month. The article presents basic information about the pathogenesis of baby colic. It emphasizes the influence of various factors characteristic of children in the first months of life: the immaturity of the digestive and nervous systems, as well as the instability and imbalance of micro-flora as the cause of their development. In some children, the predominant cause of colic is improper feeding with fast sucking, aerophagia, overfeeding, forcible feeding or incorrect dilution of the formula. Questions of diagnostics and differential diagnostics with careful exception of organic pathology requiring special therapy or surgical interventions are considered. The possible methods of treatment and the reasons for the frequent ineffectiveness of various therapeutic approaches are described. The indications for the appointment of simethicone (Bobotic) in drops as an effective drug of the first choice for stopping infant colic, regardless of the prevailing link of pathogenesis, are justified.

Key words: meteorism, infant, colic, simethicone, Bobotic.
For citation: Ruzhentsova T.A. Baby colics: from pathogenesis to treatment // RMJ. 2018. № 5(II). P. 82–85.

Pages 86-91. Современные бактериологические препараты: влияние на микробиоту кишечника и роль в лечении заболеваний. Раскина К.В., Мартынова Е.Ю., Фатхутдинов И.Р., Потешкин Ю.Е.

Summary: Modern bacteriological agents: the effect on gut microbiota and the role in the treatment of diseases
Raskina K.V.1, Martynova E.Yu.2, Fatkhutdinov I.R.3, Poteshkin Yu.E.3,4

1 Online peer-reviewed journal “Relevant endocrinology”, Moscow
2 Sechenov University, Moscow
3 LLC “Atlas Medical Center”, Moscow
4 Pirogov Russian National Research Medical University, Moscow

Human gastrointestinal tract is colonized by a complex ecosystem of microorganisms. Intestinal bacteria are not just commensals — the gut microbiota constantly undergoes the process of synbiotic co-evolution with its host. These bacteria perform numerous important functions: they produce various nutrients for the host, prevent infections caused by intestinal pathogens, and modulate the immunological response. The relationship between the composition of the intestinal microbiota and a variety of diseases (Crohn’s disease, ulcerative colitis, obesity, type 2 diabetes, etc.) has been proved. Modifying the gut microbiota creates a possibility to effectively influence human health. This is the purpose for which probiotics, prebiotics and synbiotics are used. The following review presents modern data on their optimal composition, discusses the mechanisms of influence of bacteriological agents on gut microbiota and human health, and also describes the results of studies confirming their effectiveness.

Key words: gut microbiota, probiotics, prebiotics, synbiotics, bacteriological agents, inflammatory bowel disease, Bifidobacterium, Lactobacillus, Enterococcus, oligofructose, inulin.
For citation: Raskina K.V., Martynova E.Yu., Fatkhutdinov I.R., Poteshkin Yu.E. Modern bacteriological agents: the effect on gut microbiota and the role in the treatment of diseases // RMJ. 2018. № 5(II). P. 86–91.

Pages 92-95. Синдром врожденной центральной гиповентиляции («синдром проклятия Ундины»). Толстова Е.М., Зайцева Н.С., Зайцева О.В., Мезенцева Д.А., Ефимова Е.В., Исаева Е.К., Строганов И.А., Абасеева Т.Ю., Радимова Е.Р., Ионова Е.А.

Summary: Congenital Central Hypoventilation Syndrome (“Ondine’s curse”*) in a child of twins (clinical case)
Tolstova E.M.1, Zaitseva N.S.1, Zaytseva O.V.1, Mezentseva D.A.1, Efimova E.V.2, Isayeva E.K.2, Stroganov I.A.2, Abaseeva T.Yu.3, Radimova E.R.2, Ionova E.A.2

1 A.I. Yevdokimov Moscow State University of Medicine and Dentistry
2 St. Vladimir Children’s Moscow Clinical Hospital
3 M. Vladimirsky Moscow Regional Research Clinical Institute (MONIKI), Moscow

The article presents a clinical observation of a baby from a twin with a confirmed syndrome of congenital central hypoventilation (CCHS). CCHS is a rare genetic disease manifested by primary alveolar hypoventilation during sleep. Usually the disease manifests in term infants with signs of hypoventilation and hypoxemia. Despite the hypoxemia and hypercapnia, there are no signs of respiratory distress and compensatory reactions, characteristic of respiratory failure of another genesis. At the same time, there may be signs of Hirschsprung’s disease (about 20% of patients), neurological symptoms. At the heart of the disease is a mutation of gene with defects of РНOX2B, confirmed in the described case. In our patient an absence of continuation of episodes of apnea after release of the baby from a period of newborn infancy caused a late diagnosis of the disease. Treatment is in ensuring of adequate ventilation. It is preferred to use non-invasive methods of artificial ventilation of the lungs: ventilation with a constant positive pressure, various types of oxygen masks. If it is impossible to use them, a tracheostomy is applied. An implantation of a stimulator of the diaphragmatic nerve is realized in Children older than 18 months.

Key words: congenital central hypoventilation syndrome, hypoventilation, respiratory failure, PHOX2B gene, hypercapnia, respiratory acidosis.
For citation: Tolstova E.M., Zaitseva N.S., Zaytseva O.V. et al. Congenital Central Hypoventilation Syndrome (“Ondine’s curse”*) in a child of twins (clinical case) // RMJ. 2018. № 5(II). P. 92–95.

Pages 96-103. Прогрессирующее заболевание печени: дефицит лизосомной кислой липазы (клинические наблюдения). Агеева Н.В., Агапова И.А., Амелина Е.Л., Гундобина О.С., Жаркова М.С., Каменец Е.А., Михайлова С.В., Печатникова Н.Л., Сосновский А.Е.

Summary: Progressive liver disease: а deficiency of lysosomal acid lipase (clinical cases)
Ageeva N.V.1, Agapova I.A.1, Amelina E.L.2, Gundobina O.S.3, Zharkova M.S.4, Kamenets E.A.5, Mikhaylova S.V.6, Pechatnikova N.L.7, Sosnovsky A.E.1

1 Penza Regional Pediatric Clinical Hospital named after N. F. Filatov
2 City Clinical Hospital named after D. D. Pletnyov of Moscow Health Department
3 National Medical Research Center for Children’s Health, Moscow
4 Sechenov University, Moscow
5 Research Centre of Medical Genetics of the Russian Academy of Medical Sciences, Moscow
6 Pirogov Russian National Research Medical University, Moscow
7 Morozovskaya Children’s City Clinial Hospital of Moscow Health Department

Lysosomal Acid Lipase Deficiency (LALD) is a progressive hereditary disease characterized by impaired metabolism of lipids and associated with high mortality and a risk of terminal damage to various organs, including a liver, spleen, kidneys, and heart vessels. Depending on age of manifestation of the disease, two clinical forms of the LALD are distinguished: an infantile form, previously known as Wolman disease, and an ester storage disease, it is characteristic for children older than 1 year of age and adults. Clinical manifestations of the disease are diverse regardless of the form of LALD, which is the reason for delay in establishing a correct diagnosis, early disability and death of patients.
Two clinical observations of the LALD are presented in the article: a patient with the ester storage disease and a patient with the infantile form of LALD. Both cases demonstrate the most negative prognosis of the disease and importance of timely diagnosis of the LALD.
Presence of diagnostic criteria for the LALD allows suspecting the disease in time and conduct a test for determination of lysosomal acid lipase activity by method of dry spots to confirm the diagnosis. This is necessary for early initiation of adequate therapy.

Key words: lysosomal acid lipase, Wolman disease, cholesterol ester storage disease, sebelipase alfa.
For citation: Ageeva N.V., Agapova I.A., Amelina E.L. et al. Progressive liver disease: а deficiency of lysosomal acid lipase (clinical cases) // RMJ. 2018. № 5(II). P. 96–103.



№4(II), 2018. Неврология

Pages 42. Слово редактора. П. Рачин А.

Pages 43-46. Наблюдательное исследование по оценке эффективности и безопасности теноксикама при дорсалгии в сравнении с мелоксикамом и диклофенаком натрия. Рачин А.П., Выговская С.Н., Нувахова М.Б., Воропаев А.А., Тарасова Л.Ю.

Summary: Observational study of the efficiency and safety of the use of tenoxicam in dorsalgy in comparison with meloxicam and diclofenac-sodium
Rachin A.P., Vygovskaya S.N., Nuvakhova M.B., Voropaev A.A., Tarasova L.Yu.

National Medical Research Center for Rehabilitation and Balneology, Moscow

Dorsalgia is an actual interdisciplinary problem that adversely affects the life of a person and significantly violates his quality of life.
Aim: to assess the efficacy and safety of use of Artoxan (tenoxicam) in dorsalgia in comparison with meloxicam and diclofenac sodium.
Patients and Methods: patients enrolled in the study were randomized to one of the following groups: group 1 (Artoxan) — 30 patients with chronic dorsalgia exacerbation, receiving a complex of procedures and the drug Artoxan (intramuscular injection, 20 mg daily) for 3 days. Group 2 (meloxicam) — 20 patients receiving a complex of procedures and preparation meloxicam (intramuscular injection, 15 mg daily) for 3 days. Group 3 (diclofenac sodium) — 20 patients receiving a complex of procedures and preparation diclofenac sodium (intramuscular injection, 75 mg daily) for 3 days. The following evaluation methods were used in the study: clinical-neurological and anamnestic study; visual analogue scale (VAS); verbal scale; complex pain questionnaire; Oswestrovsky painful questionnaire.
Results: the obtained data showed that in comparison with other nonsteroidal anti-inflammatory drugs (NSAIDs) Artoxan significantly reduces algic manifestations of back pain, improves the vital activity and quality of life of patients. Artoxan has a high safety profile, which is confirmed by the lack of adverse drug effects during the therapy.
Conclusion: in comparison with meloxicam and diclofenac sodium, Artoxan (tenoxicam) significantly improves the quality of life of patients and the performance of patients with acute dorsalgia, which makes it the drug of choice when prescribing NSAIDs to this category of patients.

Key words: dorsalgia, back pain, pain syndrome, tenoxicam, Artoxan.
For citation: Rachin A. P., Vygovskaya S.N., Nuvakhova M.B. et al. Observational study of the efficiency and safety of the use of tenoxicam in dorsalgy in comparison with meloxicam and diclofenac-sodium // RMJ. 2018. № 4(II). P. 43–46.

Pages 47-54. Результаты применения интермиттирующей схемы парентерального введения хондроитина сульфата и глюкозамина сульфата в старт-терапии хронической боли в суставах и спине у коморбидных пациентов. Наумов А.В., Шаров М.Н., Ховасова Н.О., Прокофьева Ю.С.

Summary: Results of the intermittent regimen of initial pain therapy with chondroitin sulfate and glucosamine sulfate for patients with osteoarthritis, back pain and comorbidity
Naumov A V.1, Sharov M.N.2, 3, Khovasova N.O.2, Prokofieva Yu.S.2

1 Pirogov Russian National Research Medical University, Moscow
2 A. I. Yevdokimov Moscow State University of Medicine and Dentistry
3 City Clinical Hospital named after S.I. Spasokukotsky, Moscow

The aim of the study was to evaluate the efficacy and safety of the intermittent regimen of therapy with chondroitin sulfate (CS) and glucosamine sulfate (GS) in the relapses of chronic pain in the joints and back.
Patients and Methods: an open prospective comparative study was conducted to assess the efficacy and safety of the intermittent regimen of therapy with CS and GS for 6 weeks in recurrences of chronic joint and back pain. The study enrolled 70 patients with generalized osteoarthritis, randomized into two equal groups, comparable in gender and age, anthropometric and clinical indicators, and comorbid conditions. For the treatment of patients of the 1st group the following intermittent regime was used: CS 2.0 ml administered the alternate days No. 20, and HS 3.0 ml administered the alternate days No. 20. Patients of the 2 nd group (comparison group) received a standard therapy with non-steroidal anti-inflammatory drugs (NSAIDs) as needed (until achieving a satisfactory pain relief).
Results: the intermittent regimen of therapy with CS and GS allowed to achieve effective pain relief in 91.4% of patients, whereas after NSAIDs therapy it was only 62.9%. During 6 weeks of treatment, due to CS and GS therapy the intensity of pain in the joints decreased by 62%, in the back by 69%, the quality of life improved by 39%, no significant adverse events were registered, including changes in biochemical parameters characterizing liver function and kidneys. The tendency to a decrease of the level of initial pain therapy is revealed.
Conclusions: the article shows the effectiveness of the intermittent regimen of therapy with CS and GS in comparison with the traditional pain treatment with the use of NSAIDs (as needed) in the management of relapses of chronic pain in comorbid patients. A more pronounced decrease in the degree of functional insufficiency and an improvement in the quality of life make it possible 
to recommend the widespread introduction of this method into clinical practice for the therapy of relapses of chronic pain.
Key words: osteoarthritis; systemic inflammation; chondroitin sulfate; glucosamine sulfate; comorbidity; joint pain; back pain; chronic pain.

For citation: Naumov A.V., Sharov M.N., Khovasova N.O., Prokofieva Yu.S. Results of the intermittent regimen of initial pain therapy with chondroitin sulfate and glucosamine sulfate for patients with osteoarthritis, back pain and comorbidity // RMJ. 2018. № 4(II). P. 47–54.

Pages 55-59. Диагностика и принципы терапии головокружения у пациентов с мигренью. Филатова Е.Г., Иванова Т.А.

Summary: Diagnosis and principles of vertigo therapy in patients with migraine
Filatova E.G., Ivanova T.A.

Sechenov University, Moscow

Aim: to determine the nature of vertigo in patients with migraine with and without aura, and to substantiate approaches to their therapy.
Patients and Methods: the study enrolled 152 patients aged from 18 to 65 years with a diagnosis of migraine with and / or without aura. The patients with neurological and / or internal diseases, blood disorders, accompanied by dizziness and imbalance, were excluded from the study. Patients’ examination included clinical neurological, otoneurological examination, hospital anxiety and depression score (HADS), anxiety sensitivity index (ASI), dizziness handicap index (DHI), otoneurological questionnaire.
Results: it was shown that 58.6% of patients had complains on vertigo. The most common type detected with migraines was psychogenic vertigo, which is a symptom of an anxiety disorder. It has been shown that anxiety sensitivity plays a decisive role in its pathogenesis. We diagnosed vestibular, systemic vertigo, caused by migraine, in 13.9% of cases. It was revealed mainly in patients with chronic migraine. The positional character of vertigo was also noted (increase in the DHIP subscale), and one of the diagnostic criteria was reducing vertigo during a migraine attack by the use of tryptans, which is characteristic of the peripheral vestibulopathy. Verigo due to migraine caused by various diseases of the peripheral vestibular apparatus (BPPV, Meniere’s disease, vestibular neuronitis) was rarely observed during our study — in 2.6% of cases.
Conclusion: correct and early diagnosis of functional vertigo with migraine is important to prevent further chronicization of the disease and to provide adequate treatment and improve the quality of life of patients with migraine. If there are signs of subclinical vestibulopathy in migraine, it is advisable to use a complex treatment: a combination of etiotropic therapy with symptomatic treatment aimed at reducing the excitability of the vestibular apparatus. For this purpose it is possible to use a homeopathic multicomponent drug Vertigoheel, which provides a symptomatic treatment of vertigo of various origin.

Key words: migraine, vertigo, headache, treatment of vertigo, vestibular vertigo, Vertigoheel.
For citation: Filatova E.G., Ivanova T.A. Diagnosis and principles of vertigo therapy in patients with migraine // RMJ. 2018. № 4(II). P. 55–59.

Pages 60-65. Метод биологической обратной связи в лечении хронической головной боли и коморбидных расстройств. Прищепа А.В., Данилов А.Б.

Summary: The method of biological feedback in the treatment of chronic headache and comorbid disorders
Prischepa A.V., Danilov A.B.

Sechenov University, Moscow

Currently, the search for and study of new methods for the effectiveness of non-drug treatment of pain syndromes is relevant. The most evidence-based approach to preventing headache is the method of biofeedback (BFB).
Aim: to evaluate the effectiveness of BFB as a monotherapy and in combination with other methods of stress management program (SM) in comparison with the standard drug therapy in patients with chronic migraine (CM) and chronic tension headache (CTH) based on clinical-neurological and psychological research.
Patients and Methods: 44 patients with chronic obstructive pulmonary disease (n = 22) and chronic migraine (CM) (n = 22) were enrolled in the study. Patients were divided into two groups. The therapeutic method in the main group was a comprehensive SM program, including the BFB method, relaxation techniques of self-help, lifestyle modification and thinking, art therapy; in the second group, patients received a standard drug therapy. The examination was carried out according to a single scheme, including: clinical and neurological examination, investigation of qualitative and quantitative characteristics of headache and its effect on vital functions (psychological examination, psychodiagnostics of stress). Additionally, the compliance of patients was assessed.
Results: in both treatment groups there was a statistically significant decrease in frequency (p≤0.01) and intensity of headache (in the stress management group p≤0.01, in the drug therapy group p≤0.05), as well as a decrease in duration of treatment, anxiety level and depression (p≤0,01), pain catastrophizing (p≤0,01), an increase in the WHO-5 general health index (p≤0,01). But only in the SM group there was a statistically significant decrease in the stress level according to PSM-25 (p≤0,01), pericranial muscle tension (p≤0,01) and tenderness in the temporomandibular joint (p≤0,05), an increase of stress resistance (p≤0,01). At the same time, the effectiveness of the complex SM program directly depended on the compliance of patients: the use of the BFB method as a monotherapy significantly reduced the effectiveness of the treatment.
Conclusion: the use of the BFB method as a monotherapy, which primarily affects muscular spasm as one of the pathogenetic mechanisms of pain, seems insufficient for achieving a high-level clinical effect and requires combining with other SM methods.

Key words: biological feedback, BFB-therapy, stress, stress management, headache, temporomandibual disorder, comorbidity.
For citation: Prischepa A.V., Danilov A.B. The method of biological feedback in the treatment of chronic headache and comorbid disorders // RMJ. 2018. № 4(II). P. 60–65.

Pages 66-68. Влияние габапентина на состояние экстероцептивной супрессии при различных вариантах прозопалгий. Грибова Н.П., Кореневская И.А., Страчунская Е.Я.

Summary: The effect of gabapentin on the state of exteroceptive suppression in various types of prosopalgia
Gribova N.P., Korenevskaya I. A., Strachunskaya E.Ya.

Smolensk State Medical University 

The article deals with the problem of prosopalgia as a facial pain syndrome which has various classifications, different causes and a large number of treatment options. Particular attention is paid to prosopalgia with a neuropathic component of pain. The relevance of the study is due to the difficulties in choosing the treatment for the patients with different types of prosopalgia and the need to objectify the results of the treatment.
Aim: to evaluate the state of the first and second periods of exteroceptive suppression (ES1 and ES2) in patients with prosopalgia before and after treatment with gabapentin.
Patients and Methods: patients with prosopalgia of various etiologies were included in the study, 23 people in total. We used the clinical method and electroneuromyographic (ENMG) method, namely the method of exteroceptive suppression (ES) with evaluation of the duration of ES1 and ES2 before and after treatment with gabapentin.
Results: the role of exteroceptive suppression in the pathophysiology of neuropathic pain in prosopalgia was determined. The clinical outcome of using gabapentin was a decrease in the severity of pain syndrome. All patients reported a decrease in the pain syndrome after 2-3 days from the start of the gabapentin therapy; the pain attacks also became shorter and less frequent. Stabilization of ES parameters was achieved after gabapentin treatment.
Conclusion: the results of the study showed that the drug gabapentin can be used for the treatment of prosopalgia with a neuropathic nature of pain by improving the control of pain on the stem and suprasegmental structures.

Key words: gabapentin, prosopalgia, neuropathic pain, exteroceptive suppression, electroneuromyography.
For citation: Gribova N.P., Korenevskaya I. A., Strachunskaya E.Ya. The effect of gabapentin on the state of exteroceptive suppression in various types of prosopalgia // RMJ. 2018. № 4(II). P. 66–68.

Pages 69-73. Роль ацетил-L-карнитина в лечении симптомов депрессии: систематический обзор и метаанализ (реферат).

Summary: Acetyl-L-Carnitine Supplementation and the Treatment of Depressive Symptoms: A Systematic Review 
and Meta-Analysis (summary)

Aim: deficiency of acetyl-L-carnitine (ALC) seems to play a role in the risk of developing depression, indicating a dysregulation of fatty acid transport across the inner membrane of mitochondria. However, data about ALC supplementation in humans are limited. We thus conducted a systematic review and meta-analysis investigating the effect of ALC on depressive symptoms across randomized controlled trials (RCTs).
Patients and Methods: a literature search in major databases, without language restriction, was undertaken from inception until 30 December 2016. Eligible studies were RCTs of ALC alone or in combination with antidepressant medications, with 
a control group taking placebo/no intervention or antidepressants.
Results: twelve RCTs (11 of which were ALC monotherapy) with a total of 791 participants (mean age 54 years,% female 65%) were included. Pooled data across nine RCTs (231 treated with ALC versus 216 treated with placebo and 20 no intervention) showed that ALC significantly reduced depressive symptoms (SMD = -1.10, 95% CI -1.65 to -0.56). In three RCTs comparing ALC versus antidepressants (162 for each group), ALC demonstrated similar effectiveness compared with established antidepressants in reducing depressive symptoms (SMD = 0.06, 95% CI -0.22 to 0.34). In these latter RCTs, the incidence of adverse effects was significantly lower in the ALC group than in the antidepressant group. Subgroup analyses suggested that ALC was most efficacious in older adults.
Conclusions: ALC supplementation significantly decreases depressive symptoms compared with placebo/no intervention, while offering a comparable effect with that of established antidepressant agents with fewer adverse effects. Future large scale trials are required to confirm/refute these findings.

Key words: acetyl-L-carnitine, depression, meta-analysis, antidepressants.
For citation: Acetyl-L-Carnitine Supplementation and the Treatment of Depressive Symptoms: A Systematic Review and Meta-Analysis (summary) // RMJ. 2018. № 4(II). P. 69–73.

Pages 74-79. Применение препарата Пантогам актив (D-, L-гопантеновая кислота) в терапии когнитивных и тревожных расстройств у пациентов с артериальной гипертензией (реферат).

Summary: Pantogam activ (D-, L-hopantenic acid) in the treatment of cognitive and anxiety disorders in patients with arterial hypertension (summary)

Aim: to evaluate the efficacy and safety of the use of D-, L- hopantenic acid (Pantogam active) in the treatment of cognitive and anxiety disorders in patients with arterial hypertension.
Patients and Methods: the study enrolled 80 patients of the cardiology department with the verified diagnosis of hypertension and comorbid cognitive and anxiety disorders (50 patients in the main group, 30 patients in the control group). All patients received standard antihypertensive therapy. Complex therapy of the patients of the main group included Pantogam active in a daily dose from 600 to 1200 mg. Psychopathological and psychometric examinations were conducted, the data were compared with the dynamics of physical parameters (ECG, 24-hour blood pressure monitoring, biochemical blood test). The duration of therapy with D-, L-gepantenic acid was 28 days.
Results: there was a significant reduction in both cognitive and anxiety disorders in the main group compared with the control group and in patients with a prior stroke. The positive dynamics was observed during the treatment period.
Conclusions: authors support the possibility of using D-, L-hopantenic acid (Pantogam active) as a drug of choice with bimodal activity (nootropic and tranquilizing) in the treatment of cognitive and anxiety disorders in patients with arterial hypertension. It is shown that the therapy with Pantogam active provides a fast (during the first week of therapy) and reliable reduction of cognitive and anxiety disorders.
A rapid (in the first week) significant reduction of cognitive and anxiety disorders during the treatment with Pantogam activ was noted.

Key words: somatopsychiatry, cognitive impairment, anxiety disorders, arterial hipertension, treatment.
For citation: Pantogam activ (D-, L-hopantenic acid) in the treatment of cognitive and anxiety disorders in patients with arterial hypertension (summary) // RMJ. 2018. № 4(II). P. 74–79.

Pages 80-84. Функциональная астения у пациентов молодого возраста: современные способы коррекции. Шутеева Т.В.

Summary: Functional asthenia in young patients: modern methods of correction
Shuteeva Т.V.

Kursk State Medical University

The aim of the study was to research the various clinical manifestations of functional asthenia in young patients and the possibilities of using citicoline (Neupilept) to correct these manifestations.
Patients and Methods: forty patients aged from 30 to 40 years with functional asthenia were examined. Among them there were 14 (35%) men and 26 (65%) women. The median age was 34.4 years. Сlinical examination using questioning (complaints), physical and auscultatory methods; neurological examination; examination of neurocognitive status using Schulte tables, MoCA test; determination of the severity of anxiety-depressive disorders by HDRS and HARS; scale of asthenic state. In all patients the clinical manifestations of functional asthenia were observed for about 6 months. The psychotraumatic stress preceded the onset of the disease in 22% of men and 56% of women, significant physical overload, improper organization of working conditions (irregular working hours, absence of holidays, overload at work) in 26% and 28% of cases, respectively. Patients were comparable in terms of level of education. The control group was represented by 15 patients with different manifestations of functional asthenia, comparable to the main complaints, age, and psychophysiological characteristics. Both groups of patients received traditional drugs — complex vitamin preparations, comparable in composition. Patients of the main group received an oral solution of Neupilept at 500 mg per day for 30 days.
Results: in the main group a significant reduction in asthenic complaints was detected during the treatment, as well as a marked decrease in anxiety-depressive symptoms, an improvement in the cognitive background. An analysis of neuropsychological indicators revealed a close relationship between the use of Neupilept and the regress of neurosomatic dysfunction.
Conclusion: the use of Neupilept for correcting clinical manifestations of functional asthenia improves the quality of life of patients, activates the processes of psychoemotional and psychophysical adaptations in conditions of mental and physical overload.

Key words: asthenia, forms of asthenia, citicoline, Neupilept.
For citation: Shuteeva Т.V. Functional asthenia in young patients: modern methods of correction // RMJ. 2018. № 4(II). P. 80–84.

Pages 85-90. Проблема немоторных симптомов при болезни Паркинсона и влияние дофаминергической терапии на их коррекцию. Шипилова Н.Н., Титова Н.В., Катунина Е.А.

Summary: The problem of non-motor symptoms of Parkinson’s disease and the effect of dopaminergic therapy on their correction
Shipilova N.N., Titova N.V., Katunina E.A.

Pirogov Russian National Research Medical University, Moscow

Parkinson’s disease is one of the most frequent neurodegenerative disorders, it is a multi-neurotransmitter dysfunction involving both the dopamine system and nondophaminergic mechanisms. It is clinically manifested in the appearance of non-motor symptoms that occur even in the prodromal period, prior to the first motor signs, and accompany each patient until the late stage of the disease, having a greater influence on the quality of life than the motor manifestations of Parkinson’s disease. The article is devoted to the features of non-motor manifestations of Parkinson’s disease. The following non-motor manifestations are considered in detail: cognitive disorders, anxiety, depression, apathy, excessive daytime sleepiness, behavioral disorders (hypersexuality, pathological overeating, addictive shopping, game addiction, punding and dopamine dysregulation syndrome). Data on incidence rate, pathogenesis, clinical features, risk factors and some aspects of treatment of non-motor symptoms are given. Important attention is paid to the problem of impulse-compulsive disorders. The high incidence of this syndrome is associated with the administration of dopamine receptor agonists, as well as their combination with levodopa. The authors present the data of their own research, devoted to the incidence rate of impulsive-compulsive disorders in patients with Parkinson’s disease, their peculiarities, as well as the effect of dopamine receptor agonists on the development of this syndrome.

Key words: Parkinson’s disease, dopamine receptor agonists, non-motor symptoms of Parkinson’s disease, excessive daytime sleepiness, cognitive impairment, anxiety, depression, apathy, impulsive-compulsive disorders.
For citation: Shipilova N.N., Titova N.V., Katunina E.A. The problem of non-motor symptoms of Parkinson’s disease and the effect of dopaminergic therapy on their correction // RMJ. 2018. № 4(II). P. 85–90.

Pages 91-93. Мобильные телефоны и риск развития опухолей головного мозга: «токсический разговор» . Пакселев А.А., Выговская С.Н., Нувахова М.Б., Рачин А.П., Тарасова Л.Ю.

Summary: Mobile telephones and the risk of development of brain tumors: «toxic talk» (review)
Paxelev A.A., Vygovskaya S.N., Nuvakhova M.B., Rachin A.P., Tarasova L.Yu.

National Medical Research Center for Rehabilitation and Balneology, Moscow

At present, the term «toxic talk» is more and more often used in the scientific community. This is not accidental. Numerous epidemiological studies, aimed at determining the reliable relationship between the radiation from a mobile phone and the risk of developing a brain tumor, are becoming increasingly important every year. The article presents an analysis of literature data on the effect of mobile phones on the risk of developing various brain tumors. It is shown, that in studies with a sufficient number of observations and carefully selected control groups there are statistically significant differences in the risk of developing brain tumors between individuals, who use mobile devices, and those who do not use them. Differences are most clearly manifested when the period of using a mobile device is 10 years or more. It was also revealed, that the most significant differences are established for tumors on the side of using mobile devices. Thus, the obtained data allow to attribute the radiation from mobile phones to the risk factors for brain tumors — acoustic neuroma, glioma and meningioma.

Key words: mobile phones, mobile devices, brain tumors, acoustic neuroma, glioblastoma, meningioma.
For citation: Paxelev A.A., Vygovskaya S.N., Nuvakhova M.B. et al. Mobile telephones and the risk of development of brain tumors: «toxic talk» (review) // RMJ. 2018. № 4(II). P. 91–93.

Pages 93-96. Мультидисциплинарный подход к лечению хронической неспецифической боли в спине. Зиновьева О.Е., Рожков Д.О.

Summary: Multidisciplinary approach to the treatment of chronic nonspecific back pain. Analysis of the clinical case
Zinovievа O.E., Rozhkov D.O.

Sechenov University, Moscow

Over the last five years back pain has come to first place among the causes of disability and overall economic loss. In each case of the treatment of the patient with the back pain the main pathogenetic mechanism of pain should be determined. In each case, a thorough somatic and neurological follow-up examination is necessary. The article discusses the advantages of a multidisciplinary approach in the treatment of patients with chronic nonspecific back pain. The program of treatment, based on a combination of drug and non-pharmacological therapy, allows to get a significant analgesic effect. Particular attention in cases of chronic pain syndrome should be given to methods of cognitive-behavioral therapy and kinesiotherapy. Complex multidisciplinary approach in cases of chronic nonspecific back pain makes it possible to effectively stop pain syndrome, restore physical and social activity of patients. The clinical case, presented in the article, can serve as an evidence of the effectiveness of an integrated multidisciplinary approach to the treatment of chronic low back pain syndrome.

Key words: chronic back pain, multidisciplinary approach, cognitive-behavioral therapy.
For citation: Zinovievа O.E., Rozhkov D.O. Multidisciplinary approach to the treatment of chronic nonspecific back pain. Analysis of the clinical case // RMJ. 2018. № 4(II). P. 93–96.



№4(I), 2018. Ревматология

Pages 10-14. Эффективные возможности комплексной реабилитации пациентов с переломами на фоне остеопороза. Марченкова Л.А., Макарова Е.В.

Summary: Efficiency opportunities of complex rehabilitation of patients with osteoporotic fractures
Marchenkova L.A., Makarova E.V.

National Medical Research Center for Rehabilitation and Balneology, Moscow

Osteoporosis is a serious problem nowadays, which leads to severe fractures and disability. Rehabilitation of such patients requires the use of a whole set of drug and non-drug measures aimed at restoring physical functionality, relieving the pain syndrome and preventing subsequent fractures. A good analgesic effect is provided by the methods based on preformed physical factors, reflexotherapy, acupuncture.
In order to prevent fractures and strengthen the musculoskeletal system, the following methods can be used: physiotherapy exercises, exercises on simulators to improve coordination, training of spine deep stabilization system and posture awareness. 
The physical therapy complex used for managing the patients with osteoporosis may include exercises with body weight load, muscle-strengthening exercises, aerobics, coordination and postural training, hydrokinesitherapy for a minimum of 2–4 weeks. Long and regular exercises have the best effect on muscle strength, prevention of falls, fractures and provide a good quality of life.
The rehabilitation course of the patients with osteoporosis should be used together with the appointment of pathogenetic antiresorptive drugs and basic therapy with calcium and vitamin D.

Key words: osteoporosis, rehabilitation, physical therapy, physiotherapy exercises, osteoporotic vertebral fractures, ossein-hydroxyapatite compound.
For citation: Marchenkova L.A., Makarova E.V. Efficiency opportunities of complex rehabilitation of patients with osteoporotic fractures // RMJ. 2018. № 4(I). P. 10–14.

Pages 15-19. Особенности профилактики перенапряжений и лечения нарушений опорно-двигательного аппарата. Смоленский А.В., Капустина Н.В., Хафизов Н.Н.

Summary: Features of prevention and treatment of muscle-skeleton disorders
Smolenskiy A.V.1, Kapustina N.V.2, Hafizov N.N.2

1 Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow
2 Medical Diagnostic Center No12 of the Ministry of Defence of the Russian Federation, Moscow

High physical activity is associated with an increased risk of injury, and professional sports activities may cause post-traumatic chronic diseases of the musculoskeletal system. In the treatment of minor injuries and their consequences and for the removal of the pain syndrome, non-pharmacological methods of treatment, in particular physiotherapy, are widely used. To reduce the pain syndrome, the UHF electric field, low-frequency alternating magnetic field, diadynamic currents and sinusoidal-modulated currents, ultrasound is used. Cryotherapy is used to treat injuries and degenerative-dystrophic diseases of large joints. Kinesiotaping is becoming increasingly popular in traumatology and restorative medicine. Massage is the means of restoring general working capacity, removing local fatigue and a rehabilitation method. In the complex restorative treatment of injuries and for the preparation of the musculoskeletal system for intensive physical activity, warming ointments are widely used. Apisarthron is a multicomponent ointment that affects all the links of the inflammatory process. Apisarthron is used in the treatment of diseases of the peripheral nervous system, musculoskeletal system, in sports medicine - for warming up muscles before sports, for relieving muscle pains after physical activity, for traumas and injuries accompanied by pain and swelling.

Key words: physical activity, disease prevention, rehabilitation, physiotherapy, massage, apitherapy, Apisarthron.
For citation: Smolenskiy A.V., Kapustina N.V., Hafizov N.N. The informative value of diagnostic tests in urogenital tuberculosis screening // RMJ. 2018. № 4(I). P. 15–19.

Pages 2. «Лечение до достижения цели» Современный подход к терапии системных аутоиммунных заболеваний (предисловие переводчика).

Pages 20-24. Остеопороз: взгляд ревматолога. Жугрова Е.С., Самигуллина Р.Р., Смакотина А.И., Чакиева Д.С.

Summary: Osteoporosis: a view of a rheumatologist
Zhugrova E.S., Samigullina R.R., Smakotina A.I., Chakieva D.S.

North-western State Medical University named after I. I. Mechnikov, St. Petersburg

Osteoporosis (OP) is the most common form of the disease, in which a progressive decrease in bone strength is associated with the onset of menopause. By their medical significance, the metabolic diseases of the skeleton take the fourth place after cardiovascular, oncological diseases and diabetes mellitus. Osteoporosis has no specific early symptomatology, except for already happened fractures. In this regard, the awareness and consideration of risk factors becomes particularly important for the prevention and diagnosis of the disease. A reliable diagnosis of osteoporosis is based on densitometry. Diagnosis of OP includes assessment of risk factors for osteoporosis and fractures, and dual X-ray energy absorptiometry. The most important task is a widespread introduction of modern methods of prevention and treatment of osteoporosis into practice. Particular attention is paid to an adequate intake of vitamin D and its concentration in the serum is important for the health of bones and calcium-phosphorus metabolism, as well as for the optimal functioning of many organs and tissues.

Key words: osteoporosis, diagnosis, risk factors, prevention, treatment, calcium, alfacalcidol.
For citation: Zhugrova E.S., Samigullina R.R., Smakotina A.I., Chakieva D.S. Osteoporosis: a view of a rheumatologist // 
RMJ. 2018. № 4(I). P. 20–24.

Pages 25-30. «Herba est ex luce». К вопросу о неконвенциональной медицине в ревматологии. Головизнин М.В.

Summary: «Herba est ex luce». To the question of nonconventional medicine in rheumatology
Goloviznin M.V.

Association of Medical Anthropologists
А.I. Yevdokimov Moscow State University of Medicine and Dentistry

The concept of bioregulatory medicine originates fr om homotoxicology, which, in turn, is associated with the name of the German physician G. Rekieweg and combines both the views of the founders of homeopathy and a number of provisions of natural sciences of the twentieth century medicine. Diseases of the joints and connective tissue were the area of ​​medicine wh ere «antihomotoxic» treatment began to be used as early as in the 1930s and 1940s, when modern rheumatology, in particular its theoretical basis, was in its infancy. However, due to a number of circumstances, homotoxicology has remained one of the alternative medical practices, which, with undoubtedly growing interest to them in the world, cause a number of objections from representatives of official medicine. Currently, homotoxicology with its more than half a century practice has entered the period of testing its experience with the tools and methods of evidence-based medicine.
Key words: bioregulatory medicine, homotoxicology, inflammation, connective tissue, rheumatology, Traumeel S, Zeel T.
For citation: Goloviznin M.V. «Herba est ex luce». To the question of nonconventional medicine in rheumatology // RMJ. 2018. № 4(I). P. 25–30.

Pages 3-6. «Лечение до достижения цели» при спондилоартритах. Вэй Дж.Ч.

Summary: Treat-to-target in spondyloarthritis
Wei J. C.

Chung Shan Medical University, Taiwan

Ankylosing spondylitis (AS) is a chronic inflammatory disease involving spine, peripheral joints and extra-articular manifestations. AS is often combined with psoriasis and inflammatory bowel diseases, forming a group of «seronegative spondyloarthropathies». The treatment goals for spondyloarthritis are maintenance of physical function, control of disease activity and prevention of X ray progression. However, not like the well-established treat-to-target (T2T) guidance in rheumatoid arthritis (RA), the T2T concept for treating AS is still immature. Clinical evidence of T2T in AS is still lacking.
To develop the foundations of the T2T strategy in the AS, several research agendas need to be accomplished: to develop and formulate a generally accepted measureable treatment target, defined through experts’ consensus; develop a clear algorithm for monitoring disease activity and adjusting therapy; well-designed comparative clinical trials to compare this T2T strategy with the current standard of treatment should be conducted to demonstrate long-term benefits 
and risks.

Key words: ankylosing spondylitis, rheumatoid arthritis, psoriasis, remission, activity, treat-to-target.
For citation: Wei J.C. Treat-to-target in spondyloarthritis // RMJ. 2018. № 4(I). P. 3–6.

Pages 31-35. Доклиническая оценка терапевтического потенциала радиофармацевтического лекарственного препарата на основе микросфер альбумина 5–10 мкм с рением-188. Зверев А.В., Клементьева О.Е., Жукова М.В., Красноперова А.С.

Summary: Preclinical evaluation of the therapeutic potential of a radiopharmaceutical drug based on 5–10 micron albumin microspheres with rhenium-188
Zverev A.V.1, Klementieva O.E.2, Zhukova M.V.2, Krasnoperova A.S.2

1 Plant “Medradiopreparat”, a branch of the “Federal Center for Design and Development of Nuclear Medicine Facilities” of FMBA of Russia, Moscow
2 Federal Medical Biophysical Center named after A.I. Burnazyan of FMBA of Russia, Moscow

The rheumatoid disease of joints is often accompanied by pain, limited mobility and leads to a gradual destruction of the joint. Currently, the method of choice in the treatment of this disease is a radionuclide therapy of joints (radiosynovectomy).
Patients and Methods: the study was performed on Wistar rats and chinchilla rabbits, in which an acute aseptic synovitis of the knee joint was simulated. A suspension based on 5-10 micron albumin microspheres labeled with rhenium-188 (MCA 5–10 micron, 188Re) was intraarticularly introduced to perform the radiosynovectomy.
Results: the data obtained in the studies of rats show significant differences in the values ​​obtained for the right hind paw in animals with a model of pathology and control animals, as well as between groups of treated and untreated animals. There is an increase in the proportion of the supporting function of the affected limb in animals treated with a radiopharmaceutical to the results that are not significantly different from the control figures on the seventh day of observation. In the first two days the level of pain in the treated and untreated rabbits was the same, lameness of the supporting type was observed, there was practically no support for the diseased paw. On the fourth day, the rabbits, which recieved the intraarticularly injected drug, did not show a pain reaction during palpation and flexion of the limb. Lameness of the supporting type was practically not expressed. On the seventh day, the treated rabbits did not have lameness or signs of pain during palpation.
Conclusions: studies of the therapeutic potential of MCA 5–10 micron, 188Re performed on two types of laboratory animals with acute aseptic synovitis of the knee joint showed the effectiveness of its intraarticular administration according to the criteria for reducing the pain sensitivity of the affected limb in rats and the positive dynamics of restoring motor activity in rabbits.

Key words: joint, inflammation, radiosynovectomy, radiopharmaceutical, rhenium-188.
For citation: Zverev A.V., Klementieva O.E., Zhukova M.V., Krasnoperova A.S. Preclinical evaluation of the therapeutic potential of a radiopharmaceutical drug based on 5-10 micron albumin microspheres with rhenium-188 // RMJ. 2018. № 4(I). P. 31–35.

Pages 35-40. Рецидив гранулематоза с полиангиитом после отмены иммуносупрессивной терапии, осложненный стойкой утратой зрения. Куприянова И.Н., Орлова О.Л., Флягина В.И.

Summary: Recurrence of granulomatous polyangiitis, complicated by a persistent loss of vision, after withdrawal of immunosuppressive therapy
Kupriyanova I.N.1, Orlova O.L.2, Flyagina V.I.2

1 Ural State Medical University, Ekaterinburg
2 Central City Hospital №2 named after A.A. Mislavsky

Granulomatous polyangiitis (GPA) is a systemic granulomatous necrotic vasculitis of small vessels, with the predominant involvement of the upper respiratory tract, lungs and kidneys associated with antineutrophilous cytoplasmic antibodies (ANCA). GPA is considered to be a relatively rare disease. The incidence rate is about 5-10 (8.5) per 100 000 population per year. The average age of onset of the disease is 45 + 1.2 years. The disease has a multi-organ character, it has a variety of symptoms. Along with a typical triad in a generalized form, the disease can begin with a local lesion of upper respiratory tract and / or a vision organ. Debuting with the clinic of ulcerative necrotic rhinitis, sinusitis, lesion of the ear, trachea, larynx, the disease can be complicated with the perforation of the nasal septum with the saddle nose deformity, the development of severe destructive pancinusitis with the spread of granulomatous tissue into orbit, loss of hearing, stenosis of the larynx. The lesion of the organ of vision (50%) is often caused by the pseudotumor of the orbit due to the formation of periorbital granuloma, inflammation of the vascular tract of the eye, which leads to a decrease in visual acuity, and eventually to a persistent loss of vision. GPA diagnosing is based on the criteria of the American College of Rheumatology for establishing the form of systemic vasculitis. Timely initiated immunosuppressive GPA therapy (glucocorticosteroids (GCS), cyclophosphamide, azathioprine, genetically engineered biological preparations (GEBP) is aimed at the induction of remission and its maintenance, as well as the treatment of recurrence. On the example of the clinical case, clinical features and outcomes of ophthalmic manifestations of recurrence of granulomatous polyangiitis after the patient’s self-withdrawal of the immunosuppressive therapy are presented. Questions of interdisciplinary interaction of experts are covered. 

Key words: granulomatous polyangiitis, ANCA, systemic vasculitis, pseudotumor of the orbit, persistent loss of vision.
For citation: Kupriyanova I.N., Orlova O.L., Flyagina V.I. Recurrence of granulomatous polyangiitis, complicated by a persistent loss of vision, after withdrawal of immunosuppressive therapy // RMJ. 2018. № 4(I). P. 35–40.

Pages 6-9. «Лечение до достижения цели» при системной красной волчанке. Вызовы современности. Мок Т.М.

Summary: Challenges in treating-to-target in systemic lupus erythematosus
Mok T.M.

City University of Hong Kong
North District Hospital, New Territories, Hong Kong

Systemic lupus erythematosus (SLE) is an autoimmune multi-systemic disease that can affect such vital organs as the kidneys and the brain. Although the survival rate of SLE patients has dramatically improved over the past few decades as a result of the use of corticosteroids and immunosuppressants, the current treatment is associated with significant adverse effects. Both the disease itself and the side effects from treatment are associated with cumulative organ damage, which reduces both the quality and expectancy of patients’ life. The international expert group on treat-to-target in SLE has formulated recommendations with the goals to yield superior outcomes in terms of clinical course, long-term damage and functional status. The working group established four overarching principles for managing SLE patients, emphasizing the importance of contribution of the patient in the decision making, the multidisciplinary approach, the regular monitoring and adjustment of therapy with the goals towards ensuring long-term survival, preventing organ damage, optimising health-related quality of life by controlling disease activity, minimising comorbidities and drug toxicity.

Key words: systemic lupus erythematosus, treatment, remission, activity, quality of life.
For citation: Mok T.M. Challenges in treating-to-target in systemic lupus erythematosus // RMJ. 2018. № 4(I). P. 6–9.



№3 (II), 2018. Оториноларингология

Pages 42. Слово редактора.

Pages 43-47. Компьютерная навигация в хирургии хронического гнойного среднего отита. Овчинников А.Ю., Хон Е.М., Щербаков А.Ю.

Summary: Computer navigation in the surgery of chronic suppurative otitis media
Ovchinnikov A.Yu., Khon E.M., Scherbakov A.Yu.

A. I. Yevdokimov Moscow State University of Medicine and Dentistry

Almost any form of chronic suppurative otitis media (CSOM) can be surgically treated.
The aim of the sudy is to determine the advantages of using computer navigation in the surgical treatment of patients with CSOM.
Patients and Methods: 25 patients with CSOM were treated with the use of computer navigation in 2015—2017 in the otorhinolaryngology department of Clinical Medical Center of A. I. Yevdokimov Moscow State University of Medicine and Dentistry. All patients were treated by an open middle ear surgery with tympanoplasty or without it depending on the prevalence of the process.
Results: in all cases, navigation contributed to surgery, displaying residual affected air cells. It was especially useful when we worked with the cavities of previously operated mastoids. During our operations, the system assured a complete dissection of the mastoid cells affected by the pathological process, including the tegmental and synodural cells. In addition, this allowed us, when finding a labyrinth fistula and dural exposure, to remove the found plastic defect at once, avoiding damage to surrounding structures. There were no serious complications during the operations.
Conclusions: in our opinion, the greatest advantages of using computer navigation in CSOM surgery are: more careful removal of pathological contents, greater safety during complex manipulations, especially with the altered normal anatomy of the middle ear, a reduction in the number of complications due to avoidance of traumas of neurovascular structures, lower blood loss, lower costs due to a decrease in the number of complications and length of stay in a hospital, a decrease in the number of relapses and the need for repeated operations, and also improvement of functional results.

Key words: chronic suppurative otitis media, CSOM, computer navigation, navigation support, attic disease, epimesotympanitis, tympanoplasty.
For citation: Ovchinnikov A.Yu., Khon E.M., Scherbakov A.Yu. Computer navigation in the surgery of chronic suppurative otitis media // RMJ. 2018. № 3(II). P. 43–47.

Pages 48-52. Возможности лучевых методов исследования в оценке эффективности хирургического этапа кохлеарной имплантации (клинико-экспериментальное исследование). Иванова И.В., Макарова Д.В., Диаб Хассан Мохамад Али, Лежнев Д.А.

Summary: The possibilities of radiological methods in evaluation of the effectiveness of the surgical stage of cochlear implantation (clinical and experimental study)
Ivanova I. V.1, Makarova D. V.1, Diab Khasan Mokhamad Ali2, 3, Lezhnev D. A.1

1 А. I. Yevdokimov Moscow State University of Medicine and Dentistry
2 Pirogov Russian National Research Medical University, Moscow
3 Scientific and Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation

Cochlear implantation (CI) is a generally accepted method for the restoration of auditory function in persons suffering from sensorineural hearing loss of the fourth degree and deafness. To obtain additional information about positioning of the intracochlear electrode and the way of its placement, multi-slice computed tomography (MSCT) is used. Cone-beam computed tomography (CBCT) is considered as an alternative method of radiation research in CI.
Aim: to study the possibilities of MSCT and CBCT in assessing the position of the implant towards the inner ear structures at the postoperative stage of CI.
Patients and Methods: the authors made a comparative analysis of the results of MSCT / CBCT studies of 2 preparations of cadaveric temporal bones and the results of examination of 3 patients after unilateral CI at the age of 5 to 23 years old. 
The electrode array was implanted with a transmembrane method, the length of the working part of the active electrode was 26.4 mm with 12/20 stimulation channels. The distance between the electrode contacts was 0.7 / 2.4 mm. MSCT was performed on the apparatus Brilliance 64 (Philips, USA), CBCT was performed on a cone-beam computer tomograph NewTom 5G (QR s. r.l., Italy).
Results: the capabilities of CBCT and MSCT in assessing the position of the active electrode towards the structures of the inner ear are equivalent, and the oblique coronary reconstruction proved to be a reliable and easy-to-use technique for confirming the intracochlear position of the electrode array.
Conclusion: radiological methods of examination in the postoperative period should be used not only to determine the intracochlear position of the electrode system, but also the correlation between the location of the electrode array and the results of the audiological perception. The criteria of image analysis proposed in the work will allow to unify the evaluation report of the visualized picture, which, in turn, makes it possible to assess the quality of CI.

Key words: multislice computed tomography; cone- beam computed tomography; cochlear implantation; criteria; surgery.
For citation: Ivanova I. V., Makarova D. V., Diab Khasan Mokhamad Ali, Lezhnev D. A. The possibilities of radiological methods in evaluation of the effectiveness of the surgical stage of cochlear implantation (clinical and experimental study) // RMJ. 2018. № 3(II). P. 48–52.

Pages 53-57. Ушная сера: актуальные вопросы нормы и патологии в клинической практике. Морозова С.В.

Summary:

Earwax: current issues of norm and pathology in clinical practice

Morozova S.V.

Sechenov University

The article presents data on the chemical composition and organoleptic properties of earwax, describes the diverse physiological value of earwax, and analyzes the diagnostic significance of the change in the composition of cerumen masses. Information on epidemiology is given, inevitable and avertible factors causing the formation of wax plug are listed. The variability of otoscopic data is described in detail, the main and probable clinical manifestations of wax plug are named, examples of syndromic diagnoses and possible complications are given. The conditions of a possible barometric trauma with a wax plug during deep diving are presented. It is indicated that the wax plug may lead to the possible conductive hearing loss, the appearance of ear noise and reflex cough. The modern ways of removing wax plug are listed and characterized: irrigation, aspiration, curettage, cerumenolysis. The author indicates the applicability of Otinum preparation for softening the cerumen masses, as well as for its topical application in external otitis. The domestic and professional conditions, which increase the probability of the wax plug formation, are listed. The article indicates the need to use modern hygienic products for the timely and correct cleaning the external auditory canal to prevent ceruminosis and inflammatory diseases of the outer ear.

Key words: earwax, ceruminosis, wax plug, Otinum, external otitis.
For citation: Morozova S.V. Earwax: current issues of norm and pathology in clinical practice // RMJ. 2018. № 3(II). P. 53–57.

Pages 58-61. Вестибулярное головокружение: в помощь практикующему врачу. Зайцева О.В., Оверченко К.В., Хирнеткина А.Ф.

Summary:

Vestibular dizziness: to help a practitioner

Zaitseva O.V., Overchenko K.V., Khirnetkina A.F.

Scientific and Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation, Moscow

The article presents summarized data about the clinical course of the most common diseases accompanied by vestibular dizziness, the principles of diagnosis, and differential diagnosis. Establishing the causes of vertigo is fundamentally important, as it provides a real opportunity to carry out pathogenetically substantiated treatment and to select adequate preventive tactics. Currently, antiemetics and vestibular suppressants are used for the management of an acute attack of vestibular vertigo, but the use of these drugs is limited to several days, since they slow down the formation of compensatory mechanisms in acute peripheral injury of the vestibular analyzer. The main groups of medicines used for the treatment of acute dizziness are anticholinergic, antihistamines, antidopaminergic drugs and benzodiazepines. The results of scientific research, including randomized clinical trials, non-interventional studies (reproducing the scheme of a daily work with the patients), and meta-analysis in this article confirm the effectiveness of the clinical use of Vertigoheel® for treating dizziness. The efficacy of Vertigoheel® for treating vertigo is comparable to that of dimenhydrinate.

Key words: dizziness, vertigo, acute vestibular syndrome, acute peripheral vestibular syndrome, central vestibular dizziness, Meniere’s disease, vestibular migraine, Vertigoheel®.
For citation: Zaitseva O.V., Overchenko K.V., Khirnetkina A.F. Vestibular dizziness: to help a practitioner // RMJ. 2018. № 3(II). P. 58–61.

Pages 62-66. Современные возможности коррекции последствий продленной интубации. Овчинников А.Ю., Мирошниченко Н.А., Горбан Д.Г., Екатеринчев В.А., Заманов М.У.

Summary: Modern possibilities of correction of consequences of prolonged intubation
Ovchinnikov A.Yu., Miroshnichenko N.A., Gorban D.G., Ekaterinchev V.A., Zamanov M.U.

A. I. Yevdokimov Moscow State University of Medicine and Dentistry

The article presents the incidence of respiratory tract damage during intubation and prolonged artificial lung ventilation (ALV), based on the own experience of the authors and literature data. The article gives the analysis of the causes and factors of damage to the larynx and trachea from the standpoint of anesthesiologists, emergency physicians and otorhinolaryngologists, as well as a complex of organizational, diagnostic and therapeutic measures aimed at their prevention and treatment. Conservative therapy of inflammatory changes in the larynx and trachea in patients after ventilation is extremely multifaceted and includes a number of well-known components: antimicrobial and respiratory therapy, physiotherapy, immunotherapy, restorative treatment and much more. The article defines the time of the «tracheostomy» during the ventilation, the algorithm for the dekanulation of patients. In cases of development of cicatricial stenosis of the larynx and / or trachea the conservative methods of treatment are used, as well as the surgery methods with endo / extra laryngeal or endo / extra tracheal approaches. The role of endoscopy in the diagnosis and treatment of post-intubation and posttracheostomic injuries of the larynx and trachea is described, and schemes for the rational pharmacotherapy of inflammatory changes in the respiratory tract are given.

Key words: tracheal intubation, artificial lung ventilation, tracheostomy, decanulation, erosive tracheitis, laryngostenosis, tracheal stenosis, videoimage laryngo-tracheal bronchoscopy.
For citation: Ovchinnikov A. Yu., Miroshnichenko N. A., Gorban D. G. et al. Modern possibilities of correction of consequences 
of prolonged intubation // RMJ. 2018. № 3(II). P. 62–66.

Pages 67-70. Разнообразие подходов при лечении хронического полипозного риносинусита. Каляпин Д.Д.

Summary: A variety of approaches to the treatment of chronic rhinosinusitis polyposa
Kalyapin D.D.

St. Petersburg scientific research Institute of Ear, Nose, Throat and Speech

Chronic rhinosinusitis polyposa is one of the most urgent problems in modern otorhinolaryngology. Nasal polyps are known since ancient times. However, the processes of polypogenesis haven’t been sufficiently studied untill now, and the problem of rhinosinusitis polyposa is still widespread. It is worth mentioning, that at the moment there are no uniform worldwide standards for treating patients with this pathology. Most of options proposed for conservative and surgical treatment have limitations in use, both medical and economic. Even in different regions and different medical institutions of our country patients with nasal polyps can be treated in various ways. In this review, we collect data about the evolution of the medical knowledge in the treatment of the polypous process in the nasal cavity, consider various modern approaches to the solution of therapeutic and surgical tasks in the treatment, as well as the prerequisites for the creation of new technologies.

Key words: chronic rhinosinusitis polyposa, polyps, surgical treatment, conservative therapy.
For citation: Kalyapin D.D. A variety of approaches to the treatment of chronic rhinosinusitis polyposa // RMJ. 2018. 
№ 3(II). P. 67–70.

Pages 71-75. Роль и значение антигистаминных препаратов в лечении аллергического ринита и крапивницы. Рязанцев С.В., Артюшкин С.А., Сосновская Д.В.

Summary: The role and importance of antihistamines in the treatment of allergic rhinitis and urticaria
Ryazantsev S.V.1, Artyushkin S.A.2, Sosnovskaya D.V.2

1 St. Petersburg scientific research Institute of Ear, Nose, Throat and Speech
2 North-western State Medical University named after I.I.Mechnikov, St.Petersburg

The most common and problematic manifestation of allergic rhinitis is the rhinedema, which blocks nasal breathing. Often, allergic rhinitis is not diagnosed or the diagnosis is established with a great delay, which, in turn, leads to inadequate therapy and, as a result, inefficiency of treatment. Otorhinolaryngologist focuses on the diagnosis and treatment of allergic rhinitis, but in the atopic march in most of cases the development of allergic rhinitis is preceded by urticaria. The article gives special consideration to the treatment of this allergopathology, which includes the elimination of the active allergen and rational drug treatment. In particular, the authors present the data concerning the effectiveness of the use of H1-histamine receptor blockers of the second generation for treating the patients with allergic rhinitis of varying severity. The article gives a review of the use of the antihistamine preparation of II generation - ebastine (Espa-Bastine®), which should be actively included in the recommended treatment regimens of allergic rhinitis and urticaria, which showed high efficacy and safety in the therapy of these diseases.

Key words: allergic rhinitis, nasal congestion, treatment, antihistamines, H1-histaminoblockers, ebastine.
For citation: Ryazantsev S.V., Artyushkin S.A., Sosnovskaya D.V. The role and importance of antihistamines in the treatment of allergic rhinitis and urticaria // RMJ. 2018. № 3(II). P. 71–75.

Pages 78-80. Применение антисептических средств в оториноларингологии. Крюков А.И., Кунельская Н.Л., Царапкин Г.Ю., Товмасян А.С.

Summary: The use of antiseptics in otorhinolaryngology
Kryukov A.I., Kunelskaya N.L., Tsarapkin G.Yu., Tovmasyan A.S.

Scientific Research Clinical Institute of Otorhinolaryngology named after L.I. Sverzhevskiy, Moscow

The problem of local diseases caused by bacterial pathogens is relevant for medicine in general, but it acquires special significance for medical specialties, where the main nosological forms are represented by purulent-inflammatory diseases. One of these specialties, in particular, is otorhinolaryngology. Despite the large number of medicines and the use of modern technologies, the lethality from the developed generalized septic complications remains high. Acute respiratory viral infections (ARVI) are the most frequent pathology and occupy one of the leading positions in the structure of the overall morbidity. The incidence of these infections remains at a high level, acquiring epidemic proportions during periods of seasonal diseases. As for the treatment of the majority of acute respiratory viral infections, the use of antibiotics is not required, excessive use should be avoided, and antiseptic drugs may be an effective option of the therapy.
The role of the infectious agent in the development of purulent-septic infections is very important, since it is known, that specificity of the infectious process and morphological changes in the organs depend the type of microorganism, causing the disease. In recent years some new antiseptic preparations have appeared, that provides the possibility of the most effective local antibacterial therapty in otorhinolaryngological practice. The article is devoted to the description of the preparation Betadine®. It is a broad-spectrum antiseptic drug with bactericidal, sporicidal and antiviral properties.

Key words: antiseptics, Betadine, otorhinolaryngology, ARVI.
For citation: Kryukov A.I., Kunelskaya N.L., Tsarapkin G.Yu., Tovmasyan A.S. The use of antiseptics in otorhinolaryngology // 
RMJ. 2018. № 3(II). P. 78–81.

Pages 82-86. Особенности микробиоты ЛОР-органов и этиотропной антибиотикотерапии при воспалительных заболеваниях и их осложнениях. Кривопалов А.А., Рязанцев С.В., Шамкина П.А., Шервашидзе С.В., Щербук А.Ю.

Summary: Features of the microbiota of ENT organs and etiotropic antibiotic therapy of inflammatory diseases and their complications
Krivopalov A.A.1, Ryazantsev S.V.1, Shamkina P.A.1, Shervashidze S.V.1, Scherbuk A.Yu.2

1 St. Petersburg scientific research Institute of Ear, Nose, Throat and Speech
2 St. Petersburg State University

In connection with the high resistance of microorganisms — pathogens of infectious diseases of the ENT organs to the antibacterial drugs most often used in outpatient and hospital clinical practice, it is important to study of the microbiota of patients with otogenic and rhinosinusogenic pyoinflammatory intracranial complications for improving the results of treatment at all stages of medical care. The authors conducted a retrospective analysis of 303 histories of patients with otogenous and rhinosinusogenic pyoinflammatory intracranial complications (PIC) and sepsis, who were treated in multi-profile hospitals in St. Petersburg, Krasnoyarsk, Irkutsk, Kursk, Chelyabinsk for the period 2000-2014. Based on the results of culture studies, the authors have shown that when carrying out empirical antibacterial therapy, it is advisable to include carbapenems (meropenem, ertapenem, imipenem, doripenem, imipenem / cilastatin) or respiratory fluoroquinolones (ciprofloxacin, levofloxacin (Levoleth ® R)) in the initial treatment schedule in combination with amikacin and metronidazole. The authors gave personal recommendations on the conduct of etiotropic antibiotic therapy of these nosologies.

Key words: ENT organs, intracranial complications, antibacterial therapy, fluoroquinolones, levofloxacin.
For citation: Krivopalov A.A., Ryazantsev S.V., Shamkina P.A. et al. Features of the microbiota of ENT organs and etiotropic antibiotic therapy of inflammatory diseases and their complications // RMJ. 2018. № 3(II). P. 82–86.

Pages 87-88. История кафедры оториноларингологии МГМСУ им. А. И. Евдокимова (к 80-летию со дня образования). Овчинников А.Ю., Вишняков В.В., Мирошниченко Н.А.



№3(I), 2018. Болезни дыхательных путей

Pages 14-18. Мукорегуляторы в программе лечения острой респираторной вирусной инфекции. Клячкина И.Л., Белоцерковская Ю.Г., Романовских А.Г.

Summary: Mucoregulators in the treatment of acute respiratory viral infection
Klyachkina I.L., Belotserkovskaya Yu.G., Romanovskikh A.G.

Russian Medical Academy of Continuous Professional Education, Moscow

Acute respiratory viral infections are a large, etiologically heterogeneous group of infectious diseases of a viral etiology. Despite a wide variety of viruses, all of them have a tropism to the tissues of the respiratory tract, and the infectious process caused by them is characterized by a similar clinical picture. Rhinosinusitis and exudative otitis media most often occur in outpatient practice. In this case, the most painful symptom is an acute cough. An important place in the treatment of these diseases belongs to mucoactive drugs and, first of all, mucoregulators. The main representatives of this group are carbocysteine ​​and carbocisteine lysine salt ​​(Fluifort). The drug activates the synthesis of physiological and less viscous mucus in goblet cells, while the amount of secreted mucus decreases. In addition, it has anti-inflammatory and antiviral effects. It takes part in the restructuring and regeneration of the damaged mucous membrane of the respiratory tract, reduces the number of goblet cells, increases the effectiveness of antibiotic therapy. The drug is well tolerated, and its daily dose can be administered in one scoop. After 4 days of treatment, the effectiveness of the drug reaches its maximum and for at least 8 days the rheology of mucus is maintained at the same level (pronounced aftereffect).

 Key words: acute respiratory viral infections (ARVI), rhinosinusitis, exudative otitis media, acute cough, mucoactive drugs, mucoregulators, carbocysteine, Fluifort.
For citation: Klyachkina I.L., Belotserkovskaya Yu.G., Romanovskikh A.G. Mucoregulators in the treatment of acute respiratory viral infection // RMJ. 2018. № 4. P. 1–6.

Pages 20-25. Эффективность и безопасность ингаляционных глюкокортикостероидов у больных бронхиальной астмой (лекция). Емельянов А.В.

Summary: Efficacy and safety of inhaled glucocorticosteroids in patients with bronchial asthma (lecture)
Emelyanov A.V. 

North-western State Medical University named after I.I.Mechnikov, St.Petersburg

The review is focused on the clinical pharmacology of inhaled glucocorticosteroids (IGCS), mechanisms of their action, efficacy and peculiarities of clinical use in patients with asthma. These drugs are indicated for the treatment of asthma of varying severity in adults and children. They are used as a monotherapy in mild asthma, for the treatment of moderate and severe asthma they are used in a combination with long-acting b2-agonists, antileukotriens and long-acting theophyllines. Dosage regimens for the combination of IGCS and long-acting b2-agonists are considered. The article provides recommendations for reducing steroid doses when asthma control is achieved. The ratio risk/benefit has to be considered when appointing IGCS. Data on possible side effects, factors affecting their development and methods of prevention are given. The prospects of clinical use of IGCS in patients with mild asthma are considered.

Key words: inhaled glucocorticosteroids, efficacy, safety, asthma.
For citation: Emelyanov A.V. Efficacy and safety of inhaled glucocorticosteroids in patients with bronchial asthma (lecture) // RMJ. 2018. № 3(I). P. 20–25.

Pages 26-29. Влияние биорегуляционных препаратов на качество жизни больных хронической обструктивной болезнью легких. Долинина Л.Ю.

Summary: Influence of bioregulatory drugs on the quality of life of patients with chronic obstructive lung disease
Dolinina L.Yu.

North-western State Medical University named after I. I. Mechnikov, St. Petersburg

The quality of life (QOL) of patients with chronic obstructive pulmonary disease is currently one of the leading criteria for assessing the effectiveness of therapy. QOL indicator is closely related to health, and it is one of the key concepts of modern medicine, used for a deep multi-dimensional analysis of important components of human health in accordance with WHO criteria.
Aim: to study the quality of life of patients with chronic obstructive pulmonary disease (COPD) on the background of basic therapy and in combination with basic therapy with bioregulatory drugs, to analyze the cytological structure of sputum and bronchial washings, levels of inflammatory mediators in sputum and serum before and after treatment.
Patients and Methods: all patients (168 patients, including 90 patients with COPD and CAD) were divided into two groups: the main group (60 patients) received the basic COPD therapy and bioregulatory drugs, the control group (108 patients) received only basic therapy. The quality of life was assessed using the SF-36 questionnaire.
Results: In the group of patients who received bioregulatory agents against the background of basic therapy, there was a significant improvement in the indices of QOL on all scales characterizing both physical and psychological components of health. In both groups, there was a tendency to a decrease in the number of macrophages and eosinophils in sputum and bronchial washings. In the main group, the percentage of neutrophil content in sputum decreased significantly. In the second group, there was a tendency to 
a decrease in the level of macrophages and eosinophils in the bronchial washings. A decrease in the level of IL-8 and TNF-α in sputum was observed in all patients (p <0.005). In the main group, the level of γ-INF in sputum, as well as γ-INF and TNF-α in the bronchial washings, significantly decreased. In the control group, there was a significant decrease in the level of IL-8 in bronchial washings.
After treatment, there was a significant decrease in the C-reactive serum protein and γ-INF in both groups. In the main group there was also a significant (p <0.005) decrease in ESR.
Conclusion: the study has showed, that bioregulatory drugs (Lymphomyosot, Mucosa compositum, Coenzyme compositum, Traumel C) complement and enhance the anti-inflammatory effect of basic treatment, which affects the quality of life of patients.

Key words: chronic obstructive pulmonary disease, inflammation, quality of life, bioregulatory medications.
For citation: Dolinina L.Yu. Influence of bioregulatory drugs on the quality of life of patients with chronic obstructive lung disease // RMJ. 2018. № 3(I). P. 26–29.

Pages 30-35. Современная муколитическая терапия заболеваний дыхательных путей. Княжеская Н.П., Бобков Е.В.

Summary: Curent mucolytic therapy of respiratory tract diseases
Kniazheskaya N.P., Bobkov E.V.

Pirogov Russian National Research Medical University, Moscow

The process of bronchial mucus formation and its proximal movement is one of the protective functions of the respiratory system. Bronchial mucus provides not only mechanical protection of the epithelium from microbes, but it also has bacteriostatic properties. In this situation, a symptom-oriented therapy is used to manage the most frequent manifestations of the disease. Most often, regime of moderate physical activity and a home care regime is recommended as the main therapy. In addition, mucolytic or antitussive agents are used to support the treatment process. Particular emphasis is placed on the group of mucolytics. Acetylcysteine is a representative of this group of drugs, which provides not only mucolytic, but also the antioxidant and antitoxic effects. Acetylcysteine thins the sputum, increases its volume,​​ contributes to its expectoration, and reduces inflammation as well. The drug has been used in clinical practice for more than 50 years and has not lost its value yet. Recent studies have shown its effect on bacterial biofilms, which contributes to its wider use in the treatment of upper and lower respiratory tract.

Key words: mucolytics, mucociliary clearance , antioxidants, cytoprotectors, biofilms, acetylcysteine.
For citation: Kniazheskaya N.P., Bobkov E.V. Curent mucolytic therapy of respiratory tract diseases // RMJ. 2018. № 3(I). P. 30–35.

Pages 36-39. Хронический абсцесс легкого у пациента с синдромом Клиппеля – Треноне – Вебера – Рубашова. Скорняков С.Н., Сабадаш Е.В., Медвинский И.Д., Бердников Р.Б., Хольный П.М., Дьячков И.А., Николаева М.О., Щиголев М.И., Масютина Д.Д., Иванчикова Е.Д.

Summary: The chronic lung abscess in a patient with Klippel – Trenaunay – Weber Syndrome
Skornyakov S.N.1,2, Sabadash Е.V.1,2, Medvinsky I.D.1,2, Berdnikov R.B.1,2, Holny P.M.2, Dyachkov I.A.1,2, Nikolaeva M.O.1,ShchigolevM.I.1, Masyutina D.D.1, Ivanchikova E.D.1

1 Ural State Medical University, Yekaterinburg
2 Ural research Institute of Phthisiopulmonology, Yekaterinburg

Klippel – Trenaunay – Weber (KTW) syndrome is a congenital angiodysplasia of peripheral vessels with the formation of pathological arteriovenous communications, the presence of which causes the violation of blood flow along the main veins of the affected limb with the development of varicose transformation of superficial veins of the extremities. The syndrome is characterized by a variety of clinical manifestations, so treatment requires a multidisciplinary approach. The disease needs surgical treatment, often with a large number of complications. In the vast majority of cases, staged surgical treatment is used, it is often traumatic and leads to a large number of complications (bleeding, trophic ulcers, hypertrophic and keloid scars). The frequency of postoperative relapse reaches 30–48%. The article presents a clinical case of chronic lung abscess in a patient with Klippel-Trenaunay-Weber syndrome. The presented clinical case is a unique example of the combination of the syndrome of congenital angiodysplasia and chronic lung abscess. Patients with KTW syndrome rarely come into the view of a pulmonologist or thoracic surgeon, and this clinical case is a clear illustration of the possible pulmonary manifestation of congenital angiodysplasia.

Key words: Klippel – Trenaunay – Weber syndrome, lung abscess, clinical case.
For citation: Skornyakov S.N., Sabadash Е.V., Medvinsky I.D. et al. The chronic lung abscess in a patient with Klippel – Trenaunay – Weber Syndrome // RMJ. 2018. № 3(I). P. 36–39.

Pages 4-8. Клинико-функциональные параметры, содержание оксида азота и особенности клеточного состава индуцированной мокроты при сочетании бронхиальной астмы и хронической обструктивной болезни легких. Чубарова С.В., Собко Е.А., Демко И.В., Соловьева А.А., Минеева Е.С., Кублик Е.С.

Summary: Clinical and functional parameters, nitric oxide content and peculiarities of induced sputum in combination of asthma and chronic obstructive pulmonary disease
Chubarova S.V.1,2, Sobko Е.А.1,2, Demko I.V.1,2, Soloveva A.A.1, Мineeva Е.S.1, Кublik Е.S.1

1 Krasnoyarsk State Medical University named after Prof. V.F.Voino-Yasenetsky
2 Regional clinical hospital, Krasnoyarsk

Aim: To study the clinical and functional parameters, the content of exhaled nitric oxide and peculiarities of the cellular composition of induced sputum in patients with a combination of asthma and COPD.
Patients and Methods: The study enrolled 57 respondents, which were divided into 3 groups. The first group included 20 patients with asthma, the second group included 19 patients with a combination of asthma and COPD, the third group consisted of 19 patients with COPD. All patients underwent a general clinical study, evaluation of the functional state of the respiratory system using the methods of spirography and body plethysmography, the study of the cell composition of induced sputum and the content of exhaled nitric oxide.
Results: According to the data obtained, the level of exhaled NO is much higher in the patients with the combination of asthma and COPD and is associated with the number of exacerbations of the disease (r = 0.60, p = 0.022), which indicates a high degree of inflammation in the bronchial tree. The analysis of cytograms of induced sputum indicates the formation of eosinophilic type of inflammation in asthma, neutrophilic — in COPD. The combination of asthma and COPD is characterized by the violation of physiological ratios of individual cell populations in induced sputum in the direction of increasing the number of eosinophils and neutrophils, which indicates a mixed pattern of inflammation and correlates with the increase in the basic treatment (r=0,70, p=0,021).
Conclusion: The combination of asthma and COPD is characterized by a more severe course of the disease, low rates of respiratory function, hyperinflation, and a high level of exhaled NO compared with the patients with severe asthma. The cellular composition of induced sputum testifies of the eosinophilic type of inflammation in asthma, neutrophilic type in COPD and mixed type in the combination of asthma and COPD.

Key words: bronchial asthma, chronic obstructive pulmonary disease, induced sputum, exhaled nitric oxide, inflammation.
For citation: Chubarova S.V., Sobko Е.А., Demko I.V. et al. Clinical and functional parameters, nitric oxide content and peculiarities of induced sputum in combination of asthma and chronic obstructive pulmonary disease // RMJ. 2018. № 3(I). P. 4–8.
Введение

Pages 9-11. Современные методы доклинической диагностики поражения органа зрения при саркоидозе. Скорняков С.Н., Сабадаш Е.В., Медвинский И.Д., Демин А.П., Егоров Е.А., Перетрухина М.В., Черненко М.А., Филатова Е.А., Дьячков И.А., Иванчикова Е.Д.

Summary: Current methods of pre-clinical diagnostics of visual organ disorders in patients with sarcoidosis
Skornyakov S.N.1,2, Sabadash Е.V.1,2, Medvinsky I.D.1,2, E.A. Egorov2, Demin A.P.2, Peretrukhina M.V.1, Chernenko M.A.1, Filatova E.A.2, Dyachkov I.A.1,2, Ivanchikova E.D.1

1 Ural State Medical University, Yekaterinburg
2 Ural research Institute of Phthisiopulmonology, Yekaterinburg

The study is devoted to the evaluation of the informative value of additional methods of examination of the visual organs in pulmonary and extrapulmonary sarcoidosis.
Aim: to evaluate the informative value of optical coherent tomography (OCT) of the visual organ in pulmonary sarcoidosis.
Patients and Methods: a prospective study was conducted, it included 36 patients (72 eyes). Depending on the presence or absence of a diagnosis of sarcoidosis, two groups were formed. The first study group consisted of patients with verified newly diagnosed pulmonary and extrapulmonary sarcoidosis, it included 18 people (36 eyes). The second group was the control group, consisted of patients with tuberculosis of various locations and included 18 people (36 eyes).
Results: in the group of patients with pulmonary and extrapulmonary sarcoidosis, the vast majority of patients did not have complaints on the part of the visual organs, however, in the study of the retina with the help of an OCT, pathological changes were observed in the form of edema, retinal detachment and degenerative changes. In the group of patients with pulmonary and musculoskeletal tuberculosis, neither complaints on the part of visual organs nor changes in the retina were detected.
Conclusions: OCT is a high-precision method of early diagnosis, which allows to make an intravital non-invasive eye biopsy at the tissue level. OCT of the retina should be performed for all patients with pulmonary and extrapulmonary sarcoidosis for early diagnosis and prevention of serious complications such as significant vision loss and irreversible blindness

Key words: sarcoidosis, tuberculosis, optical coherence tomography.
For citation: Skornyakov S.N., Sabadash Е.V., Medvinsky I.D. et al. Current methods of pre-clinical diagnostics of visual organ disorders in patients with sarcoidosis // RMJ. 2018. № 3(I). P. 9–11.



№1(II), 2018. Кардиология

Pages 104-109. Ацетилсалициловая кислота от А до Я: азбука применения в кардиологии. Оганезова Л.Г.

Summary: Acetylsalicylic acid from A to Z: the alphabet of usage in cardiology
Oganesova L.G.

Pirogov Russian National Research Medical University, Moscow

The paper describes, in schematic form, results of the most important trials of acetylsalicylic acid (ASA), recommendations for ASA appointment in main categories of patients. Thus, HOT study showed the greatest effect of ASA in the group of patients with AH and high and very high risk of CVD. The largest meta-analysis Antithrombotic Trialists’ Collaboration showed that previous ASA intake leads to 2 times increase of survival rate in patients with stroke and transient ischemic attack in anamnesis; it proved the efficacy of ASA in patients with both acute myocardial infarction (MI), and with a history of MI as well as the importance of ASA intake as first-line drug in patients with stable and unstable angina pectoris. In addition, the results of studies in patients with diabetes mellitusб atrial fibrillation and the elderly, most common in cardiologists practice. Various forms of ASA (enterik and buffer) are observed, as well as their advantages and disadvantages, according to research data.

Key words: acetylsalicylic acid, cardiovascular complications, risk, cardiology, Sanovasc.
For citation: Oganesova L.G. Acetylsalicylic acid from A to Z: the alphabet of usage in cardiology // RMJ. 2018. № 1(II). P. 104–109.

Pages 110-114. Сартаны и проблема коморбидности. Кириченко А.А.

Summary: Sartans and the problem of comorbidity
Kirichenko A.A.

Russian Medical Academy of Сontinuous Professional Education, Moscow

Comorbidity is the presence of two and/or more pathogenetically interrelated diseases in one patient. It occurs frequently, especially in elderly and old patients. Comorbidity increases the severity of the condition, worsens the prognosis and complicates the treatment. In the choice of antihypertensive drug, it is important not only to reach the target value of arterial pressure, but also to effect the mechanisms of development and the symptoms of concomitant diseases. Angiotensin II receptor blockers are involved in modulating the effect of angiotensin on cell growth, proliferation, inflammatory responses and oxidative stress. The studies of angiotensin receptor blockers have shown their multiple effects and the possibility of additional positive effects in chronic heart failure, myocardial hypertrophy of the left ventricle of the heart, heart rhythm disorders (atrial fibrillation), metabolic syndrome, diabetes mellitus, kidney disease, obstructive bronchial diseases, oncological diseases. Further study of the problem of comorbidity will allow to specify the prescription of medicines to patients with various cardiovascular diseases and concomitant pathology with common pathogenetic mechanisms and to reduce the number of the drugs used in therapy.

Key words: angiotensin II, angiotensin receptor blockers, comorbidity, cardiovascular diseases, hypertension, chronic heart failure, diabetes mellitus.
For citation: Kirichenko A.A. Sartans and the problem of comorbidity // RMJ. 2018. № 1(II). P. 110–114.

Pages 115-119. Выбор препарата для диуретической терапии: взгляд клинического фармаколога. Максимов М.Л., Ермолаева А.С., Кучаева А.В.

Summary: Choice of the drug for the diurethic therapy: a view of a clinical pharmacologist
Maksimov M. L.1, Ermolaeva A. S.2, Kuchaeva A. V.1

1 Kazan State Medical Academy, branch of the Russian Medical Academy of Continuous Professional Education
2 Sechenov University, Moscow

Diuretics are the drugs used to enhance diuresis, remove excess amounts of water from the body and eliminate edema. 
The review presents clinical and pharmacological approaches to diuretic therapy, data on the use of the main classes of diuretics. The article focuses on the efficasy and safety of loop diuretics, and the latest drug from this group — torasemide, which has additional advantages. Due to the ability of torasemide to block aldosterone receptors thus inhibiting myocardial fibrosis, this drug may provide additional benefits in terms of slowing the progression of chronic heart failure and increasing patient survival. The efficasy and safety of torasemide are practically not affected even by a significant decrease in the glomerular filtration rate. Torasemide is a probable alternative to furosemide in the treatment of edematous-ascitic syndrome, including the one resistant to diuretics, in patients with liver cirrhosis. Torasemide is better tolerated than other loop diuretics. Torasemide, obviously, should be considered as the drug of choice for the treatment of most variants of edematous syndrome, including those resistant to standard diuretic therapy.

Key words: diuretics, torasemide, chronic heart failure, arterial hypertension, chronic renal failure, efficacy, safety, edemas, Trigrim®.
For citation: Maksimov M.L., Ermolaeva A.S., Kuchaeva A.V. Choice of the drug for the diurethic therapy: a view of a clinical pharmacologist // RMJ. 2018. № 1(II). P. 115–119.

Pages 120-125. Антагонисты минералокортикоидных рецепторов: место в практике кардиолога. Задионченко В.С., Ялымов А.А., Шехян Г.Г., Щикота А.М., Иванова Н.А., Терпигорев С.А., Кабанова Т.Г., Никишенков А.М.

Summary: Mineral corticoid receptors antagonists: the place in the practice of a cardiologist
Zadionchenko V.S.1, Yalymov A.A.1, Shekhyan G.G.1, Shchikota A.M.1, Ivanova N.A., Terpigorev S.A.2, Kabanova T.G. 2, Nikishenkov A.M.2

1 A.I.Yevdokimov Moscow State University of Medicine and Dentistry
2 Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy

The article presents an overview of the main effects of aldosterone. Aldosterone affects the receptors thus causing an increase in blood pressure, sodium reabsorption, water retention and a decrease of potassium level. The possibilities of the use of aldosterone antagonists for the prevention and treatment of cardiovascular diseases (primary aldosteronism, arterial hypertension, myocardial infarction, chronic heart failure, etc.) are described in terms of evidence-based medicine. The article provides data of large clinical studies which prove the undoubted advantage of eplerenone, as a selective mineralocorticoid receptors antagonist, over spironolactone. Eplerenone is a selective mineralocorticoid receptors blocker with limited cross reactivity for androgenic and progesterone receptors, so it does not significantly affect the sexual sphere, as contrasted with spironolactone. Eplerenone has a wide evidence base, the best safety profile, tolerability, predictable dose-dependent effect, not associated with liver function, so it can be recommended as a drug of choice for aldosterone blockade in patients with primary aldosteronism, arterial hypertension, myocardial infarction and chronic heart failure.

Key words: aldosterone, mineralocorticoid receptor antagonist, aldosterone antagonist, spironolactone, eplerenone, Espiro, arterial hypertension, heart failure, myocardial infarction.
For citation: Zadionchenko V.S., Yalymov A.A., Shekhyan G.G. et al. Mineral corticoid receptors antagonists: the place in the practice of a cardiologist // RMJ. 2018. № 1(II). P. 120–125.

Pages 126-128. Приобретенная механическая гемолитическая анемия, вызванная дисфункцией имплантированных сердечных клапанов. Николенко Л.А.

Summary: Acquired mechanical hemolytic anemia, caused by dysfunction of implanted heart valves (with a description of clinical cases)
Nikolenko L.A.

Federal Center of Cardiovascular Surgery, Chelyabinsk

Surgical correction of the heart valves makes urgent the problem of postoperative anemia, which can have a different character. The course of the postoperative period in such patients largely depends on the possibility of developing the acquired mechanical hemolytic anemia. In connection with the improvement of the methodology of surgical interventions, as well as with the modernization of prosthetic heart valve (HV), cardiovascular risk in heart operations during the last decades has significantly decreased in all age groups. Using a new generation of prostheses has reduced the frequency of hemolytic anemia to 1%. In modern conditions, the most frequently expressed signs of hemolysis are caused by the prosthesis dysfunction, for example, due to the formation of para-valvular fistula. The destruction of erythrocytes with the development of hemolysis is associated with a violation of blood flow through the defective prosthesis and an increased damage to erythrocytes by the valves. The syndrome of mechanical hemolysis is confirmed by the detection the fragments of erythrocytes (Fragmentes Red Cell (FRC)) or schistocytes in the patient’s blood smear.

Key words: anemia, prosthetic heart valves, cardiovascular surgery, postoperative anemia, mechanical hemolysis, schistocytes.
For citation: Nikolenko L.A. Acquired mechanical hemolytic anemia, caused by dysfunction of implanted heart valves (with a description of clinical cases) // RMJ. 2018. № 1(II). P. 126–128.

Pages 68-75. Медикаментозная терапия больных со сниженной сократительной способностью миокарда, получившая доказательства положительного влияния на их выживаемость с учетом новых требований. Мазур Н.А., Миклишанская С.В.

Summary: Drug therapy of patients with reduced myocardial contractility, which has a proven positive effect on patients’ survival, taking into account new requirements
Mazur N.A., Miklishanskaya S.V.

Russian Medical Academy of Continuous Professional Education, Moscow

The article presents data on the current problem of the drug therapy of patients with reduced myocardial contractility, which has a proven positive effect on patients’ survival, for solving the health issues of the country’s population. It is shown, that in the conditions of the limited funds allocated to medical institutions for providing free treatment, it is important to use only those means that have a proven positive effect on retaining the working capacity and life expectancy. A critical assessment is made of the unreasonable way of using the allocated funds and personal money of patients. As the evidence of the most rational management of such patients, the authors use and compare the data presented almost simultaneously (in 2016 and 2017) in the USA and Europe in the Guidelines for the treatment of patients with heart failure with reduced myocardial contractility. Comparative analysis shows the incompleteness of the current ideas about the ways of treating such patients. It demonstrates the importance of agreements on the need to develop common criteria for assessing the effectiveness of the means used to treat patients. Today, the principles, underlying the «evidence-based medicine», require substantial clarification.

Key words: heart failure, left ventricular ejection fraction, heart failure treatment, evidence-based medicine, life expectancy, nicorandil.
For citation: Mazur N.A., Miklishanskaya S.V. Drug therapy of patients with reduced myocardial contractility, which has a proven positive effect on patients’ survival, taking into account new requirements // RMJ. 2018. № 1(II). P.68 –75.

Pages 76-81. Кризовое течение артериальной гипертензии на догоспитальном этапе: алгоритм ведения пациента. Филиппова О.В.

Summary: Hypertensive crisis at the prehospital stage: patient management algorithm
Filippova O.V.

Sechenov University, Moscow

The article discusses the treatment of hypertensive crisis at the prehospital stage. The uncomplicated hypertensive crisis can be treated on the out-patient basis; for this purpose various oral preparations can be prescribed, taking into account contraindications to their use. The pressure should be decreased gradually, by 20-25% compared to the initial value during 2-6 hours with the subsequent achievement of the target BP within 24-48 hours. The drug of the first choice can be captopril (for example, the well-known orginal preparation Kapoten), which has wide indications for use and a relatively small number of restrictions. In the absence of contraindications, nifedipine or moxonidine may be used as an alternative. However, nifedipine has a pronounced proarrhythmic effect, and therefore is not suitable for some patients. Moxonidine acts long and is characterized by a late onset of action, which causes a slow onset of its effect, and also increases the risk of uncontrolled hypotensive reaction leading to destabilization of hemodynamics, and has a number of negative side effects from the central nervous system. For the treatment of hypertensive crisis, a short course of beta-blocker may be prescribed to the patients with tachycardia and expressed vegetative manifestations. To relief the crisis against the background of heart failure and edema, furosemide may be used. After relief of the hypertensive crisis, it is necessary to select or adjust a constant antihypertensive therapy.

Key words: hypertension, hypertensive crisis, cardiovascular diseases, antihypertensive drugs, captopril, Kapoten, nifedipine, beta-blockers.
For citation: Filippova O.V. Hypertensive crisis at the prehospital stage: patient management algorithm // RMJ. 2018. № 1(II). P. 76–81.

Pages 82-85. Алкоголь и сердце. Васильев А.П., Стрельцова Н.Н.

Summary:

Alcohol and heart disease

Vasiliev A.P., Streltsovа N.N.

Tyumen Cardiology Research Center (branch of Tomsk National Research Medical Center of Russian Academy of Sciences) 

A thousand-year human experience of alcohol consumption in different regions independently of each other as well as eating fermenting fruits that contain ethanol among most animals indicate its specific biological value. The fact that endogenous ethanol is constantly present in the human body prove that this chemical compound is not extraneous for human nature, but it plays an active role in metabolism. Frequently found in literature simplified beliefs of alcohol as a pure evil and as a significant ethiopathogenetic risk factor for severe somatic and psychosocial diseases is a wrongful view. The study presents current data on the beneficial effect of alcohol on the cardiovascular system, harmful effects of heavy alcohol consumption; the prevalence of alcoholic heart disease and pathophysiologic mechanisms for its development, clinical manifestations of each stage of development. The survey highlights the importance of diagnosis of cardiomyopathy at early and reversible stages.
Nevertheless, it should be emphasized once more that the term «struggle with alcoholism» cannot be substituted for the term «fighting with alcohol». History shows that such substitution has no future and there is no sense due to biological, traditional, religious and other factors. Moderate alcohol consumption must be the indispensable condition.

Key words: alcohol, heart, cardiovascular diseases, cardiomyopathy, clinical picture, diagnosis.
For citation: Vasiliev A.P., Streltsovа N.N. Alcohol and heart disease // RMJ. 2018. № 1(II). P. 82–85.

Pages 86-88. Взаимосвязь сердечно-сосудистых осложнений и неалкогольной жировой болезни печени. Ахмедов В.А.

Summary: Interrelation of cardiac-vascular complications and non-alcoholic fatty liver disease
Akhmedov V.A.

Omsk State Medical University

The review analyses the pathogenetic mechanisms of cardiovascular diseases formation in patients with non-alcoholic fatty liver disease. The article considers the role of insulin resistance, pro-inflammatory cytokines, adipocytokines, genetic factors in the formation of atherosclerosis, diastolic left ventricular dysfunction and chronic heart failure. It is noted that ectopic accumulation of adipose tissue can be a key pathogenetic element in the formation of cardiovascular diseases, and therefore patients with NAFLD have a high risk of their development. It is shown that individuals with NAFLD and higher C protein levels have the highest risk of cardiovascular disease. It is demonstrated, that the degree of histological changes in the liver in patients with NAFLD correlates with atherosclerotic changes in the carotid arteries. The increase of transaminases in the biochemical blood test of patients with NAFLD is an independent risk factor for the formation of heart failure. It is noted that the echocardiographic signs of sclerotic changes in the aortic valve have a clear connection with NAFLD. It is shown that PNPLA3 GG genotype is associated with the severity of atherosclerotic changes in the carotid arteries in young patients with NAFLD.

Key words: non-alcoholic fatty liver disease, insulin resistance, risk, cardiovascular diseases, atherosclerosis.
For citation: Akhmedov V.A. Interrelation of cardiac-vascular complications and non-alcoholic fatty liver disease // RMJ. 2018. № 1(II). P. 86–88.

Pages 89-94. Применение препарата Пантогам актив (D-, L-гопантеновая кислота) в терапии когнитивных и тревожных расстройств у пациентов с артериальной гипертензией (реферат).

Summary: Pantogam activ (D-, L-hopantenic acid) in the treatment of cognitive and anxiety disorders in patients with arterial hypertension (summary)

Aim: to evaluate the efficacy and safety of the use of D-, L- hopantenic acid (Pantogam active) in the treatment of cognitive and anxiety disorders in patients with arterial hypertension.
Patients and Methods: the study enrolled 80 patients of the cardiology department with the verified diagnosis of hypertension and comorbid cognitive and anxiety disorders (50 patients in the main group, 30 patients in the control group). All patients received standard antihypertensive therapy. Complex therapy of the patients of the main group included Pantogam active in a daily dose from 600 to 1200 mg. Psychopathological and psychometric examinations were conducted, the data were compared with the dynamics of physical parameters (ECG, 24-hour blood pressure monitoring, biochemical blood test). The duration of therapy with D-, L-gepantenic acid was 28 days
Results: there was a significant reduction in both cognitive and anxiety disorders in the main group compared with the control group and in patients with a prior stroke. The positive dynamics was observed during the treatment period.
Conclusions: authors support the possibility of using D-, L-hopantenic acid (Pantogam active) as a drug of choice with bimodal activity (nootropic and tranquilizing) in the treatment of cognitive and anxiety disorders in patients with arterial hypertension. It is shown that the therapy with Pantogam active provides a fast (during the first week of therapy) and reliable reduction of cognitive and anxiety disorders.
A rapid (in the first week) significant reduction of cognitive and anxiety disorders during the treatment with Pantogam activ was noted.

Key words: somatopsychiatry, cognitive impairment, anxiety disorders, arterial hipertension, treatment.
For citation: Pantogam activ (D-, L-hopantenic acid) in the treatment of cognitive and anxiety disorders in patients with arterial hypertension (summary) // RMJ. 2018. № 1(II). P. 89–94.

Pages 95-99. Сочетание сердечно-сосудистых заболеваний и тревоги/депрессии у пожилых пациентов: как повысить эффективность лечения и качество жизни. Котова О.В., Акарачкова Е.С.

Summary: Combination of cardiovascular disease and anxiety / depression in elderly patients: how to improve treatment effectiveness and quality of life
Kotova O.V.1, Akarachkova E.S.2
 
1 Head of the psycho-neurological department of the international society «Stress under control»
2 President of the international society «Stress under control»
 
Regardless of the socioeconomic development of the country, the main causes of death and disability of elderly and senile people (60 years and older) are noncontagious diseases, many of which are often found together. According to the World Health Organization, more than 20% of adults aged 60 years and older suffer from psychoneurological disorders. In elderly people with ischemic heart disease (IHD), the incidence of depression is higher compared to those with good health. Treatment of patients with cardiovascular diseases (CVD) and mental pathology should be comprehensive and include both drug and non-pharmacological therapy. The article discusses the possibilities of therapy with the preparation Tenoten for patients suffering from CVD. There are data of clinical studies confirming that the drug positively influences the blood pressure profile (BP) in women with arterial hypertension (AH) in postmenopause, in early forms of AH it promotes more rapid achievement of the target values of blood pressure, and leads to statistically significant improvement of the clinical status in patients with acute myocardial infarction. The role of modifying the CVD patient’s sedentary lifestyle is discussed as one of the non-pharmacological methods.

Key words: cardiovascular diseases, anxiety, depression, comorbidity, approaches to therapy, sedentary lifestyle, Tenoten.
For citation: Kotova O.V., Akarachkova E.S. Combination of cardiovascular disease and anxiety / depression in elderly patients: how to improve treatment effectiveness and quality of life // RMJ. 2018. № 1(II). P. 95–99.

Pages 99-103. Мультиспиральная компьютерная томография в оценке ожирения больных ишемической болезнью сердца. Коков А.Н., Брель Н.К., Груздева О.В., Каретникова В.Н., Масенко В.Л., Герман А.И., Кашталап В.В., Барбараш О.Л.

Summary: Multispiral computered tomography in estimation of obesity in patients with ischemic heart disease
Kokov A.N., Brel N.K., Gruzdeva O.V., Karetnikova V.N., Masenko V.L., German A.I., Kashtalap V.V., Barbarash O.L.

Scientific Research Institute of Complex Issues of Cardiovascular Diseases, Kemerovo

The aim of the study was to evaluate the quantitative indices of abdominal adipose tissue according to the data of multispiral computed tomography (MSCT) in patients with ischemic heart disease (IHD).
Patients and Methods: 88 patients with a verified diagnosis of ischemic heart disease were included in the study. The comparison group consisted of 32 patients without ischemic heart disease. All patients of these groups underwent MSCT at the level of L4-L5 lumbar vertebrae. In a transverse section of 1 mm thick, the area of the abdominal adipose tissue, as well as its visceral (VAT) and subcutaneous (SAT) components, was measured at the level of L4—5 intervertebral disc. The evaluation of the volume of abdominal adipose tissue and its components was carried out on a 20 mm thick transverse section. In addition, all the patients were calculated the body mass index and the ratio of the circumference of the waist to the hip circumference (WC / HC).
Results: the body mass index (BMI) in the comparison groups did not differ significantly. The group of patients with IHD showed significantly higher values of WC / HC than the control group. The prevalence of obesity in terms of the VAT area in the group of patients with IHD was 70.4%, in the comparison group — 43.8%, in terms of the VAT volume in the group of patients with IHD — 78.4%, in the control group — 56.25% with reliable differences. The prevalence of obesity according to morphometric data obtained with the use of MSCT significantly exceeds the prevalence of obesity verified with the use of BMI in both groups. Using a volumetric index of visceral adipose tissue allows the most reliable determination of a group of patients with visceral obesity.
Conclusion: multispiral computed tomography has been proved to be the most reliable method in assessing obesity, in comparison with the routine anthropometric methods. The volumetric evaluation of VAT is not only as good as the quantitative estimation based on the VAT area, but also allows to increase the diagnostic capabilities of identifying a group of patients with cardiometabolic risk associated with obesity.

Key words: visceral obesity, waist circumference, hip circumference, body mass index, multispiral computed tomography, cardiovascular diseases, ischemic heart disease.
For citation: Kokov A.N., Brel N.K., Gruzdeva O.V. et al. Multispiral computered tomography in estimation of obesity in patients with ischemic heart disease // RMJ. 2018. № 1(II). P. 99–103.



№2(ll), 2018. Педиатрия

Pages 100-101. Пробиотическая терапия: от показаний к выбору. Плоскирева А.А.

Pages 102-106. Тактика коррекции газообразования у детей раннего возраста. Старостина Л.С.

Summary: Tactics of correction of intestinal gas generation in young children
Starostina L.S.

Sechenov University, Moscow

Intestinal gas generation is a physiological process that occurs in the body of every person, regardless of age or sex. Excessive intestinal gas generation may appear periodically in an absolutely healthy person. However, excessive gas generation which lasts for a long time can be a manifestation of either gastrointestinal or any other disease. Most often, excessive gas occurs in young children due to physiological processes and digestion features.
Functional digestive disorders (FDD) still occupy one of the leading places in the structure of diseases of the digestive system. Among FDD the most frequent disorders are abdominal pains that occur in 90% of cases, especially in young children, leading to the development of intestinal colic. According to the International Classification of Diseases-10, excessive gas (flatulence) is one of the manifestations of irritable bowel syndrome. Diagnosis of the causes of FDD is often rather difficult, which leads to an excessive number of unnecessary examinations, and, as a result, to irrational therapy. Most often, this situation is due to a lack of understanding the problem.

Key words: intestinal gas generation, bloating, intestinal colic, intestinal motility, simethicone.
For citation: Starostina L.S. Tactics of correction of intestinal gas generation in young children // RMJ. 2018. № 2(II). P. 102–106.

Pages 107-112. Обоснование энерготропной терапии вегетативных расстройств у детей. Неудахин Е.В.

Summary: Substantiation of energotropic therapy of vegetative disorders in children
E. V. Neudakhin

Scientific and practical center for specialized medical care for children named after V. F. Voino-Yasenetskiy

The article presents information on the terminology of vegetative disorders. It shows the expediency of using the term «syndrome of vegetative dystonia», which is a complex of symptoms caused by violation of autonomic regulation of all organs and systems of the organism, metabolic processes as a result of primary or secondary morphofunctional changes in the suprasegmentary and / or segmental structures of the autonomic nervous system, combined with psychoemotional disorders. The pathogenesis of vegetative disorders is considered from the viewpoint of alternative interaction of the processes forming adaptive-compensatory reactions in the body. It is demonstrated that the pathogenesis of the syndrome of vegetative dystonia is caused by the imbalance between the sympathetic and parasympathetic regulation of the organs and systems of the organism, connected with the disintegration of the higher vegetative centers. The mechanisms of action of energotropic drugs (L-carnitine and coenzyme Q10) are described in detail, information on the effectiveness of their use for various manifestations of vegetative disorders is presented. Data from the literature indicate a pronounced energotropic and vegetotropic action of these drugs. The discussed drugs are systemic drugs, which corresponds to the systemic nature of autonomic regulation. The positive effect of their action is associated, first of all, with their participation in the energy supply of all organs and systems of the body.

Key words: children, vegetative dystonia, L-carnitine, coenzyme Q10, alternative interaction.
For citation: Neudakhin E. V. Substantiation of energotropic therapy of vegetative disorders in children // RMJ. 2018. № 2(II)P. 107–112.

Pages 113-117. Стресс: как уменьшить его влияние на качество жизни человека. Н. Холодова И., Е. Зайденварг Г.

Summary: Stress: how to reduce its impact on the quality of human life
Kholodova I. N., Zaidenvarg G. E.

Russian Medical Academy of Сontinuous Professional Education, Moscow

The article considers the influence of stress on human health. The issues of the physiology of stress, its definition and classification of stages according to Selye are covered. The influence of chronic stress on the psycho-somatic sphere of a person are described in detail. Possible ways of preventing and treating the consequences of stress are identified. It is shown that complex homeopathic drugs with bioregulatory properties are effective and safe in the treatment of stress, they are able to restore interactions between organs and systems, cells and their environment, as well as between individual molecules, and they can be used for a long time and combined with other medicines and methods of treatment. One such drugs is Homeostres, which physiologically and purposefully effects the key manifestations of stress. The results of clinical studies of the effectiveness of Homeostres are presented. It is demonstrated that the drug quickly eliminates the symptoms of stress without causing sleepiness, retardation and addiction.

Key words: stress, Hans Selye, stages of stress, consequences of stress, allostatic load, treatment of stress, Homeostres.
For citation: Kholodova I.N., Zaidenvarg G.E. Stress: how to reduce its impact on the quality of human life// RMJ. 2018. № 2(II). P. 113–117.

Pages 118-121. Результаты применения метода мини-перкутанной нефролитотрипсии у детей с мочекаменной болезнью. Арустамов Л.Д., Рудин Ю.Э., Меринов Д.С., Вардак А.Б.

Summary: Results of the use of the method of mini-percutaneous nephrolithotripsy in children with urolithiasis
Arustamov L.D., Rudin Yu.E., Merinov D.S., Vardak A.B.

Research Institute of Urology and Interventional Radiology named after N. A. Lopatkin

Aim: to determine the main advantages of the mini-percutaneous nephro-lithotripsy (mini-PNL) method in pediatric patients with urolithiasis, according to the standard evaluation criteria for this method.
Patients and Methods: 74 children aged from 1 year to 16 years with urolithiasis were enrolled in the study. The mean age 
of the patients operated with mini-PNL was 7.5 years. The study involved 51 (68.9%) boys and 23 (31.1%) girls. The results 
of treatment of patients after mini-PNL were compared with the results of 80 children who were operated with a standard PNL. The duration of the operation and hospitalization, possible complications and the effectiveness of the surgery (residual stones) were evaluated.
Results: in the mini-PNL group, complete removal from stones was observed in 90.5% of cases (in 67 of 74 patients), whereas after standard PNL the total removal was 86.2%. 3 patients (4%) required the repeated percutaneous surgery after mini PNL and 11 patients (13.7%) — after standard PNL. In the remaining 4 (5.4%) patients, residual stones were fragmented by remote shock wave lithotripsy. The duration of mini-PNL ranged from 30 to 150 minutes, the average duration was 45.5 minutes, which is comparable to standard PNL with the duration of 42.7 minutes. The average duration of stay in the clinic was 2.58 days (duration range 1—8 days). The main reason for the increase in bed-days was episodes of hyperthermia in the postoperative period. Blood transfusion was not required for any child both during the operation and in the postoperative period.
Conclusion: mini-PNL is effective (90.5%) for treating nephrolithiasis in children. This is a minimally invasive method for treating kidney stones with minimal possible kidney trauma.

Key words: percutaneous nephrolithotripsy, mini-percutaneous nephrolithotripsy, urolithiasis, children.
For citation: Arustamov L.D., Rudin Yu.E., Merinov D.S., Vardak A.B. Results of the use of the method of mini-percutaneous nephrolithotripsy in children with urolithiasis // RMJ. 2018. № 2(II). P. 118 –121.

Pages 122-124. Место эмолентов в профилактике развития атопического дерматита. Незабудкин С.Н., Незабудкина А.С., Сардарян И.С., Погорельчук В.В.

Summary: The place of emollients in the prevention of atopic dermatitis
S. N. Nezabudkin, A. S. Nezabudkina, I. S. Sardaryan, V. V. Pogorelchuk

St. Petersburg State Pediatric Medical University

It is known that one of the factors causing the development of atopic dermatitis (AtD) is a violation of the barrier and protective functions of the skin. Emollients (softening and moisturizing creams, bathing products) are appointed to all the patients with AtD or with a risk of its developing, regardless of AtD severity, area, acuity of the skin process, presence or absence of complications.
The aim of the study was to prevent the AtD by the use of emollients in children of early age with known history of allergies.
Patients and Methods: 40 children participated in the study, aged 0 to 6 months. The observation period was 3 months.
Results: in group 1 the evaluation of the efficacy of the prophylactic administration of Atopic emollients was made during 3 months of observation. In all children of this group there were no manifestations of AtD during the time of observation. In the second group, where simple skin care products (soap, shampoo) were used, 17 children had manifestations of mild AtD (SCORAD 6.9 ± 1.4). To these children pimecrolimus was administered with a positive effect. 2 children had moderate to severe AtD manifestations (SCORAD 24,2 ± 2,7) which required methylprednisolone administration.
Conclusions: thus, the conducted study confirmed the necessity of using Atopik emollients for children with a history of allergies to prevent the development of AtD. A wide range of Atopic products allows to use them as a basic care, and as an additional means to topical anti-inflammatory therapy. No adverse reactions were observed during the use of these agents.

Key words: atopic dermatitis, epidermal barrier dysfunction, basic skin care algorithm, emollients, Atopic, methylprednisolone, pimecrolimus, simple skin care products.
For citation: Nezabudkin S.N., Nezabudkina A.S., Sardaryan I.S., Pogorelchuk V.V. The place of emollients in the prevention of atopic dermatitis // RMJ. 2018. № 2(II). P. 122–124.

Pages 125-128. Современные рекомендации по уходу за кожей новорожденного: традиции и инновации (обзор литературы). Беляева И.А.

Summary: Current recommendations for a newborn’s skin care: traditions and innovations (literature review)
Belyaeva I. A.

National Medical Research Center of Children’s Health, Moscow
Pirogov Russian National Research Medical University, Moscow

Protecting the sensitive skin of newborns, as well as maintaining the integrity and health of the skin barrier is a difficult but important task for professionals in the neonatal period which can have an impact on skin health in the future. Understanding the unique differences of the skin of newborn babies is essential for a daily care, including bathing, caring for the umbilical cord, and applying emollients to dry skin. In recent years, some practical approaches to the care of newborns have been revised, including excessive «hygienic activity», but the basic components of caring for a healthy and damaged skin of the baby remain unchanged and are based on an understanding of the anatomical and physiological features of the skin of a newborn baby as one of the most important functional systems. Tactics of a newborn’s skin care should be aimed primarily at preventing potentially harmful influences from environmental factors and requires a paradigm shift: from examining which product or regimen can be useful, to how possible intervention can lead to unexpected negative consequences, based on from the universal postulate «do no harm».

Key words: skin, newborn baby, skin care, bathing, diaper dermatitis, D-panthenol.
For citation: Belyaeva I. A. Current recommendations for a newborn’s skin care: traditions and innovations (literature review) // 
RMJ. 2018. № 2(II). P. 125–128.

Pages 74. Кафедре педиатрии с курсом поликлинической педиатрии РМАНПО присвоено имя академика Г.Н. Сперанского.

Pages 75-78. Актуальная проблема Витамин-К-дефицитная коагулопатия у детей первых месяцев жизни: решенные вопросы и актуальные проблемы. Бражникова О.В., Заплатников А.Л., Никитин В.В., Ефимов М.С., Дементьев А.А., Чабаидзе Ж.Л., Гавеля Н.В., Ашурова Б.А., Королева А.С., Потанина Ю.В., Трофимов А.А., Медоев С.Б., Гаевый О.В., Подкопаев В.Н., Айсанова М.Р., Ягубян К.А.

Summary: Vitamin-K-deficiency coagulopathy in children of the first months of life: solved and actual problems
Brazhnikova O.V.1,2, Zaplatnikov A.L.1,2, Nikitin V.V.2, Efimov M.S.1, Dementyev A.A.1, Chabaidze Zh.L.1, Gavelya N.V.2, Ashurova B.A.2, Koroleva A.S.2, Potanina Yu.V.2, Trofimov A.A.2, Medoev S.B.2, Gaevy O.V.1,2, Podkopaev V.N.1,2,
Aysanova M.R.1, Yagubian K.A.1

1 Russian Medical Academy of Сontinuous Professional Education, Moscow
2 Children’s City Clinical Hospital named after Z.A. Bashlyaeva, Moscow

Vitamin K-deficient coagulopathy is the most common cause of emergency hospitalization of children of the first months of life with hemorrhagic syndrome, which develops as a result of exclusive breastfeeding, biliary atresia, hereditary and acquired diseases with cholestasis and malabsorption syndrome, etc. On the part of the mother, the main risk factors of vitamin-K-deficiency, developing in the fetus and the newborn, are the use of indirect anticoagulants by a woman during pregnancy, anticonvulsant drugs, broad-spectrum antibiotics, severe liver and bowel disorders, as well as fetoplacental insufficiency, gestosis, preeclampsia, etc. Clinical manifestations of vitamin-K-deficiency coagulopathy in children of the first weeks and months of life have low specificity and can be manifested by isolated cutaneous hemorrhoids syndrome, excessive bleeding, haemorrhages, and spontaneous hemorrhages (including intracranial hemorrhages). The issue of prescribing vitamin K for prophylactic purposes and the role of polymorphisms of the VKORC1 gene in the development of hemorrhagic syndrome with vitamin K deficiency in children of the first months of life are discussed.

Key words: vitamin K, vitamin K-deficient coagulopathy, vitamin K epoxy reductase, hemorrhagic neonatal disease, breastfeeding, children, polymorphisms of VKORC1 gene.
For citation: Brazhnikova O.V., Zaplatnikov A.L., Nikitin V.V. et al. Vitamin-K-deficiency coagulopathy in children of the first months of life: solved and actual problems // RMJ. 2018. № 2(II). P.75 –78.

Pages 79-84. Использование ирригационной терапии гипертоническими растворами при инфекционном риносинусите у детей. Гаращенко Т.И., Тарасова Г.Д., Тулина А.С., Ильенко Л.И., Гаращенко М.В., Лазарева С.И.

Summary: The use of irrigation therapy with hypertensive solutions for the treatment of infectious rhinosinusitis in children
Garashchenko T.I.1,2, Tarasova G.D.1, Tulina A.S.1, Ilenko L.I.2, Garashchenko M.V.2, Lazareva S.I.2

1 Federal Scientific-Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation, Moscow
2 Pirogov Russian National Research Medical University, Moscow

Aim: to study the efficacy and safety of the Aqualor Forte nasal spray (hypertonic sea water solution) in children with acute infectious rhinosinusitis (AIRS).
Patients and Methods: 100 children aged from 6 to 14 years with AIRS participated in the study. Patients were divided into 2 groups: group 1 - 50 patients received Aqualor Forte 3 times a day, group 2 - 50 children received a drug containing 0.1% xylometazoline solution 2-3 times a day. Patient examination was performed before the first application of the drugs and in 15 minutes after the application, then after 1 hour, 72 ± 6 hours, 7 days. The dynamics of the course of the disease was assessed in scores, taking into account the subjective and objective symptoms of AIRS.
Results: a more pronounced decrease in subjective and objective symptoms of AIRS was detected during the monotherapy with Aqualor Forte, as compared to the use of xylometazoline drug. According to the data of anterior active rhinomanometry (AARM), the decongestive effect of xylometazoline was higher than that of Aqualor Forte in 15 minutes after the first application, it was comparable after 1 hour, but after 3 and 7 days the decongestive effect of Aqualor Forte was significantly higher. After 3 to 7 days of the use of xylometazoline there is a decrease of the total volumetric air flow and an increase of the AARM total resistance, which indicates a growing disorder in the microcirculation system of the mucous tunic of nose. No such disorders were detected in the group of patients who used Aqualor Forte. The use of xylometazoline caused the undesirable effects in 20 (40%) patients. There were no undesirable effects in the group of patients treated with Aqualor Forte.
Conclusion: Aqualor Forte, containing the hypertonic natural sterile sea water, can be recommended as a monotherapy in children with AIRS for a safe relief of nasal breathing.

Key words: acute infectious rhinosinusitis, hypertonic sea water solution, anterior active rhinomanometry, treatment of rhinosinusitis in children, Aqualor Forte.
For citation: Garashchenko T.I., Tarasova G.D., Tulina A.S. et al. The use of irrigation therapy with hypertensive solutions for the treatment of infectious rhinosinusitis in children // RMJ. 2018. № 2(II). P. 79–84.

Pages 84-89. Острые инфекции с сочетанным поражением дыхательной и пищеварительной систем: вызов современности. Каннер Е.В., Горелов А.В., Печкуров Д.В., Максимов М.Л.

Summary: Acute infections with coexistent affection of the respiratory and digestive systems: the challenge of modernity
Kanner E.V.1, Gorelov A.V.1,2, Pechkurov D.V.3, Maksimov M.L.4

1 Central Research Institute of Epidemiology of The Federal Service on Customers’ Rights Protection and Human Well-being Surveillance, Moscow
2 Sechenov University, Moscow
3 Samara State Medical University
4 Kazan State Medical Academy (branch of Russian Medical Academy of Сontinuous Postgraduate Education)

Acute respiratory (ARI) and acute enteric infections (AEI) rank first in the structure of morbidity and the economic losses in Russia and in the entire world. At the same time, the problem of the mortality of children from acute upper respiratory tract infections and their complications remains urgent.
The article presents current information on prevalence, epidemiology, clinical features, diagnosis of ARI.
Besides ARI pathogens which selectively affect the respiratory tract, recently attention has been paid to viruses that cause also the symptoms of the digestive system disorders, especially vomiting and diarrhea. On the other hand, at present, we know the AEI pathogens, which cause also the lesions of the respiratory tract. The article presents epidemiological and clinico-pathogenetic features concerning these ARI and AEI data.
Currently, the problem of diagnosis and treatment of coexistent infections in children remains very urgent. The diversity and discovery of new respiratory viruses, their variability, the rapid formation of strains resistant to antiviral agents and modifying adaptive immune responses in humans, lead to an increase in the frequency of viral mixed infections, which determines the need to develop and implement new diagnostic and treatment algorithms.

Key words: acute respiratory infections, enteric infections, viruses, mixed infection.
For citation: Kanner E.V., Gorelov A.V. Pechkurov D.V., Maksimov M.L. Acute infections with coexistent affection of the respiratory and digestive systems: the challenge of modernity // RMJ. 2018. № 2(II). P. 84–89.

Pages 92-95. Возможности биорегуляционной медицины в лечебных программах у детей. Холодова И.Н., Захарова И.Н.

Summary: Possibilities of bioregulatory medicine in the treatment of young children
Kholodova I.N., Zakharova I.N.

Russian Medical Academy of Сontinuous Professional Education, Moscow

The article discusses the role of bioregulatory medicine in curative and preventive programs in children. Bioregulatory medicine treats the body as an integrated system, where the development of any process is carried out through a multilevel interaction between different systems of the body, and the patient can not be cured with the help of a single substance, since it can not cover all the processes interrelated with the root cause and compensate for the intra-network disturbances that have appeared. The complex treatment and the use of multicomponent drugs can almost completely eliminate the effect of many pathogenic factors and achieve cure. The article gives a detailed analysis of the composition and characteristics of a complex antihomotoxic drug Viburkol. Its example shows the possibility of treating children with various pathological conditions (acute respiratory infections, teething) from the position of bioregulatory medicine. The data of international and Russian researchers on the possibilities of using Viburkol in pediatric practice are presented. It is shown that the complex effect of Viburkol on various pathological symptoms (pain, fever, restlessness, etc.) combined with good tolerability and the practicaly absence of side effects makes it possible to recommend it in the treatment of children.

Key words: bioregulatory medicine, homotoxicology, complex antihomotoxic drug, Viburkol, ARI, teething.
For citation: Kholodova I.N., Zakharova I.N. Possibilities of bioregulatory medicine in the treatment of young children // RMJ. 2018. № 2(II). P. 92–95.

Pages 96-99. Антибиотик-индуцированные изменения микробиома желудочно-кишечного тракта и их коррекция. Усенко Д.В.

Summary: Antibiotic-induced changes in the microbiota of the gastrointestinal tract and their correction
Usenko D.V.

Central Research Institute of Epidemiology of The Federal Service on Customers’ Rights Protection and Human Well-being Surveillance, Moscow

The widespread use of antibiotics in the last 80 years has saved millions of human lives, but it has caused another important problem — antibiotic-associated violations of human microbiome. In addition to the formation of antibiotic-resistant strains of microorganisms, the use of antibiotics significantly destroys the ecology of the human microbiome. Microbiome with dysbiotic changes can not perform the vital functions, such as digestive, synthetic, as well as providing colonization resistance and regulation of the body’s immune system. This review summarizes current studies of the short-term and long-term effects of antibiotic use, as well as the possibilities of using probiotics for their correction. Probiotics are living microorganisms, mostly the representatives of obligate human microflora, which, when ingested into the gastrointestinal tract of a person in sufficient quantity, retain their activity, vitality and have a positive impact on human health. The most frequent and clinically significant negative effect of antibiotic therapy is antibiotic-associated diarrhea. The article describes the possibilities of preventing the antibiotic-associated diarrhea, which include, along with the rational antibiotic therapy, the use of eubiotics — pre- and probiotics.

Key words: antibiotics, probiotics, children, lactobacillus GG, microbiome, gastrointestinal tract, microbiota.
For citation: Usenko D.V. Antibiotic-induced changes in the microbiota of the gastrointestinal tract and their correction // 
RMJ. 2018. № 2(II). P. 96–99.



№1(I), 2018. Эндокринология

Pages 12-16. Особенности побочных эффектов глюкокортикоидов в сравнении с проявлениями эндогенного гиперкортицизма. Древаль А.В., Будул Н.А., Комердус И.В., Бритвин Т.А., Глазков А.А.

Summary: Features of the side effects of glucocorticoids in comparison with manifestations of endogenous hypercorticism
A.V. Dreval, N.A. Budul, I.V. Komerdus, T.A. Britvin, A.A. Glazkov

Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy

Aim: the aim of the study was to analyze the side effects of glucocorticoids (GC) and compare them with manifestations of endogenous hypercorticism (EH).
Patients and Methods: the study included patients with EH (75 people) - group 1; patients receiving systemic glucocorticoids (GC) receiving methylprednisolone and prednisolone (44 people) - group 2; patients receiving topical GC receiving budesonide and betamethasone (43 patients) - group 3.
Results and discussion: manifestations of hypercorticism were more frequently observed in the EH group than during GC therapy (p <0,05). Among specific manifestations of hypercorticism, matronism was the most frequently observed symptom (in 88% of EH patients, in 34,1% of patients receiving systemic GC, in patients receiving topical GC this symptom was not observed). Proximal myopathy and a tendency to easy formation of hematomas was more frequent in EH patients than in the group of patients receiving GC (in 60% and 50,7% of cases, respectively). Striae were observed in EH patients and in patients receiving large doses of prednisolone. During the course of MP therapy, which was comparable in duration to the course of prednisolone therapy (1 month), however, the median dose when recalculated to prednisolone was significantly lower (30 mg), striae did not develop. Also, striae were not observed during topical GC therapy. After a month of receiving methylprednisolone, there was an increase in the incidence of hypokalemia and dyslipidemia, as well as the development of early disorders of carbohydrate metabolism, which were absent before the administration of GC. The frequency of arterial hypertension with EH was higher than that of GC. The frequency of bone density disorders in the EH group (with glucocorticosteroma) and during methylprednisolone therapy did not differ (p> 0,05). However, in EH patients low-trauma fractures (ribs, spine) were observed.
Conclusions: clinical and laboratory manifestations of hypercorticism were more often observed in EH patients than during the therapy with various forms of GC. However, adverse effects developed after a month of receiving small doses of systemic GK (hypokalemia, dyslipidemia, etc.).

Key words: glucocorticoids, endogenous hypercorticism, matronism, striae, weight gain, hypokalemia, Itsenko-Cushing’s syndrome.
For citation: Dreval A.V., Budul N.A., Komerdus I.V. et al. Features of the side effects of glucocorticoids in comparison with manifestations of endogenous hypercorticism // RMJ. 2018. № 1 (I). P. 12–16.

Pages 17-22. Анализ данных регистра больных акромегалией Московской области. Покрамович Ю.Г., Древаль А.В.

Summary: Analysis of the Moscow Region registry of acromegalia patients
Yu.G. Pokramovich, A.V. Dreval

Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirskiy

Acromegalia is a rare neuroendocrine disease caused by a chronic hyperproduction of somatotrophic hormone (STH) in individuals with complete physiological growth. In 2005 the Moscow region registry of patients with acromegalia was created to carry out regular monitoring and to optimize treatment.
Aim: to conduct a comparative analysis of the data of the registry of patients with acromegalia in 2007 and 2017.
Patients and methods: the analysis of 304 patients (237 women, 67 men) included in the Moscow regional registry as of December 2017 is presented. Among them: 32 patients with newly diagnosed acromegalia, 202 patients receiving somatostatin analogues (SSA), 70 patients after surgical treatment of the adenoma of the pituitary. Instrumental and laboratory examinations of patients were carried out in the Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirskiy.
Results and discussion: the previous analysis was carried out in 2007, at that time 70 patients were registered in it (23% of the current value). The analysis of clinical manifestations of acromegalia revealed no significant differences between 2007 and 2017 (p> 0,05). Most of the patients had complaints on sweating, swelling, headache and muscle weakness, which occurred more often in women, then in men. Examination of the patients for the late complications revealed no statistically significant differences in the pathology of the cardiovascular system, the gastrointestinal tract, the thyroid gland. During the treatment of patients with Octreotide-Depot, the STH baseline decreased fr om 7,0 ng / ml to 2,5 ng / ml (p <0,05), and the median exceeding the upper lim it of normal IGF-1 decreased from 265,6% to 115,2% (p <0,05).
Conclusion: keeping a registry of patients with acromegalia allows to track the course of the desease, determine the tactics and strategy of treatment, and evaluate the effectiveness of the therapy in dynamics.

Key words: registry, acromegalia, somatotrophic hormone, IGF-1, somatostatin analogues, Moscow region, pituitary.
For citation: Pokramovich Yu.G., Dreval A.V. Analysis of the Moscow Region registry of acromegalia patients // RMJ. 2018. № 1 (I). P. 17–22.

Pages 23-27. Опыт применения системы Bethesda в оценке результатов тонкоигольной аспирационной биопсии узловых образований щитовидной железы. Нечаева О.А., Бавыкина Л.Г., Глазков А.А., Бритвин Т.А.

Summary: Experience with the new Bethesda system for reporting thyroid cytopathology in evaluating the results of fine needle aspiration cytology of thyroid nodules
O.A. Nechaeva, L.G. Bavykina, A.A. Glazkov, T.A. Britvin

Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy

Aim: to assess the accuracy on fine needle aspiration (FNA) cytology in verification of thyroid carcinoma.
Patients and Methods: the retrospective study of 1675 case report form was performed. Thyroid ultrasound and FNA were performed on all patients during 2016. All thyroid cyto-pathological slides were reviewed and classified according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). During statistical processing, the relative and absolute frequencies of occurrence of characteristic values (categories on TBSRTC in the prediction of thyroid cancer malignancy of tumors, etc.), the sensitivity, specificity, the prognostic value of the positive (PPV)  and negative result (NPV) were calculated.
Results and Discussion: 115 cases with high cancer risk were communicated to the surgeon, thyroid carcinoma was detected in 46 (40%) cases. The sensitivity of FNA cytology diagnostic in the detection of thyroid carcinoma for categories IV+V+VI on TBSRTC were 89,1% (95% CI 77–95,3%). The specificity of FNA diagnostic accuracy were 46,3% (35,1–58%) for category IV malignant, 97,1% (90–99,2%) for category V and 100% (94,7–100%) for category VI category on TBSRTC. The prognostic value of the PPV and NPV results of the cytological study for detection of thyroid cancer in the nodules of IV–VI categories on TBSRTC is calculated. The highest value of positive and negative results was recorded in VI category, that is, a positive result (the presence of a malignant tumor) in a cytological study was confirmed by histological examination. The least value of positive and negative cytological results was expected in IV category, the method allowed to reveal thyroid cancer only in 30,4% and allowed to exclude it only in 53,6%.
Conclusions: fine needle aspiration cytology in the diagnosis of thyroid lesion using the Bethesda system for reporting thyroid carcinoma is an informative method. However, further studies are still needed to verify thyroid cancer in IV category on TBSRTC.

Key words: carcinoma, Bethesda system, thyroid, fine needle aspiration, sensitivity, specificity, prognostic value.
For citation: Nechaeva O.A., Bavykina L.G., Glazkov A.A., Britvin T.A. Experience of using the Bethesda system in evaluating the results of fine needle biopsy of thyroid nodules // RMJ. 2018. № 1 (I). P. 23–27.

Pages 28-33. Психические расстройства у больных сахарным диабетом 2-го типа. Бобров А.Е., Володина М.Н., Агамамедова И.Н., Никитина Т.Е., Карачёва Ю.В., Третьякова Д.А., Парпара М.А., Старостина Е.Г.

Summary: Mental disorders in type 2 diabetic patients
А.Е. Bobrov1,2, M.N. Volodina3, I.N. Agamamedova1, T.E. Nikitina1, Yu.V. Karachyova1, D.A. Tretyakova1, М.А. Parpara1
E.G. Starostina3.

1 National Medical Research Center of Psychiatry and Narcology named after V.P. Serbskiy, Moscow
2 Pirogov Russian National Research Medical University, Moscow
3 Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy

The review presents an analysis of literature on the prevalence and types of mental disorders in type 2 diabetes mellitus (DM2). It has been shown that DM2 is frequently associated with depressive and anxiety disorders, eating disorders and cognitive dysfunction, including dementia. The presence of psychopathological symptoms commonly hinders differential diagnosis and contributes to misinterpretation of the patient´s status. Thus, physical symptoms of depression may imitate the pain syndrome similar to that of diabetic neuropathy, whereas clinical manifestations of phobia of hypoglycemia and panic attacks can be indistinguishable from the symptoms of hypoglycemia. Patients with DM2 and comorbid somatoform disorders frequently undergo multiple examinations with subsequent administration of unnecessary treatment, which, taken together, dramatically increase the use of medical resources. Some mental disorders affect the patient’s compliance to the treatment of DM2 and quality of life in DM2 patients, as well as may shorten the life expectancy, independently of other factors. Early detection and treatment of non-severe (non-psychotic) mental disorders in DM2 can be rather successfully done by endocrinologists, internists and general practitioners after appropriate training and supervision.

Key words: diabetes mellitus, mental disorder, cognitive disorder, depression, anxiety, stress-related disorder, eating disorder, somatoform disorder.
For citation: Bobrov А.Е., Volodina M.N., Agamamedova I.N. et al. Mental disorders in type 2 diabetic patients // RMJ. 2018. № 1 (I). P. 28–33.

Pages 3-7. Менопауза. Древаль А.В.

Summary: Menopause (lecture)
A.V. Dreval
Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirskiy
The lecturer considers the changes, which develop in the female reproductive system with aging. The classification of reproductive system aging stages and changes in the hormonal status at every stage are given. It is shown, that naturally menopause starts at the age of 42 to 60 years (median of 51.4 years), and the most frequent symptoms of menopausal transition / perimenopause and early postmenopausal years are hot flashes, but other characteristic symptoms are also observed: vaginal dryness, sleep disturbance, depression. Clinical manifestations in each stage are presented. Long-term effects of estrogen deficiency are considered. The lecturer pays particular attention to the diagnosis and differential diagnosis of menopause. Indications for hormonal therapy of menopausal symptoms are given.

Key words: menopause, menopausal transition, postmenopause, estrogen, follicle-stimulating hormone
For citation: Dreval A.V. Menopause (lecture) // RMJ. 2018. № 1 (I). P. 3–7.

Pages 34-40. Неалкогольная жировая болезнь печени – взаимосвязи с метаболическим синдромом. Бабенко А.Ю., Лаевская М.Ю.

Summary: Non-alcoholic fatty liver disease – relationships with metabolic syndrome
A.Yu. Babenko, M.Yu. Laevskaya

National Medical Research Centre named after V.A. Almazov, Saint-Petersburg

The continuous parallel increase in the number of people suffering from metabolic syndrome and non-alcoholic fatty liver disease indicates a close pathogenetic relationship of these pathologies. Therefore it is necessary to form approaches to the treatment of the latter, taking into account various components of the metabolic syndrome. The review considers both the pathogenetic relationships of non-alcoholic fatty liver disease and metabolic syndrome as well as current trends in diagnosis and treatment. The summary of information on the leading risk factors for non-alcoholic fatty liver disease clearly demonstrates the key role of various manifestations of the metabolic syndrome in it’s development. The importance of correction of various manifestations of the metabolic syndrome as the main method of preventing non-alcoholic fatty liver disease is pointed out. Modern diagnostic algorithms using the innovative non-invasive techniques are presented. The possibilities of personalization of treatment approaches are indicated depending on the presence or absence of violations of carbohydrate metabolism and the stage of liver damage. The place of bariatric surgery as a personalized approach to the treatment of patients with morbid forms of obesity is defined. Finally, the prospects for further development of methods for treating non-alcoholic fatty liver disease are discussed.

Key words: non-alcoholic fatty liver disease, obesity, metabolic syndrome, fibrosis markers, fibrosis score, glitazones, еssential phospholipids.
For citation: Babenko A.Yu., Laevskaya M.Yu. Non-alcoholic fatty liver disease – relationships with metabolic syndrome // RMJ. 2018. № 1 (I). P. 34–40.

Pages 41-46. Ранняя диагностика диабетической полинейропатии и применение альфа-липоевой кислоты для профилактики ее прогрессирования. Бреговская А.В., Бабенко А.Ю., Гринева Е.В.

Summary: Early diagnosis of diabetic polyneuropathy and the use of alpha-lipoic acid to prevent its progression
A.V. Bregovskaya, A. Yu. Babenko, E.V. Grineva

National Medical Research Center named after V.A. Almazov, St. Petersburg

The literature review is devoted to the issues of early diagnosis of diabetic neuropathy (DN), as well as the possibilities of preventing its progression. DN is one of the most common complications of diabetes mellitus (DM), and it is a pathogenetic factor in the development of the diabetic foot syndrome, which determines the need not only for its diagnosis at preclinical stages, but also for measures to reduce the progression rate. Due to the lack of objective non-invasive methods for assessing the damage of small nerve fibers in the early stages, it is necessary to look for new diagnostic methods, such as corneal confocal microscopy (CMR), which not only makes it possible to assess the degree of damage to the corneal nerves, but also to provide new information about the possibilities of pathogenetic therapy of DN at pre-clinical stages. Currently, the DN therapy is based on the compensation of DM with the minimization of the variability of glycemia during the day, the correction of other complications of diabetes and concomitant diseases, anticonvulsants, antideprimants and opioid analgesics therapy when developing painful forms of DN, as well as pathogenetic therapy aimed at reducing the of the lesion nerve fibers progression. Numerous sources indicate the prescribing of alpha-lipoic acid (ALA) preparations as an effective and safe pathogenetic therapy within the framework of complex DN treatment. The increase in the efficiency of ALA against the background of strict glycemic control is shown, as well as optimal control of cardiovascular complication risks.

Key words: diabetes mellitus, diabetic neuropathy, early diagnosis, small nerve fibres, corneal confocal microscopy, alpha lipoic acid.
For citation: Bregovskaya A.V., Babenko A.Yu., Grineva E.V. Early diagnosis of diabetic polyneuropathy and the use of alpha-lipoic acid to prevent its progression // RMJ. 2018. № 1 (I). P. 41–46.

Pages 48-54. Подходы доказательной медицины при разработке и регистрации фармакологических препаратов для лечения сахарного диабета. Бабенко А.Ю., Драй Р.В., Каронова Т.Л., Макаренко И.Е.

Summary: Evidence-based approaches for development and marketing authorization of diabetes drugs
A.Yu. Babenko1, R.V. Dry2, T.L. Karonova1, I.E. Makarenko2

1 National Medical Research Centre named after V.A. Almazov, St. Petersburg, Russia
2 GC «Geropharm», St. Petersburg, Russia

The development and marketing authorization of a medicinal product must follow the principles of evidence-based medicine at all stages of pharmaceutical and clinical development. These principles are supported both at the scientific and regulatory level in order to bring to the market drugs with proven effectiveness and safety. The introduction of the Federal Law No. 61-FZ in 2010 tightened the requirements for providing the drug evidence base. Since May 6, 2017, the Eurasian Economic Union has introduced the unified rules for the development and marketing authorization of drugs, as an adaptation of the rules of the European Union. This, on the one hand, imposes strict rules on the manufacturer concerning preclinical and clinical trials of medicines, and on the other hand, it substantially increases the guarantees of introducing high-quality drugs to the domestic market.
There are different approaches to conducting clinical trials of original and generic drugs. The article describes the features of research programs of original diabetes drugs based on small molecules and biological preparations, as well as generics and biosimilars.

Key words: diabetes mellitus, generics, biosimilars, clinical trials, evidence-based medicine.
For citation: Babenko A.Yu., Dry R.V., Karonova T.L., Makarenko I.E. Evidence-based approaches for development and marketing authorization of diabetes drugs // RMJ. 2018. № 1 (I). P. 48–54.

Pages 55-59. Мишени метаболического тандема: неалкогольная жировая болезнь печени и сахарный диабет 2-го типа. Звенигородская Л.А., Мкртумян А.М., Шинкин М.В., Нилова Т.В., Петраков А.В.

Summary: Metabolic tandem targets: non-alcoholic fatty liver disease and type 2 diabetes mellitus
L.A. Zvenigorodskaya, A.M. Mkrtumyan, M.V. Shinkin, T.V. Nilova, A.V. Petrakov

Moscow Clinical Scientific and Practical Center named after А.S. Loginov

According to the World Health Organization estimates, non-alcoholic fatty liver disease (NAFLD) will be ranked number one in the liver diseases pattern by 2020. Liver transplantation in patients with cirrhosis as the outcome of NAFLD currently ranks next to the viral liver cirrhosis.
According to current concepts, NAFLD is a liver disease defined as fatty dystrophy, fatty degeneration with inflammation and possible outcome in cirrhosis. The causal relationship between NAFLD and diabetes mellitus is the subject of numerous discussions. Insulin resistance is the binding pathogenetic link between these diseases. First of all, insulin resistance is carried out at the level of hepatocyte. Until now, there is no standard therapy for NAFLD. Correction of body weight, changes in food addiction, physical activity are the most effective measures to prevent the development of NAFLD and diabetes mellitus. None of the drugs used for the treatment of NAFLD has evidence base for the effect on the histological pattern of NAFLD.

Key words: non-alcoholic fatty liver disease, type 2 diabetes mellitus, complex medication, taurine.
For citation: Zvenigorodskaya L.A., Mkrtumyan A.M., Shinkin M.V. et al. Metabolic tandem targets: non-alcoholic fatty liver disease and type 2 diabetes mellitus // RMJ. 2018. № 1 (I). P.55 –59.

Pages 60-64. Роль D-гормона в регуляции артериального давления. Балашова Н.В., Барсуков И.А., Матвеев Ю.Н.

Summary: The role of D-hormone in the blood pressure regulation
N.V. Balashova, I.A. Barsukov, Yu.N. Matveyev

Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy

This review contains data on the vitamin D participation in the pathogenesis of arterial hypertension (AH). Data on vitamin D regulation of the formation of renin in the juxtaglomerular kidney apparatus are presented. It is noted, that local renin-angiotensin-aldosterone systems (RAAS) play more important role in the formation of pathophysiological disorders in AH than circulating RAAS. Attention is focused on the interaction of local RAAS and paracrine factors, in particular TGF-beta factor (TGF-β), at the endothelium level. The experimental and therapeutic effects of vitamin D, including its native forms, active metabolites and vitamin D receptor activators are analyzed. Given the prevalence of the diseases associated with vitamin D deficiency, it is necessary to introduce screening tests to detect the deficit of this vitamin in the population. With receiving the new data on the pathogenesis of AH formation, additional prognostic criteria of the disease appear, allowing the development of innovative approaches to its therapy, for example, the use of vitamin D preparations and its metabolites to correct the development of hypertension, including AH in the metabolic syndrome.

Key words: vitamin D, renin, aldosterone, angiotensin, TGF-beta factor (TGF-β), adiponectin.
For citation: Balashova N.V., Barsukov I.A., Matveyev Yu.N. The role of D-hormone in the blood pressure regulation // RMJ. 2018. № 1 (I). P. 60–64.

Pages 8-11. Влияние физической нагрузки на обменные процессы у пациентов с метаболическим синдромом. Мисникова И.В., Ковалева Ю.А.

Summary: Influence of physical activity on the metabolic processes in patients with metabolic syndrome (lecture)
I.V. Misnikova, Yu.A. Kovaleva

Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy, Moscow

In the modern world, the conditions of human life lead to reducing the time of physical activity of a person. It has been proved, that sedentary lifestyle results in an increased obesity among population, it is also considered to be a risk factor for the development of various chronic diseases and metabolic disorders. Physical exercises help to improve metabolism and cardioprotection, reduce insulin resistance, and lead to a better oxidative ability and overall health. Physical exercises improve the metabolism in muscles and in the whole organism. This may be due to their participation in the regulation of catabolic and anabolic processes depending on energy needs, as well as the improvement of mitochondrial function by activating mitochondrial biogenesis and remodeling, increasing the density of mitochondria and their viability. The types of physical activity are considered, the level of physical activity is assessed. It is concluded, that regular physical activity, including aerobic and anaerobic exercises, should be an integral component of the prevention and treatment of metabolic disorders, including metabolic syndrome.

Key words: physical activity, metabolism, mitochondria, metabolic syndrome, ATP
For citation: Misnikova I.V., Kovaleva Yu.A. Influence of physical activity on the metabolic processes in patients with metabolic syndrome (lecture) // RMJ. 2018. № 1 (I). P. –11.



№28, 2017. Хирургия

Pages 2035-2038. Эффективность многокомпонентных топических препаратов у пациентов с острым тромбофлебитом вен нижних конечностей. Богачев В.Ю., Капериз К.А., Лобанов В.Н.

Summary: Effectiveness of multicomponent topical preparations in patients with acute thrombophlebitis of the veins of the lower extremiteis
Bogachev V.Yu.1,2, Kaperiz K.A.2, Lobanov V.N.2

1 Russian National Research Medical University named after N.I. Pirogov, Moscow
2 First Phlebological Center, Moscow

According to international and Russian recommendations, treatment of thrombophlebitis should be comprehensive and, along with compulsory compression, include both systemic and local use of anticoagulant drugs.
The aim of the study was to evaluate the efficacy, safety and convenience of using the combined preparation Thrombless Plus gel in patients with thrombophlebitis of the lower extremities.
Patients and Methods: 153 compliant patients aged from 18 to 75 years with thrombophlebitis of inflows of superficial veins of the lower extremities without a threat of spread to the deep venous system and not requiring surgical intervention were included in the study. Patients were divided into three equal groups: in the main group Thrombless Plus was used for a local thrombophlebitis therapy, in the control groups Venolife and Troxevasin NEO gels were used. Patients applied Thrombless Plus and comparator agents independently in the projection of the inflamed vein 2 times a day for 21 days. Comparison criteria were presence / absence of thrombus and its length in the control vein, severity of hyperemia, pain and area of ecchymosis. Symptom evaluation was also performed independently by the patient and the physician on a visual analogue scale. 
Results: Thrombless Plus had a significantly faster and longer analgesic effect, and, unlike comparison groups, it helped to reduce hyperemia and area of ecchymoses by an average of 5 cm2. The length of the thrombosed area decreased more rapidly with the use of Thrombless Plus, and the recanalization for 21 days reached 40% versus 15% and 24% in the groups of Troxevasin Neo and Venolife, respectively. 
Conclusion: The study demonstrated the high efficacy and safety of the Thrombless Plus gel, applied 2 times a day, in patients with thrombophlebitis of the lower extremities of various genesis, which makes it possible to consider it as a drug of choice in the treatment of this frequent surgical pathology.

Key words: thrombophlebitis, lower extremity varicose vein disease, topical preparations, Thrombless Plus.
For citation: Bogachev V.Yu., Kaperiz K.A., Lobanov V.N. Effectiveness of multicomponent topical preparations in patients with acute thrombophlebitis of the veins of the lower extremiteis // RMJ. 2017. № 28. P. 2035–2038.

Pages 2039-2042. Применение сульфатиазола серебра в комплексном лечении гнойных ран. Каторкин С.Е., Быстров С.А., Безбородов А.И., Назаров Р.М., Лисин О.Е., Личман Л.А., Шестаков Е.В.

Summary: Application of silver sulfatiazole in the complex treatment of purulent wounds
Katorkin S.E., Bystrov S.A., Bezborodov A.I., Nazarov R.M., Lisin O.E., Lichman L.A., Shestakov E.V.

Samara State Medical University

Aim: To evaluate the effectiveness of treatment of purulent wounds with silver sulfatiazole preparations in a surgical hospital. 
Patients and Methods: The analysis of 160 patients applied to the Samara State Medical University Clinic for the period 2016 - 2017 with purulent wounds of soft tissues of various etiologies was carried out. Patients were monitored from the first visit to a surgeon to the discharge from the hospital. All patients were divided into 2 groups by random sampling: group I (n = 82) included the patients with even numbers of case histories, who used silver sulfatiazole dressings for local treatment of wounds in the postoperative period. Group II (n = 78) consisted of patients with odd numbered disease histories who used in the postoperative period the salve dressings with antibacterial ointments on a water-soluble basis - levosin, levomecol. The following parameters were studied in the dynamics: the wound fluid, the presence of edema and hyperemia of the tissues around the wound, the time of wound cleansing, the body's temperature reaction, the leukocyte reaction, culture and sensitivity tests were performed on 1, 5, 10 days after the operation, terms of hospitalization.
Results: Statistically significant differences in the rate of subsidence of inflammatory phenomena in comparison groups were revealed. The data obtained indicate a more pronounced dynamics of normalization of the temperature response, a decrease in the local inflammatory response and a leukocytosis level in patients treated with silver sulfatiazole dressings. 
The conclusion: The use of silver sulfatiazole ointments allows to improve the results of treatment of patients with purulent soft tissue pathology and to reduce the risk of secondary infection in comparison with traditional antibacterial ointments by bacterial contamination, and accelerating the postoperative wound cleansing from pus and fibrin.

Key words: purulent wounds, silver sulfatiazole, wound healing ointment, bacterial contamination, salve dressings, inflammation, infected wounds 
For citation: Katorkin S.E., Bystrov S.A., Bezborodov A.I. et al. Application of silver sulfatiazole in the complex treatment of purulent wounds // RMJ. 2017. № 28. P. 2039–2042.

Pages 2043-2048. Результаты клинического исследования эффективности местной терапии послеожоговых и послеоперационных рубцов. Птухин М.И.

Summary: Results of the clinical study of the effectiveness of local therapy of burn and postoperative scars
Ptukhin M.I.

City Clinical Hospital No. 40, Burn Center, Ekaterinburg

Currently, the number of skin defects, in particular, scarring, tends to increase. Modern clinical experience makes it possible to use highly effective, scientifically based approaches to the treatment of scars of various genesis.
The aim of the study was to evaluate the therapeutic effectiveness and tolerability of the Kontraktubeks gel in patients with burn and postoperative scars.
Patients and Methods: 30 patients were included in the study. Patients applied Gel Kontraktubeks twice a day for 12 weeks + 6 days. At the 1st, 6th and 12th weeks. the subjective and objective changes in clinical symptomatology were assessed using the POSAS scale (The Patient and Observer Scar Assessment Scale).
Results of the study: Statistically significant changes in the clinical picture against the backdground of using the Kontraktubeks gel were noted already 6 weeks after the start of the treatment. According to POSAS, evaluated by a doctor, the elasticity of scars at palpation increased on 16.7% (p <0.001). After 12 weeks of application of the gel, a positive dynamics was observed due to a decrease in density, increased elasticity of the scars, and a decrease in the intensity of vascularization. The analysis of subjective criteria for the 6th week of the study revealed a significant reduction in pain, itching and scar density. At the 12th week after the beginning of treatment with gel Kontraktubeks, a statistically significant decrease in pain and itching was noted from 3 to 1 point and from 5 to 2 points, respectively, and the color of scars changed from bright pink to blanching.
Conclusion: Kontraktubeks gel is an effective and safe therapy for burn and post-operative scars. During the study there were no serious adverse events, no additional therapy was required.

Key words: burn scars, postoperative scars, hypertrophic scars, allantoin, Kontraktubeks.
For citation: Ptukhin M.I. Results of the clinical study of the effectiveness of local therapy of burn and postoperative scars // RMJ. 2017. № 28. P. 2043–2048.

Pages 2048-2052. Алкогольный эпизод в этиопатогенезе прободных язв. Никитин В.Н., Полуэктов В.Л., Заблоцкая Е.А., Клипач С.Г.

Summary: Alcoholic episode in etiopathogenesis of perforated ulcers
Nikitin V.N.1,2, Poluektov V.L.1, Zablotskaya E.A.3, Klipach S.G.2

1 Omsk State Medical University
2 City Clinical Emergency Hospital No. 2, Omsk
3 Clinical Medical Unit No.9, Omsk

According to the world statistics the perforated ulcer takes the leading place in the structure of the mortality of duodenal bulb ulcer complications.
The aim of the study was to determine the role of the alcoholic episode in the etiopathogenesis of the perforated duodenal ulcer. 
Patients and Methods: The authors studied twelve patients operated for duodenal bulb ulcer during the period from April 2014 to May 2017. Among them there were 10 men (83.3%), 2 women (16.7%), the average age was 39.33 years. Inclusion criteria: the patient had a perforated duodenal ulcer and an alcoholic episode in the anamnesis. The amount of ethanol in the venous blood was determined by the standard method of gas chromatography. Surgical intervention included upper and midline laparotomy, excision of the ulcer with a perforated aperture (with subsequent histological examination) and duodenoplasty with the use of a double-layer continuous suture with the application of node "locks", sanitation and drainage of the abdominal cavity.
Results: In 91.7% of cases, the concentration of ethanol in the blood of patients on admission corresponds to mild and moderate alcohol intoxication. In 100% of the patients the morphological study showed: inflammatory-dystrophic changes in the wall of the vascular bed in the ulcerative lesions area, inflammatory endoneural edema and degeneration of intermuscular neural plexuses, and the presence of thrombosed intramural vessels in the perforation area. The results allowed to consider the pathogenesis of the perforated ulcer from the position of the hypothesis of acute microthrombosis, triggered by alcohol. The average duration of the operation was 79.6 min; the average duration of inpatient treatment was 10.8 bed-days. Postoperative complications and deaths were not observed.
Conclusion: Alcohol episode, regardless of the amount of consumption, triggers a cascade of pathological reactions, the outcome of which is an acute microthrombosis of altered vessels of the intestinal wall, acute ischemia and necrosis of the affected segment with the formation of end-to-end defect in the bottom of the ulcer crater. The use of the proposed method of radical duodenoplasty is reproducible.

Key words: perforated duodenal ulcer, alcoholic episode, acute microthrombosis theory, duodenoplastic.
For citation: Nikitin, V.N. Poluektov V.L., Zablotskaya E.A., Klipach S.G. Alcoholic episode in etiopathogenesis of perforated ulcers // RMJ. 2017. № 28. P. 2048–2052.

Pages 2053-2056. Сравнительный анализ эффективности селективных ингибиторов циклооксигеназы-2 у амбулаторных хирургических пациентов. Каторкин С.Е., Быстров С.А., Безбородов А.И., Назаров Р.М., Лисин О.Е., Личман Л.А., Шестаков Е.В.

Summary: Comparative analysis of the efficacy of selective cyclooxygenase-2 inhibitors in outpatient surgical patients
Katorkin S.E., Bystrov S.A., Bezborodov A.I., Nazarov R.M., Lisin O.E., Lichman L.A., Shestakov E.V.

Samara State Medical University
 
In recent years, there has been a significant increase in outpatient surgical interventions. Pain syndrome is one of the most important factors affecting the early rehabilitation of these patients.
Aim: to analyze the effectiveness of the use of tableted forms of Cox-2 selective inhibitors for anesthetizing outpatients in the early postoperative period.
Patients and Methods. All patients (n = 92) after low-traumatic surgical interventions were divided into 2 groups: patients of group I (n = 46) in the postoperative period were prescribed nimesulide (a sulfonanilide-NSAID) for pain relief; patients of group II (n = 46) were prescribed lornoxicam (an oxicam-NSAID). The drugs were administered for five days. To assess the effectiveness of the drugs, a visual analogue pain scale (VAS, Huskisson E.C., 1974) was used. Patients made marks on the scale 3 times a day.
Results of the study. Nimesulide had a more pronounced analgesic effect during the first 3 days after surgical intervention in comparison with lornoxicam. Pain intensity marks were significantly lower in patients of group I than in patients of group II both at rest and movement (p = 0.02). At the same time, during the period from 4 to 5 days, there were no significant differences in the intensity of pain in patients of groups I and II.
The conclusion. The tableted forms of NSAIDs must be used for relieving pain after the outpatient surgery. Nimesulide is an effective, quick-relief NSAID with good tolerability, and sufficient analgesic activity in the postoperative period.

Key words: pain, postoperative pain syndrome, nimesulide, analgesia, outpatient surgery.
For citation: Katorkin S.E., Bystrov S.A., Bezborodov A.I. et al. Comparative analysis of the efficacy of selective cyclooxygenase-2 inhibitors in outpatient surgical patients // RMJ. 2017. № 28. P. 2053–2056.

Pages 2056-2058. Клинические результаты хирургической резекции склеры у больных с первичной глаукомой. Корчуганова Е.А., Румянцева О.А., Егоров Е.А., Казанцева А.Ю.

Summary: Clinical results of surgical resection of the sclera in patients with primary glaucoma
Korchuganova E.A., Rumyantseva O.А., Egorov E.А., Kazantseva А.Yu.

Russian National Research Medical University named after N.I. Pirogov, Moscow 

Glaucoma continues to lead among diseases causing the loss of visual functions. Most surgical operations are carried out on patients with advanced glaucoma stages. Especially high risks of postoperative complications are observed in patients with high vision and residual field of vision. Surgical treatment of glaucoma is mainly aimed at creating or stimulating the ways of intraocular fluid outflow from the eye. A non-penetrating non-invasive operation has been developed to increase uveoscleral outflow by improving scleral permeability.
The aim of this research is to study the clinical efficacy of surgical resection of the sclera.
Patients and Methods: 79 patients (79 eyes) have been operated, most of patients (77%) had an advanced glaucoma, 19% had a developed glaucoma and 4% (3 eyes) had glaucoma stage IV. In 23 cases, 1 resection was performed, in 56 patients (56 eyes) - 2 resections were performed in the projection between the rectus muscles. Technique of the operation: after the conjunctiva is cut off from the limbus, the sclera is excised in the projection between the rectus muscles in the upper half of the eyeball with a size of 7.0x5.0 mm to a depth of 2/3 - 4/5 of its thickness in the projection of the ciliary body and the intrascleral collector canals. After hemostasis, 1-2 nodal seams are applied to the conjunctiva 8/00. Objective studies included: determination of visual acuity, level of intraocular pressure (IOP), outflow index (OI). Evaluation of the results was carried out 6 months after the operation.
Results: in all cases there were no sudden changes in IOP, it was normalized against the background of a weakening of the drug regimen.
Conclusion: The high efficiency of the developed method for the surgical treatment of glaucoma was noted by activating an additional path of outflow through the suprachoroidal space and the sclera. Complications in the early and late operating period were absent.

Key words: glaucoma, sclera, uveoscleral outflow, surgical treatment of glaucoma.
For citation: Korchuganova E.A., Rumyantseva O.А., Egorov E.А., Kazantseva А.Yu. Clinical results of surgical resection of the sclera in patients with primary glaucoma. // RMJ. 2017. № 28. P. 2057–2058.

Pages 2059-2062. Современные антисептики и хирургические аспекты их применения. Черняков А.В.

Summary: Modern antiseptics and surgical aspects of their use
Chernyakov A.V.

Russian National Research Medical University named after N.I. Pirogov, Moscow
City Clinic No. 15 named after M.M. Filatov, Moscow

Modern surgery is based on the principles of aseptics and antiseptics, adequate anesthesia, replenishment of blood loss. Modern antiseptics include inorganic substances, bioorganic and synthetic inorganic compounds. Currently, there is no "ideal antiseptic", which is caused by the properties of the drugs and the characteristics of modern pathogenic microorganisms. To increase efficiency, it is necessary to introduce antiseptic agents with a broad antimicrobial spectrum. One such preparations is Betadine®, povidone-iodine in the form of a complex of polyvinylpyrrolidone iodine. The drug has several release forms and can be used for prevention and treatment. It is possible to use the drug in the treatment of fresh wounds of soft tissues, skin of the surgical field, skin before blood taking and biopsy, mucous membranes, "donor" wounds, postoperative scars, grafts. High effectiveness of the drug against pathogenic microorganisms is associated with a wide spectrum of antibacterial activity, long-term preservation of antiseptic properties, the absence of resistant forms of microorganisms, absence of toxicity in long-term and frequent use, rare allergic reactions, storage stability.

Key words: prevention, wounds, surgical field, infectious complications, care, intravenous catheter, surgeon's hands, Betadine®, povidone-iodine. 
For citation: Chernyakov A.V. Modern antiseptics and surgical aspects of their use // RMJ. 2017. № 28. P. 2059–2062.

Pages 2063-2068. Профилактика и лечение патологических рубцов в хирургической практике. Черняков А.В.

Summary: Prevention and treatment of pathological scars in surgical practice
Chernyakov A.V.

Russian National Research Medical University named after N.I. Pirogov, Moscow
City Clinic No. 15 named after M.M. Filatov, Moscow

The formation of surgical scar involves external and internal factors and includes exudation and inflammation phases, proliferation, reorganization. There are no reliable reasons for the development of hypertrophic and keloid scars at the present time. Their formation is based on the violations in the synthesis and degradation of collagen at various stages of scar development. Pathological scars can appear at any age, but most often they occur in young patients. Rational tactics of treating pathological scars include therapeutic, physiotherapeutic, radiological, surgical and cosmetic methods. The multicomponent drugs affecting various stages of scar formation process are very effective. The measures aimed at prevention of keloid scars include the minimally invasive treatment methods that reduce skin damage and the use of various therapeutic and physiotherapeutic agents that impede the formation of keloid tissue.

Key words: collagen, fibroblasts, metalloproteinases, peeling, mesotherapy, dermabrasion, endothelioprotective effect, proliferation, conjugated hyaluronidase.
For citation: Chernyakov A.V. Prevention and treatment of pathological scars in surgical practice // RMJ. 2017. № 28. P.2063 –2068.

Pages 2069-2071. Казуистический случай миграции металлофиксатора в левое легкое после остеосинтеза шейки правой бедренной кости. Ерёмкин В.Ю., Гусев В.В., Черешнев К.И.

Summary: Casuistic migration of the metal fixator from the neck of the right femur to the left lung
Yeryomkin V.Yu., Gusev V.V., Chereshnev K.I.

Central City Clinical Hospital No. 23, Ekaterinburg

Migration of the metal fixator is not a typical complication of osteosynthesis operations, and as a result, it can cause significant diagnostic problems (due to migration of the fixator to adjacent areas, and in rare cases, distant anatomical regions), as well as create a threat to the lives of patients, damaging vital organs and major vessels. In particular, the metal structures of the proximal femur under the influence of muscle contractions and changes in the position of the body can migrate to the gluteal region. There are publications describing their migration into the small pelvis and the perineal region. Each of these complications can have either a typical course, or its own special scenario.
The article describes a casuistic clinical case of a patient admitted to the hospital with complaints of hemoptysis, pain in the left hypochondrium region, within 2 days. As a result of the examination, a migration of the metal fixator of the right femur cervix into the left lung complicated by pulmonary hemorrhage was revealed. The patient underwent surgical treatment.

Key words: migration, osteosynthesis, clinical case, pulmonary hemorrhage.
For citation: Yeryomkin V.Yu., Gusev V.V., Chereshnev K.I. Casuistic migration of the metal fixator from the neck of the right femur to the left lung // RMJ. 2017. № 28. P. 2069–2071.



№27, 2017. Урология

Pages 1987-1991. Антимикробная профилактика инфекционных камней почек после перкутанной нефролитотрипсии. Перепанова Т.С., Раджабов У.А., Голованов С.А., Меринов Д.С., Арустамов Л.Д.

Summary: Antibacterial prophylaxis of infectious kidney stones after percutaneous nephrolithotripsy
Perepanova T.S., Radzhabov U.A., Golovanov S.A., Merinov D.S., Arustamov L.D.

Institute of urology and interventional radiology named after N.А. Lopatkin, Moscow

Depending on the type of stone, the risk of recurrence is 50-80%, the postoperative prophylaxis reduces this risk to 10-15% (Christian F. et all. 2015). Frequent development of relapses of infectious kidney stones after percutaneous nephrolithotripsy (PNLT), and the revealed difference in uropathogens in urine and kidney stones require the search for the new regimens of antimicrobial prophylaxis of relapses of infectious stones.
The aim of the study was to reduce the number of relapses of infectious stones after PNLT.
Patients and Methods: 190 patients with coral kidney stones after PNLT were included in the study. We determined the efficacy of postoperative antibacterial prophylaxis regimens of infectious kidney stones based on the results of bacteriological examination of the stone (group 1 of patients) or urine (group 2) taken from the pelvis in the course of PNLT on the frequency of relapses of infectious kidney stones after PNLT.
Results: The observation period for patients after PNLT was 6-18 months after the operation. In 43 (22,6%) patients out of 190 there were relapsed stones. The highest frequency of recurrence was observed in 21 patients of the 1st group (36.2%), in the 2nd group in 10 patients (16.9%) and in the 3rd group (antimicrobial treatment was not performed) in 12 patients (16.4%). Differences between groups 1 and 2 were at the statistical trend level (p = 0.032), the differences between groups 1 and 3 were statistically reliable (p = 0.01).
The conclusion: It was revealed that the postoperative antibacterial prophylaxis regimens of infectious kidney stones, based on the results of bacteriological examination of the urine, taken from the pelvis in the course of PNLT, has the advantages over the antimicrobial regime based on the results of bacteriological examination of stones removed during PNLT.

Key words: infectious stones, struvite, relapse of infectious stones, percutaneous nephrolithotripsy, antibacterial prophylaxis of infectious kidney stones. 
For citation: Perepanova T.S., Radzhabov U.A., Golovanov S.A. et al. Antibacterial prophylaxis of infectious kidney stones after percutaneous nephrolithotripsy // RMJ. 2017. № 27. P. 1987–1991.

Pages 1992-1996. Современный взгляд на лечение синдрома нижних мочевыводящих путей: цитомедины как класс лекарственных препаратов. Карпов Е.И.

Summary: Modern view on the treatment of the lower urinary tract syndrome: cytomedines as a class of drugs
Karpov E.I. 

City Clinic No. 6, Ryazan
Medical Center «Harmony», Ryazan

Chronic prostatitis is the most common cause of recurrent urinary tract infections in men. The main cause of the development of chronic prostatitis is a violation of microcirculation in the prostate gland and drainage of its acini. Antibiotic therapy is effective during the treatment, but it is sometimes unreliable in the long term. As a result, the problem of recurrence of prostatitis remains unresolved. The methods of treatment that lead to the better blood circulation in the prostate include α-adrenoblockers, prostate massage, physiotherapy, testosterone preparations, cytomedins.
Cytomedines are peptides, a unique class of drugs. The use of prostatic cytomedines leads to the restoration of hemodynamics of the prostate gland, the elimination of edema and inflammation, decrease of the clinical manifestations of prostatitis, and improves the quality of the ejaculate. They increase detrusor tone, regulate detrusor by influencing the rhythm of spontaneous contractile activity. Prostatic peptides do not have toxic or mutagenic effects. The prostatic cytomedines preparation Vitaprost, presented in various dosage forms, is widely used in the treatment of chronic prostatitis.

Key words: chronic prostatitis, chronic pelvic pain syndrome, CPPS, cytomedines, Vitaprost, α-adrenoblockers, testosterone, prostate massage.
For citation: Karpov E.I. Modern view on the treatment of the lower urinary tract syndrome: cytomedines as a class of drugs // RMJ. 2017. № 27. P. 1992–1996.

Pages 1997-2002. Комплексная этиопатогенетическая терапия больных хроническим бактериальным простатитом. Кульчавеня Е.В., Бреусов А.А.

Summary: Complex etiopathogenetic therapy of patients with chronic bacterial prostatitis
Kulchavena E.V.1,2, Breusov A.A.3


1 Novosibirsk Scientific Research Institute of Tuberculosis
2  Novosibirsk State Medical University
3 «BIOVER» Medical Center, Novosibirsk

The results of treatment of patients with chronic prostatitis (CP) remain unsatisfactory, the disease tends to a continuously recurrent course, which determines the urgency of finding new approaches to therapy.
Aim: to determine the efficacy and safety of the combined use of Afhalaza and levofloxacin in patients with chronic bacterial prostatitis (CBP).
Study design: simple open comparative non-randomized bidirectional study.
Patients and Methods: The study included 62 patients with CBP. The symptomatology was assessed according to a point scale. All patients received levofloxacin. 24 patients (comparison group - CG) did not receive additional treatment, and 38 patients of the main group (MG) additionally received Afhalaza sublingually for 4 months. Patients of both groups were examined after 1 month of the treatment, after completion of antibacterial therapy, and 4 months after receiving Aphalaza in the MG and without receiving any additional treatment – in the CG. 
Results: Every second patient with CВP had sexual dysfunction. Levofloxacin therapy made it possible to achieve reliable eradication of the pathogen and normalization of the prostate secretion in 94.7% of patients, but sexual dysfunction in patients of comparison group remained. The use of Aphalaza for 4 months significantly improved the performance of sexual function and the end result of therapy. Against the background of Aphalaza administration, restoration of libido was noted, as well as the improvement of erectile function according to the cumulative assessment of the answers to the II, III and IV questions of the male copulatory function scale. There were no significant adverse reactions to the treatment or complications of the therapy. 
The conclusion: Levofloxacin is highly effective in patients with chronic bacterial prostatitis. It is advisable to include Aphalaza in the complex treatment of patients with chronic bacterial prostatitis.

Key words: prostatitis, prostatic tuberculosis, sexual dysfunction, Aphalaza, release-active antibodies, erectile dysfunction, levofloxacin.
For citation: Kulchavena E.V., Breusov A.A. Complex etiopathogenetic therapy of patients with chronic bacterial prostatitis // RMJ. 2017. № 27. P. 1997–2002.

Pages 2003-2010. Терапия доброкачественной гиперплазии предстательной железы: в фокусе – воспаление (доклад профессора Грегори Роберта в рамках XVII конгресса Российского общества урологов).

Pages 2007-2010. Информативность диагностических тестов в скрининге мочеполового туберкулеза. Шевченко С.Ю., Кульчавеня Е.В., Лаушкина Ж.А.

Summary: The informative value of diagnostic tests in urogenital tuberculosis screening
Shevchenko S.Yu.1,2, Kulchavenya E.V.1,2, Laushkina Zh.A.1

1 Novosibirsk Research Institute of Tuberculosis 
2 Novosibirsk State Medical University

Despite a slight decrease in the share of urinogenital tuberculosis (UT) in the structure of the incidence rate of extrapulmonary forms of tuberculosis, its medical, epidemic and social significance is great. Urinogenital tuberculosis (UT) is characterized by polymorphism of clinical manifestations and the absence of pathognomonic symptoms, which significantly complicates its recognition. 
The aim of the study was to determine the informative value of the recombinant tuberculosis antigen in standart dilution (RTA) as a screening method in the differential diagnosis of UT.
Patients and methods. A simple open cohort study was conducted. It included 126 patients who received treatment the extrapulmonary tuberculosis department of the Novosibirsk Research Institute of Tuberculosis in 2014-2015. Patients were divided into three groups: group 1 - patients with active UT, n = 31 (24.6%); group 2- patients with inactive UT, n = 16 (12.7%); group 3 - patients with chronic infections of the urogenital tract with excluded UT, n = 79 (62.7%). The comparison group included 105 patients aged from 18 to 78 years hospitalized with suspected respiratory tuberculosis (RT). In addition to the standard clinical-laboratory, X-ray and bacteriological examination, they all had a skin test with RTA.
Results. The RTA sensitivity in adult patients with pulmonary tuberculosis was 74.5%, the RTA specificity in RT was 86%. RTA sensitivity in patients with active UT was 78.6%, and sensitivity of subcutaneous challenge tuberculin test was 82.8%. Thus, the false positive result of RTA in patients without tuberculosis was 76.9%, and there were no any false positive results of Koch’s test, which indicates an extremely low specificity of RTA (23.1%) for urogenital tuberculosis in adults.
Conclusions. RTA can be used in UT screening, though its positive result cannot be used as a basis for establishing a diagnosis, but only as a reason for an additional phthisiourological examination.

Key words: tuberculosis, diagnostics, recombinant tuberculosis antigen in standart dilution, Koch’s test, urinogenital tuberculosis.
For citation: Shevchenko S.Yu., Kulchavenya E.V., Laushkina Zh.A. The informative value of diagnostic tests in urogenital tuberculosis screening // RMJ. 2017. № 27. P.2007 –2010.

Pages 2011-2014. Внутритканевая лучевая терапия (брахитерапия) рака предстательной железы. Собственный опыт работы Национального медицинского исследовательского радиологического центра Минздрава России. Каприн А.Д., Бирюков В.А., Черниченко А.В., Корякин А.В., Поляков В.А., Карякин О.Б., Галкин В.Н., Аполихин О.И., Иванов С.А., Сивков А.В., Ощепков В.Н., Алексеев Б.Я., Обухов А.А., Лепилина О.Г.

Summary: Interstitial radiotherapy therapy (brachytherapy) of prostate cancer. Own experience of the National Medical Research Radiological Center of the Ministry of Health of Russia
A.D. Kaprin1, V.A. Biryukov2, A.V. Chernichenko3, A.V. Koryakin4, V.A. Polyakov3, O.B. Karyakin2, V.N. Galkin2, O.I. Apolikhin4, S.A. Ivanov2, A.V. Sivkov4, V.N. Oschepkov5, B.Ya. Alekseev1, A.A. Obukhov2, O.G. Lepilina2
1 National Medical Research Radiological Center, Moscow
2 Medical Radiological Research Center named after A.F. Tsyb, branch of National Medical Research Radiological Center, Obninsk
3 Moscow Scientific Oncological Institute named after P.A. Herzen, branch of National Medical Research Radiological Center
4 Research Institute of Urology and Interventional Radiology named after N.A. Lopatkin, branch of National Medical Research Radiological Center, Moscow
5 Multifield Clinical Medical Center "Medical City", Tyumen

Currently, the main methods of treatment of localized prostate cancer (PC) are surgery and radiation therapy. Brachytherapy is an interstitial radiation therapy, which allows to bring a highly effective dose of radiation to the affected organ using a minimally invasive intervention. There are low and high dose rate brachytherapy, depending on the source of radiation. This article reflects the main stages of the historical development of PC brachytherapy both abroad and in our country. The description of the main methods of brachytherapy used in modern medical practice is given. Reference is made to the methodological recommendations of the world's leading communities on the contact radiation therapy with the use of  low dose rate radiation sources. The main indications and contraindications to PC brachytherapy are described. Summary data on the effectiveness of the method are presented depending on different groups of the PC course prognosis. For the first time, the combined results of low dose rate brachytherapy received from the branches of the National Medical Research Radiological Center were published. The article provides the data of clinical trials of Russian I-125 sources initiated by National Medical Research Radiological Center within the program of import substitution.  

Key words: prostate cancer, interstitial radiation therapy, brachytherapy, indications, contraindications, prognosis groups, combined results, Russian microsources I-125.
For citation: Kaprin A.D., Biryukov V.A., Chernichenko A.V. et al. Interstitial radiotherapy therapy (brachytherapy) of prostate cancer. Own experience of the National Medical Research Radiological Center of the Ministry of Health of Russia // RMJ. 2017. № 27. P. 2011–2014.

Pages 2015-2018. Местнораспространенный и локализованный рак предстательной железы группы высокого риска прогрессирования: стратегия лечения, обзор клинических исследований. Солодкий В.А., Павлов А.Ю., Гафанов Р.А., Гармаш С.В., Кравцов И.Б., Фастовец С.В., Ивашин А.К.

Summary: Regional and localized prostate cancer in the high-risk group: treatment strategy, review of clinical trials
Solodkiy V.A., Pavlov A.Yu., Gafanov R.A., Garmash S.V., Kravtsov I.B., Fastovets S.V., Ivashin A.K.

Russian scientific center of radiology and nuclear medicine, Moscow 

Over the past few years, recommendations for treating patients with high-risk nonmetastatic prostate cancer have changed significantly. This publication reviews the clinical and pathological criteria needed to determine the optimal treatment for this group of patients. To determine the optimal method of treatment, mandatory examination is necessary in order to exclude the metastatic lesions. Magnetic resonance imaging (MRI) and osteoscintigraphy are among the recommended methods of examination. The determining factor in the choice of treatment is life expectancy, and concomitant diseases. High radiation doses are essential to achieve the therapeutic effect, while the addition of androgen deprivation therapy (ADT) statistically significantly improves the overall and cancer-specific survival. The long-term  appointment of neo / adjuvant ADT (2-3 years) significantly improves survival compared with short-term ADT (4-6 months). Radical prostatectomy with extended pelvic lymph node dissection is considered an acceptable method of treatment, and ADT alone is an inappropriate treatment option for treating this group of patients.

Key words: prostate cancer, high-risk cancer groups, androgen deprivation therapy, hormonal therapy, remote radiation therapy, radical prostatectomy.
For citation: Solodkiy V.A., Pavlov A.Yu., Gafanov R.A. et al. Regional and localized prostate cancer in the high-risk group: treatment strategy, review of clinical trials // RMJ. 2017. № 27. P. 2015–2018.

Pages 2019-2025. Хирургическое лечение больных локализованным и местнораспространенным раком предстательной железы: результаты одноцентрового исследования. Алексеев Б.Я., Нюшко К.М., Крашенинников А.А., Воробьев Н.В., Сафронова Е.Ю., Калпинский А.С., Сергиенко С.А., Тараки И.А., Темиргереев М.З., Каприн А.Д.

Summary: Surgical treatment of patients with localized and locally advanced prostate cancer: the results of a single center study
B.Ya. Alekseev, K.M. Nyushko, A.A. Krasheninnikov, N.V. Vorobiev, E.Yu. Safronova, A.S. Kalpinskiy, S.A. Sergienko, I.A. Taraki, M.Z. Temirgereev, A.D. Kaprin
National Medical Research Radiological Center, Moscow

At present prostate cancer (PC) is an extremely urgent oncological problem in Russia because of a steady increase in the incidence and mortality of men due to this pathology. The introduction of new methods of laboratory and radiation diagnostics allows not only to diagnose PC, but also to more accurately assess the clinical stage of the disease. A multidisciplinary individual approach to each patient provides more treatment opportunities. Many new methods of PC treatment are being developed and studied. Radical prostatectomy (RPE) and radiotherapy (remote radiation therapy, brachytherapy) are currently the "gold standard" for radical treatment of patients with PC, nevertheless surgical treatment remains the main method of therapy for patients with localized and locally advanced prostate cancer, demonstrating satisfactory oncological and functional results.
Aim: to evaluate immediate and long-term results of surgical treatment of patients with PC.
Patients and methods: professionals of the oncourology department of the Moscow Scientific Oncological Institute named after P.A. Herzen made a retrospective analysis of 1 846 patients with prostate cancer who underwent RPE from 1998 to 2016. A detailed analysis of preoperative characteristics of patients, data of pathomorphological study, intra- and postoperative complications, as well as distant functional and oncological results of surgical treatment is given. It has been revealed, that there is a tendency to an increase in the number of PC patients with a high risk of disease progression and the presence of unfavorable prognosis factors, requiring surgical treatment.
Conclusion: the accumulation of surgical experience allows to significantly optimize the results of treating the patients with PC, and to reduce the frequency of complications. The advantage of surgical treatment is the possibility of precise staging and detection of unfavorable pathomorphological factors, which allows to develop rational treatment tactics. In patients with adverse postoperative prognostic factors (lymphogenic metastases, including extracapsular invasion), an adjuvant therapy is recommended to improve survival rates.

Key words: prostate cancer, radical prostatectomy, remote radiation therapy, brachytherapy.
For citation: Alekseev B.Ya., Nyushko K.M., Krasheninnikov A.A. et al. Surgical treatment of patients with localized and locally advanced prostate cancer: the results of a single center study // RMJ. 2017. № 27. P. 2019–2025.

Pages 2026-2031. Морфологические результаты применения метода электрохимического лизиса у больных раком предстательной железы. Вельшер Л.З., Пушкарь Д.Ю., Стаханов М.Л., Горчак Ю.Ю., Аниканова Е.В., Андреева О.В., Фирсов К.А., Ишевский Г.Б.

Summary: Morphological results of electrochemical lysis in patients with prostate cancer.
Velsher L.Z.1 , Pushkar D.Yu.1, Stakhanov M.L.1,2, Gorchak Yu.Yu.1, Anikanova E.V.1, Andreeva O.V.3, Firsov K.A.1, Ishevskiy G.B.1,2

1 Moscow State Medical Stomatological University named after A.I.Evdokimov
2 Cancer Center at the Central clinical hospital No. 2 named after N.A. Semashko of Russian Railways, Moscow
3 Smolensk Regional Institute of Pathology

The aim of the study was to evaluate the pathomorphological changes in the prostate tissues and the tumor tissue contained in it, resulting from electrochemical lysis.
Patients and methods. A pilot study was carried out to compare the pathomorphological changes in preparations of the removed prostate glands of patients with prostate cancer. Patients of the main group (n = 18) received non-invasive electrochemical lysis sessions, followed by radical prostatectomy. Patients of the control group (n = 18) underwent radical prostatectomy. Sessions of electrochemical lysis for the patients of the main group were performed using a device BET-7 with cutaneous  plate electrodes. Patients received 3-5 sessions of electrochemical lysis, lasting for less than 180 minutes. The current strength was not more than 40 mA, the voltage was 5–20 V. 
Results. The macroscopic examination of the removed prostate glands revealed focal hemorrhages in 27.8% of the patients and softening regions in 61.1% of patients in the main group. In the control group 11.1% of the patients had focal hemorrhages at  macroscopic  examination (р<0,05). 38.9% of patients of the first group had areas of total destruction of the tumor, 72,2% of the patients had degenerative  changes in the stroma of the tumor, 61.1% of patients had degenerative changes in the parenchyma of the tumor, 50% of the patients had focal proliferation of connective tissue. 33.4% of patients had similar changes in regional lymph nodes. Morphological changes were focal and were not detected in prostate tissue outside the tumor growth. The morphological changes described were not found in patients of the control group, with the exception of connective tissue proliferation in the tumor in 11.3% of patients (p <0.05).
Conclusions. Method of electrochemical lysis causes selective damage to prostate cancer.

Key words: prostate cancer, electrochemical lysis, morphological study, destruction of tumor tissue, dystrophy, sclerosis.
For citation: Velsher L.Z., Pushkar D.Yu., Stakhanov M.L. et al. Morphological results of electrochemical lysis in patients with prostate cancer. // RMJ. 2017. № 27. P.2026 –2031.



№25, 2017. Клинические рекомендации и алгоритмы для практикующих врачей

Pages 1819. Слово редактора.

Summary:    

       

Pages 1820-1822. Старческая астения: что необходимо знать о ней врачу первичного звена?. Ткачева О.Н., Ткачева, Котовская Ю.В., Остапенко В.С., Шарашкина Н.В.

Summary: Senile asthenia: what must the primary care physician know about it?
Tkacheva O.N.1, Runikhina N.K.1, Kotovskaya Yu.V.1,2, Ostapenko V.S.1, Sharashkina N.V.1

1 Russian gerontological scientific and clinical center, Moscow
2 Peoples’ Friendship University of Russia, Moscow

In recent years the syndrome of senile asthenia (frailty syndrome) has become a subject of special interest not only to geriatricians, but also doctors of all specialties, since it can be the main point of application of medical, rehabilitation and preventive measures in the elderly and senile age. Senile asthenia is defined as a multifactorial medical syndrome, characterized by a decrease in strength, endurance and physiological functioning, which increases the risk of dependence and death. The prevalence of senile asthenia varies widely and depends on the age of people included in epidemiological studies, their gender, race, place of living, and the diagnostic criteria. The article presents data on the prevalence of senile asthenia syndrome and geriatric syndromes. The authors suggest the variants of senile asthenia diagnosis both according to the classical Fried criteria, and by means of scales / indices of senile asthenia. The importance of specific approaches in the diagnosis of senile asthenia in elderly patients in the future is shown.

Key words: senile asthenia, "frailty", elderly, aging, complex geriatric evaluation, screening.
For citation: Tkacheva O.N., Runikhina N.K., Kotovskaya Yu.V. et al. Senile asthenia: what must the primary care physician know about it? // RMJ. 2017. 
№ 25. P. 1820–1822.

Pages 1823-1825. Особенности клинических подходов к ведению пациентов со старческой астенией. Ткачева О.Н., Котовская Ю.В., Ткачева, Остапенко В.С.

Summary: Features of clinical approaches to managing patients with senile asthenia
Tkacheva O.N.1,2, Kotovskaya Yu.V.1,3, Runikhina N.K.1,2, Ostapenko V.S.1,3

1 Russian gerontological scientific and clinical center, Moscow
2 Russian National Research Medical University named after N.I. Pirogov, Moscow
3 Peoples' Friendship University of Russia, Moscow

To reduce the risk of cardiovascular morbidity and mortality in middle-aged patients, it is important to control arterial hypertension, dyslipidemia, and glycemia in accordance with current recommendations of the scientific community. Patients over 75-80 years old make up the most fast growing part of the population, but they are rarely included into randomized clinical trials, that makes a problem for a direct application of the existing clinical recommendations for the prevention of cardiovascular disease to this category of patients. In addition, these patients often have accumulated functional deficits, the senile asthenia syndrome, polymorbidity, which often has a greater impact on prognosis than traditional risk factors, as well as high exposure to undesirable phenomena due to changes in pharmacokinetics and pharmacodynamics of the drugs, and because of the appointment of a large number of medicines (polypharmacy). It must be admitted that we have the limited knowledge of how to optimally use the approaches to the prevention of cardiovascular diseases, the effectiveness of which has been proved in younger people. It is necessary for the physicians managing the elderly patients to develop the skills of the management of senile asthenia and the implementation of geriatric approaches in cooperation with geriatric physicians.

Key words: primary prevention, aging, senile asthenia, arterial hypertension, dyslipidemia, diabetes mellitus, multimorbidity.
For citation: Tkacheva O.N., Kotovskaya Yu.V., Runikhina N.K., Ostapenko V.S. Features of clinical approaches to managing patients with senile asthenia // RMJ.  2017. № 25. P. 1823–1825.

Pages 1826-1828. Оптимизация лекарственных назначений у пациентов пожилого и старческого возраста: можно ли победить полипрагмазию?. Ткачева О.Н., Переверзев А.П., Ткачева, Котовская Ю.В., Шевченко Д.А., Апресян В.С., Филиппова А.В., Данилова М.Г., Разуванова Е.М., Макеев Д.Г., Аскерова А.А.

Summary: Optimization of medicinal prescriptions in patients of elderly and senile age: is it possible to defeat polypharmacy?
Tkacheva O.N.1, Pereverzev A.P.1,2, Runikhina N.K.1, Kotovskaya Yu.V.1,2, Shevchenko D.A.2, Apresyan V.S.2, Filippova A.V.2, Danilova M.G.2
Razuvanova E.M.2, Makeev D.G.2, Askerova A.A.2

1 Russian gerontological scientific and clinical center, Moscow
2 Peoples' Friendship University of Russia, Moscow

The population of the Earth is aging, and this process is largely due to advances in pharmacology. The appointment of modern medicines to elderly people contributes to the prolongation of their life, prevents the development of certain diseases and complications, but the use of excessive amounts of drugs by elderly people can lead to adverse drug events, including serious and fatal ones. At the same time, as the patients become older and frailer, the emphasis of pharmacotherapy shifts towards controlling the symptoms of diseases, improving the quality of life and minimizing the use of potentially dangerous preventive drugs that will benefit little over a relatively short expected life expectancy. To reduce the risk of negative consequences of polypharmacy in elderly patients, a number of approaches can be recommended that include educational activities, ancillary computer systems, and modern methods presented by the authors in this article: anticholinergic load scales, STOPP / START criteria, Bierce criteria, index of rational drugs administration, comorbidity indices. The use of these tools during the drug audit can reduce the drug load and improve the safety of pharmacotherapy.

Key words: elderly, safety, polypharmacy. 
For citation: Tkacheva O.N., Pereverzev A.P., Runikhina N.K. et al. Optimization of medicinal prescriptions in patients of elderly and senile age: is it possible to defeat polypharmacy? // RMJ. 2017. № 25. P. 1826–1828.

Pages 1829-1832. Артериальная гипертония у очень пожилых: значение старческой астении. Котовская Ю.В., Ткачева О.Н., Ткачева, Остапенко В.С., Лузина А.В.

Summary: Arterial hypertension in the very elderly patients: the significance of senile asthenia
Kotovskaya Yu.V.1,2, Tkacheva О.N.1, Runikhina N.K.1, Ostapenko V.S.1, Luzina A.V.1

1 Russian gerontological scientific and clinical center, Moscow
2 Peoples' Friendship University of Russia, Moscow

Planning of  the therapeutic interventions in the elderly patients is impossible without taking into account the influence of the therapy on physical and cognitive functioning. Despite the convincing evidence of an unfavorable predictive value of high blood pressure (BP) in middle-aged people, its effect on prognosis in the very elderly people is still discussed, as well as the question of whether to treat arterial hypertension (AH) in elderly patients, and how intensively. The review presents data of observational and randomized clinical trials that allow us to say that it is not the chronological but the biological age (senile asthenia), that becomes an important criterion for choosing the treatment of  hypertension in the elderly patients. The article discusses in detail the mechanisms involved in the regulation of blood pressure, as well as the influence of BP on the risk of morbidity and mortality in patients of senile age. Recommendations for antihypertensive therapy in elderly and senile patients are given.

Key words: arterial hypertension, orthostatic hypotension, very elderly people, senile asthenia, biological age.
For citation: Kotovskaya Yu.V., Tkacheva О.N., Runikhina N.K. et al. Arterial hypertension in the very elderly patients: the significance of senile asthenia // RMJ.  2017. № 25. P. 1829–1832.

Pages 1833-1836. Стеноз аортального клапана у пациентов пожилого и старческого возраста. Котовская Ю.В., Курашев Д.Х., Темненко Н.А., Гароян В.О., Хабибуллои Н.Н., Щербакова В.Л., Ткачева, Ткачева О.Н.

Summary: Stenosis of the aortic valve in patients of elderly and senile age
Kotovskaya Yu.V.1,2, Kurashev D.Kh.2, Temnenko N.A.1, Garoyan V.O.1, Khabibulloi N.N.1, Shcherbakova V.L.1, Runikhina N.K.2, Tkacheva O.N.2

1 Peoples' Friendship University of Russia
2 Russian gerontological scientific and clinical center, Moscow

Aortic stenosis remains the most common cardiac valve disease in elderly and senile patients and presents a challenge for diagnosis and treatment choice. Recent years have been marked by advances in cardiac surgery, primarily in the development of transcatheter replacement methods (or implantation) of the aortic valve, which makes it possible to correct aortic stenosis in very elderly patients. However, problems of assessing the risk of interventions associated with concomitant diseases and care for the elderly patients remain relevant. The presented review analyzes the prevalence of aortic stenosis, its pathogenesis, conservative and surgical treatment, summarizes modern approaches to diagnosis and algorithms for aortic stenosis in patients of older age groups in terms of the work of a multidisciplinary team including the geriatric doctor. The indications for operative intervention in aortic stenosis and recommendations for choosing the intervention method are described in detail.

Key words: aortic stenosis, elderly age, senile asthenia, multimorbidity, transcatheter replacement of the aortic valve.
For citation: Kotovskaya Yu.V., Kurashev D.Kh., Temnenko N.A. et al. Stenosis of the aortic valve in patients of elderly and senile age // RMJ. 2017. № 25. 
P. 1833–1836.

Pages 1837-1840. Симпозиум «Мифы и реальность. Риск сердечно-сосудистых осложнений у коморбидного больного».

Pages 1841-1845. Симпозиум «Актуальные вопросы применения бета-блокаторов в клинической практике: все ли известно практическому врачу».

Pages 1846-1849. Практические аспекты применения антагонистов минералокортикоидных рецепторов в лечении артериальной гипертензии. Плисюк А.Г., Орлова Я.А.

Summary: Practical aspects of the use of mineralocorticoid receptor antagonists in the treatment of arterial hypertension
Plisyuk A.G., Orlova Ia.A.

Medical Research and Education Center of Moscow State University named after M.V. Lomonosov

The essence of the main approach to the treatment of arterial hypertension (AH), declared in the European guidelines for the management of patients with AH in 2013, is that the main benefit of antihypertensive therapy is associated with a reduction in blood pressure itself and practically does not depend of the drug which provides this effect. In the Russian guidelines for the diagnosis and treatment of hypertension, the key provision is also the need to achieve target blood pressure (BP). The brief review discusses practical issues of the use of mineralocorticoid receptor antagonists (MCRAs) in the treatment of hypertension. MCRAs are not the first line drugs for the treatment of hypertension. However, they play a special role in treating the resistant hypertension. MCRAs also proved to have a positive effect on prognosis in patients with chronic heart failure. If the target blood pressure level is not reached during the 3–drug therapy including a diuretic (resistant hypertension), MCRAs may be added to treatment: spironolactone (starting dose -12.5-25 mg / day) or eplerenone (starting dose - 25- 50 mg / day).

Key words: arterial hypertension, spironolactone, eplerenone, mineralocorticoid receptors antagonists.
For citation: Plisyuk A.G., Orlova Ia.A. Practical aspects of the use of mineralocorticoid receptor antagonists in the treatment of arterial hypertension // RMJ. 2017. № 25. P.1846 –1849.

Pages 1850-1851. Натрийуретические пептиды, гипертензия, сердечная недостаточность и магний (комментарий).

Pages 1852-1854. Резолюция национального Совета экспертов. Лечение дислипидемий у пациентов после острого коронарного синдрома в реальной клинической практике в Российской Федерации.

Pages 1855-1859. Сахарный диабет: управление рисками в пожилом и старческом возрасте. Дудинская Е.Н., Ткачева О.Н.

Summary: Diabetes mellitus: risk management in the elderly and senile patients
Dudinskaya E.N., Tkacheva O.N.

Russian gerontological scientific and clinical center, Moscow

The population of the planet is steadily growing older. According to the UN forecasts, by 2050 the share of people aged 60 and over will grow from 12.3% in 2015 to 21.5%. Aging of the population is associated with an increase in the prevalence of diabetes mellitus type 2 (DM2). Such patients require a special diagnostic and treatment approach. Therapy of DM2 in the elderly people is a difficult task due to the concomitant diseases, polypharmacy, features of the functional and psychosocial status of patients and is currently becoming very individual. When choosing a hypoglycemic therapy for elderly patients, it is necessary to be guided not only by the effectiveness of the drug, but also by its safety in relation to the risk of hypoglycemia. This review provides the main information about the pathophysiology of carbohydrate metabolism, the clinical features of diabetes and the use of hypoglycemic drugs in elderly and senile patients. Diagnostic criteria of diabetes in elderly age are given. Particular attention is paid to reviewing the aims of glycemic control, the problem of hypoglycemia, the prevention of hypoglycemic episodes, the reduction of cardiovascular risk.

Key words: diabetes, hypoglycemia, cardiovascular risk, prevention, elderly age.
For citation: Dudinskaya, E.N. Tkacheva O.N. Diabetes mellitus: risk management in the elderly and senile patients // RMJ. 2017. № 25. P.1855 –1859.

Pages 1860-1862. Патогенетические предпосылки применения ингибиторов дипептидилпептидазы-4 в управлении сахарным диабетом 2-го типа. Демидова Т.Ю., Куленок С.Г., Гасанзаде П.А.

Summary: Pathogenetic reasons of using dipeptidyl-peptidase 4 inhibitors in the management of type 2 diabetes mellitus
Demidova T.Yu., Kulenok S.G., Gasanzadeh P.A.

Russian Medical Academy of Continuing Professional Education, Moscow

Over the past decade, incretin-based therapy has become one of the priority areas of drug therapy for patients with type 2 diabetes mellitus (DM). The importance and necessity of realization of incretin effects in maintaining glucose homeostasis is well studied and proven, which makes the incretin-based therapy the most promising one in the modern management algorithms for type 2 diabetes (drugs do not cause hypoglycemic reactions, provide a predictable, glucose-dependent hypoglycemic effect, have a wide range of positive non-glycemic effects). Despite the high effectiveness of the incretin drugs in the majority of patients, the hypothesis of their ability to restore the impaired incretin effects is widespread but not fully justified. In type 2 diabetes, the endocrine part of the pancreas retains sensitivity to GLP-1, but becomes resistant to the influence of the GIP, which apparently is the main reason for the decrease or absence of incretin effects. The incretin-directed therapy stimulates the GLP-1 receptors and thus increases insulin secretion in response to oral and intravenous glucose stimulation, thereby eliminating the potential differences between these stimuli, but not restoring the incretin defects in the patients.

Key words: diabetes mellitus type 2, incretins, hypoglycemia.
For citation: Demidova T.Yu., Kulenok S.G., Gasanzadeh P.A. Pathogenetic reasons of using dipeptidyl-peptidase 4 inhibitors in the management of type 2 diabetes mellitus // RMJ. 2017. № 25. P. 1860–1862.

Pages 1863-1867. Рациональная фармакотерапия диабетической периферической невропатии: взгляд клинического фармаколога. Журавлева М.В., Городецкая Г.И., Прокофьев А.Б., Кукес В.Г., Архипов В.В., Пономаренко Т.М., Красных Л.М., Родина Т.А., Сереброва С.Ю., Ших Е.В., Соколов А.В.

Summary: Rational pharmacotherapy of diabetic peripheral neuropathy: a view of a clinical pharmacologist
Zhuravleva M.V.1,2, Gorodetskaya G.I.1,2, Prokofev A.B.1,2, Kukes V.G.1,2, Archipov V.V.1,2, Ponomarenko T.M.2, Krasnykh L.M.1,2, Rodina T.A.1,2, Serebrova S.U.1,2, Shikh E.V.1,2, Sokolov A.V.1,2

1 Scientific Centre for Expert Evaluation of Medicinal Products, Moscow 
2 First Moscow State Medical University named after I.M. Sechenov

The number of patients with diabetes is steadily growing in the world. One of the most frequent complications of diabetes is the development of diabetic neuropathy. Currently, there are the following basic strategies of diabetic neuropathy treatment: tight glycaemic control, control of other risk factors, symptomatic therapy, including symptomatic therapy of chronic pain with anticonvulsants and antidepressants, and pathogenetic therapy aimed at slowing the progression of nerve damage.
To improve the quality of medical care for patients with DPN, the drugs for tight glycaemic control, correction of risk factors and symptomatic therapy, can be used in complex with the drugs containing alpha-lipoic acid (ALA), which have the largest evidence base among the drugs of pathogenetic therapy. However, as it turned out, there are big differences in the bioavailability of various oral ALA preparations, and only those with a rapid release of the active substance can be compared in their characteristics with ALA preparations for parenteral administration.

Key words: diabetic peripheral neuropathy, neuropathic pain, alpha-lipoic acid.
For citation: Zhuravleva M.V., Gorodetskaya G.I., Prokofev A.B. et al. Rational pharmacotherapy of diabetic peripheral neuropathy: a view of a clinical pharmacologist // RMJ. 2017. № 25. P. 1863–1867.

Pages 1868-1871. Место растительных препаратов в лечении проявлений острого и хронического бронхитов. Бердникова Н.Г., Новиков К.Н., Климова О.Ю., Цыганко Д.В., Ленкова Н.И.

Summary: Place of herbal preparations in the treatment of manifestations of chronic bronchitis and chronic obstructive pulmonary disease
Berdnikova N.G.1, Novikov K.N.2, Klimova O.Ju.1, Cyganko D.V.3, Lenkova N.I.1
1 First Moscow State Medical University named after I.M.Sechenov
2 Moscow State University named after M.V. Lomonosov
3 City Clinic named after I.V. Davydovskij, Moscow
­­Respiratory tract diseases take the leading place in the infectious pathology of various organs and systems and are traditionally the most mass diseases among the population. There are many possible factors that are etiologically significant for the development of inflammatory processes in the bronchial apparatus: passive smoking, occupational hazards, smog, domestic and industrial air pollution, respiratory viral infections, living conditions, gender, age, etc.
The article considers the treatment of acute and chronic bronchitis. The authors consider the use of herbal preparations which are an effective symptomatic tool in the treatment of cough of various genesis, in treating the inflammatory diseases of the respiratory, respiratory irritation caused by physical, chemical factors, professional laryngitis, etc.

Key words: chronic bronchitis, bronchial obstruction, cough, herbal preparations, thyme extract, plantain extract.
For citation: Berdnikova N.G., Novikov K.N., Klimova O.Ju. et al­­. Place of herbal preparations in the treatment of manifestations of chronic bronchitis and chronic obstructive pulmonary disease // RMJ. 2017. № 25­. P. 1868–1871.

Pages 1874. Резолюция ведущих специалистов в области педиатрии, оториноларингологии, аллергологии, иммунологии, гомеопатии. Возможности терапии кашля у детей.

Pages 1876-1879. Цинк в комплексной терапии диффузной алопеции. Олисова О.Ю., Гостроверхова И.П., Лепехова А.А.

Summary: Zinc in the complex therapy of diffuse alopecia
Olisova O.Yu., Gostroverhova I.P., Lepyokhova A.A.

First Moscow State Medical University named after I.M. Sechenov

Alopecia is a pathological hair loss. Non-scarring alopecia include diffuse alopecia (DA), androgenetic and focal alopecia.
The aim of the study: evaluation of the effectiveness of dietary supplement Zinkit in the complex therapy of DA.
Patients and Methods: 32 female patients aged from 18 to 65 years with DA were observed. Patients were divided into two groups - the main group (n=16) and controlgroup (n=16). Both groups received complex therapy, including antioxidants, drugs for improving microcirculation, multivitamins and peptide containing serum for topical application. Patients of the main group additionally used zinc containing "Zinkit " by one tablet (10 mg of zinc) 2 times a day during meals, dissolved in 200 ml of water, for 3 months. The efficacy of the therapy was assessed by questioning patients (reduce of the hair loss intensity) and trichoscopy before therapy and after two months. Phototrichogram (FTG) was performed for an objective evaluation of the effectiveness of the therapy.
As a result of the therapy, all patients of the main and control groups had a positive effect. In the main group 9 women (56.25%) noticed a significant improvement; 4 women (25%) - improvement; 3 women (18.75%) - a slight improvement: in the control group, 5 women (31.25%) had a significant improvement, 6 (37.5%) - improvement, 5 (31.25%) – a slight improvement. After the therapy, the trichoscopic and FTG results improved in both groups.
Conclusion: zinc containing "Zinkit" as a part of complex therapy of DA helps to reduce the intensity of hair loss, providing hair thickening and growth. All patients noted good tolerability of "Zinkit".

Key words: alopecia, diffuse alopecia, trichoscopy, phototrichogram, zinc.
For citation: Olisova O.Yu., Gostroverhova I.P., Lepyokhova A.A. Zinc in the complex therapy of diffuse alopecia // RMJ. 2017. № 25. P. 1876–1879.

Pages 1880-1883. Обследование пациентов с когнитивными нарушениями. Ткачева О.Н., Чердак М.А., Мхитарян Э.А.

Summary: Examination of patients with cognitive impairments 
Tkacheva O.N.1, Cherdak M.A.1, Mkhitaryan E.A.1,2
1 Russian gerontological scientific and clinical center, Moscow
2 First Moscow State Medical University named after I.M. Sechenov
Cognitive functions impairment is a frequent impairment in elderly and senile people. The most severe form of cognitive impairment (CI) is dementia, which disrupts the patient's professional, daily and social activity. The CI is characterized by a frequent combination with non-cognitive disorders - emotional affective and behavioral disorders, which can distort the clinical picture of the disease and cause choosing a wrong treatment for the patient­. Diagnosis and determination of the etiology of the CI at the pre-existing stage are crucial for the timely initiation of therapy in order to prolong the period with a higher level of functioning, which not only facilitates the patient's own life, but also reduces the burden on carers, as well as the socioeconomic burden for the whole society. The article discusses modern approaches to CI classification, issues of their etiology, presents clinical and paraclinic methods of CI diagnosis, and suggests an algorithm for examining patients with possible CI.

Key words: cognitive disorders, mild cognitive impairment, dementia, biomarkers, neuropsychological testing, scales.
Fot citation: Tkacheva O.N., Cherdak M.A., Mkhitaryan E.A.­ Examination of patients with cognitive impairments // RMJ. 2017. № 25. P. 1880–1883.

Pages 1884-1887. Ацетилсалициловая кислота в профилактике инсульта: пути повышения эффективности и безопасности. Фонякин А.В., Гераскина Л.А.

Summary: Acetylsalicylic acid in the stroke prevention: ways to improve efficiency and safety
Fonyakin A.V., Geraskina L.A.

Scientific Center of Neurology, Moscow

The article considers the main aspects of the use of acetylsalicylic acid (ASA) for the primary and secondary stroke prevention. It is shown that in primary prevention, it is necessary to single out the category of people with an increased risk of stroke, for which the use of ASA may be most effective. This category includes women over 75 years old with moderate and high ten-year CAD risk, patients with arterial hypertension and chronic kidney disease of the 3rd stage, persons with asymptomatic carotid atherosclerosis, as well as patients with coronary pathology. In secondary prevention, ASA is mostly used in non-cardioembolic stroke, as well as in cardioembolic stroke, which developed against a background of cardiac pathology that does not require oral anticoagulant therapy. The optimal daily dosage of ASA for a long use is 75-150 mg per day. To improve compliance to treatment, the most optimal drug form is the enteric-soluble form of ASA.

Key words: Ischemic stroke, primary prevention, secondary prevention, acetylsalicylic acid, enteric-soluble form.
For citation: Fonyakin A.V., Geraskina L.A. Acetylsalicylic acid in the stroke prevention: ways to improve efficiency and safety // RMJ. 2017. № 25. P. 1884–1887.

Pages 1888-1893. Диалог невролога и психиатра: стресс и пожилой человек. Акарачкова Е.С., Котова О.В.

Pages 1893-1897. Применение антиконвульсанта прегабалина в практике ревматолога: терапия остеоартроза коленных суставов. Филатова Е.С., Туровская Е.Ф., Алексеева Л.И.

Summary: The use of anticonvulsant pregabalin in rheumatologist practice: therapy of knee osteoarthritis
Filatova E.S., Turovskaya E.F., Alekseeva L.I.

Scientific Research Institute of Rheumatology named after V.A. Nasonova, Moscow
The main manifestation of osteoarthritis (OA) of the knee joints is chronic pain syndrome. It reduces the quality of life of patients, forcing them to seek treatment.
Aim: To evaluate the efficacy of pregabalin in patients with knee osteoarthritis.
Patients and Methods: 60 patients with OA of knee joints with a neuropathic pain component (DN4> 4) were included in the study. The patients are divided by the random numbers method into two groups: 1-st group – received therapy with aceclofenac; 2nd group - received aceclofenac + pregabalin for 5 weeks. All the patients included in the study had clinical and neurological examination with assessment of WOMAC functional index, pain intensity at movement, the diagnosis of neuropathic pain (NP) (by questionnaire DN4 and Pain DETECT), pain intensity according to the VAS at rest.
Results: the patients of group 1 had a more severe and prolonged course of the disease, a more pronounced neuropathic component of the pain syndrome (NCPS), however, radiologic changes in the joints, pain intensity according to the VAS (both at rest and at movement), quality of life, the severity of anxiety and depression on the hospital scale were the same in both groups. The study showed a positive dynamics in both groups regarding the NCPS, but complex therapy with the use of a drug from the group of anticonvulsants (pregabalin) showed a more significant positive effect not only in relation to NCPS, but also with respect to functional activity (according to WOMAC) and the severity of pain according to the VAS.
Conclusion: patients with OA of knee joints should be examined before beginning the therapy for central sensitization using questionnaires of neuropathic pain (DN4). Complex therapy with anticonvulsants in patients with OA of knee joints with signs of NP allows not only to effectively reduce the severity of the pain syndrome, but also to improve the functional activity of patients, and therefore, the quality of life.

Key words: osteoarthritis of knee joints, chronic articular pain, neuropathic pain component, pregabalin, aceclofenac.
For citation: Filatova E.S., Turovskaya E.F., Alekseeva L.I. The use of anticonvulsant pregabalin in rheumatologist practice: therapy of knee osteoarthritis // RMJ. 2017. № 25. P. 1893–1897.

Pages 1898-1904. Влияние вискосапплиментарной терапии с использованием гиалуроната натрия на потребность в эндопротезировании коленных суставов при остеоартрозе. Беляева Е.А., Авдеева О.С.

Summary: Effect of viscosupplementary therapy with sodium hyaluronate on the need for the knee replacement in osteoarthrosis
Belyaeva E.A., Avdeeva O.S.
Tula State University, Medical Institute
Osteoarthrosis  (OA) is the most common joint disease in humans. In recent years, the use of  hyaluronic acid (HA) preparations for intra-articular administration has been increased.
Aim. To study the effect of viscosupplementary therapy with AC "Fermatron" on the need for the knee replacement in patients with osteoarthrosis.
Patients and Methods. A retrospective analysis of medical records of patients with a verified diagnosis of OA for the period from 2013 to 2015 was conducted.
For the analysis 2 groups of patients were formed (the main group -388 people (295 women and 93 men) and the control group-378 people (276 women and 102 men)). The average age of the patients was 63.5 ± 9.5 years. To objectify the data obtained, three age subgroups of 50-60 years old, 61-70 years old and over 71 years old, were identified. Patients of the control group received traditional OA therapy. Patients of the main group additionally received the intra-articular injections of the drug "Fermatron" 1% 2 ml by courses of 3 injections into the target joint with an interval of 7 days. The number of courses varied from one to three with 8-12 months intervals. Assessment of the need for the knee replacement was carried out at the end of 2015.
Results. After three years in the main group, the total number of patients requiring the joint replacement was 11.1%, which was almost two times lower than in the control group - 21.3% (p <0.05). The need for the joint replacement in the patients of the main group who received the "Fermatron" by three times courses is significantly lower in all age groups than in the control group, and it amounts to correspondingly 10.10% and 21, 65% at the age of 51-60 years; 12.24% and 33.3% at the age of 61-70 years; 29.17% and 50% (p <0.05) at the age of 71 years. For patients older than 71 years with IV radiographic stage in the main and control groups, the differences are not reliable.
Conclusions. Intra-articular administration of the drug "Fermatron" 1% 2 ml can be used to treat patients of all age groups with OA of knee joints, not only to modify the symptoms of the disease, but also to delay the joint replacement. In this case, the best effect of the therapy is observed when the courses are repeated at intervals of 8 to 12 months.

Key words: osteoarthrosis, knee joints, viscosupplementary therapy, "Fermatron", need for the joint replacement  
For citation: Belyaeva E.A., Avdeeva O.S. Effect of viscosupplementary therapy with sodium hyaluronate on the need for the knee replacement in osteoarthrosis // RMJ.  2017. № 25. P. 1898–1904.



№24, 2017. Болевой синдром

Pages 1737. Слово редактора. Екушева Е.В.

Pages 1738-1744. Персистирующая идиопатическая лицевая боль: сложный путь к сложному диагнозу. Пархоменко Е.В., Нартов С.Э., Карпов Д.Ю.

Summary: Persistent idiopathic facial pain: a difficult path to a complex diagnosis
Parkhomenko E.V.1, Nartov S.E.2, Karpov D.Yu.1,2

1 Altai State Medical University, Barnaul
2 LLC «Karpov’s Neuroclinic», Barnaul

The presented literature review provides data on prevalence, classification, pathogenesis, clinical picture, diagnosis and treatment of persistent idiopathic facial pain (PIFP). Possible pathogenetic mechanisms of this disease are discussed. The authors emphasize the dysfunctional character of the pain syndrome and high comorbidity with mental disorders. Particular attention is paid to differential diagnosis of PIFP with trigeminal neuralgia, migraine, trigeminal vegetative cephalalgia, facial myofascial pain. The article highlights the importance of the multidisciplinary approach at the stage of differential diagnosis of the PIFP, the interaction of various specialists (neurologists, dentists, otolaryngologists, maxillofacial surgeons, psychiatrists) for excluding the profile pathology. The article provides information on the management of patients with PIFP in accordance with modern world views on the pathogenesis and treatment of this disease. Information on the effectiveness of some pharmacological drugs and non-drug therapies (laser therapy, transcranial magnetic stimulation of the brain, methods based on biofeedback, virtual reality) are presented. Methods of psychotherapy (cognitive-behavioral therapy, hypnosis) can also be useful in PIFP.

Key words: persistent idiopathic facial pain (PIFP), atypical facial pain, trigeminal neuralgia, myofascial pain, neuropathy, depression, diagnosis, classification of facial pains, differential diagnosis, treatment. 
For citation: Parkhomenko E.V., Nartov S.E., Karpov D.Yu. Persistent idiopathic facial pain: a difficult path to a complex diagnosis // RMJ. 2017. № 24. P. 1738–1744.

Pages 1745-1749. Тригеминальные боли: топическая диагностика, клинические проявления. Мингазова Л.Р., Орлова О.Р., Сойхер М.Г., Сойхер М.И., Федюшина Е.Ю.

Summary: Trigeminal pain: topical diagnosis, clinical manifestations
Mingazova L.R.1, Orlova O.R.2, Soikher M.G.1, Soikher M.I.1, Fedyushina E.Yu.1

1 Center of Interdisciplinary Dentistry and Neurology, Moscow
2 First Moscow State Medical University named after I.M.Sechenov

Facial pain syndromes, caused by lesion of the trigeminal nerve system, are diverse in clinical manifestations, have severe course and chronic recurrent nature. The collection of an anamnesis, in particular the description of a pain phenomenon by a patient, as well as an objective study of clinical manifestations, makes it possible to determine firstly the level of lesion, and then the cause of the disease.
The article shows the main etiological factors, clinical manifestations of lesion of the peripheral branches of the trigeminal nerve. A description of the clinical picture of iatrogenic lesion of the peripheral branches of the trigeminal nerve is given. The article considers the Gasser’s ganglion lesion in the cranial cavity, basilar lesion of the root of trigeminal nerve, trigeminal nucleus lesion. Two clinical cases are described.
Thus, if a neuropathic disorder associated with a trigeminal nerve pathology is suspected in a patient with orophacial pain, a careful history and clinical examination should be performed. Having determined the topical level of the lesion, continue the diagnostic search with the help of instrumental, laboratory and other methods of investigation.

Key words: trigeminal nerve, topical diagnosis, trigeminal pain, odontogenic pain.
For citation: Mingazova L.R., Orlova O.R., Soikher M.G. et al. Trigeminal pain: topical diagnosis, clinical manifestations // RMJ. 2017. № 24. P. 1745–1749.

Pages 1750-1755. Дисфункция височно-нижнечелюстного сустава. Исайкин А.И., Смирнова Д.С.

Summary: Temporomandibular joint disorder
Isaikin A.I., Smirnova D.S.

First Moscow State Medical University named after I.M. Sechenov 

Approaches to the diagnosis and treatment of facial pains, significantly differ from each other depending on the profile of the doctor. The most frequent causes of the orofascial pains are diseases of the dento-facial system. Most patients apply to dentists who usually cope with this problem successfully, but in a number of cases the pain has a different nature. The most common cause of facial pains not associated with dental diseases is a temporomandibular joint disorder (TMJD), the development of which is mainly caused by two interrelated processes: the pathology of the joint itself (especially the displacement of the disc) and the pathology of the masticatory muscles surrounding the joint. Significant role in these processes is played by psychogenic factors. A wide range of therapeutic measures is used for the treatment of TMJD, the most important of them are early diagnosis, explanation of the benign nature of the disease, the use of NSAIDs, physiotherapy procedures, the use of the kappa, in the case of inefficiency, minimally invasive interventions are possible. In connection with the multifactorial nature of chronic orofacial pain, approaches to the prevention and treatment of this condition should be based on a biopsychosocial model of the pain development.

Key words: facial pain, temporomandibular joint disorder, Nise®, nimesulid, blocks.
For citation: Isaikin A.I., Smirnova D.S. Temporomandibular joint disorder // RMJ. 2017. № 24. P. 1750–1755.

Pages 1756-1758. Краниальные диабетические невропатии. Пизова Н.В.

Summary: Cranial diabetic neuropathies
Pizova N.V.

Yaroslavl State Medical University

Diabetes mellitus (DM) is a disease in which neuropathies often develop. The frequency of neuropathy among patients with diabetes, depending on the method of their detection, varies from 25% to 90%. This article presents the clinical classification of asymmetric diabetic neuropathies (DNP). Cranial neuropathies (CNR) are considered in detail. Literature data on the prevalence of CNR with lesions of the third, fourth, sixth and seventh cranial nerves are presented. A clinical picture of cranial diabetic neuropathies with the lesion of certain oculomotor nerves is described both in isolation and in combination. Data on the clinical course of diabetic ophthalmoplegia are presented. Particular attention is paid to the main types of treatment: control of glycemia, pathogenetic therapy, the use of symptomatic drugs in the presence of pain syndrome. The possibilities of pathogenetic therapy of diabetic neuropathies and the place of preparations containing B vitamins in the treatment of this pathology are considered in detail. Group B vitamins have a wide spectrum of pharmacodynamics properties and are involved as coenzyme forms in most metabolic processes. The variant of application of complex preparations of group B vitamins in DNP treatment is considered.

Key words: diabetes mellitus, cranial neuropathy, B vitamins.
For citation: Pizova N.V. Cranial diabetic neuropathies // RMJ. 2017. № 24. P. 1756–1758.

Pages 1760-1763. Взаимосвязь бруксизма и болевой дисфункции височно-нижнечелюстного сустава. Орлова О.Р., Коновалова З.Н., Алексеева А.Ю., Мингазова Л.Р., Сойхер М.И.

Summary: Interrelation of bruxism and painful temporomandibular joint disorder

Orlova О.R.1, Konovalova Z.N.2, Alekseeva A.Yu.1, Mingazova L.R.2, Soyher M.I.2

1 First Moscow State Medical University named after I.M.Sechenov 
2 Center of Interdisciplinary Dentistry and Neurology, Moscow

Bruxism is characterized by jaw clenching, grinding or rubbing of teeth, and it is one of the main etiological factors of painful temporomandibular joint disorder (TMJD) and is more often diagnosed in patients with this pathology. The development of temporomandibular joint disorder is probably caused by the hyperactivity of the masticatory muscles, which are anatomically closely related to the joint structures, and the increased pressure on the TMJ, which causes the dislocation of the joint disc, accompanied by pain and movement disorders in the joint. For the diagnosis of bruxism the questionnaires, clinical examination, polysomnography, electromyography (EMG), brux-checkers are used. The leading way to treat bruxism and TMJD is the local administration of botulinum neuroprotein (BNP) to the spasmodic muscles. In many studies, BNP was administered in minimal or moderate doses to the masticatory and temporal muscles or only to the masticatory muscles. In the EMG study of injected (masticatory) and non-injected (temporal) muscles in patients with bruxism, it was found that episodes of bruxism decreased only in injected muscles. Success in the treatment of the TMJD in patients with bruxism is achieved by injecting BNP into the temporal, masticatory and lateral pterygoid muscles. 

Key words: bruxism, temporomandibular joint, botulinum therapy, botulinum toxin type A, TMdJ, facial pain. 
For citation: Orlova О.R., Konovalova Z.N., Alekseeva A.Yu. et al. Interrelation of bruxism and painful temporomandibular joint disorder // RMJ. 2017. № 24. P. 1760–1763.

Pages 1764-1766. Боль в лице: клинический разбор. Азимова Ю.Э., Скоробогатых К.В.

Summary: Facial pain: clinical analysis
Azimova Yu.E., Skorobogatykh K.V.

University Headache Clinic, Moscow

 Persistent idiopathic facial pain (PIFP) is defined as an ongoing facial pain that does not have the characteristics of cranial neuralgia and is not associated with other causes. This form of facial pain is considered today as a polyethological syndrome, which includes a myogenic or iatrogenic source of peripheral sensitization in the face area, insufficiency of the central analgesic systems, and the presence of comorbid emotional affective disorders. PIFP is one of the least diagnosed causes of orofacial pain and a difficult-to-cure disease in clinical practice. PIFP is an interdisciplinary problem, because patients with prosopalgia apply to doctors of various specialties. It is extremely important at the primary stage of patient management to exclude the secondary nature of prosopalgia. This article examines the criteria of the PIFP, the main complaints of patients, the features of the clinical course, differential diagnosis and the most important approaches to treatment. Two clinical cases are described.
PIFP is one of the most therapy resistant chronic pain syndromes. The greatest effect is achieved by a multidisciplinary approach using a combined pharmacotherapy with antidepressants and anticonvulsants with analgesic effect and non-drug therapy.

Key words: persistent idiopathic facial pain, prosopalgia, atypical facial pain, antidepressants, anticonvulsants.
For citation: Azimova Yu.E., Skorobogatykh K.V. Facial pain: clinical analysis // RMJ. 2017. № 24. P. 1764–1766.

Pages 1767-1770. Лечение ботулотоксином пациентов с параличом лицевого нерва. Красавина Д.А.

Summary: Botulinotoxin treatment of patients with facial paralysis
Krasavina D.A. 

St. Petersburg State Pediatric Medical University

Facial paralysis is currently one of the actual pathologies of the peripheral nervous system. The article considers in detail the etiology of this pathology. The clinical picture of facial paralysis depends on the degree of impaired conductivity and the level of the lesion. The clinical picture consists of the symptoms of the lesion of the intermediate and facial nerves. In the treatment of facial nerve lesions, it is advisable to consider both conservative and surgical approaches. On the unaffected side, it is advisable to use the drugs containing the botulinum toxin type A as an alternative to surgical treatment. Botulin therapy is a way of treatment of various pathologies manifested by autonomic dysfunction, pain and muscle spasms with the botulinum toxin injections. The advantage of this treatment is that it is easy to use and has a dose-dependent effect, does not require surgical intervention, and at the same time gives a good result. The 3-4 months period of relaxation of the muscles of the unaffected side enables the manifestation of active muscle movements on the affected side.

Key words: facial paralysis, facial nerve, neuropathy, botulinum therapy, botulinum toxin type A.
For citation: Krasavina D.A. Botulinotoxin treatment of patients with facial paralysis // RMJ. 2017. № 24. P. 1767–1770.

Pages 1770-1774. Боль в клинической практике стоматолога: ускользающая простота. Ляшев И.Н., Екушева Е.В.

Summary: Pain in the clinical practice of the dentist: elusive simplicity
Lyashev I.N.1, Ekusheva E.V.2

1 Scientific and Clinical Center of Otorhinolaryngology of Federal Medical Biological Agency of Russia, Moscow
2 Institute for Advanced Studies of the Federal Medical Biological Agency, Moscow

Practicing dentists, like general practitioners, often encounter an orofacial pain. Correct diagnosis and determination of the tactics of treatment of pain syndrome often becomes a difficult task for the clinician. Careful collection of anamnesis and careful analysis of the patient's status before the additional diagnosing can be the key to choosing the right algorithm for further activities. The need to have basic knowledge in related disciplines and close cooperation with specialists in these fields is the basis of an effective approach in the treatment of pain syndrome. This article presents data on the prevalence of orofacial pain in the general population, the issues of classification and diagnostic criteria for orofacial pain are discussed. The clinical features of odontogenic pain syndrome are highlighted. The authors give several observations from their own clinical practice as the examples of difficult routes of patients with a long history of orofacial pain. Careful comparison of the complaints, the history, the clinical course of the disease and the data of objective research helps the clinician to find a more serious neurological and surgical pathology disguised until now.

Key words: orofacial pain, facial pain, facial neuralgia, facial neuropathy, herpetic neuropathy, myofascial pain syndrome, temporomandibular joint arthritis, temporomandibular joint dysfunction, odontogenic pain. 
For citation: Lyashev I.N., Ekusheva E.V. Pain in the clinical practice of the dentist: elusive simplicity // RMJ. 2017. № 24. P. 1770–1774.

Pages 1775-1779. Нейропатическая орофациальная боль у детей. Войтенков В.Б., Екушева Е.В.

Summary: Neuropathic orofacial pain in pediatrics
Voitenkov V.B.1, Ekusheva E.V.2

1 Pediatric Research and Clinical Center of Infectious Diseases of the Federal Medical Biological Agency, St-Petersburg
2 Advanced Training Institute of the Federal Medical Biological Agency, Moscow

Despite the relatively rare development of orofacial pain in children, this area of modern medicine is a complex pediatric problem requiring the involvement of a multidisciplinary team of specialists, primarily a neurologist and a dentist. The subjective nature of pain makes it a difficult concept, especially in childhood, because newborns or young children can not express in words all the sensations experienced in pain. In the overwhelming majority of cases, orofacial pain of the neuropathic nature is the diagnosis by exclusion. Since the cause for the development of pain in the face and oral cavity in children may be tumors and other serious diseases, a thorough examination using a wide range of instrumental diagnostic tools is necessary. The management of this group of patients can not be limited only by the use of medicines and requires, especially in the case of chronic pain syndrome, the actions of a multidisciplinary team of specialists involving various methods of physiotherapy, psychotherapy and physiotherapy. Therapy of orofacial pain in children, especially of neuropathic nature, is poorly understood and requires further comprehensive development. 

Key words: orofacial pain, neuropathic pain, children.
For citation: Voitenkov V.B., Ekusheva E.V. Neuropathic orofacial pain in pediatrics // RMJ. 2017. № 24. P. 1775–1779.

Pages 1779-1784. Нейромодуляция в лечении кластерной головной боли. Исагулян Э.Д., Осипова В.В., Екушева Е.В., Сергеев А.В., Артеменко А.В.

Summary: Neuromodulation in the treatment of cluster headache
Isagulyan E.D.1, Osipova V.V.2.3, Ekusheva E.V.4, Sergeev A.V. 2, Artemenko А.V.2

1 National Medical Research Center of Neurosurgery named after acad. N.N. Burdenko, Moscow
2 First Moscow State Medical University named after I.M. Sechenov
3 Scientific Neuropsychiatric Center named after Z.P. Solovyov, Moscow
4 Advanced Training Institute of the Federal Medical Biological Agency, Moscow

Cluster headache is one of the most frequent trigeminal vegetative cephalalgia, this type of primary headache is one of the most painful, associated with an increase in the number of suicidal attempts and, in general, negatively affects the quality of life of patients. Despite the large number of existing schemes of pharmacotherapy, cluster headache is refractory to conservative treatment in almost a third of cases, which predetermines the development of surgical methods of treatment, especially methods of neurostimulation. In clinical practice, three methods of neurostimulation are used: occipital nerves stimulation (ONS), sphenopalatine ganglion stimulation (SPGS), deep brain stimulation (DBS). When choosing a method, the principle "from simple to complex" is observed, beginning with the use of stimulation of peripheral structures (ONS and SPGS) and, in case of their inefficiency, DBS. Great attention should be paid to the selection of patients. An important factor in the appointment of neurostimulation is the reduction in the latency period, it is necessary to send the patient with a diagnosed incurable pain syndrome to the neurosurgeon as soon as possible for a consultation on the possible choice of treatment, since the duration of refractory pain is associated with a reduction in the potential effect of the stimulant.

Key words: cluster headache, neurostimulation, occipital nerves stimulation, sphenopalatine ganglion stimulation, deep brain stimulation 
For citation: Isagulyan E.D., Osipova V.V., Ekusheva E.V. et al. Neuromodulation in the treatment of cluster headache // RMJ. 2017. № 24. P. 1779–1784.

Pages 1785-1788. Цервикогенная головная боль и цервикогенный фактор при первичных головных болях: противоречия в диагностике и терапии. Сергеев А.В.

Summary: Cervicogenic headache and cervicogenic factor in primary headaches: contradictions in diagnosis and therapy
Sergeev A.V.

First Moscow State Medical University named after I.M. Sechenov

Cervicogenic headache (CH) is one of the most common forms of secondary cephalalgia. From the point of view of neurobiology, CH is the most well-studied headache. The functional connection of the neurons of the posterior horns C1-3 with the caudal nucleus of the V pair forms the basis for the trigeminocervical complex (TCС) and the development of CH. Despite this, the clinical diagnosis of CH, the differential diagnosis between CH and cervicogenic component in primary forms of headaches (migraine, tension headache), the definition of effective treatment is very difficult. The article considers the issues of clinical features, differential diagnostics of CH, evidence-based approaches to the drug and non-drug therapy, the role of local anesthesia. Diagnosis and treatment of the CH is a complex, multidisciplinary task, associated with certain complexities and requiring an active combination of local anesthesia, manual therapy, curative gymnastics and, if necessary, pharmacotherapy. Literature data on the use of non-steroidal anti-inflammatory drugs are given, among which ibuprofen (for example, in the product Nurofen®), analgesics and other groups of drugs are most effective.

Key words: cervicogenic headache, neck pain, migraine, tension headache, non-steroidal anti-inflammatory drugs, ibuprofen, Nurofen® Express.
For citation: Sergeev A.V. Cervicogenic headache and cervicogenic factor in primary headaches: contradictions in diagnosis and therapy // RMJ. 2017. № 24. P. 1785–1788.

Pages 1790-1795. Влияние коморбидных заболеваний на течение мигрени и подходы к терапии. Екушева Е.В., Филатова Е.Г., Алексеева А.Ю.

Summary: The effect of comorbid diseases on the course of migraine and approaches to therapy
Ekusheva E.V.1, Filatova Е.G.2, Alekseeva A.Yu.2

1 Advanced Training Institute of the Federal Medical Biological Agency, Moscow
2 First Moscow State Medical University named after I.M.Sechenov, Moscow

Migraine is characterized by high maladaptation and a decrease in the quality of life of patients due to the high frequency, duration and severity of headache attacks. Comorbid diseases and frequent cephalgia attacks significantly contribute to the unfavorable course, further chronicization of migraine and a worse prognosis in these patients. The comorbid diseases make the pain itself heavier and worsen the condition of patients in the attack-free period. In this regard, the main areas of migraine therapy are the relief of an already developed attack, preventive therapy aimed at preventing repeated attacks and treating comorbid disorders. Triptans (selective 5-HT1B / D receptor serotonin agonists) represent a group of the most effective, pathogenetically valid drugs for relieving migraine attacks. Analysis of the clinical use of Migrepam® (zolmitriptan) for relieving migraine attacks without an aura demonstrates its high efficacy, good tolerability and safety. Effective and timely relief of attacks, adequate preventive treatment and treatment of comorbid diseases, can significantly facilitate the course of migraine, improve social adaptation, quality of life and prevent the chronicization of migraine in most patients.

Key words: migraine, comorbid diseases, triptans, zolmitriptan, Migrepam®
For citation: Ekusheva E.V., Filatova Е.G., Alekseeva A.Yu. The effect of comorbid diseases on the course of migraine and approaches to therapy // RMJ. 2017. № 24. P. 1790–1795.

Pages 1796-1798. Офтальмолог – неврологу: что может скрывать головная или лицевая боль. Оганезова Ж.Г.

Summary: Ophthalmologist to the neurologist: what can be behind headache or facial pain
Oganezova J.G.

Russian National Research Medical University named after N.I. Pirogov, Moscow

General sensory innervation may cause headache and facial pain accompanying ophthalmic diseases or eye pain accompanying neurological pathology. In most cases, if the primary cause of headache or facial pain is ophthalmic pathology, there is a clear clinical picture of eye damage with its redness and visual blurring. But sometimes the eye disease is not so obvious. And it is very important for neurologist to suspect the ophthalmological nature of the pain syndrome for the further adequate management of the patient. This publication presents an algorithm for differential diagnosis, simple examination methods and emergency care for a patient with an angle-closure glaucoma attack.

Key words: angle-closure glaucoma, acute and subacute attack, intraocular pressure, trigger.
For citation: Oganezova J.G. Ophthalmologist to the neurologist: what can be behind headache or facial pain // RMJ. 2017. № 24. P. 1796–1798.

Pages 1800-1804. Капсаициноиды в терапии боли: мишени патогенетической терапии. Рачин А.П., Шаров М.Н., Выговская С.Н., Нувахова М.Б., Воропаев А.А., Тарасова Л.Ю.

Summary: Capcaicinoides in the pain therapy: pathogenetic therapy targets
Rachin A.P.1, Sharov M.N.2, Vygovskaya S.N.1, Nuvahova M.B.1, Voropaev A.A.1, Tarasova L.Yu.1

1 National Medical Research Center for Rehabilitation and Balneology, Moscow
2 Moscow State Medical Stomatological University named after А.I. Evdokimov

This article focuses on one of the leading problems of modern medicine - pain and anesthesia. The pathophysiology of the origin of pain and the principles of the action of anesthetics are examined in detail. The analgesic effect of various drugs results from their effects on different levels of the central nervous system. The primary central substrate of the complex interaction of the nociceptive and antinociceptive systems is the posterior horns. This is the place where the "painful" and "non-painful" sensitivity canals interact, on the basis of which a flow of ascending impulses of a new quality appears.
Capsaicinoids are widely used for local anesthesia, including the treatment of neuropathic and musculoskeletal pain, since they selectively activate Ca2+ -permeable cationic TRPV1 channels, which are numerously located in the nociceptors’ endings. Numerous studies have shown that a topical application of capsaicinoid-containing local low-concentration agents is effective enough in the treatment of pain. The article provides the review of the effectiveness of the use of capsaicinoids and the comparison of natural capsaicin and its synthetic analogue Nonivamide (Capsicam) in the treatment of pain.

Key words: pain, analgesia, capsaicin, nonivamide, Capsicam.
For citation: Rachin A.P., Sharov M.N., Vygovskaya S.N. et al. Capcaicinoides in the pain therapy: pathogenetic therapy targets // RMJ. 2017. № 24. P. 1800–1804.

Pages 1805-1811. К вопросу клинических рекомендаций по остеоартриту: почему в разных странах разные стратегии?. Наумов А.В., Ховасова Н.О.

Summary: On the question of clinical recommendations on osteoarthritis: Why do different countries apply different strategies?

Naumov A.V., Khovasova N.O.

Moscow State Medical and Stomatological University named after А.I. Evdokimov

The article considers in detail the strategy of managing patients with osteoarticular diseases in general medical practice. The modern information of foreign and domestic researchers on the treatment of osteoarthritis (OA) is given. The authors' own studies show that 84% of the outpatients have joint and back pain, and 59.2% have x-ray symptoms of OA (knee and / or hip joint). At the same time, cardiovascular disease in combination or without type 2 diabetes was the comorbidity core in these patients. Particular attention is paid to the conservative treatment of OA. Currently, non-steroidal anti-inflammatory drugs (NSAIDs) are widely used. However, the use of certain NSAIDs in more than a third of cases does not have the proper effect and has a number of limitations in patients with cardiovascular diseases; on the other hand, the impossibility of a wide use of central analgesics in domestic clinical practice for chronic pain resulting from OA often raises the questions of the choice of other drug groups. In this situation, the effectiveness of symptomatic slow-acting drugs has been proven: chondroitin, glucosamine, diacerein, unsaponifiable compounds of avocado and soy. In domestic practice, pharmacopoeial substances of chondroitin sulfate (Chondroguard®) and glucosamine sulfate (Sustagard® Arthro) are used both in tableted and injectable forms, which have a number of advantages for initial use in exacerbations of chronic joint and back pain in generalized osteoarthritis.

Key words: osteoarthritis, nonsteroidal anti-inflammatory drugs, chondroitin sulfate, glucosamine sulfate, Chondroguard®, Sustagard® Arthro.
For citation: Naumov A.V., Khovasova N.O. On the question of clinical recommendations on osteoarthritis: Why do different countries apply different strategies? // RMJ. 2017. № 24. P. 1805–1811.

Pages 1812-1817. Опыт применения комплексного препарата уридинмонофосфата при обострении хронической неспецифической боли в нижней части спины. Рачин А.П., Шаров М.Н., Выговская С.Н., Нувахова М.Б., Воропаев А.А., Тарасова Л.Ю.

Summary: Experience in the use of a complex uridinemonophosphate drug in the exacerbation of chronic nonspecific lower back pain
Rachin A.P.1, Sharov M.N.2, Vygovskaya S.N.1, Nuvakhova M.B.1, Voropaev A.A.1, Tarasova L.Yu.1

1 National Medical Research Center of Rehabilitation and Balneology, Moscow
2 Moscow State Medical and Stomatological University named after А.I. Evdokimov

In the conditions of polypragmasy of exacerbation of the chronic nonspecific lower back pain, the problem of research of innovative medications meeting the high requirements of the optimal efficacy and safety ratio, including the nucleotide therapy preparations, is becoming more relevant.
The aim of the study was to assess the efficacy and safety of the use of the Keltikan® complex in exacerbation of chronic nonspecific lower back pain.
Patients and Methods: patients were divided into two groups: 1 group - 20 patients (10 women and 10 men, mean age 44.6 ± 0.84 years) suffering from exacerbation of chronic nonspecific lower back pain received a complex of procedures together with the appointment of the Keltican® complex (1 capsule 1 time / day during meals) for 20 days. Group 2 consisted of 30 patients (15 women and 15 men, mean age 46.5 ± 1.34 years) suffering from exacerbation of chronic nonspecific lower back pain, receiving a complex of procedures. The effectiveness of therapy was assessed by clinical and psychometric methods of the study after 20 days of treatment and after 90 days of observation. 
Results: the study of pain intensity in the compared groups revealed a significant decrease in this parameter in the "Keltikan® complex" group in comparison with the "Control" group after 20 days of therapy and after 90 days of observation. In an exacerbation of chronic nonspecific lower back pain, there were no adverse drug reactions in the group of patients taking the Keltikan® complex, that proves its safety. 
Conclusion: the use of the Keltikan® complex significantly reduces the pain syndrome and improves the quality of life, which makes it possible to recommend the Keltican® complex as an adjuvant therapy for this category of patients.

Key words: nucleotides, Keltikan® complex, chronic back pain, adjuvant therapy.
For citation: Rachin A.P., Sharov M.N., Vygovskaya S.N. et al. Experience in the use of a complex uridinemonophosphate drug in the exacerbation of chronic nonspecific lower back pain // RMJ. 2017. № 24. P. 1812–1817.



№23, 2017. Оториноларингология

Pages 1683. Слово редактора. Рязанцев С.В.

Pages 1684-1686. Организация послеоперационной реабилитации глухих пациентов после кохлеарной и стволомозговой имплантации. Королева И.В., Кузовков В.Е., Янов Ю.К.

Summary: Organization of postoperative rehabilitation of deaf patients after cochlear and stembrain implantation
Koroleva I.V., Kuzovkov V.E., Yanov Yu.K.

Saint Petersburg Research Institute of Ear, Throat, Nose and Speech

The article analyzes the problems of organization of rehabilitation of deaf patients after cochlear and stembrain implantation. The authors determine the conditions necessary to ensure a high effect of cochlear implantation as a high-tech method for the restoration of auditory function. There are 3 levels of interaction in the process of organization of the patient’s rehabilitation: 1) the macro level (government, including ministries of health, education and social protection), 2) meso level (cochlear implantation centers, medical and pedagogical universities), 3) microlevel (surdological / rehabilitation centers, educational institutions ). Two steps of the organization of auditory rehabilitation of children with cochlear implants are shown as a long-term process. Local  medical centers provide technical and medical support to a patient with auditory implants during his life. The present policy of the Government of the Russian Federation and Ministry of Health in the field of promotion of modern technologies of treatment and rehabilitation of deaf children and adults is consecutive.  It is concluded that an important condition for increasing the effectiveness of auditory implantation as a medical technology is the development of a system of psychological and pedagogical support for children with cochlear and brainstem implants on the basis of the centers of cochlear implantation and regional surdological centers. 

Key words: deafness, cochlear implantation, auditory brainstem implantation, organization of rehabilitation of the patients after cochlear implantation.
For citation: Koroleva I.V., Kuzovkov V.E., Yanov Yu.K. Organization of postoperative rehabilitation of deaf patients after cochlear and stembrain implantation // RMJ. 2017. № 23. P. 1684–1686.

Pages 1688-1694. Особенности неспецифической профилактики и лечения пациентов с обострением хронического тонзиллита. Рязанцев С.В., Кривопалов А.А., Еремин С.А.

Summary: Features of nonspecific prevention and treatment of patients with exacerbation of chronic tonsillitis
Ryazantsev S.V., Krivopalov A.A., Eremin S.A.
Saint Petersburg Research Institute of Ear, Throat, Nose and Speech

Sore throat remains one of the most frequent reasons for prescribing antibiotic therapy, despite the fact that in the nature of this pathology, a significant role belongs to pathogens that do not etiologically require it. Usage of modern methods of express diagnostics in clinical practice will allow to avoid unjustified prescription of antibiotics for this symptom. Chronic pathology of palatine tonsils plays an important role in tonsillofaringitis, causing persistent disturbances of microbiocenosis, local and systemic immunity, contributes to more frequent exacerbations.The use of immunostimulating preparations of bacterial lysates in chronic pathology of palatine tonsils allows to achieve a more rapid remission in the patient and to preserve it by influencing the microbiocenosis, established in chronic tonsillitis, and immune response at the local and general levels.
Aim: to evaluate the effectiveness of the drug Ismigen on the course and severity of exacerbation of chronic tonsillitis during the epidemiological season of acute respiratory infections.
Patients and Methods: 60 patients were examined and divided into 2 groups. The control group was formed by 30 patients receiving standard therapy. 30 patients of the study group received the Ismigen drug in addition to the standard therapy. The drug was prescribed sublingually 1 tablet 30 minutes before meal once a day during 10 days. In addition to therapy during the exacerbation period, the study included two Ismigen courses of 10 days to prevent recurrence of exacerbation and to obtain a more stable effect. 
Results: a statistically significant difference between subjective indices in patients using Ismigen and undergoing treatment without it was revealed on the third visit and increased steadily with the more pronounced positive dynamics in the study group until the sixth visit. In the study of objective indices the same dynamics were observed.
Conclusion: The use of immunostimulating therapy with Ismigen during the exacerbation of chronic tonsillitis (acute tonsillopharyngitis) and acute respiratory viral infection can not only reduce the severity of complaints in patients and clinical manifestations of the disease, but also shorten the time of disease and reduce the need for additional antibiotic therapy.

Key words: chronic tonsillitis, exacerbation, acute tonsillopharyngitis, Streptatest, immunostimulants, bacterial lysates, Ismigen.
For citation: Ryazantsev S.V., Krivopalov A.A., Eremin S.A. Features of nonspecific prevention and treatment of patients with exacerbation of chronic tonsillitis // RMJ. 2017. № 23. P. 1688–1694.

Pages 1695-1698. Новые технологии в оториноларингологии: стволомозговая имплантация. Янов Ю.К., Кузовков В.Е., Королева И.В., Левин С.В., Behr R., Левина Е.А., Сугарова С.Б., Лиленко А.С.

Summary: New technologies in otorhinolaryngology: brainstem implantation
Janov Yu.K.1, Kuzovkov V.E.1, Koroleva I.V.1,2, Levin S.V.1,4, Behr R.3, Levina E.A.1, Sugarova S.B.1, Lilenko A.S.1

1 St.Petersburg Research Institute of Ear, Nose, Throat and Speech
2 Russian State Pedagogical University named after A.I. Herzen, St.Petersburg
3 Fulda Clinic, Germany
4 North-Western State Medical University named after I.I. Mechnikov, St.Petersburg 

Patients with deafness who have no surgical indications to the operation of cochlear implantation used to remain deaf for life.These are patients with retrochlear pathology and impaired cochlea development. To help this group of patients, a system of brainstem implantation was created. It is a modified cochlear implant that is installed by surgical operation in the brain stem on the surface of the cochlear nucleus.
Aim: to evaluate the effectiveness of the auditory brainstem implantation method in deaf patients.
Patients and Methods. 3 patients were selected. Two adult patients with type 2 neurofibromatosis and one child aged 2 years with bilateral cochlear aplasia. 
Results: In patients with the brainstem implantation, after connection of the speech processor, the hearing thresholds ranged from 50 to 60 dB in the frequency range from 500 Hz to 4,000 Hz. At the end of the first rehabilitation, the hearing thresholds were 45-50 dB. Adults perceived different sounds, distinguished words based on duration and syllabic structure. Six months after the connection, the patients showed a positive development of these skills. The child responded well to sounds of different frequencies. Pre-speech and speech vocalizations appeared. In 2 years after the operation, adult patients distinguished the words from the closed selection. The child had a passive vocabulary of about 200 words.
Conclusions: auditory brainstem implantation is a method of choice for the rehabilitation of deaf patients in which it is impossible or impractical to conduct a cochlear implantation. Adult patients note an improvement in the quality of their life. Speech intelligibility in this group of patients varies from 30% to 70%.

Key words: auditory brainstem implantation, cerebellopontine angle, implant, ventricle, brainstem implantation, auditory rehabilitation of deaf patients, deafness, cochlear implantation.
For citation: Janov Yu.K., Kuzovkov V.E., Koroleva I.V. et al. New technologies in otorhinolaryngology: brainstem implantation // RMJ. 2017. № 23. P. 1695–1698.

Pages 1699-1702. К вопросу о классификации холестеатомы пирамиды височной кости. Аникин И.А., Хамгушкеева Н.Н., Ильин С.Н., Бокучава Т.А.

Summary: On the classification of the petrous pyramid cholesteatoma
Anikin I.A.1, Khamgushkeeva N.N.1, Ilin S.N.1, Bokuchava T.A.2

1 Saint-Petersburg Scientific Research Institute of Ear, Nose, Throat and Speech
2 Murmansk Regional Clinical Hospital named after P.A. Bayandin

Cholesteatoma is the tumor formed by keratinizing epithelium, keratin residues and perimatrix of various thicknesses with or without surrounding inflammatory reaction. In 2.9% of patients with cholesteatoma it spreads to the petrous pyramid. Aggressive growth of the petrous pyramid cholesteatoma can lead to the destruction of the underlying bone structures with the spread of the tumor to the clivus, the sphenoid sinus, the infratemporal fossa, the nasopharynx with possible penetration into the subdural space.
Aim: the detailed classification of the petrous pyramid cholesteatoma.
Patients and Methods: this prospective study included 22 patients with chronic suppurative otitis media who had a petrous pyramid cholesteatoma. The diagnosis is based on an otolaryngological examination, multispiral computed tomography (MSCT) of temporal bones, MRI of the middle ear, diffuse-weighted MRI of the brain. The average age of the patients was 39.2 ± 7 years. The Moffat-Smith 2008 classification of the petrous pyramid cholesteatoma was used in the work.
Results: MSCT of the temporal bone reveals various destructive processes with high accuracy and specificity, that is important for determining the boundaries of  the tumor and thus the classification of the petrous pyramid cholesteatoma. Based on CT images and updated Moffat-Smith petrous pyramid cholesteatoma classification, depending on the location in relation to the labyrinth the tumors were distributed on the supra-labyrinth (n-9), supra-labyrinth-apical (n-3), infra-labyrinth (n-3), infra-labyrinth-apical (n-5), massive labyrinth (n-1) and massive labyrinth petrous pyramid cholesteatoma with apical proliferation (n-1).  Thus, in this article we have attempted to describe the boundaries of various types of the petrous pyramid cholesteatoma on the basis of the MSCT of the temporal bones.
Conclusion: the use of the proposed classification will provide an opportunity to determine the type of the petrous pyramid cholesteatoma and will help in choosing the tactics of surgical treatment of this pathology.

Key words: the petrous pyramid cholesteatoma, chronic suppurative otitis media, classification, computed tomography.
For citation: Anikin I.A., Khamgushkeeva N.N., Ilin S.N., Bokuchava T.A. On the classification of the petrous pyramid cholesteatoma // RMJ. 2017. № 23. P. 1698–1702.

Pages 1703-1706. Особенности приобретенных атрезий перепончато-хрящевого отдела наружного слухового прохода и эффективность нового хирургического лечения. Аникин И.А., Еремин С.А.

Summary: Features of the acquired atresia of the membranous-cartilaginous section of the external auditory canal and the effectiveness of new surgical treatment
Anikin I.A., Eremin S.A.

St. Petersburg Scientific Research Institute of Ear, Nose, and Speech 

One of the diseases leading to hearing loss and decreasing the quality of life is the acquired atresia of the external auditory canal (EAC).
Aim: to analyze the causes of atresia in the membranous-cartilaginous part of the EAC, its severity and the influence on the results of surgical treatment.
Patients and Methods: the study included 15 patients with complete EAC atresia in the membranous cartilaginous part or partial atresia with a lumen of less than 3 mm and clinical manifestations.
Results: it has been revealed that the causes of atresia in the membranous-cartilaginous part of the EAC and the concomitant pathology of the deeper areas are mainly the trauma and the previous surgical operation. It is established that the development of cholesteatoma depends on the same reasons that caused atresia: the formation of cholesteatoma is most likely with the traumatic nature of atresia. It is revealed that a complete absence of EAC lumen always leads to the appearance of the pathology of its bone section, in contrast to stenosis. The diagnostic role of computer tomography in the detection of concomitant pathology has been confirmed. A new method has been developed to eliminate the acquired atresia of the membranous-cartilaginous part of the EAC; it includes complete meatal cartilage resection, partial auricular cartilage resection, the formation of skin flaps and fixing them to the bone part of the ear canal.
Conclusions: atresia of the EAC in the membranous cartilaginous area develops mainly as a result of trauma or surgery, and the complete atresia of the membranous cartilage part always leads to the pathology of deeper parts of the ear. A new way to eliminate atresia of the EAC showed a high efficiency of hearing restoration and a reduction in the risk of repeated atresia.

Key words: ear surgery, atresia of the external auditory canal, hearing loss, cholesteatoma, surgery, acquired atresia. 
For citation: Anikin I.A., Eremin S.A. Features of the acquired atresia of the membranous-cartilaginous section of the external auditory canal and the effectiveness of new surgical treatment // RMJ. 2017. № 23. P. 1703–1706.

Pages 1707-1710. Возможности топических нестероидных противовоспалительных средств при болевом синдроме у пациентов после тонзиллэктомии. Асманов А.И., Пивнева Н.Д., Дегтярева Д.В.

Summary: Possibilities of topical nonsteroidal anti-inflammatory drugs in patients with pain syndrome after tonsillectomy
Asmanov А.I.1,2, Pivneva N.D.1.2, Degtyareva D.V.3

1  Moscow Scientific Research Clinical Institute of Pediatrics named after Acad. Yu.E. Veltishchev, Moscow
2 Russian National Research Medical University named after N.I. Pirogov, Moscow
3 Scientific and Clinical Center of Otorhinolaryngology of FMBA of Russia, Moscow

Tonsillectomy is one of the most frequent operations in otorhinolaryngological practice. However, today there are no definite recommendations for the management of pain syndrome in the postoperative period in children and adolescents.
The aim of our study was to evaluate the efficacy of the topical form (tablets for resorption) of flurbiprofen for relieving the pain syndrome in patients after tonsillectomy.
Patients and Methods: the study included 60 patients aged from 12 to 18 years with a diagnosis of chronic tonsillitis, decompensated form. The main group consisted of patients who received, after surgery, flurbiprofen 1 tablet 3 t. / day for 5 days. Patients of the control group received systemic analgesic therapy with ketoprofen (2 ml intramuscularly). Subjective evaluation of the severity of the pain syndrome was carried out by filling in special questionnaires on the first and subsequent days after the operation.
Results of the study: the mean score of the pain intensity at rest in the postoperative period was higher in the control group and the dynamics of the decrease in the average score of the pain syndrome was more pronounced in patients receiving flurbiprofen. Similar data were obtained in assessing the severity of pain during eating. In the study 3 (10%) of the patient in the control group started to eat solid food already on the 2nd day after the operation, by the 4 th day, their number was already 18 (60%), which was significantly higher than in the control group - 12 40%).
Conclusion: The results obtained showed a high level of effective and safety of flurbiprofen in the form of tablets for resorption in the management of pain syndrome in patients after tonsillectomy.

Key words: flurbiprofen, tonsillectomy, pain syndrome, children.
For citation: Asmanov А.I., Pivneva N.D., Degtyareva D.V. Possibilities of topical nonsteroidal anti-inflammatory drugs in patients with pain syndrome after tonsillectomy // RMJ. 2017. № 23. P. – 1710.

Pages 1712-1716. Возможности медико-педагогической реабилитации пациентов с односторонним парезом гортани. Степанова Ю.Е., Готовяхина Т.В., Махоткина Н.Н., Мохотаева М.В.

Summary: The possibilities of medical and pedagogical rehabilitation of patients with unilateral paresis of the larynx
Stepanova Yu.E., Gotovyakhina Т.V., Makhotkina N.N., Mokhotayeva M.V.

St. Petersburg Scientific Research Institute of Ear, Nose, Throat and Speech

The main cause of the larynx paresis is the trauma of the recurrent laryngeal nerve during operations on the thyroid gland. This article presents the experience of specialists of the phoniatric department of St. Petersburg Research Institute of Ear, Nose, Throat and Speech in the treatment of patients with unilateral postoperative paresis of the larynx. 
The aim of the study was to evaluate the effectiveness of the complex drug treatment, physiotherapy and early phonopedic correction in patients with unilateral paresis of the larynx.
Patients and Methods: 74 patients with unilateral paresis of the larynx after operations on the thyroid gland participated in the study. The terms of application to the phoniatrist varied from 3 days to 1 year after the operation. The scheme of complex treatment included medication, physiotherapy (neuromuscular electrophonopedic laryngeal stimulation) and phonopedic correction. The results of the rehabilitation were assessed according to video endoscopy of the larynx and acoustic computer analysis before the treatment, during the treatment and after the completion of the course of therapy.
Results of the study: during the treatment, recovery of the laryngeal mobility was achieved in 12 (16.2%) patients within the period of 1 to 4 months after the operation. Normalization of the voice function due to the development of compensatory mechanisms of phonation with preservation of the laryngeal paresis was observed in 61 (82.4%) of the patients. In 1 (1.4%) patient the effect of treatment was unsatisfactory because of signs of hypotrophy of the larynx muscles on the paresis side due to the resection of the recurrent laryngeal nerve during the operation.
Conclusion: for a full rehabilitation of patients with unilateral paresis of the larynx, an early start of complex treatment consisting of drug therapy, physiotherapy and phonopedic correction is necessary. Phonopedic correction of voice disorders in cooperation with endocrine surgeons and otorhinolaryngologists, started at the earliest possible time of laryngeal paresis, will improve the efficiency of rehabilitation of patients.

Key words: larynx paresis, video endoscopic larynx, computerized acoustic analysis, neuromuscular electrophonopedic stimulation, phonopedy, physiotherapy.
For citation: Stepanova Yu.E., Gotovyakhina Т.V., Makhotkina N.N., Mokhotayeva M.V. The possibilities of medical and pedagogical rehabilitation of patients with unilateral paresis of the larynx // RMJ. 2017. № 23. P. 1712–1716.

Pages 1718-1719. Ренгалин - лечение кашля.

Pages 1720-1724. История многоканальной кохлеарной имплантации. Кузовков В.Е., Пудов В.И., Клячко Д.С.

Summary: The history of multichannel cochlear implantation
Kuzovkov V.E., Pudov V.I., Kliachko D.S.

St.Petersburg Research Institute of Ear, Throat, Nose and Speech

The article highlights the main stages of cochlear implantation (CI) development and defines the main aspects of the cochlear implants creation. Since 1977 the company "MED-EL" began the world history of multi-channel CI. In the course of many years of work, the main aspects of the creation and development of cochlear implants have been formed: the creation of an implant that does not impose restrictions on the signal used for stimulation, so that the intelligence of the system lies in a component that is outside the body and can be easily improved; careful attitude towards the sensitive structures inside the cochlea; use of the entire length of the cochlea, including the apical region, for stimulation, which should lead to the widest range of auditory sensations in height, including a very low tone, and helps to avoid a long adaptation process caused by remapping of the perceived pitch range; ergonomics in the daily use of the device by the recipients is essential for the acceptance and distribution of the implants. Among other things, constant struggle for power reduction has led MED-EL to the path from the body-worn to behind-the-ear and portable wireless audio processors, and ultimately, fully implantable systems will be developed.

Key words: cochlear implantation, multichannel cochlear implant, deafness, aspects of cochlear implant creation.
For citation: Kuzovkov V.E., Pudov V.I., Kliachko D.S. The history of multichannel cochlear implantation // RMJ. 2017. № 23. P. 1720–1724.

Pages 1725-1730. Современная фармакотерапия воспалительных заболеваний наружного и среднего уха. Фанта И.В., Павлова С.С., Шустова Т.И., Рязанцев С.В.

Summary: Modern pharmacotherapy of the external and middle ear inflammatory diseases
Fanta I.V., Pavlova S.S., Shustova T.I., Ryazantsev S.V.

St. Petersburg Research Institute of ENT

External and secondary otitis media are socially significant diseases occurring mainly in children and adults of working age, which often recur and have a tendency to chronicity. In this regard, the development of an optimal algorithm for the treatment of patients with inflammatory processes in the external and middle ear is an urgent task of clinical otorhinolaryngology. When diagnosing otitis, it is important to define of the microflora of the organism, the presence of fungi and various microorganisms associations, the resistance of which to antibiotic therapy often negatively affects the results of the treatment. Together with other causes of inflammation in the middle and external ear, the microbiological aspect becomes a factor of etiotropic therapy. The pronounced staging of acute otitis media suggests an individual approach to treatment in each of these stages. At present antibiotics are considered to be the drugs of choice in the treatment of patients with external and secondary otitis media. Due to the development of severe pain and inflammation in the ear, an important role is played by preparations of analgesic and anti-inflammatory therapy. Its effectiveness is confirmed by complex topical preparations with antimicrobial and analgesic effect (Anauran).

Key words: external and middle otitis media, etiotropic therapy, topical antibacterial drugs. 
For citation: Fanta I.V., Pavlova S.S., Shustova T.I., Ryazantsev S.V. Modern pharmacotherapy of the external and middle ear inflammatory diseases // RMJ. 2017. № 23. P. 1725–1730.

Pages 1731-1733. Лечение и профилактика острой респираторной вирусной инфекции с позиции врача-оториноларинголога. Кривопалов А.А., Шервашидзе С.В., Шаталов В.А.

Summary: Treatment and prevention of acute respiratory viral infection from the position of an otorhinolaryngologist
Krivopalov A.A., Shervashidze S.V., Shatalov V.A.

St. Petersburg Scientific research institute of ear, nose, throat and speech

The article reflects the issues of epidemiology, etiopathogenesis and treatment of acute respiratory viral diseases (ARVI) of ENT organs. The authors consider in detail the effects of the use of sea water solutions, which include the increase of ciliary motility, the activation of reparative processes in the cells of the nasal mucosa and the normalization of their functions, and as a local therapy for rhinitis in ARVI, taking into account the experience of domestic and foreign specialists. Features of various forms of sea water solutions are described, among which the individual dropper-tubes are the most preferable, sparing and hygienic ones. This form is available for the sea water solution Sialor® aqua.
The article highlights the problem of rhinosinusitis as the most frequent complication of acute respiratory viral infections, which leads to the obstruction of natural openings of the paranasal sinuses, mostly treated by vasoconstrictive drugs. Various vasoconstrictors and peculiarities of their use in the practice of an otorhinolaryngologist are considered. The article describes the advantages of using oxymetazoline, which acquires a  therapeutic activity at lower concentrations than other vasoconstrictors, providing creation of oxymetazoline dosage forms at concentrations of 0.05%, 0.025%, and a concentration of 0.01% (Sialor® rhino), which is effective and safe even in infants and newborns.

Key words: otorhinolaryngological specialized care, acute rhinosinusitis, local treatment.
For citation: Krivopalov A.A., Shervashidze S.V., Shatalov V.A. Treatment and prevention of acute respiratory viral infection from the position of an otorhinolaryngologist // RMJ. 2017. № 23. P. 1731–1733.

Pages 1734-1738. Высокодозовые фторхинолоны в лечении острого синусита. Рязанцев С.В., Сапова К.И.

Summary: High-dose fluoroquinolones in the treatment of acute sinusitis
Ryazantsev S. V., Sapova K.I.

Saint Petersburg Research Institute of Ear, Throat, Nose and Speech

The review analyzes the advantages and disadvantages of different classes of antibacterial drugs, in particular the efficacy and safety of levofloxacin (Levolet® R) for the treatment of inflammatory infections of the upper respiratory tract. The pharmacodynamics of levofloxacin is considered in detail, the results of studies of its use and effectiveness in comparison with other classes of antibacterial drugs are given. The authors focus on the latest trends in the appointment of short courses of levofloxacin, which have successfully been used in the treatment of a number of infections. Studies are being conducted on the appointment of short courses of levofloxacin at a high dose of 750 mg 1 time / day, which has increased the patient's compliance, reduced the risk of development of resistance to the antibiotic. Current information about the effectiveness and convenience of a new dosage with a pronounced therapeutic result is given. In conclusion, the authors conclude that Levolet® R is effective in treating patients with acute and exacerbation of chronic diseases of the upper respiratory tract. The proven effectiveness is 93.8-100%.

Key words: antibacterial drugs, levofloxacin, Levolet® R, upper respiratory tract infections.
For citation: Ryazantsev S. V., Sapova K.I. High-dose fluoroquinolones in the treatment of acute sinusitis // RMJ. 2017. № 23. P. 1734–1738.

Pages 1739-1743. Место топических антимикробных лекарственных средств в фармакотерапии инфекционно-воспалительных заболеваний глотки. Свистушкин В.М., Никифорова Г.Н., Мокоян Ж.Т.

Summary: Place of topical antimicrobial drugs in pharmacotherapy of inflammatory diseases of the pharynx
Svistushkin V.M., Nikiforova G.N., Mokoyan Zh.T.

First Moscow Medical State University named after I.M. Sechenov

The pharynx performs an important functional role in the human body. Infectious-inflammatory diseases of the pharynx are still the most frequent cause of applications of patients to doctors of various specialties for ambulatory treatment. Normally, the pharynx has a diverse and dynamic microflora, thus the interpretation of the results of microbiological research and, accordingly, the appointment of adequate treatment to the patients with pharyngeal pathology is a difficult task. Tonsillopharyngitis accounts for about 30% of all diagnosed otorhinolaryngological nosologies and requires adequate pharmacotherapy. Local antimicrobial drugs take the main place in the treatment of patients with inflammatory diseases of the pharynx. The widely used topical drug Grammidine (gramicidin C and cetylpyridinium chloride/±oxybuprocaine) occupies one of the leading positions in the arsenal of doctors due to its effectiveness, easy intaking and a good safety. Grammidine dosage spray is a new form of a well-proven drug which efficacy and safety is demonstrated by the results of a multicenter clinical trial.

Key words: functions of the pharynx, tonsillopharyngitis, infectious and inflammatory diseases of the pharynx, pharyngeal microflora, local antimicrobial therapy, Grammidine dosage spray.
For citation: Svistushkin V.M., Nikiforova G.N., Mokoyan Zh.T. Place of topical antimicrobial drugs in pharmacotherapy of inflammatory diseases of the pharynx // RMJ. 2017. № 23. P. 1739–1743.



№22, 2017. Эндокринология

Pages 1603-1606. Проявления гиперкортицизма у больных на фоне короткого курса лечения системными глюкокортикоидами. Древаль А.В., Комердус И.В., Будул Н.А., Бритвин Т.А., Терпигорев С.А., Кабанова Т.Г., Чеканова А.В.

Summary: Manifestations of hypercorticism in patients on the background of a short course of systemic glucocorticoids treatment
Dreval A.V., Komeredus I.V., Budul N.A., Britvin T.A., Terpigorev S.A., Kabanova T.G., Chekanova A.V.

Moscow Research and Clinical Institute named after M.F. Vladimirsky

Aim: to compare the manifestations of hypercorticism in patients receiving oral glucocorticoids (OGC) for lungs sarcoidosis, and in patients with glucocorticosteroma.
Patients and methods:  the study included 36 patients (26 (72.2%) women and 10 (27%) men, 51 [39.5, 63.7] years) who took OGC for lungs sarcoidosis (group A) and 32 patients (30 (93.7%) women and 2 (6.3%) men, 41.5 [32.2, 54.0] years) with glucocorticosteroma (group B).
Results: manifestations of hypercorticism were more often observed in group B than A (p <0.05). In group A, with increasing dose of OGC, the frequency of certain manifestations (matronism, hypokalemia, hypercholesterolemia) increased (r = 0.4, p = 0.01). Arterial hypertension in group A was found in 47.2% of cases, in group B - 96.9% of cases (p <0.05). In group A, according to densitometry, osteoporosis was recorded in 4 (22.2%) patients, osteopenia - in 2 (11.1%) patients. In group B: osteoporosis was detected in 5 (25%) pts., osteopenia – in 5 (25%) pts. In group A, after a month of taking OGC, impaired glucose tolerance (IGT) was detected in 3 pts, impaired fasting glycemia (IFG) – in 2 pts, IGT + IFG – in 1 pt. In group B: diabetes mellitus (DM) was detected in 2 pts., IGT - in 6 pts., norm – in 8 pts. 
Conclusion: manifestations of hypercorticism were more often observed in patients of group B than A. In group A the higher the dose of OGC per kilogram of body weight, the more manifestations of hypercorticism were observed. Disturbances in bone density in both groups occurred with the same frequency. After 1 month of taking OGC in group A there were violations of carbohydrate metabolism, which had not previously been diagnosed.

Key words: glucocorticoids, hypercorticism, proximal myopathy, stretch marks, Cushing’s syndrome.
For citation: Dreval A.V., Komeredus I.V., Budul N.A. et al. Manifestations of hypercorticism in patients on the background of a short course of systemic glucocorticoids treatment // RMJ. 2017. № 22. P. 1603–1606.

Pages 1607-1612. Неалкогольная жировая болезнь печени у пациентов с сахарным диабетом 2-го типа: особенности патогенеза и лечения. Звенигородская Л.А., Мкртумян А.М., Нилова Т.В., Шинкин М.В., Петраков А.В.

Summary: Nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: features of pathogenesis and treatment
Zvenigorodskaya L.A.1, Mkrtumyan A.M.1, 2, Nilova T.V.1, Shinkin M.V.1, Petrakov A.V.

1 Moscow Clinical Scientific and Practical Center
2 Moscow State Medical Stomatological University named after A.I. Evdokimov

Non-alcoholic fatty liver disease (NAFLD) is one of the most common diseases in hepatology. The disease occurs in 85-90% of patients with diabetes mellitus (DM). In the pathogenesis of NAFLD an important role is played by taurine deficiency.
The aim of the study was to determine the content of bile acids (BAs) in the blood in patients with NAFLD and type 2 diabetes; to evaluate the effect of inflammation markers, malonic dialdehyde (MDA) on the synthesis and transport of BAs; to analyze the indices of NO and endotoxin metabolites, biochemical indicators of blood, during three months of taurine therapy.
Patients and methods: 158 patients with NAFLD were examined, and 46 patients with type 2 DM, with impaired glucose tolerance (IGT) - 112. A double-blind placebo-controlled study included 40 patients with NAFLD and type 2 diabetes. Patients were divided into two groups. The main group received taurine, the control group received placebo. 
Results of the study: in patients with NAFLD without carbohydrate metabolism disorder the content of BAs in serum was 5.4 ± 1.8 μmol / L. In patients with NAFLD with IGT it was 8.88 ± 4.94 μmol / l. In 59 patients with NAFLD and type 2 DM the content of BAs was significantly decreased by 45%. The lipid peroxidation indices in patients with NAFLD and type 2 DM were increased by 2 times. The endotoxin content in the blood serum of the NAFLD group and type 2 diabetes was 12 times higher as compared to the control group. The level of NO metabolites in patients with NAFLD and type 2 DM before treatment with taurine was increased by 6.8 times. After treatment - their content decreased by 44%. Treatment with taurine was accompanied by an improvement in the biochemical parameters of the blood.
Conclusion: the obtained results prove the anti-inflammatory, antioxidant, detoxifying and membrane-stabilizing effect of taurine in patients with NAFLD and type 2 DM.

Key words: non-alcoholic fatty liver disease, bile acids, nitric oxide, endotoxin, taurine, complex drug treatment.
For citation: Zvenigorodskaya L.A., Mkrtumyan A.M., Nilova T.V. et al. Nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: features of pathogenesis and treatment // RMJ. 2017. № 22. P. 1607–1612.

Pages 1613-1620. Депрессия и сахарный диабет как коморбидные заболевания. Старостина Е.Г., Володина М.Н., Старостин И.В., Бобров А.Е.

Summary: Depression and diabetes mellitus as comorbid disorders
Starostina E.G.1, Volodina M.N.1, Starostin I.V.2, Bobrov A.E.3

1 Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy
2 National Medical Research Center of Cardiology, Moscow
3 Moscow Scientific Research Institute of Psychiatry - a branch of the Federal Medical Research Center of Psychiatry and Narcology named after V.P. Serbsky

The literature review presents the recent data on epidemiology, clinical significance and pathophysiological association of diabetes mellitus and depressive disorders. Based on the analysis of the prevalence of depression in various groups of patients with diabetes mellitus, we discuss the discrepancies in the prevalence rates related to differences in diagnostic approaches to depression and study designs, as well as to social and cultural characteristics in various countries. The review contains ample evidence proving the negative impact of comorbid depression on the development of late diabetes complications, quality of life, loss of productivity and mortality of diabetic patients. We review psychological aspects of the association between depression and diabetes, as well as its main common pathophysiological aspects, including genetic, neurochemical, neuroendocrine, metabolic, immune, inflammatory and vascular. The term “metabolic depression” is discussed that reflects a close association of the metabolic syndrome with depressive disorders and being a major predictor of subsequent type 2 diabetes mellitus. Taking into account the data on potential positive impact of depression treatment on the course of diabetes and the analysis of medical care for patients with diabetes and depression in various countries, we conclude that screening and treatment of depression should become the necessary component of routine care for diabetic patients. 

Key words: diabetes mellitus, depression, comorbidity, risk factors, antidepressants.
For citation: Starostina E.G., Volodina M.N., Starostin I.V., Bobrov A.E. Depression and diabetes mellitus as comorbid disorders // RMJ. 2017. № 22. P. 1613–1620.

Pages 1621-1628. Барьеры для статинотерапии у пациентов с сахарным диабетом 2-го типа и пути их преодоления. Кондратьева Л.В.

Summary: Barriers for statin therapy in patients with type 2 diabetes mellitus and ways to overcome them
Kondratieva L.V.

Russian Medical Academy of Сontinuous Professional Education, Moscow

Patients with diabetes have a high risk of developing cardiovascular complications. Long-term management of diabetes mellitus includes not only the achievement of targeted glycemic control. Currently, the majority of clinicians, including endocrinologists, adhere to tactics, which includes both the intensive reduction of lipid levels, above all, low-density lipoprotein cholesterol, and blood pressure control to prevent cardiovascular diseases. Statins is the class of drugs most often prescribed to patients with diabetes mellitus. Over the past few years, there have been reports in the literature of an increased risk of developing carbohydrate metabolism disorders when taking statins, which again and again draw the attention of both researchers and clinicians to the problem of safety of their appointment to patients who are at high risk of cardiovascular complications. This article is devoted to the analysis of the relationship between the benefits and risks of developing adverse events, including the possible development of diabetes mellitus on the background of statin therapy. It is shown that over the past 25 years, in numerous studies of statins and their effect on cardiovascular end-points there is no clear relationship between statin therapy and the development of type 2 diabetes. The article highlights the need to more actively identify patients with risk factors for the breakdown of carbohydrate metabolism and to take efforts to prevent the manifestation of diabetes mellitus.

Key words: diabetes mellitus, cardiovascular diseases, statins, cardiovascular risk, blood lipids.
For citation: Kondratieva L.V. Barriers for statin therapy in patients with type 2 diabetes mellitus and ways to overcome them // RMJ. 2017. № 22. P. 1621–1628.

Pages 1629-1634. Добезилат кальция как ранний ангиопротектор при диабетических микроангиопатиях. Мурашко Е.Ю.

Summary: Calcium dobesilate as an early angioprotector in diabetic microangiopathies
Murashko E.Yu.

The multidisciplinary clinical diagnostic center «Clinic TrastMed», Moscow

Microangiopathies are the most common complications in patients with diabetes mellitus (DM). Often in connection with the late diagnosis of diabetes, a large number of patients already have both micro- and macrovascular complications. The most common and extremely disabling complication of diabetes is diabetic retinopathy. The pathogenesis of diabetic retinopathy has a multifactor character and includes a change in the vascular wall, which leads to an increase in the permeability and fragility of blood vessels, a violation of blood circulation in the retina with the formation of microbleedings and occlusions and, as a result, leads to neovascularization and retinal fibrosis with the formation of secondary neovascular glaucoma and the risk of retinal detachment. Calcium dobesilate with a proven pronounced angioprotective activity is successfully used for the treatment and prevention of microangiopathies in DM. Its effect is based on reducing the permeability of the vascular wall, inhibiting the apoptosis of cells that prevents changes the membrane permeability, and DNA fragmentation, as well as adhesion of leukocytes to the walls of the retinal vessels and endotheliocytes and normalization of the level of proteins, which ultimately helps to maintain integrity hematoretinal barrier. Similarly, calcium dobesilate suppresses lipid peroxidation, reduces platelet aggregation and reduces the level of fibrinogen, thereby positively affecting the rheological properties of the blood. According to studies, the early appointment of calcium dobesilate provides both an angioprotective effect with respect to diabetic angiopathies (including diabetic nephropathy and diabetic polyneuropathy), and the regression of already existing microvascular complications. 

Key words: calcium dobesilate, microangiopathy, angioprotection, diabetic retinopathy, diabetic nephropathy, polyneuropathy.
For citation: Murashko E.Yu. Calcium dobesilate as an early angioprotector in diabetic microangiopathies // RMJ. 2017. № 22. P. 1629–1634.

Pages 1635-1640. Взаимосвязь неалкогольной жировой болезни печени и сахарного диабета 2-го типа. Шаронова Л.А., Вербовой А.Ф., Вербовая Н.И., Пашенцева А.В.

Summary: The relationship between non-alcoholic fatty liver disease and type 2 diabetes mellitus
Sharonova L.A., Verbovoy A.F., Verbovaya N.I., Pashentseva A.V.

Samara State Medical University

In clinical practice, type 2 diabetes mellitus (DM) is often combined with non-alcoholic fatty liver disease (NAFLD). According to the modern concepts, NAFLD is the main component of the metabolic syndrome and the main risk factor for cardiovascular disease. This review discusses current aspects of the pathogenesis of non-alcoholic fatty liver disease, its relationship with type 2 diabetes and obesity, and association with a high risk of cardiovascular disease. Data on the clinical picture and instrumental methods of diagnosis of NAFLD are presented. The possibility of using essential phospholipids in the treatment of NAFLD is considered as an effective, available and pathogenetically substantiated method of therapy. The article demonstrates the effectiveness of the essential phospholipids therapy in improving the laboratory and ultrasound picture of the liver, reducing insulin resistance, systemic and tissue inflammation, and the activity of fibrogenesis in the liver. It is shown that the treatment of NAFLD in patients with type 2 diabetes should start as early as possible, even at the stage of steatosis, in this case one can expect the greatest effect from the therapy used. 

Key words: type 2 diabetes, non-alcoholic fatty liver disease, pathogenesis, insulin resistance, fat function, diagnostics, essential phospholipids.
For citation: Sharonova L.A., Verbovoy A.F., Verbovaya N.I., Pashentseva A.V. The relationship between non-alcoholic fatty liver disease and type 2 diabetes mellitus // RMJ. 2017. № 22. P. 1635–1640.

Pages 1641-1645. Сон и нарушения метаболизма. Мисникова И.В., Ковалева Ю.А.

Summary: Sleep and metabolic disorders
Misnikova I.V., Kovaleva Yu.A.

Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy, Moscow

Sleep is a periodically arising condition, subject to circadian rhythm and manifested by a change in brain activity and reaction to stimuli. Sleep is an important component of the full life of every person, and its quantity and quality largely determine the state of health. There are mutual influences between sleep and metabolic disorders. The article presents the mechanisms explaining the influence of sleep deprivation and the displacement of circadian rhythms on metabolic dysregulation and causing a metabolic disorder. These changes can be multifactorial and lead to cardiovascular disorders due to excessive sympathetic stimulation, hormonal imbalance and subclinical inflammation. In turn, metabolic imbalance can lead to various sleep disorders. Thus, doctors in their clinical practice need to be attentive to both the quality and the quantity of patients' sleep, because timely correction of sleep disorders can significantly reduce the risk of metabolic disorders and their complications.

Key words: sleep, sleep deprivation, circadian rhythms, metabolic disorders, hormone level, sleep-disordered breathing.
For citation: Misnikova I.V., Kovaleva Yu.A. Sleep and metabolic disorders // RMJ. 2017. № 22. P. 1641–1645.

Pages 1646-1650. Остеопороз. Гендерные особенности профилактики и лечения. Бабенко А.Ю., Лаевская М.Ю.

Summary: Osteoporosis. Gender features of prevention and treatment
Babenko A.Yu., Laevskaya M.Yu.

National Medical Research Center named after V.A. Almazov, Saint-Petersburg

Osteoporosis and related fractures are the major public health problem worldwide and the often cause of disability and mortality. Due to its high prevalence, the greatest attention is given to osteoporosis in elderly women. Meanwhile, this problem is also relevant for the elderly men. The course of osteoporosis in men has a number of characteristics, which must be taken into account in the diagnosis and choice of therapy. Hypogonadism, cigarette smoking, alcohol abuse, and a number of diseases requiring corticosteroid treatment are the main risk factors for osteoporosis in men. An important factor is vitamin D deficiency, which is observed in more than 70% of elderly men. There are some features of pharmacotherapy choice for men with a diagnosis of osteoporosis or a high 10-year absolute risk of fracture (FRAX). Most evidences for the treatment of osteoporosis in men are based on studies in which women predominantly participate, which makes further research on the therapy of men necessary to optimize their treatment. It should be noted that alfacalcidol therapy has the same efficacy, confirmed in clinical studies both in men and women and has advantages over treatment with native forms of vitamin D.

Key words: osteoporosis, hypovitaminosis D, male sex, testosterone, ergocalciferol, cholecalciferol, calcitriol, alfacalcidol.
For citation: Babenko A.Yu., Laevskaya M.Yu. Osteoporosis. Gender features of prevention and treatment // RMJ. 2017. № 22. P. 1646–1650.

Pages 1651-1653. Молекулярно-генетические характеристики адренокортикального рака. Бяхова М.M., Воронкова И.А., Кривошеев A.B.

Summary: Molecular and genetic characteristics of adrenocortical cancer
Byakhova M.M.1, Voronkova I.A.1,2, Krivosheev A.B.2

1 Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy, Moscow
2 Endocrinological Scientific Center, Moscow

Adrenocortical cancer is a rare cancer originating from adrenal cortex which is characterized by aggressive clinical course, late diagnosis, and poor clinical outcomes. The occurrence of adrenocortical cancer is 0.5 to 2 cases per million per year. Molecular genetics of this condition remains elusive. Adrenocortical cancer is diagnosed both as a sporadic disease and as a component of some inherited syndromes. The penetrance of this disorder is low thus significantly reducing the possibility to follow hereditary nature of adrenocortical cancer. For many decades, molecular studies involved little samples and investigated genes which promote the development of this disorder. It was demonstrated that elevated expression of IGF2, inactivating mutation of TP53, and activation of Wnt/b-catenin signal pathway due to the mutation of b-catenin gene are associated with adrenocortical cancer. This paper summarizes data on key molecular genetic mechanisms of adrenocortical cancer.

Key words: adrenocortical tumors, adrenocortical cancer, molecular pathology, genetic pathology, signal pathway, inherited syndromes.
For citation: Byakhova M.M., Voronkova I.A., Krivosheev A.B. Molecular and genetic characteristics of adrenocortical cancer // RMJ. 2017. № 22. P. 1651–1653.

Pages 1654-1659. Использование селена в медицинской практике. Шестакова Т.П.

Summary: Use of selenium in medical practice (review)
Shestakova T.P. 

Moscow regional research clinical institute named after M.F. Vladimirskiy

Selenium is a microelement, which is part of the enzymes, that play an important role in the work of the thyroid gland, reproductive, immune systems and in carcinogenesis.
People receive selenium from food and water. There are selenium deficient regions on the planet, where selenium deficient diseases are common. Both lack of selenium, and its excess are unfavorable for human health. The main organ that uses selenium is the thyroid gland. It contains the largest amount of selenoproteins that regulate the formation of active and inactive forms of thyroid hormones, and also protect the thyroid gland from oxidative stress. Selenium effectively reduces the level of thyroperoxidase (TPO) antibodies in patients with autoimmune thyroiditis, improves the quality of life of patients with endocrine ophthalmopathy. Its role in the formation of diffuse and nodular goiter, as well as thyroid cancer, is studied. Researches on the effectiveness of including selenium in the treatment of Basedow's goiter are conducted. At present, large-scale studies on the effect of selenium on the replacement dose of levothyroxine sodium and the quality of life of patients with hypothyroidism have not yet been completed. Despite many unresolved issues, selenium is already used in the clinical practice of endocrinologists. The main indications for the appointment of selenium are autoimmune thyroiditis and endocrine ophthalmopathy.

Key words: selenium, thyroid, autoimmunity, TPO antibody, autoimmune thyroiditis, Graves’ disease, endocrine orbitopathy. 
For citation: Shestakova T.P. Use of selenium in medical practice (review) // RMJ. 2017. № 22. P.1654 –1659.

Pages 1661-1664. Изменение функционирования репродуктивной системы мужчин с возрастом. Древаль А.В.

Summary: Age changes in the functioning of the reproductive system of men (lecture)

Dreval A.V.

Moscow Scientific Research and Clinical Institute named after M.F. Vladimirsky

The lecture is devoted to the issues of changes occurring in the reproductive system of men with the age. It has been shown that low testosterone syndrome in middle-aged and older men occurs in a very small percentage of cases and according to the data of modern reproductive endocrinology, the mechanisms of menopause development in women and hypogonadism in adult men are incommensurable phenomena. Key indicators of the reproductive system of men in different age periods (level of testosterone, sex hormone binding globulin, gonadotropins and spermatogenesis) are highlighted. The consequences of an age-related decrease in testosterone secretion and the possibility of its elimination / prevention by testosterone drugs are presented. The author considers the influence of testosterone preparations on sexual function, bone mineral density, muscle and fat tissue, the severity of anemia and erythrocytosis, depression, cognitive function and on metabolic and cardiovascular parameters. Indications for the treatment with testosterone in older men are given. It is shown that the treatment regimens and testosterone preparations are the same as for hypogonadism of any other nature. In this case, on the background of treatment the target value of testosterone in the blood serum should be less than in young patients in order to minimize side effects.

Key words: male reproductive system, hypogonadism, testosterone, spermatogenesis, testosterone preparations. 
For citation: Dreval A.V. Age changes in the functioning of the reproductive system of men (lecture) // RMJ. 2017. № 22. P. 1661–1664.

Pages 1665-1676. Диабетическая нейропатия: некоторые вопросы дифференциальной диагностики и системной терапии болевого синдрома. Старостина Е.Г.

Summary: Diabetic neuropathy: some issues in differential diagnosis and systemic treatment of the pain syndrome
Starostina E.G.

Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy

Painful diabetic peripheral neuropathy (PDPN) is a common chronic complication of diabetes mellitus that significantly affects patients’ well-being, quality of life and functioning. This lecture deals with practical issues of clinical diagnosis of PDPN and the algorithm for differential diagnosis of the pain syndrome in the lower extremities in diabetic patients. Based on the major pathophysiological pathways in PDPN, the author presents the rationale for the use of symptomatic centrally-acting drugs to diminish pain, such as anticonvulsants, antidepressants and opioid analgesics, with description of each class of the drugs used for the treatment of PDPN, evidenced-based data on their efficacy, tolerability and contraindications, as well as the potential of combination therapy. Their dosage regimens and potential pitfalls with the use of various pharmaceutical groups are described. The agents are categorized into the 1st, 2nd and 3rd line treatments in accordance with several international clinical guidelines. The necessity is emphasized to tailor the choice of the drug supported by the evidence-based data, concomitant medications, tolerability, costs and patient’s preferences, as well as patient’s age and concomitant illnesses. 

Key words: diabetes mellitus, painful diabetic peripheral neuropathy, treatment. 
For citation: Starostina E.G. Diabetic neuropathy: some issues in differential diagnosis and systemic treatment of the pain syndrome // RMJ. 2017. № 22. P. 1665–1676.

Pages 1677-1679. Клинический случай эндогенного гиперкортицизма при беременности. Чеканова А.В., Комердус И.В., Шестакова Т.П., Бурумкулова Ф.Ф., Древаль А.В., Бритвин Т.А.

Summary: Clinical case of endogenic hypercorticism during pregnancy
Chekanova A.V.1, Comerdus I.V.1, Shestakova T.P.1, Burumkulova F.F.2, Dreval A.V.1, Britvin Т.А.1

1 Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy
2 Moscow Regional Research Institute of Obstetrics and Gynecology

A clinical case of the Cushing's syndrome, diagnosed and treated during pregnancy, resulted in the child's birth on time. Cushing's syndrome is a condition that arises from prolonged exposure to the body of excessive secretion of cortisol by the adrenal cortex, and is extremely rare in pregnant women. At the very beginning of the disease, the clinical picture of hypercorticism is not always clear and the diagnosis is often delayed, and during pregnancy it is more difficult to suspect the Cushing’s syndrome, because the detected changes may be related to the course of pregnancy. In the described case, the characteristic changes were noticed even before the onset of pregnancy, which allowed to suspect hypercorticism, despite the referral diagnosis of type 2 diabetes mellitus, and to conduct appropriate follow-up examination. The woman received surgical treatment at the 19th week of gestation, which allowed to preserve and prolong the pregnancy, and to stabilize the mother's condition. Subsequently, after delivery, insulin therapy was discontinued, the absence of carbohydrate metabolism abnormalities was confirmed, antihypertensive therapy was abolished, weight loss was noted.
Early detection of endogenic hypercorticism allows to provide relatively safe surgical treatment and improves prognosis for the mother and child.

Key words: сushing’s syndrome, pregnancy, adrenalectomy, hypercorticism, diabetes mellitus.
For citation: Chekanova A.V., Comerdus I.V., Shestakova T.P. et al. Clinical case of endogenic hypercorticism during pregnancy // RMJ. 2017. № 22. P. 1677–1679.



№21, 2017. Неврология

Pages 1497. Слово редактора.

Pages 1500-1506. Сосудистый паркинсонизм: 20 лет спустя. Левин О.С.

Summary: Vascular parkinsonism: 20 years later
Levin O.S.

Russian Medical Academy of Continuous Professional Education, Moscow

20 years ago author published review paper «Vascular parkinsonism». This article presents modern ideas about the clinical picture and the diagnosis of vascular parkinsonism (VP). The etiology of the disease, the features of the clinical course are considered in detail. Particular attention is paid to the clinical heterogeneity of the syndrome, the role of small arteries lesions in its pathogenesis, the establishment of a causal relationship between cerebral vascular pathology and clinical manifestations. The authors put forward criteria for diagnosis of VP, suitable for everyday clinical practice. The features of the course of the combination of Parkinson's and cerebrovascular disease are considered. Modern trends in the diagnosis of vascular parkinsonism treatment are given. Based on general clinical considerations, there are two main areas in the treatment of VP: basic therapy aimed at preventing further brain damage, and symptomatic therapy aimed at correcting parkinsonism and concomitant manifestations. The possibilities of stereotaxic interventions in VP have not been systematically studied yet. In some patients with limited basal ganglia lesions, they can be effective, but as the experience with stereotaxic interventions in multi-systemic degenerations shows, stereotaxic operations are often ineffective in extranigral forms of parkinsonism and multifocal brain damage.

Key words: parkinsonism, small vascular disease, vascular parkinsonism, dysbasia, levodopa.
For citation: Levin O.S. Vascular parkinsonism: 20 years later // RMJ. 2017. № 21. P. 1500–1506.

Pages 1507-1510. Современные подходы к вопросам коррекции когнитивных и эмоциональных расстройств у пациентов с хронической ишемией мозга. Шутеева Т.В.

Summary: Modern approaches to the correction of cognitive and emotional disorders in patients with chronic cerebral ischemia 
Shuteeva T.V.

Kursk State Medical University

Introduction: the article is devoted to the problem of cognitive and emotional disorders in chronic cerebral ischemia (CCI) and the possibilities of using citicoline in this pathology.
The aim of the study was to determine the possibility of using citicoline (Neipilept) to correct cognitive and anxiety-depressive manifestations in patients with CCI on the background of traditional therapy.
Patients and methods: the study included clinical examination using a survey, physical and auscultatory methods; neurological examination using the Tinetti scale; neuropsychological examination using a Mini Mental State Examination (MMSE) and a frontal dysfunction scale (FDS); HAM-A and HAM-D assessments of anxiety and depression levels; a quality of life study using the SF-36 questionnaire. The study was carried out in 2 groups of patients with CCI: main and control. The main group included 25 patients, men - 10 (40%), women - 15 (60%). Patients of the main group had the history of arterial hypertension, cerebral atherosclerosis, acute disorders of cerebral circulation, obesity. The control group included 15 patients. According to the presence of somatic pathology, the distribution in the group was similar to the main group. Both groups of patients received standard traditional therapy, including antiplatelet agents and vascular agents, and were comparable in age, type of complaints, clinical and neuropsychological examinations. Patients of the main group received citicoline (Neipilept) 1000 mg orally for 30 days.
Results: it was noticed, that the group of patients, receiving citicoline along with the baseline therapy, had improvements in the cognitive and neuropsychological functions. The drug was well tolerated by patients, did not cause any adverse effects on the general clinical status of patients. Allergic reactions were not reported, there were no exacerbations of concomitant somatic diseases.
Conclusion: the use of citicoline in complex therapy has a positive effect on the clinical course of the disease and increases the effectiveness of the treatment.

Key words: chronic cerebral ischemia, treatment of chronic cerebral ischemia, citicoline, Neipilept.
For citation: Shuteeva T.V. Modern approaches to the correction of cognitive and emotional disorders in patients with chronic cerebral ischemia // RMJ. 2017. № 21. P. 1507–1510.

Pages 1512-1517. Возможности применения мемантина в ранней терапии постинсультной деменции. Чимагомедова А.Ш., Левин О.С., Скрипкина Н.А., Гуторова Д.А., Васенина Е.Е.

Summary: Possibilities of using memantine in early therapy of post-stroke dementia
Chimagomedova A.Sh.1, Levin O.S.1, Skripkina N.A.1, Gutorova D.A.1,2, Vasenina E.Е.1

1 Russian Medical Academy of Сontinuous Professional Education, Moscow
2 «The Hospital of Veterans of Wars No. 1» of the City Health Department of Moscow

Cognitive disorders that occur in a significant number of patients after a stroke, affect the household, social and professional adaptation. Post-stroke cognitive impairment (PSCI) of different severity is detected in 20-70% of stroke patients, on average in about half of patients. The risk of PSCI development depends on various factors: age, the state of cognitive functions prior to stroke, arterial hypertension, diabetes mellitus, heart pathology, etc. An important direction in improving the prognosis is the timely treatment of cognitive disorders, but it remains unclear how long the drugs should be used. A number of studies demonstrate the neuroprotective effect of a non-selective blocker of glutamatergic NMDA receptors of memantine in ischemic brain damage. The article presents a review of the studies confirming its efficacy both in patients with vascular dementia and in the acute stage of stroke, which makes it possible to use memantine as an early therapy for cognitive impairment and to prevent complications of thrombolytic therapy.

Key words: post-stroke cognitive impairment, vascular dementia, stroke, memantine.
For citation: Chimagomedova A.Sh., Levin O.S., Skripkina N.A. et al. Possibilities of using memantine in early therapy of post-stroke dementia // RMJ. 2017. № 21. P. 1512–1517.

Pages 1518-1524. Применение милдроната в лечении когнитивных нарушений при сосудистой деменции. Гимоян Л.Г., Силванян Г.Г.

Summary: The use of mildronate in the treatment of cognitive impairments in vascular dementia
Gimoyan L.G., Silvanyan G.G.

Yerevan State Medical University named after M. Heratsi

One of the global problems in modern medicine is the problem of preserving and restoring higher mental functions. More than 20 million people in the world suffer from dementia according to WHO.
Aim: to determine the efficacy and safety of Mildronate® in the treatment of vascular cognitive impairments and to find additional possibilities of its long-term use as part of a combination therapy.
Patients and methods: a comparative observational program was conducted, during which Mildronate® was prescribed in drip infusions in a daily dose of 1000 mg of the preparation in 250 ml of physiological saline once a day for 10 days with further switching to oral administration of 500 mg twice a day for 3 months. The study group included 120 patients with a diagnosis dyscirculatory encephalopathy with cognitive impairment. The results were compared with the control group of patients (n = 135) who had a history of cerebrovascular disease (stroke, transient ischemic attack), with dyscirculatory encephalopathy with cognitive impairment and took acetylcholinesterase inhibitors as part of complex therapy. According to the degree of cognitive impairment the patients of both groups were divided into 3 subgroups.
Results: the study of cognitive functions revealed a statistically significant shortening time of remembering  of 10 words in patients treated with Mildronate®. According to the clock drawing test, 32 patients managed to achieve the normal level of recovery. Against the background of the therapy, there was also an improvement in the quality of sleep. Complex therapy with Mildronate® had a positive impact on such an integral evaluation as the patient's quality of life. In the study group, the proportion of patients with an improvement in cognitive functions was significantly greater, and the number of patients with the absence of the effect was almost 2 times less than in the control group.
Conclusion: the use of Mildronate® has a direct effect on dysfunction, harmonizes the motor and emotional sphere, significantly improves the quality of life and reduces the manifestations of comorbid pathology.

Key words: cognitive impairments, diagnosis, metabolic therapy, Mildronate®.
For citation: Gimoyan L.G., Silvanyan G.G. The use of mildronate in the treatment of cognitive impairments in vascular dementia // RMJ. 2017. № 21. P. 1518–1524.

Pages 1525-1531. Лечение мигрени в реальной практике амбулаторного приема. Корешкина М.И., Данилов Г.В.

Summary: Treatment of migraine in the outpatient practice
Koreshkina M.I.1, Danilov G.V.2
1 Headache Treatment Center of «Scandinavia» clinic, LLC «AVA-PETER», St. Petersburg
2 National Medical Research Center of Neurosurgery named after acad. N.N. Burdenko, Moscow

The problem of migraine treatment remains relevant, especially in the Russian Federation, where the frequency of migraine diagnosis lags behind its true prevalence in the population.
Aim: to evaluate the effectiveness of the drug Xephocam Rapid (Lornoxicam) for relieving migraine attacks both in monotherapy and in combination with triptans.
Patients and Methods: In a retrospective study, a 2-year analysis was conducted to assess the effectiveness of migraine treatment with Xephocam Rapid (Lornoxicam) in outpatient management in the specialized Headache Treatment Center. The drugs for relieving migraine attacks were chosen individually, taking into account the data of the headache diary for the 1-st month from the beginning of drug therapy. In this case, several ways of therapy were applied: monotherapy with Xephocam Rapid or its combination with the drugs from triptans group. 
Results: Data on the use of Xephocam Rapid in 98 patients (90 women and 8 men, mean age 38.2 ± 10.2) with migraine were analyzed. Xephocam Rapid therapy in the entire group of patients was effective in 79 (80.6%) patients and ineffective in 19 (19.4%). The efficacy of Xephocam Rapid was higher in the MA group (92,3%) than in the MO group (76.4%), however, these differences did not reach statistical significance. The frequency of side effects when taking Xephocam Rapid was low and did not require withdrawal of the drug. Side effects in the form of nausea and dyspepsia were observed in 3 patients in the MA group and 4 patients in the MO group.
Conclusion: Xephocam Rapid showed its effectiveness, low level of side effects and can be recommended for a widespread use in outpatient practice not only to neurologists, but also to family physicians.

Key words: migraine, migraine with aura, migraine without aura, chronic migraine, non-steroidal anti-inflammatory drugs, Xephocam Rapid.
For citation: Koreshkina M.I., Danilov G.V. Treatment of migraine in the outpatient practice // RMJ. 2017. № 21. P. 1525–1531.

Pages 1533-1536. Патогенетическое действие остеопатии при хронической головной боли напряжения. Мирошниченко Д.Б., Мохов Д.Е., Рачин А.П.

Summary: Pathogenetic effect of osteopathy in chronic tension headache
Miroshnichenko D.B.1, Mokhov D.E.2, Rachin A.P.1

1 National Medical Research Center of Rehabilitation and Balneology, Moscow
2 North-West State Medical University named after I.I. Mechnikov, St. Petersburg

The article considers the features of using osteopathy in the treatment of patients with chronic tension headache (CTH).
Aim: to evaluate the effectiveness of osteopathy influence on the dynamics of clinical parameters of cephalgia and psychological status, as well as polysynaptic reflex excitability of the brainstem of patients with CTH.
Patients and Methods: 108 patients with CTH participated in the study, the average age was 38.4-0.64 years. To study the effectiveness of osteopathy, all patients with CTH were randomly divided into the main group, the comparison group and the control group. The number of osteopathy sessions in the main group was determined by the dynamics of the clinical and neurological status and averaged 4-8 procedures per course, with a frequency of 1-2 times per week. In the comparison group, treatment included standard CTH therapy with classical antidepressant amitriptyline in an individual dose of 50 to 100 mg / per day. Along with the drug therapy, all patients in this group received 6-8 sessions of manual therapy. The control group consisted of 22 healthy volunteers. 
Results: all patients with CTH complained of symmetrical, compressing, aching, non-throbbing moderate headache. In 94.8% of the observations the CTH was accompanied by manifestations of psycho-emotional dysfunction. The initial results of the osteopathic examination in the study groups of patients with CTH revealed a lot of different somatic dysfunctions. It should be emphasized that there were no significant differences in the number and types of somatic dysfunctions among these groups. In the main group, against a background of osteopathic treatment, there was a significant decrease in the frequency of headaches (p <0.05), a decrease in the intensity of headaches (p <0.05), a decrease in headaches duration (p <0.05), and also a significantly greater dynamics on the anxiety / depression scale (p <0.05), indicating a decrease in emotional and affective disorders. 
Conclusion: osteopathy provides the normalization of polysynaptic reflex excitability of the brainstem, which is a marker of the functional state of the inhibitory control mechanisms of the antinociceptive system. Osteopathy can be an appropriate method of choice for the treatment of CTH.

Key words: chronic tension headache, osteopathy, blink reflex, polysynaptic reflex activity of the brainstem, somatic dysfunction.
For citation: Miroshnichenko D.B., Mokhov D.E., Rachin A.P. Pathogenetic effect of osteopathy in chronic tension headache // RMJ. 2017. № 21. P. 1533–1536.

Pages 1537-1542. Нестероидные противовоспалительные препараты при острой боли: консенсус эффективности и безопасности. Пахомова И.Г., Кучмин А.Н., Павлова Е.Ю.

Summary: Nonsteroidal anti-inflammatory drugs in acute pain: consensus of efficacy and safety
Pakhomova I.G.1, Kuchmin A.N. 2, Pavlova E.Yu.1

1 North-Western State Medical University named after I.I.Mechnikov, St. Petersburg
2 Military Medical Academy named after S.M. Kirov, St. Petersburg

An acute pain syndrome or an increase in chronic pain is quite common in the practice of a clinician. At the same time, an acute pain even for a short-term period can cause a lot of discomfort to patients. It is important to emphasize that in most cases untimely and inadequate treatment of acute pain transforms it into a chronic one, which, in turn, complicates its correction. Knowledge of the mechanisms of the pain development can help the doctor to choose the treatment and appropriate means for correcting painful sensations. One of the main tools for the treatment of acute and chronic pain in a wide range of diseases and pathological conditions are nonsteroidal anti-inflammatory drugs (NSAIDs), which have not only anti-inflammatory effects, but also influence both the peripheral and the central mechanism of algesia. Thus, these drugs have a significant advantage over other symptomatic analgesic means not only in terms of the therapeutic effect, but also in safety. Ketorol, a non-narcotic analgesic drug, has a pronounced rapid analgesic effect and a proven safety in short therapy courses.

Key words: acute pain, algebra, pain correction, nonsteroidal anti-inflammatory drugs, Ketorol.
For citation: Pakhomova I.G., Kuchmin A.N., Pavlova E.Yu. Nonsteroidal anti-inflammatory drugs in acute pain: consensus of efficacy and safety // RMJ. 2017. № 21. P. 1537–1542.

Pages 1543-1547. Болевые полиневропатии. Антипенко Е.А., Седышев Д.В.

Summary: Painful polyneuropathies
Antipenko E.A.1, Sedyshev D.V.2

1 Nizhny Novgorod State Medical Academy
2 Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko 

Polyneuropathies (PNP) are among the most common diseases of the peripheral nervous system and account for 60% of their total number, according to statistics of the Russian Federation. The article discusses the issues of etiology, pathogenesis, clinical variants, manifestations of the pain syndrome in PNP. The etiotropic and pathogenetic therapy is discussed in detail, as well as the use of B vitamins complexes which effectively reduce pain, normalize reflex reactions, and eliminate sensitivity disorders in patients with alcoholic PNP.
The aim of the study was to assess the analgesic effect of the complex of В vitamins in the treatment of alcoholic and diabetic PNP.
Patients and Methods: 41 patients (34-56 years) with chronic distal sensory diabetic and alcoholic axonal sensorimotor PNP were treated. The diagnosis was confirmed clinically and by electroneuromyography. Before treatment the level of neuropathic pain according to the DN4 questionnaire averaged 7 points, according to a 10-point visual analog scale - 6.8 points. Patients received conventional etiopathogenetic therapy in accordance with the standards of medical care and national guidelines for the treatment of PNP. The main group of 13 patients with diabetic PNP and 10 patients with alcoholic PNP received an additional complex of B vitamins in the form of a drug Neurobionum intramuscularly 1 ampoule daily for 9 days, then orally one tablet 3 times a day for 3 weeks. 
Results: patients of the main group noticed a more pronounced analgesic effect within 9 days. The greatest effect was noted for burning and paroxysmal pains. At the same time, the number of patients who experienced pain reduction of at least 50% was significantly higher in the main group. A month later, the main group experienced an increase in the therapeutic effect.
Conclusion: the use of a complex drug Neurobion in addition to the conventional therapy of painful PNP significantly reduces pain syndrome.

Key words: polyneuropathy, pain syndrome, diabetic polyneuropathy, alcoholic polyneuropathy, B vitamins complexes, electroneuromyographic study.
For citation: Antipenko E.A., Sedyshev D.V. Painful polyneuropathies // RMJ. 2017. № 21. P. 1543–1547.

Pages 1548-1552. Клиника, диагностика и терапия некоторых туннельных синдромов верхних конечностей. Пизова Н.В.

Summary: Clinic, diagnostics and therapy of some tunnel syndromes of the upper limbs
Pizova N.V. 

Yaroslavl State Medical University

The article presents the modern views on the clinic, diagnostics and complex conservative treatment of tunnel mononeuropathies of the upper limbs in the acute period. The detailed information is given about the pronator tunnel syndrome, the anterior interosseous nerve syndrome, carpel tunnel syndrome, the Guyon tunnel syndrome and cubital tunnel syndrome. The author presents her own data on the frequency of occurrence of various tunnel syndromes of the upper limbs among 68 patients. There are also the results of examination of 60 patients with electrophysiological and clinical criteria of the newly diagnosed neuropathy of the median nerves at the level of the carpal canal without a direct trauma of the upper limbs in the history, the main clinical manifestations of this pathology, general and local risk factors of their development. The main types of treatment are described. The treatment of tunnel syndromes is based on conservative therapy, the purpose of which is the decompression of the nerve trunk and restoration of its functions. The first and fundamentally important task for the doctor is the fastest and most effective relief of pain. The drugs of choice in this case are non-steroidal anti-inflammatory drugs, such as the well-proven nimesulide (Nise®). 

Key words: tunnel syndromes, risk factors, clinic, diagnosis, treatment, NSAID, nimesulide.
For citation: Pizova N.V. Clinic, diagnostics and therapy of some tunnel syndromes of the upper limbs // RMJ. 2017. № 21. P. 1548–1552.

Pages 1553-1560. Лечение неспецифической боли в спине. Баринов А.Н., Рожков Д.О., Махинов К.А.

Summary: Treatment of nonspecific back pain
Barinov A.N.1,2, Rozhkov D.O.1,2, Makhinov K.A.2,3

1 First Moscow State Medical University named after I.M.Sechenov
2 Interregional Association of Specialists in Palliative and Interventional Medicine, Moscow
3 Academy of Interventional Medicine, Moscow

Nonspecific back pain is still one of the main causes of financial and economic costs in developed countries. International recommendations for the treatment of this disease have been changed significantly over the past 30 years. A comprehensive personalized approach to treating a patient with the back pain requires the selection of the most safe and inexpensive methods of prevention, treatment and rehabilitation. In this article, the treatment of acute, subacute and chronic back pain is discussed in detail. In such patients the particular attention is given to analgesic therapy, ranging from the appointment of non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and "symptom-modifying drugs of slow action" (Teraflex®), before the application of interventional therapy.

Key words: nonspecific back pain, spondylarthrosis, facet syndrome, SI joint dysfunctions, minimally invasive treatment, interventional therapy.
For citation: Barinov A.N., Rozhkov D.O., Makhinov K.A. Treatment of nonspecific back pain // RMJ. 2017. № 21. P. 1553–1560.

Pages 1562-1566. Комбинация ибупрофена и парацетамола: первая ступень эффективного контроля скелетно-мышечной боли. Каратеев А.Е.

Summary: Combination of ibuprofen and paracetamol: the first stage of effective control of musculoskeletal pain
Karateev A.E.

Research Institute of Rheumatology named after V.A. Nasonova, Moscow

Relieving an acute and subacute musculoskeletal pain is the most important element of the complex medical care for patients suffering from joint and spine diseases. The time of starting the analgesic therapy is highly important: early prescription of effective treatment increases the probability of success and reduces the risk of pain chronicity. Therefore, the doctor should have in his arsenal reliable and safe painkillers, which can be used as the first step of a comprehensive program of analgesic therapy. Moreover, patients with the most common diseases of the musculoskeletal system - osteoarthritis and nonspecific back pain, should be trained in effective methods of pain control. In this situation, it is reasonable to use non-prescription complex analgesics, represented by a combination of ibuprofen and paracetamol, as the drugs of the “first stage”. They have a high anesthetic potential, accessibility and are easy to use. This review briefly discusses the efficacy and safety of these drugs.

Key words: musculoskeletal pain, osteoarthritis, nonspecific back pain, paracetamol, ibuprofen, combined preparations.
For citation: Karateev A.E. Combination of ibuprofen and paracetamol: the first stage of effective control of musculoskeletal pain // RMJ. 2017. № 21. P.1562 –1566.

Pages 1568-1572. Фармакопунктура комбинированным препаратом витаминов группы B в терапии хронической тазовой боли у женщин. Тынтерова А.М., Шарнина М.В., Рачин А.П.

Summary: Pharmacopuncture with a combined preparation of group B vitamins in the treatment of chronic pelvic pain in women
Tynterova A.M.1, Sharnina M.V.1, Rachin A.P.2

1 City multi-field hospital, Kaliningrad
2 Russian Research Center for Medical Rehabilitation and Balneology, Moscow

Syndrome of chronic pelvic pain is often associated with symptoms of urinary tract damage, sexual, intestinal, gynecological dysfunction or impaired function of the pelvic floor muscles with the absence of infection and other obvious pathology.
Aim: to increase the efficacy and safety of therapy for patients with chronic pelvic pain due to myofascial pain syndrome with combined gynecological pathology.
Patients and Methods: 88 women participated in the study, the mean age was 38.9 years. All patients were divided into 2 groups (the main and comparison group) of 44 patients each, standardized according to the features under study. The patients with chronic pelvic pain were treated by the method of pharmacopuncture with a combined multivitamin preparation containing a combination of neurotropic active substances of the vitamin B complex: thiamin (B1), pyridoxine (B6) and cyanocobalamin (B12). Efficiency was assessed using a comprehensive pain questionnaire, trigger points response, Spielberg-Khanin scales of state and personal anxiety. 
Results: in the course of diagnosing (gynecological and neurological examination), the following pathological conditions were detected in the patients: myofascial pain syndrome (MFPS) of the piriform muscle (31.8%), MFPS of the elevator muscle of anus (56.8%), MFBS of both muscles 11.4%). The results of the study made it possible to identify the relationship between the localization of trigger points (TP) and gynecological pathology. The use of pharmacopuncture with a combined preparation of group B vitamins and reflexotherapy in patients with chronic pelvic pain, caused by myofascial pain syndrome and gynecological pathology, showed a significant decrease in the severity of the pain syndrome and the normalization of the psycho-emotional state.
Conclusion: accumulation of clinical experience requires a critical evaluation of the efficacy and safety of the existing and new ways of treating the chronic pelvic pain.

Key words: chronic pelvic pain syndrome, pharmacopuncture, vitamins В1, В6 and В12.
For citation: Tynterova A.M., Sharnina M.V., Rachin A.P. Pharmacopuncture with a combined preparation of group B vitamins in the treatment of chronic pelvic pain in women // RMJ. 2017. № 21. P. 1568–1572.

Pages 1574-1580. Стресс как психосоматический фактор риска сердечно-сосудистых заболеваний у пациентов молодого и среднего возраста. Интервью с Е.С. Акарачковой и О.В. Котовой.

Pages 1581-1585. Тики и коморбидные расстройства детского возраста. Зыков В.П., Каширина Э.А., Наугольных Ю.В.

Summary: Tics and combodine disorders of the children’s age
Zykov V.P.1, Kashirina E.A.2, Naugolnykh Yu.V.2

1 Russian Medical Academy of Continuous Professional Education, Moscow 
2 Children's City Clinic No. 110, Moscow

Tics are the dominant form of children’s hyperkinesia, which is diagnosed in 5% - 24% of children, more often in boys. Сhronic tics are observed in 1% of children.
The aim of the research was to study comorbid disorders in children with tic hyperkinesia and to assess the possibilities of the drug correction.
Patients and Methods: 165 children and adolescents aged from 7 to 16 years were examined. Patients of the main group (n = 130) were divided into 3 groups: group 1- motor tics (n = 21), group 2 - motor and vocal tics (n = 87), 3rd group - Tourette syndrome (TS) (n = 22). The patients were prescribed a tic therapy. An assessment of tic hyperkinesia, personal and situational anxiety was made, as well as a neuropsychological study (including the study of short-term auditory and verbal memory) with the use of various scales and questionnaires.
Results and discussion: the maximum number of motor and vocal tics according to the method of tic counting for 20 minutes and the highest YGTSS were determined in the TS group. ADHS was detected in 42.8% of patients with motor tics, in 50.6% of patients with motor and vocal tics and in 86.4% of patients with TS. There was a significant decrease in the volume of short-term auditory and verbal memory in comparison with the control group, and a significant decrease in the volume of the auditory memory was characteristic for the patients with TS as compared to the patients with motor tics. During the treatment, the regression of ADHS manifestations and anxiety disorders in patients with motor and motor-vocal tics was observed. In patients with TS, consistently high rates of personal anxiety and ADHS were registered before and after the treatment. An increase in the volume of short-term auditory and verbal memory was recorded in all groups with tics and TS.

Key words: tic hyperkinesia, Tourette syndrome, ADHS, tic therapy, short-term auditory memory. 
For citation: Zykov V.P., Kashirina E.A., Naugolnykh Yu.V. Название статьи // RMJ. 2017. № 21. P.1581 –1585.

Pages 1586-1590. Менструальная мигрень: современный взгляд на проблему. Азимова Ю.Э.

Summary: Menstrual migraine: a modern view on the problem
Azimova Yu.E. 

University Headache Clinic, Moscow

The review highlights the problem of menstrual migraines, one of the heaviest forms of cephalgia. A clinical picture of menstrual migraine is described. Attacks of menstrual and menstrual-associated migraines are more intense, more prolonged, more often accompanied by nausea and vomiting, more deconditioning for the patients and resistant to treatment. The data of fundamental researches carried out in recent years, which allowed to understand in many respects the pathophysiology of menstrual migraines, are given. Sex hormones (estrogen, progesterone, testosterone) significantly affect the function of the brain. Estrogens can modulate neuronal activity through estrogen receptors, widely represented in the central nervous system. The results of foreign studies on the treatment and prevention of menstrual migraine are highlighted. Treatment of menstrual migraines involves prevention and relief of the migraine attacks. Patients with menstrual migraine face a problem of insufficient competence of gynecologists regarding migraine and insufficient competence of neurologists regarding hormonal therapy. It is shown, that complex management of patients by neurologists and gynecologists improves the quality of the treatment and is considered a «gold standard». Since migraine attacks are much more difficult to treat, it is recommended to start with triptans therapy. Triptans can also be used for short-term prevention. Currently, it can be recommended for the patients with menstrual migraine to use the drug Migrepam (zolmitriptan).

Key words: menstrual migraine, zolmitriptan, Migrepam, estradiol, progesterone, headache.
For citation: Azimova Yu.E. Menstrual migraine: a modern view on the problem // RMJ. 2017. № 21. P. 1586–1590.

Pages 1591-1594. Применение ацетилкарнитина у пациентов с диабетической полиневропатией. Камчатнов П.Р., Кабанов А.А., Ханмурзаева С.Б., Чугунов А.В., Ханмурзаева Н.Б.

Summary: The use of acetylcarnitine in patients with diabetic polyneuropathy
Kamchatnov P.R.1, Kabanov A.A.1, Khanmurzaeva S.B.2, Chugunov A.V.1, Khanmurzaeva N.B.2

1 Russian National Research Medical University named after N.I.Pirogov, Moscow
2 Dagestan State Medical University, Makhachkala

Polyneuropathy is a frequent complication of diabetes mellitus, associated with severe disability, a decrease in the quality of the patients’ life, and an increased risk of death. Treatment of patients with diabetic polyneuropathy (DPNP) includes correction of carbohydrate metabolism, restoration of the structure and functions of nerve fibers, elimination of the most significant symptoms of the disease. At present, there are data on the efficacy of the use of acetyl-L-carnitine (Carnicetine) in such patients. Information on its role in metabolism in normal and pathological conditions is considered. The effects of carnitine in patients with various types of DPNP are discussed in detail. The results of randomized clinical trials and meta-analysis on this issue are presented, indicating the effectiveness of the drug in patients with DPNP. The obtained data give grounds to consider Carnicetine as a drug, the use of which is justified in patients with DPNP as a means of pathogenetic and symptomatic therapy.

Key words: diabetes mellitus, diabetic polyneuropathy, acetyl-L-carnitine, Carnicetine, treatment.
For citation: Kamchatnov P.R., Kabanov A.A., Khanmurzaeva S.B. et al. The use of acetylcarnitine in patients with diabetic polyneuropathy // RMJ. 2017. № 21. P. 1591–1594.

Pages 1595-1601. Диагностика тромбоза мозговых вен и венозных синусов. Максимова М.Ю., Дубовицкая Ю.И., Брюхов В.В., Кротенкова М.В.

Summary: Diagnosis of cerebral veins and venous sinuses thrombosis
Maksimova M.Yu., Dubovitskaya Yu.I., Bryukhov V.V., Krotenkovа M.V.

Scientific Center of Neurology, Moscow

Thrombosis of cerebral veins and venous sinuses is a rare disease, which accounts for less than 1% of all cases of stroke. The most frequent and often early symptom of thrombosis of cerebral veins and sinuses is a headache. Diagnosis of the disease is greatly hampered by the lack of specific characteristics of this pain and the possible absence of other neurological manifestations. In this regard, headache is often the only complaint of patients with thrombosis of cerebral venous sinuses. Due to the variability of clinical symptoms, often subacute or slow development, the disease is diagnosed late or remains unrecognized. The thrombosis of the upper sagittal, lateral and transverse sinuses is the most common problem. Thrombosis of several cerebral veins is observed in 2/3 of cases. This work presents anatomical features of the structure of the venous system of the brain, the issues of etiology, pathogenesis, clinical picture, diagnosis and treatment of thrombosis of cerebral veins and venous sinuses.
The article presents three histories of the patients who received treatment in the second neurological department of the Scientific Center of Neurology at different time with a diagnosis of «thrombosis of the venous sinuses», demonstrating the modern possibilities of diagnosis and treatment of venous circulation disorders.

Key words: thrombosis of venous sinuses, cerebral vein thrombosis, headache, diagnostics, anticoagulants.
For citation: Maksimova M.Yu., Dubovitskaya Yu.I., Bryukhov V.V., Krotenkova M.V. Diagnosis of cerebral veins and venous sinuses thrombosis // RMJ. 2017. № 21. P. 1595–1601.



№20, 2017. Кардиология

Pages 1404-1408. Диагностическое значение копептина в верификации некроза миокарда у пациентов с острым коронарным синдромом без подъема сегмента ST в первые 3 часа от манифестации болевого синдрома. Жукова А.В., Арабидзе Г.Г.

Summary: Diagnostic value of copeptin in verification of myocardial necrosis in patients with non-ST elevation acute coronary syndrome at the first 3 hours from pain manifestation
Zhukova A.V., Arabidze G.G.

Moscow State Medical Stomatological University named after A.I. Evdokimov

The article presents data on the role of the new biochemical marker copeptin - the C-end part of pro-vasopressin, in diagnosis and prognosis in patients with non-ST elevation acute coronary syndrome.
Patients and Methods: the study included 128 people (52 people with verified diagnosis of non-ST elevation acute myocardial infarction, 58 people with unstable angina (UA), 18 with unconfirmed coronary events), selected according to I/E criteria. All patients were examined according to the standards of medical care, supplemented by a specific definition of the quantitative level of the human copeptin peptide.
Results: the level of copeptin in the first 3 hours from the manifestation of the pain syndrome was significantly higher in patients of Group 1, with a verified diagnosis of NSTEAMI in hospital, compared to the group of patients with UA or with unconfirmed ACS (M ± σ, 2.6 ± 1 , 8 ng / ml, median - 2.1 ng / ml against 0.7± 0.4 ng / ml, median - 0.70 ng / ml and 0.2 ± 0.1 ng / ml, median - 0, 2 ng / ml, respectively, p <0.0001).
Conclusions: copeptin, determined in the first 3 hours from the manifestation of ACS, has a high positive predictive value for the development of acute myocardial focal damage at a level of ˃0.94 ng / ml (95% CI, 71.38-89.96). 71.38-89.96). The level of copeptin <0.5 ng / ml had 100% negative prognostic value in patients with NSTEACS for the first 3 hours from the ACS debut (95% CI, 82.41-100.00). The combination of double testing for copeptin and troponin T is a highly specific test in the diagnosis of myocardial necrosis in patients with NSTEACS in the first 3 hours from the ACS debut, while troponin T values less than 58 ng / L and copeptin <0.5 ng / ml allow to exclude AMI with a probability of 95.55% (95% CI 91.47-98.65). 

Key words: copeptin, vasopressin, non-ST elevation acute coronary syndrome, acute myocardial infarction, troponin T.
For citation: Zhukova A.V., Arabidze G.G. Diagnostic value of copeptin in verification of myocardial necrosis in patients with non-ST elevation acute coronary syndrome at the first 3 hours from pain manifestation // RMJ. 2017. № 20. P. 1404–1408.

Pages 1409-1414. Использование биомаркеров фосфорно-кальциевого обмена для диагностики и риск-стратификации больных ишемической болезнью сердца. Шибанова И.А., Хрячкова О.Н.

Summary: Use of biomarkers of phosphoric-calcium metabolism for the diagnosis and risk stratification of patients with coronary artery disease
Shibanova I.A., Hryachkova O.N.

 Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

Based on the results of experimental and clinical studies the article reviews the modern insights into the approaches to the risk assessment in chronic forms of coronary artery disease, the relationship between the main biomarkers of bone tissue metabolism (calcium, phosphorus, parathyroid hormone, osteopontin and osteoprotegerin)  and the other biological markers (systemic inflammatory response, myocardial dysfunction and ischemic myocardial damage), the severity of manifestations of coronary atherosclerosis and traditional indicators characterizing the cardiovascular health (parameters of lipid and carbohydrate homeostasis, body weight).  The article presents perspectives of risk assessment in patients with coronary heart disease on the basis of determination of the bone tissue metabolism markers. Further clinical studies are needed to assess the clinical and prognostic significance of these indicators. The available materials from foreign library databases, such as Library's MEDLINE/PubMed database, were used in the review. 

Key words: atherosclerosis, risk factors, biomarkers, bone metabolism, coronary calcification, parathyroid hormone, osteopontin, osteoprotegerin.
For citation: Shibanova I.A., Hryachkova O.N. Use of biomarkers of phosphoric-calcium metabolism for the diagnosis and risk stratification of patients with coronary artery disease // RMJ. 2017. № 20. P. 1409–1414.

Pages 1416-1420. Новые технологии для точного измерения АД: преимущества и эффективность тонометра М3 Comfort с манжетой Intelli Wrap. Мамедов М.Н.

Summary: New technologies for accurate measurement of blood pressure: the advantages and efficacy of the M3 Comfort tonometer with the Intelli Wrap
Mamedov M.N.

National Medical Research Center for Preventive Medicine, Moscow

The article discusses topical issues of arterial blood pressure control and improving patient’s compliance to adequate therapy to achieve target BP levels. The review analyzes the advantages of the M3 Comfort tonometer with Intelli Wrap cuff, the unique design of which provides a 360 degree accuracy of measurement. The Intelli Wrap provides sufficient shoulder coverage with a circumference of 22 to 42 cm, it is specifically designed to distribute pressure uniformly around the shoulder to minimize the effect of the wrong cuff position. The article presents the results of studies on the use of the M3 Comfort tonometer with the Intelli Wrap. It is shown that when using this multifunctional cuff with an oscillometric device, its incorrect location towards the brachial artery does not affect the accuracy of measurements even in persons with a very large circumference of the shoulder. The article also highlights the use of the M3 Comfort tonometer (OMRON) in AH during pregnancy and postpartum period with high accuracy of automatic oscillometric measurements of blood pressure at the level of the brachial artery in pregnant women, including those with pre-eclampsia.

Key words: arterial hypertension, compliance, M3 Comfort tonometer, Intelli Wraр. 
For citation: Mamedov M.N. New technologies for accurate measurement of blood pressure: the advantages and efficacy of the M3 Comfort tonometer with the Intelli Wrap // RMJ. 2017. № 20. P. 1416–1420.

Pages 1421-1428. Статины – старые мифы и новые факты. Смирнова М.Д., Агеев Ф.Т.

Summary: Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology, Moscow

Statins are the most well studied group of cardiovascular drugs, which reduce cardiovascular morbidity and mortality and occupy one of the leading places in Russian and international clinical recommendations for the treatment and prevention of cardiovascular diseases. The article is devoted to common misconceptions concerning statins, their side effects, intaking and influence on the patients’ compliance to the therapy. The article considers the most popular misconceptions in order to provide cardiologists, therapists, and neurologists with the tools to increase the patients’ compliance to statin therapy. The common misconceptions and research data are compared. New data on the use of statins in different categories of patients, their connection with oncology, liver diseases, dementia and the risk of developing diabetes and cataracts on the background of statins therapy are discussed. The comparative characteristic of efficiency and pharmacodynamic features of various statins is given. New data on «additional» effects of statins are presented.

Key words: statins, rosuvastatin, prevention of cardiovascular complications, compliance to the therapy.
For citation: Smirnova M.D., Ageev F.T. Statins - old myths and new facts // RMJ. 2017. № 20. P. 1421–1428.

Pages 1429-1434. Алгоритм повышения эффективности контроля артериального давления при артериальной гипертензии. Загидуллин Н.Ш., Гареева Д.Ф., Сухарева Н.Н.

Summary: Algorithm for increasing the effectiveness of blood pressure control in arterial hypertension
Zagidullin N.Sh., Gareeva D.F., Sukhareva N.N.

Bashkiria State Medical University, Ufa

Now there is a great choice of antihypertensive drugs, however, it is not always possible to achieve effective control of arterial blood pressure (BP) in arterial hypertension (AH). The reasons can be both pharmacokinetic features of the drugs themselves and the features of patient’s compliance. The article attempts to create an algorithm for the selection of antihypertensive therapy based on valsartan and its combinations with hydrochlorothiazide and amlodipine with insufficient control of blood pressure in all 3 grades of BP increase, taking into account the presence of risk factors and previous therapy. The algorithm is based on studies with valsartan and its fixed combinations with hydrochlorothiazide and amlodipine, carried out in Russian patients inclusively. In particular: valsartan and its combination with hydrochlorothiazide contribute to the successful control of blood pressure and a good therapeutic effect in the majority of patients with AH of 1-2 grades. The combination of valsartan with amlodipine successfully controls arterial pressure in patients with higher grades of blood pressure increase, regardless of risk factors and concomitant diseases: the systolic and diastolic BP figures decreased to target levels in 80% of patients. Thus, an algorithm for the treatment of AH with valsartan and its combinations with hydrochlorothiazide and amlodipine as the basic antihypertensive drugs was developed. Thereby, it was possible to achieve BP control in an overwhelming number of patients at different grades of BP increase.

Key words: arterial hypertension, arterial pressure, blood pressure, combined therapy, algorithm of antihypertensive therapy, valsartan.
For citation: Zagidullin N.Sh., Gareeva D.F., Sukhareva N.N. Algorithm for increasing the effectiveness of blood pressure control in arterial hypertension // RMJ. 2017. № 20. P. 1429–1434.

Pages 1435-1439. Современные взгляды на патогенетически обоснованную терапию ХСН: у кардиологов есть повод для оптимизма. Дроботя Н.В., Калтыкова В.В., Пироженко А.А.

Summary: Modern views on pathogenetically based CHF therapy: cardiologists have a cause for optimism

Drobotya N.V.1, Kaltykova V.V.1, Pirozhenko A.A.2

1 Rostov State Medical University
2 Regional Clinical Hospital № 2

Statistics show that chronic heart failure (CHF) is still one of the most serious problems in cardiology due to its high prevalence among the world's population. Modern requirements for the treatment of patients with CHF suppose the mandatory inclusion of mineralocorticoid receptor antagonists (MRA) in the complex drug therapy of this contingent of patients. The use of MRA is pathogenetically justified, since hyperactivation of the renin-angiotensin-aldosterone system with an increase in the content of its final aldosterone product underlies the development and progression of CHF. Currently, in Russia doctors use two main AMPs - spironolactone and eplerenone. The results of RCTs EPHESUS and EMPHASIS-HF convincingly demonstrated the ability of eplerenone to reduce the risk of cardiovascular death due to the progression of CHF, as well as the number of hospitalizations for CHF. Advantages of eplerenone in comparison with spironolactone are the possibility of using in patients with CHF of different etiology, including after myocardial infarction, almost complete absence of hormonal side effects, low risk of hyperkalemia at therapeutic doses (25-50 mg / day) and negative drug interactions.

Key words: chronic heart failure, mineralocorticoid receptor antagonists, spironolactone, eplerenone, cardiovascular diseases.
For citation: Drobotya N.V., Kaltykova V.V., Pirozhenko A.A. Modern views on pathogenetically based CHF therapy: cardiologists have a cause for optimism // RMJ. 2017. № 20. P.1435 –1439.

Pages 1440-1443. Актуальные вопросы применения бета-адреноблокаторов в клинической практике: все ли известно практическому врачу?. Небиеридзе Д.В.

Summary: Topical issues of the use of β-adrenoblockers in clinical practice: is everything known to a practical doctor?
Nebieridze D.V.

National Medical Research Center for Preventive Medicine, Moscow

The review presents topical issues of the appointment of β-blockers in various clinical situations. β-blockers have antihypertensive effect and possess antianginal and cardioprotective effects. β-blockers are one of the most effective classes of drugs that slow the progression of heart failure and reduce cardiovascular mortality. The β-blockers are a heterogeneous class of the drugs in terms of the opportunities of their clinical use. A number of β-blockers, especially non-selective ones, have negative effects and can not be used in a number of clinical situations (metabolic syndrome, type 2 diabetes mellitus). Modern super selective β-blockers do not have these negative effects and can be widely used in clinical practice, including metabolic syndrome, diabetes mellitus (DM) type 2. The review focuses on metoprolol tartrate, which has the most extensive evidence base of its efficiency in cardiovascular diseases (CVD). Another problem related to β-blockers is their infrequent appointing or underdosing. In this regard, a practical doctor should be bolder in appointing them in the recommended therapeutic doses according to the instructions for the medical use of the drug in various clinical situations. 

Key words: β-blockers, metabolic effects, heart rate, metoprolol.
For citation: Nebieridze D.V. Topical issues of the use of β-adrenoblockers in clinical practice: is everything known to a practical doctor? // RMJ. 2017. № 20. P. 1440–1443.

Pages 1444-1451. Роль блокаторов ангиотензиновых рецепторов в лечении хронической сердечной недостаточности. Овчинников А.Г.

Summary: The role of angiotensin receptor blockers in the treatment of chronic heart failure
Ovchinnikov A.G.

National Research Medical Center of Cardiology, Moscow

The article highlights the role of the renin-angiotensin-aldosterone system (RAAS) in the formation of chronic heart failure (CHF) and methods of its suppressing with angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Angiotensin receptor blockers are one of the main classes of drugs used to treat heart failure. At the same time, candesartan, due to its exceptionally high affinity for angiotensin type 1 receptors, provides the longest possible blockade of tissue RAAS. The results of the main clinical studies on the evaluation of clinical and prognostic efficacy of angiotensin receptor blockers in patients with chronic systolic and diastolic heart failure are presented. The article describes the influence of this class of drugs on hemodynamics, structural rearrangement of the left ventricle of the heart, clinical state and survival of patients with CHF. The review presents practical recommendations on the features of the use of angiotensin receptor blockers in various clinical situations - in the treatment of heart failure with a preserved left ventricular ejection fraction and arterial hypertension, where this class of drugs (particularly candesartan), has a high therapeutic potential for influencing the course of the disease. 

Key words: renin-angiotensin-aldosterone system, angiotensin receptor blockers, diastolic dysfunction, heart failure with preserved ejection fraction, systolic heart failure.
For citation: Ovchinnikov A.G. The role of angiotensin receptor blockers in the treatment of chronic heart failure // RMJ. 2017. № 20. P. 1444–1451.

Pages 1452-1456. Роль и место торасемида в клинической практике лечения отечного синдрома: все ли возможности исчерпаны?. Елисеева Л.Н., Бледнова А.Ю., Оранский С.П., Бочарникова М.И.

Summary: The role and place of torasemide in the clinical practice of the treatment of edema syndrome: are all the possibilities exhausted?
Eliseeva L.N., Blednova A.Yu., Oransky S.P., Bocharnikova M.I.

Kuban State Medical University, Krasnodar

The article presents an analysis of authors' own data on the study of dosages of loop diuretics in the treatment of edema syndrome in clinical practice. In addition, the presented literature review on the use of loop diuretics in various clinical situations will allow practical doctors to analyze modern principles of the therapy of edema syndrome taking into account recommendations and clinical experience.
Aim: analysis of the frequency and spectrum of diuretics in real clinical practice, assessment of the compliance of the dosages with modern standards and recommendations.
Patients and Methods: the results of a questionnaire survey of 482 patients (random sampling) of the therapeutic departments of hospitals on the Krasnodar Territory were analyzed. The questionnaires included data from the clinical examination, the results of laboratory and instrumental methods. The severity of heart failure was clarified by the questionnaire "The Scale of Clinical Condition Assessment" and the questionnaires developed by us.
Results : among the patients in the therapeutic departments of hospitals on the Krasnodar Territory, there were mostly women (60.8% mean age 56.2 ± 3.3 years), 39.2% men (mean age 60.4 ± 4.1 years) ; most of patients were middle-aged (28%) and elderly (34%) people. Cardiovascular diseases predominated as the main and concomitant pathology, accompanied by a high level of comorbidity. Drug therapy for cardiovascular disease was generally in line with current clinical guidelines, but the most frequently used dose of loop diuretics, in particular torasemide (5 mg to 20 mg, 11 mg / day on average) indicates a low dose range and should be revised.
Conclusion: the frequency and nosological spectrum of torasemide are comparable with the recommendations, but the possibility of correcting the effectiveness of therapy by increasing the dosages used is noteworthy.

Key words: loop diuretics, torasemide, chronic heart failure, edema syndrome.
For citation: Eliseeva L.N., Blednova A.Yu., Oransky S.P., Bocharnikova M.I. The role and place of torasemide in the clinical practice of the treatment of edema syndrome: are all the possibilities exhausted? // RMJ. 2017. № 20. P. 1452–1456.

Pages 1457-1462. Ацетилсалициловая кислота: позиции во вторичной профилактике сохраняются. Карпов Ю.А.

Summary: Acetylsalicylic acid retains its position in secondary prevention of CVD
Karpov Yu.A.

National Medical Research Center of Cardiology, Moscow

The article is devoted to the possibilities of using acetylsalicylic acid (ASA) in the pharmacotherapy of cardiovascular diseases (CVD) for primary prevention of cardiovascular complications (CVC). The history of ASA creation and introduction into clinical practice is covered. The mechanism of ASA action depending on the dose of the drug is considered in detail. New data on the effectiveness of ASA, based on the results of two recently completed large studies, are presented. It is shown that according to the results of the analysis of the large Swedish registry, which included patients taking ASA in low cardioprotective doses for primary and secondary CVD prevention, patients who stopped ASA treatment had a significantly higher cardiovascular risk. Among patients who received ASA for secondary prevention of CVD, discontinuation of the use of the drug was associated with an increase in the incidence of cardiovascular events by 46%. The results of another new study, COMPASS, comparing the efficacy of oral anticoagulant rivaroxaban and ASA in patients with stable course of coronary heart disease and / or atherosclerosis of peripheral arteries, demonstrated that the use of a combination of rivaroxaban and ASA reduced the risk of cardiovascular events by 24%, and the number of large bleedings increased by 70%. In patients taking only rivaroxaban, in comparison with ASA alone, there were no significant differences in the incidence of CVC, but the number of bleedings significantly increased. The data indicate that ASA therapy continues to be effective in reducing the risk of CVCs and remains safe.

Key words: cardiovascular diseases, acetylsalicylic acid, cardiovascular complications, secondary prevention.
For citation: Karpov Yu.A. Acetylsalicylic acid retains its position in secondary prevention of CVD // RMJ. 2017. № 20. P. 1457–1462.

Pages 1463-1465. Первый российский дженерик бисопролола с полной терапевтической эквивалентностью: данные, основанные на клинических исследованиях. Мамедов М.Н.

Summary: The first Russian generic of bisoprolol with full therapeutic equivalence: data based on clinical studies
Mamedov M.N.

National Medical Research Center of Preventive Medicine, Moscow

Cardiovascular diseases (CVD) are the leading cause of death in the Russian Federation. β-adrenoblockers (β-AB)  are one of the main groups of cardiovascular drugs with antihypertensive and anti-ischemic action and a wide evidence base. Currently, the preference is given to the selective β1-ABs with prolonged action not only because of the simplicity of their regimen, but also due to the high safety of these drugs. The availability of the cardiovascular drugs with prolonged use is very important. Thus, the appearance of new generics is considered to be positive.
A review of the literature devoted to the peculiarities of the application of the first Russian generic of bisoprolol in CVD is presented. The article provides an overview of data on generics of β-blockers available in Russia, with an analysis of clinical studies on the efficacy of various generics of bisoprolol. Arilil is a domestic bisoprolol generic, manufactured according to GMP requirements. Along with the biological equivalence of the original drug, there is data from a multicenter, randomized clinical trial on the complete therapeutic equivalence of Arilil to the original preparation of bisoprolol. 

Key words: cardiovascular diseases, β-adrenoblockers, bisoprolol, generiс.
For citation: Mamedov M.N. The first Russian generic of bisoprolol with full therapeutic equivalence: data based on clinical studies // RMJ. 2017. № 20. P. 1463–1465.

Pages 1466-1470. Актуальные вопросы клинического применения блокатора рецепторов ангиотензина кандесартана. Максимов М.Л., Дралова О.В., Кургузова Д.О.

Summary: Topical issues of the clinical use of Candesartan as an angiotensin receptor blocker 
Maksimov M.L.1, Dralova O.V.2, Kurguzova D.O.2

1 Kazan State Medical Academy - a branch of Russian Medical Academy of Сontinuous Professional Education 
2 First Moscow State Medical University named after I.M. Sechenov

Arterial hypertension is one of the most important and modifiable risk factors for cardiovascular complications. Renin-angiotonezin-aldosterone system (RAAS) is extremely important for the regulation of many parameters of the cardiovascular system and kidney function, including maintenance of arterial pressure and water-salt metabolism. Also, RAAS plays a leading role in the formation of cardiovascular pathology and the development of hypertension, atherosclerosis, coronary heart disease, and chronic heart failure. Angiotensin (AT) II is very important for damaging the target organs, contributing to vasoconstriction, hypertrophy, fibrosis and remodeling of arterial vessels and myocardium, development of endothelial dysfunction, atherosclerosis and other disorders. Adverse effects of hyperactivated RAAS are realized through angiotensin II-stimulated AT1 receptors, which is expressed in the provocation of vasocontraction and inflammation, in hypertrophy and fibrosis of the heart muscle and blood vessels. Angiotensin receptor blockers selectively prevent the stimulation of AT1 receptors, which are associated with most of the negative effects of angiotensin II. Candesartan is a selective antagonist of angiotensin II type 1 receptors, successfully used in patients with arterial hypertension and chronic heart failure. The article reviews the results of the most significant domestic and international studies on the efficacy and safety of candesartan.

Key words: candesartan, Hyposart, angiotensin receptor blockers, angiotensin II receptor antagonists, sartans, efficacy, safety, generic, arterial hypertension, chronic heart failure, renin-angiotensin-aldosterone system.
For citation: Maksimov M.L., Dralova O.V., Kurguzova D.O. Topical issues of the clinical use of Candesartan as an angiotensin receptor blocker // RMJ. 2017. № 20. P. 1466–1470.

Pages 1471-1480. Эффективность и безопасность применения L-карнитина при хронической сердечной недостаточности: метаанализ рандомизированных контролируемых исследований (реферат).

Summary: Efficacy and Safety of L-Carnitine Treatment for Chronic Heart Failure: A Meta-Analysis of Randomized Controlled Trials (summary)

Background: whether additional benefit can be achieved with the use of L-carnitine (L-C) in patients with chronic heart failure (CHF) remains controversial. We therefore performed ameta-analysis of randomized controlled trials (RCTs) to evaluate the effects of L-C treatment in CHF patients.
Material and Methods: Pubmed, Ovid Embase, Web of Science, and Cochrane Library databases, Chinese National Knowledge Infrastructure (CNKI) database, Wanfang database, Chinese Biomedical (CBM) database, and Chinese Science and Technology Periodicals database (VIP) until September 30, 2016, were identified. Studies that met the inclusion criteria were systematically evaluated by two reviewers independently.
Results: 17 RCTs with 1625 CHF patients were included in this analysis. L-C treatment in CHF was associated with considerable improvement in overall efficacy (OR = 3.47, Р < 0.01), left ventricular ejection fraction (LVEF) (WMD: 4.14%, Р = 0.01), strike volume (SV) (WMD: 8.21ml, Р = 0.01), cardiac output (CO) (WMD: 0.88 L/min, Р < 0.01), and E/A (WMD: 0.23, Р < 0.01). Moreover, treatment with L-C also resulted in significant decrease in serum levels of BNP (WMD: −124.60 pg/ml, Р = 0.01), serum levels of NT-proBNP (WMD: −510.36 pg/ml, Р < 0.01), LVESD (WMD: −4.06 mm, Р < 0.01), LVEDD (WMD: −4.79 mm, Р < 0.01), and LVESV (WMD: −20.16ml, 95% CI: −35.65 to −4.67, Р < 0.01). However, there were no significant differences in all-cause mortality, 6-minute walk, and adverse events between L-C and control groups.
Conclusions: L-C treatment is effective for CHF patients in improving clinical symptoms and cardiac functions, decreasing serum levels of BNP and NT-proBNP. And it has a good tolerance.

Key words: chronic heart failure, L-carnitine, clinical studies, BNP.
For citation: Efficacy and Safety of L-Carnitine Treatment for Chronic Heart Failure: A Meta-Analysis of Randomized Controlled Trials (summary) // RMJ. 2017. № 20. P. 1471–1480.

Pages 1481-1485. Метаболическая терапия в комплексном лечении сердечно-сосудистых осложнений сахарного диабета типа 2. Аметов А.С., Прудникова М.А.

Summary: Metabolic therapy in the complex treatment of cardiovascular complications of type 2 diabetes мellitus

Ametov A.S., Prudnikovа M.A. 

Russian Medical Academy of Continuous Professional Education, Moscow

The article considers epidemiological and pathogenetic aspects of metabolic therapy of type 2 diabetes mellitus (DM 2) and its complications. The causes of the development of cardiovascular diseases (CVD) in patients with diabetes mellitus 2: a violation of the supply and utilization of glucose in cardiomyocytes, accumulation of final glycation products and mitochondrial dysfunction. The role of metabolic therapy with the use of the amino acid taurine in diabetes and cardiovascular diseases is described. The antioxidant, vascular, hypolipidemic and gigolglycemic effects of taurine, its role in the pathology of coronary vessels, the mechanisms of ischemia-reperfusion and the possibility of its use in chronic heart failure are considered in detail. The article provides arguments for the possibility of including taurine preparations into the complex treatment of diabetes mellitus 2. It has been shown that the use of taurine in the complex therapy of carbohydrate metabolism disorders and diabetic macroangiopathies, according to the conducted studies, contributes to the normalization of carbohydrate, fat metabolism, cardiac muscle and vascular wall, which significantly improves the course of vascular pathology, associated with DM 2.

Key words: diabetes, cardiovascular diseases, taurine.
For citation: Ametov A.S., Prudnikovа M.A. Metabolic therapy in the complex treatment of cardiovascular complications of type 2 diabetes mellitus // RMJ. 2017. № 20. P. 1481–1485.

Pages 1486-1488. Неалкогольная жировая болезнь печени и вероятность развития нарушений сердечного ритма. Ахмедов В.А.

Summary: Non-alcoholic fatty liver disease and probability of development of heart rate diseases
Akhmedov V.A. 

Omsk State Medical University

The review presents modern information on the possibility of the formation of rhythm disturbances, such as atrial fibrillation, prolongation of the QTc interval, ventricular arrhythmias and HBB in patients with non-alcoholic fatty liver disease. The article shows a world-wide prevalence of obesity and non-alcoholic fatty liver disease. Possible pathogenetic mechanisms of the formation of cardiac arrhythmias in patients with non-alcoholic fatty liver disease are considered. The article describes possible involvement of a number of factors associated with the metabolic syndrome, such as C reactive protein, tumor necrosis factor alpha, interleukin-6, transforming growth factor beta, endothelin -1 in the formation of ultrastructural changes in cardiomyocytes, increase in fibroblasts differentiation and myocardium fibrosis, which serves as a risk factor for the formation of cardiac arrhythmias. There is a connection between the thickness of epicardial fat layer and the progression of insulin resistance, increased risk of cardiac accidents and nonalcoholic fatty liver disease. It is shown that in patients with type 2 diabetes mellitus, the mechanisms of cardiac arrhythmias are similar to those in patients with nonalcoholic fatty liver disease without diabetes mellitus, and even factors associated with diabetes mellitus did not have such a significant influence on the occurrence of cardiac rhythm disturbances.

Key words: non-alcoholic fatty liver disease, heart rhythm disturbances, atrial fibrillation, QTc interval elongation, ventricular arrhythmias.
For citation: Akhmedov V.A. Non-alcoholic fatty liver disease and probability of development of heart rate diseases // RMJ. 2017. № 20. P. 1486–1488.

Pages 1490-1494. Сахарный диабет и заболевания сердечно-сосудистой системы. Гуревич М.А.

Summary: Diabetes mellitus and diseases of the cardiovascular system
Gurevich M.A.

Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy 

Given the high prevalence of diabetes mellitus (DM) and the continued increase in the number of such patients in the population, as well as a significant increase in the incidence of coronary heart disease (CHD) and cardiovascular complications in these patients, the problem of managing a patient with cardiovascular disease on the background of DM is very actual. Such patients have a common, usually combined structure of risk factors and have an extremely unfavorable prognosis in terms of development of macro- and microvascular complications, general and cardiovascular mortality. The article emphasizes the necessity of correcting arterial pressure, medicamental influence on the prevention of micro- and macrovascular complications. It is also important to eliminate the dyslipidemic disorders, and to use the metabolic drugs. One of the modern requirements for the treatment of patients with type 2 diabetes with concomitant diseases of the cardiovascular system is an individual approach to the selection of anti-ischemic, lipid-controlling, antihypertensive and hypoglycemic agents, with mandatory non drug treatment. Successful prevention of cardiovascular complications in such patients is possible in case of high compliance between the patient and the doctor, because strict control of blood glucose, blood lipid levels and adequate therapy of hypertension, CHD will lead to a significant reduction in the incidence of cardiovascular complications in these patients and will improve their survival.

Key words: diabetes mellitus, dyslipidemia, cardiovascular diseases, arterial hypertension, metabolic therapy, risk factor, microangiopathy.
For citation: Gurevich M.A. Diabetes mellitus and diseases of the cardiovascular system // RMJ. 2017. № 20. P. 1490–1494.



№19, 2017. Мать и дитя. Педиатрия

Pages 1331-1334. К вопросу о «поздней геморрагической болезни новорожденного». Заплатников А.Л., Бражникова О.В., Гавеля Н.В., Никитин В.В., Ашурова Б.А., Королева А.С., Потанина Ю.В., Медоев С.Б., Гаевый О.В., Шабля В.В., Мизецкая Е.А., Волохин А.Ю.

Summary: To the question of «late hemorrhagic disease of the newborn»
Zaplatnikov A.L.1,2, Brazhnikova O.V.1,2, Gavelya N.V.2, Nikitin V.V.2, Ashurova B.A.2, Koroleva A.S.2, Potanina Yu.V.2, Medoev S.B.2, Gaevyi O.V.1,2, Shablya В.В.2, Mizetskaya E.A.2,. Volokhin A.Yu2

1 Russian Medical Academy of Continuous Professional Education, Moscow
2 Children's City Clinical Hospital named after Z.A. Bashlyaeva, Moscow

Hemorrhagic disorders in children are acute conditions requiring urgent provision of adequate medical care. The article highlights the issues of polyethiologic origin and development of this pathological condition. Late hemorrhagic disease of the newborn is a collective concept that, unlike the term "hemorrhagic disease of the fetus and newborn", can not be used for nosological verification. This is due to the fact that in children of the first weeks and months of life, the vitamin K deficiency resulting in hemorrhagic disorders can be caused by a number of reasons - an alimentary factor (feeding exclusively by mother's milk), developmental defects of the hepatobiliary system, hereditary, congenital and acquired diseases with cholestasis and malabsorption, irrational use of antibiotics, prolonged parenteral nutrition with insufficient vitamin K supplementation, etc. In this regard, in each case of development of K-vitamin-deficient coagulopathy, early verification of the etiological factors is necessary. Timely elimination of the cause of vitamin K deficiency and etiopathogenetic approach when choosing methods of treatment significantly increase the effectiveness of therapy and improve the prognosis in general.

Key words: vitamin K, breastfeeding, children, vitamin K deficiency, mother's milk, newborns, late hemorrhagic disease of the newborn.
For citation: Zaplatnikov A.L., Brazhnikova O.V., Gavelya N.V. et al. To the question of «late hemorrhagic disease of the newborn» // RMJ. 2017. № 19. P. 1331–1334.

Pages 1335-1340. Особенности функционирования пищеварительной системы у детей раннего возраста: коррекция наиболее частых расстройств. Старостина Л.С., Яблокова Е.А.

Summary: Features of the young children digestive system functioning: correction of the most frequent disorders
Starostina L.S., Yablokova E.A.

First Moscow State Medical University named after I.M. Sechenov, Moscow

Almost every article devoted to the state of the digestive tract (DT) in young children begins with the phrase about the high incidence of digestive system disorders in the first year of life.
Functional disorders (FD) of the digestive tract change the digestion and absorption of food, motor function, the composition of the intestinal microbiota, and the activity of the immune system. The causes of FDs often lie outside the affected organ and are caused by a violation of the nervous and humoral regulation of the digestive tract.
This article describes the algorithm for diagnosis and treatment of DT functional disordes in accordance with Roman criteria III. We consider such FDs as posseting, rumination syndrome, cyclic vomiting syndrome, baby colics, functional diarrhea, baby dyschezia, functional constipation. Attention is given to simethicone preparations (Sab® Simplex), which is used not only for treating baby colics, but also before diagnostic studies and for treating acute poisoning with detergents in both children and adults.

Key words: functional disorders, posseting, rumination syndrome in infants, cyclical vomiting syndrome, baby colics, functional diarrhea, baby dyschezia, functional constipation, simethicone preparations, Sab® Simplex.
For citation: Starostina L.S., Yablokova E.A. Features of the young children digestive system functioning: correction of the most frequent disorders // RMJ. 2017. № 19. P. 1335–1340.

Pages 1341-1345. Безопасная и эффективная помощь при прорезывании молочных зубов. Великорецкая М.Д., Старостина Л.С.

Summary: Safe and effective aid for the first teeth eruption
Velikoretskaya M.D., Starostina L.S.

The First Moscow State Medical University named after I.M. Sechenov, Moscow

The first teething can be accompanied by swelling and reddening of the gums, increased salivation, fever, anxiety of the child, altered defecation pattern, disturbance of sleep and appetite. The use of the teething gel for massage of the gums will help the child to endure an unpleasant period of teething.
The aim of the study was to assess the effectiveness, safety and tolerability of the teething gel Pansoral teething in children with painful symptoms of teething.
Patients and methods: 60 children aged 3 to 20 months (mean age 10.3) with local pain symptoms accompanying teething were included in the study. Mothers applied the gel Pansoral teething with a finger on the painful gum area, lightly massaging, 1 to 5 times a day (including necessarily before bedtime). The duration of the use of the gel did not exceed 7-8 days. Evaluation of the effectiveness of the dental gel was carried out by a doctor on the 1st, 4th and 8th days of use. To assess these symptoms, severity scales were used, at the end of the observation period, parents were asked to fill in a questionnaire to evaluate the criteria for the effectiveness of the gel.
Results: We have registered the positive results of using the teething gel Pansoral teething. Already on the fourth day of its use, there was a decrease in the assessment of puffiness by 41% and gum hyperaemia by 53%. The gingival tenderness decreased by 40% and 73% on the 4th and 8th day, respectively. The significance of the anxiety assessment decreased by 40% by the fourth day and by 80% by the 8th day of the use of the teething gel. 23% of 60 parents assessed the application of the gel by 10 points, 50% - 9 points, a minimum score of 6.7 points was recorded in 8% (5) of the parents. All participants in this study noted good tolerability of Pansoral teething and its pleasant organoleptic characteristics.
Conclusions: the use of the gel based on plant extracts facilitates the process of teething in children 1-2 years of age, allows to avoid undesirable reactions, which can be caused by the use of preparations containing chemical anesthetics and anti-inflammatory drugs. Teething gel Pansoral teething is an effective and safe means for the painful eruption of milk teeth.

Key words: children, teething, puffiness, gel Pansoral teething, efficiency, safety.
For citation: Velikoretskaya M.D., Starostina L.S. Safe and effective aid for the first teeth eruption // RMJ. 2017. № 19. P. 1341–1345.

Pages 1346-1351. Дефицит лизосомной кислой липазы. Строкова Т.В., Багаева М.Э., Матинян И.А.

Summary: Lysosomal acid lipase deficiency
Strokova Т.V.1,2, Bagaeva M.E.1,2, Matinyan I.A.1

1 Federal Research Center for Nutrition, Biotechnology and Food Safety, Moscow
2 Russian National Research Medical University named after N.I. Pirogov, Moscow

Lysosomal acid lipase deficiency (LAL-D) is a rare autosomal recessive disease associated with the presence of mutations of the LIPA gene. The article presents modern information on the disease associated with a deficiency of lysosomal acid lipase, describes the most common clinical and laboratory signs of the disease, the features of enzyme-replacement therapy by sebelipase  alpha, outcomes and prognosis of the disease in children. There are two forms of the disease: Wolman's disease and the accumulation of cholesterol esters. The age of the onset of the disease and the rate of its progression are variable. The manifestation of Wolman's disease is observed in young infants and is characterized by a rapid rate of progression, and has an unfavorable outcome during the first year of life. The debut of the accumulation of cholesterol ester is detected in older children and adults, progresses more slowly and is characterized by a less severe clinical course. The accumulation of esters is manifested by hepatosplenomegaly, cytolysis syndrome, hypercholesterolemia, dyslipidemia, microvesicular steatosis in the biopsy material, the formation of fibrosis and cirrhosis in case of the absence of therapy. The current possibilities of prenatal diagnosis are discussed, a clinical example of the accumulation of cholesterol ester and the effectiveness of therapy in children is given.

Key words: lysosomal acid lipase deficiency, Wolman's disease, hypercholesterolemia, dyslipidemia, cytolysis syndrome, children, hepatomegaly.
For citation: Strokova Т.V., Bagaeva M.E., Matinyan I.A. Lysosomal acid lipase deficiency // RMJ. 2017. № 19. P. 1346–1351.

Pages 1352-1355. Хрящевой протеин при различных типах дисплазии. Белова Ю.С., Карякина Е.В.

Summary: Сartilage oligometric matrix protein in various types of dysplasia
Belova Yu.S.1, Karyakina E.V.2

1 Saratov State Medical University named after  V.I.Razumovsky
2 Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of  Saratov State Medical University named after  V.I.Razumovsky1

This study provides data about the importance of cartilage oligomeric matrix protein in the development of pseudoachondroplasia and multiple epiphyseal dysplasia, which prove that the most common causes of pseudoachondroplasia are mutations in the cartilage oligomeric matrix protein, which confirm a genetic predisposition to the disease. In multiple epiphyseal dysplasia the determination of cartilage oligomeric matrix protein provides the differential diagnosis in order to identify skeletal dysplasias in children with unexplained nerve symptoms. 
It is suggested that there are phenotypic overlaps between pseudoachondroplasia and multiple epiphyseal dysplasia, which are proved by the identification of gene mutations in the cartilage oligomeric matrix protein. The analysis of the data presented in the review confirms that there are common pathogenetic mechanisms underlying the two clinically related achondroplasias, pseudochondroplasia and multiple epiphyseal dysplasia.
The results of our own studies and published data justify the advisability of including cartilaginous oligomeric matrix protein into the metabolic homeostasis assessment  of children with undifferentiated connective tissue dysplasia, as an up-to-date biological marker of the cartilage tissue metabolism, along with other indicators characterizing the metabolic state of the body.

Key words: cartilaginous oligomeric matrix protein, undifferentiated connective tissue dysplasia, children.
For citation: Belova Yu.S., Karyakina E.V. Сartilage oligometric matrix protein in various types of dysplasia // RMJ. 2017. № 19. P. 1352–1355.

Pages 1357-1359. Применение топической терапии в лечении риносинусита у детей. Крюков А.И., Кунельская Н.Л., Ивойлов А.Ю., Мачулин А.И., Яновский В.В.

Summary: The topical therapy in the treatment of rhinosinusitis in children
Kryukov A.I.1,2, Kunelskaya N.L.1,2, Ivoylov A.Yu.1, 2 ,3, Machulin A.I.1, Yanovsky V.V.1

1 Otorhinolaryngology Healthcare Research Institute named after L.I. Sverzhevskiy, Moscow
2 Russian National Research Medical University named after N.I. Pirogov, Moscow
3 Children's city hospital №9 named after G.N. Speransky, Moscow

The article covers the issues of epidemiology, etiology, classification, clinic and treatment of acute rhinosinusitis (ARS) in children. The review of literature data and the results of clinical studies on the role of pathogenic flora in the etiology of ARS are presented. Treatment of rhinosinusitis in children is one of the topical problems in modern otorhinolaryngology. The main directions of the treatment of rhinosinusitis include: systemic and topical antibacterial therapy; nonspecific hyposensitizing therapy; irrigation-elimination therapy (IET) (nasal shower, method of moving medicines, retronasal shower with saline solution, mineral and sea water); physiotherapyI;immunocorrection; topical corticosteroid therapy; antimycotic therapy; therapy with intranasal decongestants (vasoconstrictors); natural drugs therapy. Despite the widespread use of various treatment methods, to date, remains relevant purpose of topical antiseptics in the treatment of rhinosinusitis in children. Presents data on the use of the decongestants (Sialor Rhino) and products based on sea salt (Sialor Aqua) in the treatment of ARS. The choice of drugs for local anti-inflammatory therapy must be justified by the efficiency and safety of their use.

Key words: children, ARS, topical antiseptic, irrigation-elimination therapy, decongestants, Sialor Aqua, Sialor Rhino. 
For citation: Kryukov A.I., Kunelskaya N.L., Ivoylov A.Yu. et al. The topical therapy in the treatment of rhinosinusitis in children // RMJ. 2017. № 19. P. 1357–1359.

Pages 1360-1363. Практика использования тиамфеникола глицината ацетилцистеината при респираторной патологии у детей: вопросы и ответы. Колосова Н.Г., Малахов А.Б.

Summary: Practice of using thiamphenicol glycinate acetylcysteinate for respiratory pathology treatment  in children: frequently asked questions
Kolosova N.G., Malakhov A.B.

First Moscow State Medical University named after I.M. Sechenov, Moscow

The global spread of antibiotic resistance among pathogens of community-acquired respiratory diseases against the background of a reduction in the development of new antibiotics is a serious threat to public health in most countries of the world. In this regard, it is necessary to rationally use the antibacterial drugs taking into account the natural activity and acquired resistance of the pathogen, as well as the severity and complications of the disease. An alternative to the systemic use of antibiotics in some cases is the topical use of drugs. The article deals with the use, effectiveness and safety of thiamphenicol glycinate acetylcysteinate (TGA) for respiratory diseases in children. In Russia, TGA is represented by the preparation Fluimucil®-antibiotic IT, and is available as a lyophilizate for the preparation of a solution that can be used for injections and inhalations. TGA helps to improve the course of the disease, in some cases avoid invasive procedures and reduce the use of systemic antibiotics.

Key words: respiratory infections, children, thiamphenicol glycinate acetylcysteinate, antibiotic therapy, inhalation therapy, rhinosinusitis, acute bronchitis.
For citation: Kolosova N.G., Malakhov A.B. Practice of using thiamphenicol glycinate acetylcysteinate for respiratory pathology treatment  in children: frequently asked questions // RMJ. 2017. № 19. P.1360 –1363.

Pages 1364-1367. Кашель при острых респираторных инфекциях у детей: выжидательная тактика, симптоматическое лечение или патогенетическая терапия?. Заплатников А.Л., Гирина А.А., Майкова И.Д., Короид Н.В., Ивахненко Ю.И.

Summary: Cough in the acute respiratory infections in children: expectant treatment, symptomatic treatment or pathogenetic therapy?
Zaplatnikov A.L.1,2, Girina A.A.3, Maikova I.D.2, Koroid N.V.2, Ivakhnenko Yu.I.1,2

1 Russian Medical Academy of Postgraduate Education, Moscow
2 Children's City Clinical Hospital named after Z.A. Bashlyaeva, Moscow 
3 Khanty-Mansiysk State Medical Academy

The highest incidence rate of acute respiratory infection (ARI), as well as the risk of complications, occurs in childhood. Frequent ARIs in children lead to a significant material burden on the family budget and are accompanied by significant economic losses for the country as a whole. The article considers the questions of pathogenesis, clinical picture of cough, algorithm of its treatment and features of therapy appointment. Discussing the rational use of medicines for the cough treatment in children with ARI, it should be noted that most of the recommendations traditionally reflect an algorithm based on a clinical assessment of cough. A detailed analysis of the characteristics of coughing is aimed at clarifying such parameters as frequency, paroxysm, intensity, productivity, soreness, sleep and appetite disorder, sputum character, etc. The presented algorithm of therapy requires a detailed description of the characteristics of cough, which must be carried out in dynamics, because the nature of the cough depends on the period of the disease. The pathogenetic approach to the cough therapy is based on the relief of inflammation in ARI, which is achieved by drugs with an anti-inflammatory mechanism of action. In this regard, the innovative drug Rengalin with combined antitussive and anti-inflammatory effects is particularly interesting.

Key words: acute respiratory infection, childhood, cough, cough treatment algorithm, Rengalin.
For citation: Zaplatnikov A.L., Girina A.A., Maikova I.D. et al. Cough in the acute respiratory infections in children: expectant treatment, symptomatic treatment or pathogenetic therapy? // RMJ. 2017. № 19. P. 1364–1367.

Pages 1368-1369. Ренгалин - лечение кашля.

Pages 1371-1374. Фитотерапия в лечении кашля у детей. Шаталина С.И., Колосова Н.Г.

Summary: Phytotherapy in the treatment of cough in children
Shatalina S.I., Kolosova N.G.

First Moscow State Medical University named after I.M. Sechenov, Moscow

Respiratory infections are the most common cause of cough in children. Due to the inflammatory process in the respiratory tract, there is a violation of mucociliary clearance, accompanied by hypersecretion and a change in the rheological properties of the bronchial secretion. Drug therapy for cough should be rational, and have multidirectional mechanisms of action with a minimum risk of developing adverse events and ultimately contribute to reducing the time of the disease. At present, specialists have formed the newest concept of phytotherapy using the experience of traditional medicine, as well as implementing all modern scientific achievements in pharmacy. The article examines the benefits of plant drugs on the example of Eucabal® preparations. The plant components of the Eucabal® syrup form a thin layer and mechanically protect the mucous membrane of the respiratory tract from irritating agents that provoke a cough reflex and thus relieve a dry irritating cough. The smell of the essential oils of Eucabal® balm C excites the breathing, deepening and increasing it, contributing to the effectiveness of the mucolytic effect. The action of the balm can be potentiated by the simultaneous oral use of Eucabal® syrup.

Key words: pediatrics, phytotherapy, acute respiratory diseases, cough, mucociliary clearance disorders, drug plants, expectorants, Eucaba.
For citation: Shatalina S.I., Kolosova N.G. Phytotherapy in the treatment of cough in children // RMJ. 2017. № 19. P. 1371–1374.

Pages 1375-1380. Хронобиологический подход к терапии артериальной гипертензии у подростков. Неудахин Е.В.

Summary: Chronobiological approach to the therapy of arterial hypertension in adolescents
Neudakhin E.V. 

Scientific and Practical Center for Specialized Medical Care for Children named after V.F. Voino-Yasenetsky, Moscow

The article briefly summarizes the general ideas about biorhythms of the organism. Particular attention is paid to the importance of alternative interaction of the body's reactions in the formation of biorhythms. The necessity of their inclusion in the development of methods for treating diseases is substantiated. The article considers the mechanisms of development of arterial hypertension (AH), in particular, special attention is paid to primary arterial hypertension (PAH). PAH is most often found in adolescence, when there is a neuroendocrine alteration of the body, its vegetative reactivity changes. The problem of treatment and prevention of hypertension is described in detail in the literature. Much attention is paid to the ways of changing the lifestyle, the use of non-drug therapies, the choice of antihypertensive drugs (AHD). At the same time, it is necessary to achieve the maximum therapeutic effect with minimal doses of AHD. This is possible with the use of the chronotherapy method, taking into account the biorhythms of the body. Chronotherapy of AH helps to get a more pronounced therapeutic effect with a smaller dose of AHD, it focuses on an individual approach to the treatment of patients, which is especially important in pediatrics.

Key words: adults, adolescents, arterial hypertension, biorhythms, desynchronosis, chronotherapy.
For citation: Neudakhin E.V. Chronobiological approach to the therapy of arterial hypertension in adolescents // RMJ. 2017. № 19. P.1375 –1380.

Pages 1381-1384. Антибиотик-ассоциированная диарея: патогенетические аспекты терапии и профилактики. Плоскирева А.А., Горелов А.В., Голден Л.Б.

Summary: Antibiotic-associated diarrhea: pathogenetic aspects of therapy and prevention
Ploskireva A.A.1, Gorelov A.V.1, Golden L.B.2

1 Central Research Institute of Epidemiology, Moscow
2 Infectious Clinical Hospital No. 2, Moscow

The article reviews the literature on modern views on the pathogenesis, clinical picture and pathogenetic therapy of antibiotic-associated diarrhea (AAD). The pathogenetic role of the destabilization of the microbiocenosis system in the development of diarrheal syndrome is shown. The results of the studies of risk of AAD development are presented. The aspects of pathogenetic therapy aimed at optimizing the parameters of the microbiocenosis are described in detail. A promising area in the therapeutic correction of microbiocenosis disorders is the metabiotic drugs (Hylak forte) that are structural components of probiotic microorganisms and / or their metabolites and / or signaling molecules with a known chemical structure that can optimize the main specific physiological functions, associated with the activity of the macroorganism and its microflora. The effectiveness and safety profile of metabiotic therapy has been examined in experimental studies and clinical practice. A metabiotic drug is Hylak forte. The complex composition of this drug provides a wide therapeutic effect on the gastrointestinal microbiocenosis. Hylak forte is recommended for patients with established disorders of microbiocenosis of the small and large intestine with AAD or during antibiotic treatment.

Key words: antibiotic-associated diarrhea, antibacterial drugs, probiotics, metabiotics, Hylak forte.
For citation: Ploskireva A.A., Gorelov A.V., Golden L.B. Antibiotic-associated diarrhea: pathogenetic aspects of therapy and prevention // RMJ. 2017. № 19. P. 1381–1384.

Pages 1385-1390. Клинико-экономический анализ применения генно-инженерных биологических препаратов в лечении полиартикулярного варианта ювенильного идиопатического артрита. Севостьянов В.К., Жолобова Е.С.

Summary: Clinical and economic analysis of the use of gene-engineering biological preparations in the treatment of polyarticular juvenile idiopathic arthritis
Sevostyanov V.K.1,2, Zholobova E.S.3,4

1 Children’s city clinic No.122, Moscow
2 Research Institute of Health Organization and Medical Management, Moscow
3 Moscow City Center for Children's Rheumatology «Morozovskaya Children's City Clinical Hospital»
4 First Moscow State Medical University named after I.M. Sechenov, Moscow

A comparative clinical and economic analysis of genetically engineered biological preparations (GEBP) used in the treatment of polyarticular juvenile idiopathic arthritis (JIA) was conducted with the aim of selecting the most economically preferable alternative. In searching for data on the comparative efficacy of GEBP, all the drugs used in patients with polyarticular JIA have shown high clinical efficacy in clinical trials and in real clinical practice. At the stage of the pharmacoeconomic study, the direct costs of GEBP therapy for the polyarticular JIA were analysed, including the cost of the annual pharmacotherapy course (52 weeks), as well as additional costs associated with the drugs administration, the other costs were assumed equal. As a result of the analysis of the effectiveness of GEBP used for the treatment of the polyarticular JIA, the most preferred alternative from the point of view of the "cost minimization" analysis are the etanercept and abatacept drugs, since these treatment schemes require the least costs for the annual course of the patient’s treatment. In real clinical practice, the choice of the drug should also be carried out in accordance with the «portrait of the patient».

Key words: genetically engineered biological therapy, clinical and economic analysis, juvenile idiopathic arthritis.
For citation: Sevostyanov V.K., Zholobova E.S. Clinical and economic analysis of the use of gene-engineering biological preparations in the treatment of polyarticular juvenile idiopathic arthritis // RMJ. 2017. № 19. P.1385 –1390.

Pages 1391-1395. Инновационные средства ухода за кожей детей с атопическим дерматитом. Мигачева Н.Б., Орлов Е.В., Чаплыгина С.И., Хлопова Э.А., Тямбина О.А., Насырова Л.Н., Осипова Е.А.

Summary: Innovative skin care products for children with atopic dermatitis
Migacheva N.B.1, Orlov E.V.1, Chaplygina S.I.1,2, Khlopova E.A.2, Tyambina O.A.1, Nasyrova L.N.1, Osipova E.A.1

1 Samara State Medical University
2 Children's City Clinical Hospital № 1 named after. N.N. Ivanova, Samara

Atopic dermatitis (AD) is the most common disease among chronic dermatoses and one of the most urgent problems in pediatrics. In recent years, topical nonsteroidal skin care products with an anti-inflammatory effect have appeared. They are comparable with anti-inflammatory drugs by their effectiveness.
The aim of the study was to evaluate the effectiveness of «Atopik» new innovative skin care products («Atopik Soothing Cream» and «Atopic Cream for Intensive Care») for children with mild to moderate atopic dermatitis.
Patients and methods: the patients were children aged from 1 year to 12 years with a mild and moderate atopic dermatitis. Three visits were performed: the first one was screening (the first day of observation), during which all participants were given recommendations on nutrition and skin care using «Atopik cream for daily care». The second one was the basic (the 14th day of observation), the patients were randomized and divided into 2 groups: the children of the 1st group received «Atopik cream soothing» as an additional skin care, and the children of the second group - «Atopic cream for intensive care». The third visit was the final (the 28th day of observation). The EASI index was used as the main objective criterion. In addition, we studied the moisture parameters of the stratum corneum and transepidermal moisture loss (TEML), the intensity of itching was assessed using the Visual Analog Scale (VAS).
Results of the study. In the first group of children, the clinical efficacy of the test product was confirmed by a significant decrease of the EASI index, a positive trend was observed in the analysis of the VAS index, the values of the TEML also differed at the final visit, changes in the moisture content of the stratum corneum during the follow-up period were statistically unreliable. In the second group of children, in the majority of the studied parameters (except for the moisture level of the stratum corneum), a pronounced positive dynamics was also observed.
Conclusions: Improvement of the course of AtD in patients of both groups was manifested by a decrease in the severity of the majority of clinical symptoms of the disease, a decrease in the prevalence of the skin process, relief of itching, which was confirmed by a positive dynamics of objective indicators of skin condition and, in the parents' opinion, was accompanied by a decrease in symptoms of anxiety of the observed children and normalization of the night sleep.

Key words: atopic dermatitis, children, skin care products, Atopic.
For citation: Migacheva N.B., Orlov E.V., Chaplygina S.I. et al. Innovative skin care products for children with atopic dermatitis // RMJ. 2017. № 19. P. 1391–1395.

Pages 1396-1397. 85 лет в системе непрерывного профессионального образования врачей-педиатров. К юбилею кафедры педиатрии РМАНПО. Заплатников А.Л., Захарова И.Н.



№18, 2017. Болезни дыхательных путей

Pages 1265. Слово редактора.

Pages 1268-1272. Эффективность бронходилатационной терапии: уравнение со множеством неизвестных. Игнатова Г.Л., Антонов В.Н.

Summary: The effectiveness of bronchodilator therapy: an equation with many variables
Ignatova G.L., Antonov V.N.

South Ural State Medical University, Chelyabinsk

The article discusses the problems of the appointment of double bronchodilator therapy in the treatment of chronic obstructive pulmonary disease (COPD). For the treatment of COPD, fixed combinations of long-acting anticholinergic drugs and long-acting β2-agonists (LAAD / LABA) with a duration of 24 hours are approved: glycopyrronium bromide / indacaterol, tiotropium / olodaterol, muclucidinium / vilanterol. These combinations showed an advantage over their monocomponents and placebo in terms of influencing the forced expiratory volume in 1 second, dyspnoea and quality of life, and they also showed a high safety.
 Aim: to study the efficacy, safety and compliance to the preparation glycopyrronium bromide / indacaterol 50/110 mcg in actual clinical practice. 
 Patients and methods: the study included 49 male patients treated in City Clinic No. 4 and the City Pulmonary Center in Chelyabinsk in 2016-2017. The analysis of drug therapy in all patients was carried out. The main endpoints of observation were: 1) for the effectiveness assessment - the dynamics of the mMRC index, the forced expiratory volume for the 1st second (FEV1), the    BODE prognostic index, the number of exacerbations; 2) for safety assessment - the number of adverse events (ECG changes: number of extrasystoles, QT interval elongation, changes in pacemaker); 3) for the assessment of compliance - testing on the Moriska-Green questionnaire. The dynamics of the changes in the parameters was evaluated within 6 months from the beginning of therapy. The prognostic evaluation BODE index has been calculated.
 Results and conclusions: The use of double bronchodilator therapy with the combined preparation glycopyrronium bromide / indacaterol 50/110 μg is effective for improving the clinico-functional parameters of the respiratory system and the prognosis of patients with COPD, and it is safe from the point of view of the effect on the cardiovascular system. The combined drug provides the necessary compliance to the management of patients with different COPD.

Key words: COPD, double bronchodilation, glycopyrronium bromide / indacaterol. 
 For citation: Ignatova G.L., Antonov V.N. The effectiveness of bronchodilator therapy: an equation with many variables // RMJ. 2017. № 18. P. 1268–1272.

Pages 1272-1274. Моделирование изменения показателя объема форсированного выдоха за 1-ю секунду у пациентов с хронической обструктивной болезнью легких. Жукова О.В., Конышкина Т.М.

Summary: Modeling the change of the forced expiratory volume 1-second in patients with chronic obstructive pulmonary disease
Zhukova O.V., Konyshkina T.M.

Nizhny Novgorod State Medical Academy

Chronic Obstructive Pulmonary Disease (COPD) is a disease characterized by impaired ventilatory function by an obstructive type, partially reversible, which usually progresses and is associated with an increased chronic inflammatory response of the lungs to the action of pathogenic particles or gases. The main method of diagnosis and documentation of pulmonary function changes in COPD is spirometry. The classification of COPD is based on the spirometry indices according to the severity of obstructive ventilation disorders. 
The aim of this work was to predict the change in FEV1 in patients with COPD as a consequence of a change in the degree of severity of the disease during 10 years period.
Patients and methods: data from the ECLIPSE study (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints), about the change in FEV1 in patients suffering from COPD during the year, served as a model. Forecasting was carried out using the software MO Excel. The study included 1000 patients. They were distributed over the years, depending on the change in the value of FEV1. The results are shown in the diagrams on which the abscissa corresponds to the number of patients with a certain level of FEV1, and the ordinate axis to the value of FEV1.
Results: in the course of the study, the changes in FEV1 were modeled and the mean, upper and lower boundary values for all COPD severity degrees were determined.
Conclusion: as a result of the simulation, we find that in 5-6 years, patients suffering from COPD experience deterioration. In patients with the upper limit of FEV1 values of each degree of severity, this indicator tends to the middle border, in patients with an average border, the indicator tends to the lower border. Patients with the lower limits of the value of FEV1, after 5-6 years pass into a more severe degree of COPD.

Key words: chronic obstructive pulmonary disease, forced expiratory volume in the first second, change in FEV1, spirometry, disease severity, modeling, prediction, time horizon.
For citation: Zhukova O.V., Konyshkina T.M. Modeling the change of the forced expiratory volume 1-second in patients with chronic obstructive pulmonary disease // RMJ. 2017. № 18. P. 1272–1274.

Pages 1275-1280. Бронхолитическая терапия в реальной клинической практике: сравнение оригинального иностранного и отечественного воспроизведенного препаратов. Визель А.А., Ермолова С.О., Бердникова Н.Г., Михопарова О.Ю., Салахова И.Н., Вафина А.Р.

Summary: Bronchodilator therapy in the «real-life» clinical practice: comparison of original foreign and russian generic drugs
Vizel A.A.1, Ermolova S.O.2, Berdnikova N.G.3, Mikhoparova O.Yu.4, Salakhova I.N.1, Vafina A.R.1

1 Department of Phthisiopulmonology of Kazan State Medical University 
2 Department of pulmonology of the Leningrad Regional Clinical Hospital (St. Petersburg) 
3 Department of Clinical Pharmacology and Propaedeutics of Internal Diseases of the First Moscow State Medical University named after I.M. Sechenov
4 Clinical Hospital of «Medical and Sanitary Unit of the Ministry of Internal Affairs of the Russian Federation for the Republic of Tatarstan» (Kazan)

 Obstructive lung diseases are defined by the order of the Russian Ministry of Health and the Government of the Russian Federation as socially significant. The availability of original and generic medicinal products in the country is a matter of national security and a guarantee of medicinal provision for the citizens of the country.
The aim of the work was to compare the effect of the original and generic short-acting domestic bronchodilators on the volume of forced expiratory flow (FEV1) in the «real-life» clinical practice sampling in patients with obstructive pulmonary disease.
 Patients and methods: A total of 238 patients were examined (160 men and   78 women, 67.2% and 32.8%) whose mean age was 60.5±0.96 (20 to 87 years, median 65 years, standard deviation±14.8 years). There were 92 patients with chronic obstructive pulmonary disease (COPD), 104 – with bronchial asthma (BA), 42 (38.7%, 43.7%, 17.6%, respectively) – with a combination of COPD / BA.
The following inhalations solutions bronchodilators were performed by nebulizer: 38 patients received Salbutamol-native, 126 -Ipraterol-native, 74-Berodual solution (16%, 52.9% and 31.1%, respectively). The results were collected and processed in SPSS-18.
Results: In evaluating all the patients all three drugs led to a significant increase in FEV1. Mean values in all subgroups corresponded to a positive sample with bronchodilator (more than 12% and 200 ml or more). In the combination of COPD / BA, the mean values of the FEV1 increase corresponded to a positive sample with a bronchodilator only after Berodual's solution and Ipraterola-native. When patients were leveled by sex, age and degree of bronchial obstruction, it was found that in COPD and bronchial asthma, the broncholytic effect of Ipratherola-native did not differ significantly in the increase in FEV1 in patients with COPD compared Berodual's solution, but was even more stable than in Berodual's solution. And only in Ipraterol-native, the increase in FEV1 was statistically significant in all subgroups of patients.
The conclusion: Our multicenter study confirmed the clinical equivalence of the original foreign and generic domestic drugs when performing a test with a bronchodilator in the «real-life» medical practice in patients with obstructive pulmonary disease.

Key words: fenoterol / ipratropium, salbutamol, bronchodilators, COPD, bronchial asthma, import substitution.
For citation: Vizel A.A. Ermolova S.O., Berdnikova N.G. et al. Bronchodilator therapy in the «real-life» clinical practice: comparison of original foreign and russian generic drugs // RMJ. 2017. № 18. P. 1275–1280.

Pages 1280-1285. Особенности течения внебольничной пневмонии на фоне гриппа A(H1N1)pdm09. Сергеева И.В., Демко И.В.

Summary: Features of the course of community-acquired pneumonia on a background of influenza A(H1N1)pdm09
Sergeeva I.V., Demko I.V.

Krasnoyarsk State Medical University named after Professor V.F. Voyno-Yasenetsky

Influenza A(H1N1)pdm09, in addition to high contagiousness, differs from seasonal influenza by the increased development of complicated forms.
Aim: to study the features of the course of community-acquired pneumonia on a background of influenza A(H1N1)pdm09.
Patients and methods: 169 patients aged 18 to 85 years were examined between 2009 and 2016. The diagnosis of community-acquired pneumonia was verified on the basis of clinical and epidemiological data at the time of admission to the hospital, X-ray and laboratory diagnostic methods. Criteria for the severity were: the degree of respiratory failure, the severity of the intoxication syndrome, the volume of inflammatory infiltration, the presence of complications, the decompensation of comorbidities. Severe community-acquired pneumonia was registered in 96 (56.8%) patients, in 73 patients (43.2%) - community-acquired pneumonia of moderate severity.
Results: the course of community-acquired pneumonia on a background of influenza A(H1N1)pdm09 in the patients examined by us was characterized by an acute onset, manifested by severe intoxication syndrome and respiratory tract disease, the degree of manifestation of which depended on the severity of the disease. In 56.8% of cases, severe course of pneumonia was registered, mainly in young people aged 18-29 years with a burdened premorbid background with a predominance of metabolic syndrome, which determined its leading role in the development of severe pneumonia on a background of influenza A(H1N1)pdm09. According to the X-ray examination in patients with severe pneumonia, bilateral pneumonia with total and fractional lesion was more often diagnosed (64.6%), unilateral pneumonia prevailed in the group of patients with moderate pneumonia (83.5%) with predominant localization in the right lung (68, 5%). A feature of hematological parameters in severe pneumonia was a slight leukocytosis with thrombocytopenia, which increased depending on the day of admission. In the biochemical parameters of severe pneumonia, there was an increase in C-reactive protein (CRP), creatinine, aspartate aminotransferase (AST), creatine phosphokinase (CPK), total protein reduction, which is regarded as a manifestation of multiple organ on the background of endogenous intoxication. 
Conclusion: community-acquired pneumonia against the background of influenza A(H1N1)pdm09 occurs in severe form, which is based on the syndrome of a pronounced systemic inflammatory response.

Key words: influenza A(H1N1)pdm09, community-acquired pneumonia, patients, severity of the course, premorbid background, laboratory diagnostic methods.
For citation: Sergeeva I.V., Demko I.V. Features of the course of community-acquired pneumonia on a background of influenza A(H1N1)pdm09 // RMJ. 2017. № 18. P. 1280–1285.

Pages 1286-1287. Ренгалин - лечение кашля.

Pages 1288-1295. Клиническая результативность новых лекарственных препаратов в схемах лечения туберкулеза с множественной и широкой лекарственной устойчивостью возбудителя. Кильдюшева Е.И., Егоров Е.А., Скорняков С.Н., Медвинский И.Д., Залетаева Г.Е., Подгаева В.А., Луговкина Т.К., Охтяркина В.В., Кравченко М.А., Фадина О.В., Щипунов С.В., Гущин А.С.

Summary: Clinical effectiveness of new drugs in the treatment of pulmonary tuberculosis with multi-drug-resistant and extensively-drug-resistant pathogen
Kildyusheva E.I.1, Egorov E.A.1, Skornyakov S.N.1, Medvinsky I.D.1, Zaletaeva G.E.1, Podgaeva V.A.2, Lugovkina T.K.2, Okhtyarkina V.V.2, Kravchenko M.A.1, Fadina O.V.1, Schipunov S.V.1, Guschin A.C.3

1 Ural Research Institute for Phthisiopulmonology
2 Chelyabinsk Regional Clinical Antituberculosis Dispensary
3 «Pharmasyntes», Irkutsk

In the last decade, the problem of drug-resistant tuberculosis, especially with multiple drug resistance (MDR) and extensively drug-resistant (XDR) pathogen has come to the first place in Russia after stabilization of the tuberculosis incidence rate.
Aim of the study: assessing clinical results of the inclusion of new combined dosage forms and monopreparations with anti-tuberculosis activity in the treatment of tuberculosis of respiratory organs with MDR and XDR of the pathogen.
Patients and methods: the article analyzes the clinical results of additional inclusion of the following drugs into the individualized tubercular regimens (TRs): sodium para-aminosalicylate + isoniazid (Isopask), hydroxymethylquinoxaline dioxide + isoniazid (Hixozide), thioureidoiminomethylpyridinium perchlorate (Perchlozon®), Bedaquiline. 
Results and discussion: Combined TR with additional inclusion of Isopask is evaluated as safer in comparison with PASK (p <0.005). Treatment with      Perchlozon in combination with the 4th tubercular regimen ensured the achievement of a targeted clinical and bacteriological result in the first 90 days of chemotherapy. However, the number of cases of concomitant (two or more) adverse events in patients treated with Perchlozon® was significantly higher in comparison with the patients in the control group (30% and 5.5%, respectively, p <0.05). At the same time, undesirable phenomena were reversible in character, and stopped after continuation of using Perchlozon® or its cancellation. The use of Bedaquiline in the individualized 5th tubercular regimen made it possible to increase the cessation of bacterial excretion in patients with XDR from 36.6 to 59.8% (p <0.05). The prolongation of the QT interval in 1.8% of patients was the reason for Bedaquiline 's abolition. Inhalation of the combined drug Hixozide in addition to the 4th or 5th tubercular regimens provided good clinical efficacy for bronchial tuberculosis and nonspecific endobronchitis in patients with respiratory tuberculosis. The сomplete decrement of endobronchitis was observed in 62,5% of treated patients and in 27,3% - among the control group (p<0,05).

Key words: treatment of pulmonary tuberculosis, multiple drug resistance, extensively- drug resistance, drug safety.
For citation: Kildyusheva E.I., Egorov E.A., Skornyakov S.N. et al. Clinical effectiveness of new drugs in the treatment of pulmonary tuberculosis with multi-drug-resistant and extensively-drug-resistant pathogen // RMJ. 2017. № 18. P. 1288–1295.

Pages 1296-1299. Предварительные результаты влияния клапанной бронхоблокации на функцию внешнего дыхания у больных туберкулезом легких с сопутствующими хроническими неспецифическими заболеваниями легких. Мышкова Е.П., Склюев С.В.

Summary: Preliminary results of the effect of bronchial valve blocking on the respiratory function in patients with pulmonary tuberculosis with  concomitant chronic nonspecific lung diseases
Myshkova E.P., Sklyuev S.V.

Novosibirsk Scientific Research Institute of Tuberculosis

The article presents a retrospective analysis of the results of treatment of patients with infiltrative pulmonary tuberculosis in the phase of decay with concomitant chronic nonspecific lung diseases.
The aim of the study was to evaluate the effect of bronchial valve blocking on the respiratory function in patients with infiltrative destructive pulmonary tuberculosis with concomitant chronic nonspecific lung diseases.
Patients and methods: 102 patients were included in an open comparative retrospective study. In 49 patients (main group), the endobronchial valve was used in the treatment, and 53 patients (comparison group) received standard antituberculous polychemotherapy. The parameters of the respiratory function (RF) were determined at three critical points during hospitalization and in the long-term period.
Results: the installation of an endobronchial valve led to a slight decrease in the level of vital lungs capacity (VLC) and the forced expiration volume. After removal of the valve, these RF values came to the initial level. Standard polychemotherapy of patients in the comparison group contributed to a 6% decrease in the VLC values below the baseline, while the level of bronchial patency was preserved. At the final measurement in the main group, the proportion of patients with normal volumetric RF values increased with a simultaneous decrease in the proportion of patients with moderate and significantly reduced rates. Also in the main group there was an increase in the proportion of patients with normal indices of bronchial patency, and in the comparison group the proportion of patients with normal indices remained at the same level.
Conclusion: the use of the endobronchial valve results in a non-significant (less than 10% decrease in relation to the initial indices) and reversible disruption of both volume and bronchial patency of respiratory function. There is a significant irreversible decrease in the parameters of the respiratory function during the long treatment of patients with infiltrative pulmonary tuberculosis.

Key words: pulmonary tuberculosis, bronchial valve blocking, endobronchial valve, spirometry, complications.
For citation: Myshkova E.P., Sklyuev S.V. Preliminary results of the effect of bronchial valve blocking on the respiratory function in patients with pulmonary tuberculosis with concomitant chronic nonspecific lung diseases // RMJ. 2017. № 18. P. 1296–1299.

Pages 1301-1306. Влияние комбинированной базисной терапии в программах льготного лекарственного обеспечения на течение бронхиальной астмы. Лещенко И.В.

Summary: The effect of the combined basic therapy in the medicine assistance scheme on the course of  bronchial asthma
Leshchenko I.V.

Ural State Medical University, Yekaterinburg

Bronchial asthma (BA) is an urgent public health problem. Treatment of asthma is based on the level of disease control. The change in the structure of basic therapy is one of the causes of exacerbations of asthma and an increase in material costs. One of the most promising and, at the same time, the most well-studied approaches to the treatment of persistent asthma is the use of fixed combinations of inhaled glucocorticosteroids (IGCC) and long-acting β2-agonists (DDBA). The combination of budesonide / formoterol Turbuhaler® is recommended for both basic therapy and for relief of asthma symptoms. This dosage regimen is known as SMART (Symbicort Maintenance And Reliever Therapy) or single inhaler regimen. The use of this regimen contributes to the effective resolution of problems in achieving asthma control: a) providing ongoing monitoring or relief of symptoms and b) reducing the risks of exacerbation of the disease. Improving the control of asthma will reduce the steroid load, reduce the number of hospitalizations and calls for emergency medical care for patients with asthma.

Key words: bronchial asthma, medicine assistance scheme, combined basic therapy, combination of IGKS / DDBA, efficacy, Turbuhaler®, Symbicort®
For citation: Leshchenko I.V. The effect of the combined basic therapy in the medicine assistance scheme on the course of  bronchial asthma // RMJ. 2017. № 18. P. 1301–1306.

Pages 1307-1311. Право граждан на лекарственное обеспечение при оказании медицинской помощи в условиях стационара. Александрова О.Ю.

Summary: The right of citizens for the medicines in the provision of medical care in stationary conditions
Alexandrova O.Yu. 

Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy

The article considers the statements of the program of the state guarantees for the provision of free medical care to the citizens on the basis of medical assistance standards, clinical recommendations, lists of medicines. The state guarantees free drug provision of the citizens in medical settings with medicines from the Vital and Essential Drugs List. However, a number of by-laws regulate the requirement to comply with the standards of medical care and clinical recommendations. Normative acts of the Federal Compulsory Medical Insurance Fund regulate the examination of the medical care quality, including compliance with standards of medical care and clinical recommendations. Federal laws also regulate the carrying out expert examination of state and departmental medical quality and safety control. According to these legal acts, compliance by medical organizations with the standards of medical care is a mandatory requirement. But if the provisions of all federal regulatory legal acts are observed, the physician has the right to prescribe to the patient any medications based on the tasks of the medical process and the patient's state of health.

Key words: standards of medical care, clinical recommendations, medicines.
For citation: Alexandrova O.Yu. The right of citizens for the medicines in the provision of medical care in stationary conditions // RMJ. 2017. № 18. P. 1307–1311.

Pages 1312-1316. Современные подходы к терапии кашля во врачебной практике. Пикуза О.И., Закирова А.М.

Summary: Modern approaches to cough therapy in medical practice
Pikuza O.I., Zakirova A.M.

Kazan State Medical University

The article is devoted to the therapy of cough which is one of the frequent reasons for seeking medical help. The authors show the causes and mechanism of coughing. Underestimation of the cough nature due to its misinterpretation often leads to a late start of rational therapy and increases the risk of developing bacterial complications. Features of the mechanisms for the formation of various options for coughing provide an optimal choice of adequate therapy. The algorithm of rational antitussive therapy includes several stages. At the initial stage, it is needed to carefully collect the history for a more accurate assessment of the nature of the cough (productivity, intensity, time and duration of its occurrence during the day, impact on quality of life) and determine the cause of its occurrence. At the second stage for the correct diagnosis it is necessary to analyze the results of the conducted physical and laboratory-instrumental methods of studies. The final stage is the differential selection of antitussive drugs, taking into account their pharmacological characteristics. The article examines in detail the groups of drugs that affect cough, taking into account their mechanism of action. Particular attention is paid to the multicomponent phytopreparation (Eucabal®) with a wide range of therapeutic effects, the effectiveness and safety of which have been proven in clinical studies.

Key words: cough, causes, mechanism, cough treatment, phytotherapy, Eucabal®.
For citation: Pikuza O.I., Zakirova A.M. Modern approaches to cough therapy in medical practice // RMJ. 2017. № 18. P. 1312–1316.

Pages 1317-1320. Особенности использования небулайзеров в терапии хронических заболеваний легких. Княжеская Н.П.

Summary: Features of the use of nebulizers in the therapy of chronic lung diseases
Knazheskaya N.P.

Russian National Research Medical University named after N.I. Pirogov, Moscow

Incorrect inhalation technique is a common problem, resulting in a poor delivery of the drug to the respiratory tract, reducing control of the disease and increasing the frequency of exacerbations. At present, nebulizers are widely used in the treatment of lung diseases, which provide medication even in situations where inhalation systems can not cope with this task. An example of such a situation may be an exacerbation of bronchial asthma (BA) or chronic obstructive pulmonary disease (COPD), the age of the patients (children or the elderly), and the forms of drugs created specifically for this method of use. The advantages of nebulizer therapy include the lack of the need for coordination of breathing and drug intake (patients with poor inhalation techniques, elderly, young children, patients in serious condition, etc.); absence of propellant gas; the possibility of continuous supply of drugs and the use of large doses of the drug. The medicine quickly enters the target group of the airways, even through the narrowed bronchi.

Key words: nebulizers, inhalation therapy, ultrasonic nebulizers, jet nebulizers, virtual valves, mesh-nebulizers.
For citation: Knazheskaya N.P. Features of the use of nebulizers in the therapy of chronic lung diseases // RMJ. 2017. № 18. P. 1317–1320.

Pages 1322-1324. Резолюция совета экспертов «Место противовоспалительной терапии при ХОБЛ в реальной клинической практике» от 8 апреля 2017 г., Новосибирск. Лещенко И.В., Куделя Л.М., Игнатова Г.Л., Невзорова В.А., Шпагина Л.А.

Summary: Resolution of the Board of Experts «Place of anti-inflammatory therapy in COPD in real clinical practice» dated April 8th, 2017, Novosibirsk

Leshchenko I.V.1, Kudelya L.M.2, Ignatova G.L.3, Nevzorova V.A.4, Shpagina L.A.2

1 Ural State Medical University, Yekaterinburg, Russia
2 Novosibirsk State Medical University, Russia
3 South-Ural State Medical University, Chelyabinsk, Russia
4 Pacific State Medical University, Vladivistok, Russia

Currently, chronic obstructive pulmonary disease (COPD) represents a global problem, which is associated with the prevalence of the disease and high mortality. The main cause of the death of patients with COPD is the progression of the disease. In 2016-2017 years there were a number of major authoritative meetings, where the therapeutic options of the treatment of patients with COPD were discussed, taking into account the phenotypes, the need of prevention of exacerbations, as well as the features of inhalation therapy. Despite the fact that the inhaled long-acting bronchodilators take the first place in the treatment of COPD patients, the aim of the authors was to draw the reader's attention to the therapy with fixed combinations of inhaled glucocorticosteroids (ICS) / long-acting β2-agonists (LABA), emphasizing the priority of the extra-fine particles aerosols in COPD, and a combination of ICS / LABA together with long-acting anticholinergics (LAMA). Recommendations and clinical observations of the treatment of this nosology are given, as well as results of comparative studies of efficacy and safety of the triple combination  ICS / LABA / LAMA versus other COPD therapies presented.

Key words: COPD, inhalation therapy, recommendations, inhaled glucocorticosteroids, long-acting β2-agonists, extra-fine-particles aerosols.
For citation: Leshchenko I.V., Kudelya L.M., Ignatova G.L. et al. Resolution of the Board of Experts «Place of anti-inflammatory therapy in COPD in real clinical practice» dated April 8th, 2017, Novosibirsk // RMJ. 2017. № 18. P. 1322–1324.

Pages 1324-1327. Иммунологические и биохимические механизмы восприимчивости туберкулеза при сахарном диабете. Абдуллаев Р.Ю., Комиссарова О.Г., Михайловский А.М.

Summary: Immunological and biochemical mechanisms of tuberculosis susceptibility in diabetes mellitus
Abdullaev R.Yu.1, Komissarova O.G.1,2, Mikhailovsky A.M.3

1 Central Research Institute of Tuberculosis, Moscow
2 Russian National Research Medical University named after N.I. Pirogov, Moscow.
3 Orenburg State Medical University

The problem of tuberculosis in patients with diabetes mellitus (DM) has been receiving increasing attention in recent years. The growing interest is due, on the one hand, to an increase in the number of patients with multidrug-resistant tuberculosis, and on the other, a steady increase in the prevalence of diabetes. Objective reality determines the urgency of the problem of the combined pathology, as well as the need for a proper understanding of the mechanisms of development of the tuberculous process in this category of patients.
The review covers literature data on the immunological and biochemical mechanisms of  susceptibility to tuberculosis in diabetes mellitus. Analysis of the results of numerous studies suggests that the presence of diabetes is associated with a delayed immune response when infected with Mycobacterium tuberculosis (MTB). Hyperglycemia causes a disturbance in the function of macrophages, lymphocytes and neutrophils. In particular, the chemotactic and phagocytic function of macrophages decreases, the expression of signals from infected macrophages is blocked, the rate of migration of lymphocytes and neutrophils decreases, as well as the level of cytokines associated with congenital and acquired immunity. The combination of all these processes during the first 2 weeks after infection creates conditions for rapid multiplication of the MTB and thereby increases the risk of tuberculosis.

Key words: tuberculosis, diabetes mellitus, susceptibility, macrophages, neutrophils, lymphocytes, reactive oxygen intermediates.
For citation: Abdullaev R.Yu., Komissarova O.G., Mikhailovsky A.M. Immunological and biochemical mechanisms of tuberculosis susceptibility in diabetes mellitus // RMJ. 2017. № 18. P. 1324–1327.



№17, 2017. Гастроэнтерология

Pages 1211-1214. Анализ эффективности скрининга для лечения гастроэзофагеальной рефлюксной болезни в поликлиническом звене. Лисина М.В., Личман Л.А., Гребенкина И.Н., Лисин О.Е., Каторкин С.Е., Киселева И.В.

Summary: Analysis of the effectiveness of screening for the treatment of gastroesophageal reflux disease in the city clinic
Lisina M.V., Lichman L.A., Grebenkina I.N., Lisin O.E., Katorkin S.E., Kiseleva I.V.

Samara State Medical University

Aim: to determine the role of screening examination in the early diagnosis and effectiveness of treatment of gastroesophageal reflux disease (GERD) in a city clinic in patients of younger and older age groups.
Patients and methods: we analyzed 189 patients who applied to the Samara State Medical University Clinic during 2016 with complaints for heartburn, periodic acid reflux after bendover of body, pain in the xiphosternum area after eating. Most of the patients were initially sent to the emergency surgical hospital of the Samara State Medical University Clinic to exclude emergency surgical pathology. When contacting the clinic of Samara State Medical University, patients were referred to a therapist and a gastroenterologist for an outpatient treatment strategy. All patients were divided into 2 age groups: from 18 to 45 years and from 46 to 65 years. The screening study included a patient questionnaire, GERD screening questionnaire, and an esophagogastroduodenoscopy (EGD). The effectiveness of basic therapy in patients of the compared groups was analyzed at 1, 2, 3, 6, and 12 months. It has been statistically proven that early screening of GERD can shorten the duration of conservative therapy and achieve a stable remission in a shorter period of time.  
Results: screening of young people more often show GERD of I and II degrees, which makes it possible to prescribe adequate therapy in the early stages of the disease, stop the progression of the pathological process and avoid serious complications. Patients over 45 years of age had  GERD of a more severe degree, in 50% of cases accompanied with esophagitis, which significantly complicates and reduces the effectiveness of basic therapy. The main screening method for diagnosing GERD is questioning and identifying risk factors in a survey. 
Conclusion: screening by the GERD questionnaire allows to suspect the disease at an early stage, without a pronounced endoscopic picture, to prescribe base conservative and to achieve a stable remission in a short time.

Key words: GERD, erosive esophagitis, heartburn, screening, EGD, questionnaire.
For citation: Lisina M.V., Lichman L.A., Grebenkina I.N. et al. Analysis of the effectiveness of screening for the treatment of gastroesophageal reflux disease in the city clinic// RMJ. 2017. № 17. P.1211 –1214.

Pages 1215-1219. Эффективность стандартной тройной эрадикационной терапии первой линии на основе эзомепразола и других ингибиторов протонной помпы у больных с Helicobacter pylori-ассоциированным гастритом. Сарсенбаева А.С., Петухова Т.П., Федоренко С.В., Уфимцева И.В.

Summary: The effectiveness of standard triple eradication first line therapy based on esomeprazole and other proton pump inhibitors in patients with Helicobacter pylori gastritis
Sarsenbaeva A.S.1, Petuhova Т.P.1, Fedorenko S.V.2, Ufimtseva I.V.3

1 South Ural State Medical University, Chelyabinsk
2 Clinic «All Medicine» of «ChTRP Medical Center», Chelyabinsk
3 Medical center «Lotos», Chelyabinsk

In Russia, the level of Helicobacter pylori infection remains quite high. Currently, the new approaches to H. pylori eradication are being persistently searched for because the effectiveness of traditional methods of eradication therapy (ET) has decreased. One way to overcome the resistance of H. pylori is the more effective deacidification with high doses of proton pump inhibitors (PPIs) and the use of stronger acid reducing drugs.
The aim of the research was to study the effectiveness of ET on the basis of various PPIs in patients with H. pylori gastritis.
Patients and methods: 108 patients with chronic H. pylori gastritis were included into the study. By random number method 2 groups of 54 patients were formed to analyze the effectiveness of ET. The first group of patients received standard triple ET based on esomeprazole (Nexium) (esomeprazole 40 mg/day (Nexium®) + clarithromycin 1 g / day + amoxicillin 2 g / day) for 14 days. The second group of patients received standard triple ET based on other PPI (omeprazole 40 mg/day, or pantoprazole 80 mg / day, or rabeprazole 40 mg / day, or lansoprazole 60 mg / day + clarithromycin 1 g/day + amoxicillin 2 g/day) for 14 days. Efficacy was monitored 6 months later by a histological method and H. pylori antigen testing in feces by polymerase chain reaction.
Results: H. pylori elimination was achieved with the use of esomeprazole (Nexium) in 92.6% of patients, whereas in the case of other PPIs, only 77.8% of patients had it. Esomeprazole (Nexium®) has a reliable acid-suppressive effect, and its use is the key to effective ET even in the hyperacid gastritis.
Conclusions: the dependence of the ET efficacy on the proton pump inhibitor has been established. The eradication schemes with esomeprazole (Nexium®) showed advantages in the patients of complex categories: with a low degree of contamination, in conditions of atrophy of the mucous membrane of the antrum of the stomach, as well as at any degree of activity of the inflammatory process.

Key words: Helicobacter pylori, chronic gastritis, eradication therapy, proton pump inhibitors, esomeprazole, Nexium.
For citation: Sarsenbaeva A.S., Petuhova Т.P., Fedorenko S.V., Ufimtseva I.V. The effectiveness of standard triple eradication first line therapy based on esomeprazole and other proton pump inhibitors in patients with Helicobacter pylori gastritis // RMJ. 2017. № 17. P. 1215–1219.

Pages 1220-1224. Helicobacter pylori у больных ревматическими заболеваниями: частота инфицированности и оценка эффективности альтернативной схемы эрадикационной терапии. Каратеев А.Е., Цурган А.В., Мороз Е.В.

Summary: Helicobacter pylori in patients with rheumatic diseases: the incidence of infection and evaluation of the effectiveness of the alternative scheme of eradication therapy
Karateev A.E.1, Tsurgan A.V.1, Moroz E.V.2

1 Scientific Research Institute of Rheumatology named after V.A. Nasonovа, Moscow
2 The main military clinical hospital named after Acad. N.N. Burdenko, Moscow

Helicobacter pylori (H. pylori) is the main cause of peptic ulcer and chronic gastritis, and a serious risk factor for complications in the upper gastrointestinal tract caused by non-steroidal anti-inflammatory drugs (NSAIDs). Eradication of H. pylori is considered to be an important element of treatment and prevention of NSAID-gastropathy.
The aim of the study was to evaluate the infection of H. pylori in patients with rheumatic diseases (RDs), the effect of this microorganism on the development of NSAID- gastropathy and the possibility of its eradication by nifuratel.
Patients and methods: the urease test was used to assess the presence of H. pylori in patients who regularly took NSAIDs and underwent an endoscopic examination at the Clinic of Scientific Research Institute of Rheumatology named after V.A. Nasonovа for the period from 01.02.2017 to 31.03.2017 (2 months, total sampling). A total of 109 patients, 72.5% of women and 27.5% of men with an average age of 53.5 ± 13.6 years were examined. The frequency of erosions and gastric ulcers in patients with or without H. pylori was compared. After that, 32 patients infected with H. pylori with erosions, ulcers and / or ulcerative anamnesis received anti-Helicobacter therapy (omeprazole 20 mg + amoxicillin 1000 mg + nifuratel 400 mg 2 r. / day for 10 days). The achievement of eradication was evaluated by polymerase chain reaction (PCR) in the feces  6 weeks after completion of the course of treatment.
Results: H. pylori was detected in 56% of the examined patients. In infected patients erosion and ulcers were detected significantly more often than in uninfected patients:  47,5% и 23,0% (OR 3,68; 95% Cl 1,56–8,68), р<0,001. The full course of eradication therapy was completed in 31 patients, in 1 patient the treatment was interrupted due to the development of a skin allergic reaction. In other cases, no adverse events were noted. Eradication was achieved in 81,3% of patients. In 4 patients, PCR appeared to be positive, and in 2 patients the result of treatment remained unknown.
Conclusion: most Russian patients with RDs are infected with H. pylori. The presence of H. pylori is associated with a greater incidence of NSAID-gastropathy. Eradication therapy with nifuratel is effective and well tolerated.

Key words: H. pylori, NSAIDs, NSAID-gastropathy, eradication, nifuratel.
For citation: Karateev A.E., Tsurgan A.V., Moroz E.V. Helicobacter pylori in patients with rheumatic diseases: the incidence of infection and evaluation of the effectiveness of the alternative scheme of eradication therapy // RMJ. 2017. № 17. P. 1220–1224.

Pages 1225-1231. Оценка эффективности и безопасности применения микронизированных полиферментных препаратов у больных хроническим панкреатитом c внешнесекреторной недостаточностью поджелудочной железы. Минушкин О.Н., Масловский Л.В., Евсиков А.Е.

Summary: Evaluation of the efficacy and safety of micronized polyenzymatic preparations in patients with chronic pancreatitis with exocrine pancreatic insufficiency
Minushkin O.N., Maslovsky L.V., Evsikov A.E.

Central State Medical Academy of the Administrative Department of the President of the Russian Federation, Moscow

Pancreatic exocrine insufficiency (PEI) is a consequence of pancreatic diseases associated with the loss of functioning parenchyma. Recently, there has been an increase in the incidence of PEI. According to current guidelines, PEI treatment includes diet, enzyme replacement therapy (ERT) and the treatment of the underlying disease. The authors conducted an open non-comparative study of the efficacy and safety of the modern micronized enzyme drug «Ermitale®» 36 000.
Aim of the study: to evaluate the effectiveness of treatment of PEI patients with the drug «Ermitale®» 36 000 in a dose of 1 capsule during a meal 3-4 times a day, depending on the severity of PEI with the use of clinical, instrumental and laboratory parameters.
Patients and methods: The study included 20 patients with PEI chronic pancreatitis. The drug «Ermitale®» 36000 was administered depending on the data of the elastase test. The appointment of other enzyme preparations was excluded. Before and after the treatment, ultrasound of the abdominal cavity, a hydrogen test, clinical and biochemical blood tests (total protein, albumin, cholesterol, triglycerides, prothrombin), coprogram, carbolenic test were performed. 
Results: The disappearance or significant decrease in the intensity of the symptoms of the disease was noted, laboratory and anthropometric indicators of nutritional status were significantly improved, which was naturally accompanied by a significant improvement in the quality of life of patients. The used doses of the drug depend on the degree of PEI. There are no significant complications of the treatment.
Conclusions: «Ermitale®» is a drug that effectively suppresses PEI, that is indicated by: a positive dynamics of clinical indicators (absolute number of lymphocytes) and biochemical blood test (albumin, lipid profile, prothrombin), an increase in body mass index. The drug «Ermitale®» is safe to use and well tolerated.

Key words: pancreas, pancreatic exocrine insufficiency, enzyme replacement therapy, «Ermitale®».
For citation: Minushkin O.N., Maslovsky L.V., Evsikov A.E. Evaluation of the efficacy and safety of micronized polyenzymatic preparations in patients with chronic pancreatitis with exocrine pancreatic insufficiency // RMJ. 2017. № 17. P. 1225–1231.

Pages 1232-1237. Современные возможности лечения функциональной диспепсии с позиций актуальных клинических рекомендаций. Кучерявый Ю.А., Андреев Д.Н.

Summary: Modern possibilities of functional dyspepsia treatment in terms of current clinical recommendations
Kucheryavy Yu.A., Andreev D.N.

A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation

Functional dyspepsia (FD) is one of the most common gastroenterological diseases. Etiopathogenesis of FD is considered as a complex multifactorial process, the cause-effect relations of which are still actively studied. Motor disorders (slowing evacuator function, disturbance of relaxation accommodation) and gastric sensitivity (visceral hypersensitivity to stretching) are considered the main pathophysiological mechanisms of FD, underlying the generation of symptoms of this disease. Modern tactics of managing patients with FD, based on the Roman criteria IV (2016), regulates the strategy of differentiated use of proton pump inhibitors and prokinetics in various variants of FD, as well as the use of multipurpose therapy (Iberogast®) regardless of the clinical variant of the disease.

Key words: functional dyspepsia, Roman criteria IV, proton pump inhibitors, prokinetics, Helicobacter pylori, eradication, Iberogast.
For citation: Kucheryavy Yu.A., Andreev D.N. Modern possibilities of functional dyspepsia treatment in terms of current clinical recommendations // RMJ. 2017. № 17. P. 1232–1237.

Pages 1238-1242. Трудности ведения пациентов с гастроэзофагеальной рефлюксной болезнью: в фокусе – приверженность лечению и риски, ассоциированные с длительной антисекреторной терапией. Евсютина Ю.В.

Summary: Difficulties in managing patients with gastroesophageal reflux disease - focus on the treatment compliance and the risks associated with prolonged antisecretory therapy
Evsyutina Yu.V. 

First Moscow State Medical University named after I.M. Sechenov

The review presents a modern view of the risk factors for gastroesophageal reflux disease (GERD), compliance to antisecretory therapy and ways to increase it, the diagnosis and treatment of extra-esophageal manifestations of GERD, and the risks associated with long-term therapy with proton pump inhibitors (PPIs).
Risk factors for GERD are lowering the pressure of the lower esophageal sphincter, increasing the number of transient relaxations of the lower esophageal sphincter, eating certain products and taking medications, increasing the body mass index. The contribution of Helicobacter pylori infection to the pathogenesis of GERD and Barrett's esophagus is controversial.
One of the reasons for the treatment failure in patients with GERD is a low treatment compliance. This problem can be solved by the appointment of PPIs with double delayed release, which can be used regardless of mealtime.
A great difficulty for clinicians are extra-esophageal manifestations of GERD - bronchial asthma, cough and laryngopharyngeal reflux. Such patients need a long-term therapy with PPIs, whose safety (increased risk of infection, reduced bone mineral density, hypomagnesemia) is an open question for discussion.

Key words: GERD, proton pump inhibitors, therapy compliance, extra-esophageal manifestations of GERD.
For citation: Evsyutina Yu.V. Difficulties in managing patients with gastroesophageal reflux disease - focus on the treatment compliance and the risks associated with prolonged antisecretory therapy // RMJ. 2017. № 17. P.1238 –1242.

Pages 1244-1247. Кишечная микробиота: современные представления о видовом составе, функциях и методах исследования. Кожевников А.А., Раскина К.В., Мартынова Е.Ю., Тяхт А.В., Перфильев А.В., Драпкина О.М., Сычев Д.А., Фатхутдинов И.Р., Мусиенко С.В., Никогосов Д.А., Жегулина И.О., Бавыкина Л.Г., Каршиева А.В., Селезнева К.С., Алексеев Д.Г., Потешкин Ю.Е.

Summary: Intestinal microbiota: modern concepts of the species composition, functions and diagnostic techniques
Kozhevnikov A.A.1, Raskina K.V.2, Martynova E.Yu.2, Tyakht A.V.3, Perfiliev A.V.4, Drapkina O.M.5, Sychev D.A.6, Fatkhutdinov I.R.4, Musienko S.V.3, Nikogosov D.A.3, Zhegulina I.O.4, Bavykina L.G.4, Karshieva A.V.4, Selezneva K.S.4, Alekseev D.G.3,7, Poteshkin Yu.E.1, 4

1 Russian National Research Medical University named after N.I. Pirogov, Moscow; 2 First Moscow State Medical University named after I.M. Sechenov; 
3 Biomedical Holding «Atlas», Moscow; 4 «Atlas Medical Center», Moscow; 5 National Medical Research Center for Preventive Medicine, Moscow; 6 Russian Medical Academy of Postgraduate Education, Moscow; 7 Novosibirsk State National Research University

Intestinal microbiota is a community of different types of microorganisms inhabiting the human intestine. According to the latest data, the number of its representatives is not less than the number of cells in the human body, and the number of genera and species is estimated to exceed 50 and 500, respectively. In the course of an extensive study of the European (MetaHIT) and American (HMP) populations, it was found that Bacteroidetes and Firmicutes are the dominant types of microorganisms in microbiota. Currently, the concept of the intestinal microbiota enterotypesis is actively discussed. It postulates the existence of stable clusters of key bacterial genera in the human body that are not continent-specific and population-specific: they are enterotypes with the predominance of Bacteroides, Prevotella and Ruminococcus. The dominance of these or other species depends largely on the age of the individual. There is evidence that microorganisms can colonize the digestive tract of the fetus even before birth. The intestinal microbiota performs a protective function, participates in the regulation of the immune, nervous and endocrine systems, is an important participant in the digestive processes, synthesizes B and K vitamins, local antibiotics, short-chain fatty acids, plays an important role in neutralizing drugs and xenobiotics. The article briefly describes and compares the features of traditional and modern methods of microbiota research.

Key words: microbiota, precision medicine, enterotype, culture method, sequencing, polymerase chain reaction, PCR, real-time PCR, mass spectrometry, 16s rRNA, shotgun-sequencing, RT-Q-PCR.
For citation: Kozhevnikov A.A., Raskina K.V., Martynova E.Yu. et al. Intestinal microbiota: modern concepts of the species composition, functions and diagnostic techniques // RMJ. 2017. № 17. P. 1244–1247.

Pages 1248-1257. Место урсодезоксихолевой кислоты в терапии неалкогольной жировой болезни печени на разных стадиях заболевания: стеатоз, стеатогепатит, фиброз/цирроз. Казюлин А.Н.

Summary: Place of ursodeoxycholic acid in the therapy of non-alcoholic fatty liver disease at different stages: steatosis, steatohepatitis, fibrosis / cirrhosis
Kazyulin A.N.

Moscow State Medical Stomatological University named after А.I. Evdokimov
Central Clinical Hospital № 2 named after N.A. Semashko of Russian Railways, Moscow

In the last quarter of a century, epidemiological studies have shown a steady increase in the incidence of non-alcoholic fatty liver disease (NAFLD) in all countries of the world among various population groups, including adolescents and children. NAFLD is described as a pathological condition characterized by a significant lipid deposition in hepatocytes or liver parenchyma in patients who have no history of alcohol abuse.
The review provides the latest relevant data on the development, course and diagnostics of NAFLD. Much attention is paid to the methods of primary and secondary prevention of the disease. The purpose of therapeutic measures in NAFLD is to prevent the development of steatosis, by affecting the modifiable risk factors, and in case of its presence to prevent the outcome of steatosis in non-alcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma by using the secondary prevention methods.
Particular attention is paid to the use of preparations of ursodeoxycholic acid (UDCA). The accumulated experimental and clinical data show that UDCA is a drug of pleiotropic action, which is expressed in its multifactorial effect on the liver. In turn, the drug of choice is Urdoksa (AF Obolenskoe, Russia), which is produced in accordance with GMP criteria, and has a proven pharmaceutical equivalence and bioequivalence with leading UDCA drugs.

Key words: non-alcoholic fatty liver disease, non-alcoholic steatosis of the liver, non-alcoholic steatohepatitis, preventive measures, ursodeoxycholic acid, Urdoksa.
For citation: Kazyulin A.N.Place of ursodeoxycholic acid in the therapy of non-alcoholic fatty liver disease at different stages: steatosis, steatohepatitis, fibrosis / cirrhosis // RMJ. 2017. № 17. P. 1248–1257.

Pages 1258-1261. Применение ингибиторов протонной помпы и связанные с этим риски. Кропова О.Е., Шиндина Т.С., Максимов М.Л.

Summary: Proton pump inhibitors and risks associated with their using
Kropova O.E.1, Shindina T.S.1, Maksimov M.L.2

1 Clinic No.5 of the Administrative Department of the President of the Russian Federation, Moscow
2 Kazan State Medical Academy – branch of Russian Medical Academy of Continuous Professional Education

At present, there are many diseases in which proton pump inhibitors (PPIs) are used. This article shows the history of the use of the drugs blocking acid products, with a description of the mechanisms of action. The article also presents the basic principles of using PPIs and the connection between the administration of these drugs and class-specific side effects (B12 and iron deficiency anemia, osteoporosis, calcium and magnesium malabsorption, the risk of developing clostridial infection, increased risk of cardiovascular pathology in PPI and clopidogrel polypharmacy). The data of retrospective studies on the effect of proton pump inhibitors on the risk of ischemic stroke are given. These studies showed a correlation between the use of PPIs (most pronounced in omeprazole, pantoprozole, lansoprozole, esomeprosol and not established in rabeprozole) and the risk of developing ischemic stroke. The authors show a dose-dependent effect that causes the development of ischemic stroke (the higher the dose, the higher the risk). Thus authors recommend to continue studying the mechanisms of development of this correlation and its reliability.
 
Key words: proton pump inhibitors, class-specific side effects, PPIs stroke, omeprazole, pantoprozole, lansoprozole, esomeprosol, rabeprozole.
For citation: Kropova O.E., Shindina T.S., Maksimov M.L. Proton pump inhibitors and risks associated with their using // RMJ. 2017. № 17. P. 1258–1261.

Pages 1261-1263. Редкое клиническое наблюдение аневризмы воротной вены у молодой женщины. Ахмедов В.А.

Summary: Rare clinical observation of an aneurysm of the portal vein in a young woman
Akhmedov V.A., Gaus O.V.

Omsk State Medical University

The presented clinical observation characterizes a rare clinical case of an aneurysm of the portal vein in a young woman, first clinically manifested during pregnancy, under the guise of decompensated liver cirrhosis, which was excluded by the results of liver needle core biopsy. The disease started with coffee-grounds vomiting, which happened on the 7th week of pregnancy. The examination  revealed a splenomegaly (70 cm2), an aneurysm of the portal vein, and a cavernous transformation of the portal vein. Despite the satisfactory state of health on the background of conservative treatment, according to the results of ultrasound, there was a negative dynamics - expansion of the portal vein to 30 mm, according to the results of fibrogastroduodenoscopy - esophageal varices of the Ш degree, gastric varices of the I-II degree, signs of portal gastropathy. In April 2014, taking into account the negative dynamics, the patient was sent for surgical treatment to the State Scientific Center of the Federal Medical Biophysical Center named after A.I. Burnazyan (Moscow), where the follow-up study revealed an aneurysm of the portal vein with a rare feature - compression of  hepaticocholedochus, formation of a hepatoportal block and development of cavernous transformation of segmental branches of the portal vein, which required a high-tech surgical treatment.

Key words: clinical case, an aneurysm of the portal vein, young age.
For citation: Akhmedov V.A., Gaus O.V.Rare clinical observation of an aneurysm of the portal vein in a young woman // RMJ. 2017. № 17. P. 1261–1263.



№16, 2017. Онкология

Pages 1155-1163. Возможности и ограничения стереотаксического облучения в лечении больших артериовенозных мальформаций головного мозга. Маряшев С.А., Голанов А.В., Яковлев С.Б., Антипина Н.А., Фильченкова Н.В.

Summary: Possibilities and limitations of stereotactic irradiation in the treatment of large arteriovenous malformations of the brain
Maryashev S.A., GolanovA.V.,Yakovlev S.B., Antipina N.A., Filchenkova N.V.

National Medical Research Center of Neurosurgery named after Academic N.N. Burdenko, Moscow

Arteriovenous malformations (AVM) are congenital anomalies of cerebral vessels, in which insufficiently formed blood vessels shunt the blood directly from the arterial blood circulation system into the venous system, bypassing the capillary network.
Currently, there are several ways to treat AVM, depending on the size, structure, location, clinical manifestations, as well as the condition and desire of the patient. In the world, extensive experience in the surgical and endovascular treatment of AVM has been accumulated. Despite the progress of microsurgical techniques and the improvement of methods for endovascular treatment, there is a large number of patients, to whom surgical methods are not applicable, or whose treatment is incomplete (AVM continues to function). In recent decades, stereotaxic irradiation (radiosurgery and stereotaxic radiation therapy) takes an increasingly important place in the treatment of patients with AVM.
Aim: to improve the results of treatment of large AVM by creating an algorithm and standardizing the hypofractionation.
Patients and methods: in National Medical Research Center of Neurosurgery named after Academic N.N. Burdenko for the years 2005-2013 108 patients with large AVM were treated by stereotactic irradiation. In 89 cases three methods of hypofractionation were used on linear electron accelerators "Novalis" and «Cyber knife».
Results: obliteration of AVM after stereotaxic radiation therapy in the mode of hypofractionation was found on average in 42% of patients. The optimal fractionation regimen is the total focal dose up to 24 Gy, fed for 2 fractions, while AVM obliteration was achieved in 46% of patients. Statistically significant factors predicting the onset of AVM obliteration during hypofractionation in a single-factor analysis are the AVM volume ≤14 cm3 and the absence of previous embolization.
Conclusion: stereotactic irradiation in the mode of hypofractionation is an acceptable treatment option for large AVMs (with a volume of 10 cm3 or more).

Key words: arteriovenous malformation, radiosurgery, stereotaxic irradiation, hypofractionation, obliteration, AVM.
For citation: Maryashev S.A., Golanov A.V., Yakovlev S.B. et al. Possibilities and limitations of stereotactic irradiation in the treatment of large arteriovenous malformations of the brain // RMJ. 2017. № 16. P. 1155–1163.

Pages 1164-1168. Радиохирургическое лечение метастазов почечно-клеточного рака на аппарате «Гамма-нож». Никитин Д.И., Зубаткина И.С., Иванов П.И.

Summary: Radiosurgical treatment of metastases of renal cell carcinoma on the apparatus "Gamma-knife"
Nikitin D.I., Zubatkina I.S., Ivanov P.I.

Clinic of Radiosurgery, Stereotactic Radiotherapy and General Oncology of the Medical Institute named after Sergei Berezin, St. Petersburg

The aim: to study the results of radiosurgical treatment on the apparatus «Gamma-knife» of patients with metastases of renal cell carcinoma in the brain, to analyze the factors affecting the effectiveness of treatment and the life expectancy of patients.
Patients and methods: from 2009 to 2016, patients with metastases of renal cell carcinoma in the brain who underwent radiosurgical treatment with the Gamma Knife apparatus (Leksell Gamma Knife, Elekta AB, Sweden) with controlled tumor dynamics by MRI imaging and survival time. The study included 101 patients, follow-up data and the results of the control magnetic resonance imaging of these patients were fully available for study. The patients' life expectancy, local control and the appearance of new metastases in the brain after the radiosurgical treatment were studied using the technique of analyzing censored data with the construction of the Kaplan-Mayer probability function. A comparison of life expectancy in groups of patients was carried out using a nonparametric log rank test.
Results: the evaluation of the results of radiosurgery treatment was carried out on the basis of control MR studies using the Gamma-Plan Follow-up program. Local control was achieved in 95% of cases. The emergence of new metastases in the brain was noted in 45% of patients, the median time to detect new metastatic foci in the brain was 10.4 months. Analysis of life expectancy after radiosurgical treatment revealed a median of 13.8 months: in RPA I, 24.9; RPA II - 16.5; RPA III - 4.7 months.
Conclusion: the obtained data showed a high level of local control of metastasis of renal cell carcinoma in the brain after radiosurgical treatment, which, together with the development of methods of systemic therapy, opens the prospect of increasing the life expectancy of patients. Given the radioresistance of metastasis of renal cell carcinoma to radiation therapy and a high rate of relapse after total brain radiation, radiosurgical treatment can be considered a method of choice for the treatment of this group of patients.

Key words: renal cell cancer, metastases to the brain, «Gamma Knife», radiosurgery, local control, life expectancy, RPA-classes
For citation: Nikitin D.I., Zubatkina I.S., Ivanov P.I. Radiosurgical treatment of metastases of renal cell carcinoma on the apparatus «Gamma-knife» // RMJ. 2017. № 16. P. 1164–1168.

Pages 1169-1172. Применение стереотаксической лучевой терапии у пациентов с первичными и метастатическими опухолями легких. Мартынова Н.И., Воробьев Н.А., Михайлов А.В., Смирнова Е.В., Гуцало Ю.В.

Summary: The use of stereotactic radiation therapy in patients with primary and metastatic lung tumors
MartynovaN.I.1, Vorob'ev N.A.1 - 3, Mikhailov A.V.1, Smirnova E.V.1,3, Gutsalo Yu.V.1

1 Medical and Diagnostic Center of International Institute of Biological Systems named after Berezin Sergei, St. Petersburg
2 Saint Petersburg State University
3 North Western State Medical University named after I.I. Mechnikov, St. Petersburg

This study illustrates the evaluation of the treatment of  patients with lung neoplasms of various nature and sizes in the IIBS clinic performed on two types of linear accelerators.
Patients and methods: from December 2011 to February 2017, 71 patients with total 103 primary and metastatic formations of the lungs  were treated. Of all the tumors, 37 were central and 66 were peripheral; patients receiving treatment for primary lung tumors were refused a surgical treatment. Treatment was carried out on two types of linear accelerators: CyberKnife (CK) (with the use of the Synchrony Breathing System for 38 (59.4%) out of 64 tumors) and TrueBeam STx (TB) (with the use of the Gating Breathing System on the area of 39 tumors).
Results: the observation group consisted of 50 patients with 71 lung formations. The average volume of tumors was 44.7 cm3 (0.2-496.5 cm3). Median observation was 7 months (1-57 months). Local control was achieved in 100% of cases, median duration of control was 6 months (1-57 months). Local control was maintained even in most cases of systemic progression of the underlying disease. For 19 (26,8%) formations, according to the results of treatment, a complete response was achieved, the median of which was 5 months (1-47 months). Continued growth was observed in 16 (22.5%) cases, 15 of which were primary tumors. The frequency of early toxicity (cough, dyspnea) in CK treatment was lower (8% vs. 19% for TB), most patients did not exceed grade II severity, complications of grade III toxicity were observed in 5 patients. The frequency of late radiation complications did not differ in patients receiving treatment on both linear accelerators and did not exceed the grade II in all patients. Early and late radiation complications of grade IV were not observed in any patient. 1-, 2- and 3-year overall survival was 83.6, 77.3 and 65.8%, respectively.
Conclusion: stereotactic radiotherapy allows to achieve and maintain local control in the majority of patients at a sufficiently low incidence of radiation complications. When irradiating primary lung tumors, higher doses may be more effective in achieving and maintaining local control.

Key words: stereotactic radiation therapy, non-small cell lung cancer, metastases to the lungs.
For citation: Martynova N.I., Vorob'ev N.A., A.V. Mikhailov et al. The use of stereotactic radiation therapy in patients with primary and metastatic lung tumors // RMJ. 2017. № 16. P. 1169–1172.

Pages 1172-1174. Ингибиторы PARP – новое направление в лечении рака предстательной железы. Павлов А.Ю., Гафанов Р.А., Кравцов И.Б., Фастовец С.В.

Summary: PARP inhibitors - a new direction in the treatment of prostate cancer
Pavlov A.Yu., Gafanov R.A., Kravtsov I.B., Fastovets S.V.

Russian scientific center of radiology and nuclear medicine, Moscow

Prostate cancer is the most common form of malignant neoplasms in men. Despite significant success in the treatment of patients in advanced stages of the disease, problems remain with regard to the optimal treatment of both hormone sensitive and castration-resistant prostate cancer. In a recent study, in 23% of cases with metastatic prostate cancer, latent aberrations in BRCA1 / 2 and ATM were identified, which are known to be key genes in DNA repair, and in 8% of the patients, congenital mutations in these genes were detected. The use of poly (ADP-ribose) -polymerase inhibitors in the treatment of patients with prostate cancer is considered. Particular attention is paid to such drugs as olaparib and velparib. It is noted that the appearance of drugs of this class, of course, has a great prospect in use and inspires certain hopes for the optimization of therapeutic measures. Inhibition of PARP is one of the most promising approaches to "precise therapy". Over the next few years, through ongoing clinical research, we need to have a better understanding of whether our expectations will be actually translated into clinical reality. Among the many promising drugs, there will undoubtedly be those that do not justify the current hopes.

Key words: castration-resistant prostate cancer (CRPC), poly (ADP-ribose) -polymerase inhibitors, olaparib, velparib, abiraterone,
For citation: Pavlov A.Yu., Gafanov R.A., Kravtsov I.B., Fastovets S.V. PARP inhibitors - a new direction in the treatment of prostate cancer // RMJ. 2017. № 16. P. 1172–1174.

Pages 1175-1180. Возможности протонной терапии. Клинические аспекты. Воробьев Н.А., Михайлов А.В., Смирнова Е.В., Гуцало Ю.В., Мартынова Н.И.

Summary: Possibilities of proton therapy. Clinical aspects
Vorobiev N.A.1-3, Mikhailov A.V.1, Smirnova E.V.1,3, Gutsalo Yu.V.1, Martynova N.I.1

1 Medical and Diagnostic Center of International Institute of Biological Systems named after Berezin Sergei, St. Petersburg
2 Saint Petersburg State University
3 North Western State Medical University named after I.I. Mechnikov, St. Petersburg

The article presents the possibilities of proton therapy as a new method of treating malignant tumors, which has certain advantages over standard photon radiation therapy. This is due to the possibility of creating the maximum dose of radiation in the target area without exceeding the tolerated dosages for normal tissues, even if the target is close to the critical structures of the body. A higher dose leads, respectively, to a greater probability of death of cancer cells.
Currently, there is an active accumulation of experience in the clinical use of proton therapy. The presented studies show the potential advantage of proton therapy in the treatment of CNS tumors, chord and chondrosarcoma of the skull and skeleton base, head and neck tumors, malignant tumors in children. The role of protons in cancer of the rectum, stomach, prostate, pancreas is actively studied. The results obtained should help to identify groups of patients for whom proton therapy will be crucial in improving disease control, overall survival and maintaining quality of life.

Key words: proton therapy, chordoma, chondrosarcoma, malignant tumors in children, radioinduced tumors.
For citation: Vorobiev N.A., Mikhailov A.V., Smirnova E.V. et al. Possibilities of proton therapy. Clinical aspects // RMJ. 2017. № 16. P. 1175–1180.

Pages 1181-1185. Метастатическое поражение головного мозга, современные стандарты лечения. Банов С.М., Голанов А.В., Зайцев А.М., Бекяшев А.Х., Ветлована Е.Р., Дургарян А.А.

Summary: Brain metastases, modern treatment standards
Banov C.M.1, Golanov A.V.1, Zaitsev A.M.2, Bekyashev A.Kh.3, Vetlovana E.R.1, Durgaryan A.A.1

1 National Medical Research Center Of Neurosurgery named after Academic N.N. Burdenko, Moscow
2 Moscow Scientific Oncological Institute named after P.A. Herzen, Moscow
3 National Medical Research Center of Oncology named after N.N. Blokhin, Moscow

The development of chemotherapy has led to significant progress in the therapy of malignant tumors, but its effectiveness against brain metastases remains insufficient. Fractional whole brain radiotherapy, surgical treatment and radiosurgery are the standard methods of treating patients with brain metastases.
Improving the methods of neuroimaging, the introduction into clinical practice of the principles of microsurgery and radiosurgery with the use of the Gamma-knife and Cyber-knife devices has significantly changed the results of treatment of patients with brain metastases, which allowed to formulate new principles for the treatment of this group of patients.
This review summarizes the available methods for treating patients with brain metastases, with an emphasis on overall survival, local control, distant metastases, quality of life, and the potential for potential combinations of existing treatments. The article shows that personalized approaches in the treatment of patients with brain metastases are optimal and improve the results of treatment.

Key words: brain metastases, radiosurgery, microsurgery, whole brain radiotherapy. 
For citation: Banov C.M., Golanov A.V., Zaitsev A.M. et al. Brain metastases, modern treatment standards // RMJ. 2017. № 16. P. 1181–1185.

Pages 1186-1189. Гипофракционированное облучение рецидива юношеской ангиофибромы основания черепа: наш опыт и обзор литературы. Нерсесян М.В., Галкин М.В., Рыжова М.В., Голанов А.В., Капитанов Д.Н., Черекаев В.А., Антипина Н.А.

Summary: Hypofractionated irradiation of the  recurrence of juvenile skull base angiofibroma: our experience and literature review
Nersesyan M.V., Galkin M.V., Ryzhova M.V., Golanov A.V., Capitanov D.N., Cherekaev V.A., Antipin N.A.

National Medical Research Center of Neurosurgery named after Academic N.N. Burdenko, Moscow

Juvenile angiofibroma of the skull base (JASB) is a benign tumor that usually develops in adolescent boys and is characterized by aggressive growth and abundant blood supply. Clinical manifestations of JASB are: difficulty in nasal breathing; frequent, sometimes profuse nasal bleeding; hearing impairment; deformation of the facial skeleton; exophthalmos, visual and oculomotor disorders. The common primary treatment for JASB is surgical removal, which is usually accompanied by marked bleeding. With the development of relapse and the presence of an inoperable part of the tumor (in the region of the orbit, the cavernous sinus), it is justified to conduct radiation treatment. Most often, radiation treatment of JASB is carried out in the form of a long course - in the standard fractionation mode. Modern devices allow for conformational stereotactic irradiation of JASB in alternative (shorter) regimes - radiosurgery and hypofractionation. This not only reduces the time of treatment, but also reduces the radiation load on the surrounding tissues.
Two cases of irradiation of JASB recurrences in the mode of hypofractionation with pronounced effect were considered in the work. There is also a literature review on the radiation treatment of JASB using different fractionation regimes. Control of tumor growth, tumor response to treatment, early and late complications are considered.

Key words: juvenile angiofibroma, base of skull, recurrence, radiotherapy, radiosurgery, hypofractionation, treatment of juvenile angiofibroma
For citation: Nersesyan M.V., Galkin M.V., Ryzhova M.V. et al. Hypofractionated irradiation of the  recurrence of juvenile skull base angiofibroma: our experience and literature review // RMJ. 2017. № 16. P. 1186–1189.

Pages 1190-1194. Опыт применения повторного стереотаксического облучения в режиме гипофракционирования при рецидивах рака головы и шеи. Михайлов А.В., Воробьев Н.А., Сокуренко В.П., Смирнова Е.В., Мартынова Н.И., Гуцало Ю.В.

Summary: Experience in applying stereotaxic reirradiation in the mode of hypofractionation in cases of head and neck cancer recurrence
Mikhailov A.V.1, Vorobiev N.A.1-3, Sokurenko V.P.4, Smirnova E.V.1, Martynova N.I.1, Gutsalo Yu.V.1

1 Medical and Diagnostic Center of International Institute of Biological Systems named after Berezin Sergei, St. Petersburg
2 North-Western State Medical University named after I.I.Mechnikov, St. Petersburg
3 St. Petersburg State University
4 Russian Research Center of Radiology and Surgical Technologies named after Acad. A.M. Granova, St. Petersburg

Recurrences of head and neck cancer develop in more than half of patients after aggressive primary treatment. Surgical treatment in these cases provides the best results, but it is not always feasible. In this regard, reirradiation remains an actual problem of modern oncology.
Aim to study the tolerability and immediate efficacy according to the criterion of local control of stereotaxic reirradiation in the mode of hypofractionation in patients with local and regional relapses of head and neck cancer.
Patients and methods: 8 patients with local and regional head and neck cancer recurrences were included in the study, who received a course of radiotherapy as part of the initial treatment. Patients underwent a repeated course of radiation therapy in the mode of hypofractionation (35 Gy for 7 fractions). Volumes of irradiation were formed using PET-CT with 18F-FDG, MRI and CT. The dose was administered using the techniques of volumetric modulated arc therapy (VMAT) using IGRT (orthogonal X-ray and CT in a conical beam) to monitor the positioning of the patient.
Results: early radiation reactions were expressed in the form of radial mucositis I-II degree, radiation dermatitis I-II degree. One patient died due to development of profuse bleeding after 3 weeks after the end of radiation treatment. An objective response was achieved in 6 of 8 patients. With a median follow-up of 11 months, there was no development of late radiation complications leading to a decrease in the quality of life.
Conclusion: stereotaxic reirradiation in the mode of hypofractionation in patients with locoregional recurrence of head and neck cancer is a well tolerated type of treatment that provides high local control results while maintaining a satisfactory quality of life. Nevertheless, the risk of developing fatal post-radiation complications determines the need for careful selection of candidates for this type of treatment.

Key words: reirradiation, head and neck cancer, relapse, hypofraction.
For citation: Mikhailov A.V., Vorobiev N.A., Sokurenko V.P. et al. Experience in applying stereotaxic reirradiation in the mode of hypofractionation in cases of head and neck cancer recurrence // RMJ. 2017. № 16. P. 1190–1194.

Pages 1194-1199. Стереотаксическая биопсия опухолей головного мозга с планированием в условиях магнитно-резонансной томографии. Щербань А.Е., Иванов П.И., Черкашин М.А., Желбунова Е.А.

Summary: Stereotactic biopsy of brain tumors with MRI planning
ShcherbanA.E., Ivanov P.I., Cherkashin M.A., Zhelbunova E.A.

Medical and Diagnostic Center of International Institute of Biological Systems named after Berezin Sergei, St. Petersburg

Currently, stereotactic biopsy is a widespread minimally invasive intervention in neurosurgical practice. It is performed in pathological voluminous formations inaccessible for open surgical interventions or in the case of a high risk of complications during anesthesia.
Histological diagnosis is crucial for building the right treatment plan (radiation therapy, chemotherapy) and determining the prognosis of the disease. The success of the stereotactic biopsy depends on the state of the stereotaxic apparatus, the modern specialized software for determining the coordinates of the target and the careful step-by-step execution of the algorithm for performing this manipulation.
The work describes in detail the indications for a stereotactic biopsy, the technique of its implementation, and the factors that influence the success of the study. Clinical examples of patients, examined and operated in MIBS, with various pathological processes of the brain are presented.
An analysis of the work has shown that stereotactic biopsy of pathological formations of the brain is a safe and effective method of diagnosis.
The data obtained correspond to the data of large neurosurgical centers. The diagnostic reliability of a stereotactic biopsy is 93-96%.

Key words: stereotactic biopsy, stereotaxic biopsy of brain tumors, brain tumor, encephalitis, primary CNS lymphoma, radio necrosis, Leksell Stereotactic System®, immunohistochemical study, brain biopsy technique.
For citation: ShcherbanA.E., Ivanov P.I., Cherkashin M.A., Zhelbunova E.A. Stereotactic biopsy of brain tumors with MRI planning // RMJ. 2017. № 16. P. 1194–1199.

Pages 1200. Оценка ранних результатов радиохирургического лечения рецидивирующих глиобластом головного мозга с использованием мультимодальной нейровизуализации. Токарев А.С., Рак В.А., Евдокимова О.Л., Степанов В.Н., Крылов В.В.

Pages 1201. Использование мультипараметрического протокола магнитно-резонансной-томографии головного мозга для дифференциальной диагностики неврином и менингиом в области мостомозжечкового угла при подготовке пациентов к стереотаксическому радиохирургическому лечению. Токарев А.С., Шатохина Ю.И., Степанов В.Н., Чувилин С.А., Евдокимова О.Л., Рак В.А., Крылов В.В.

Pages 1202. Применение мультипараметрического протокола магнитно-резонансной томографии пациентов с метастатическим поражением головного мозга для оценки ответа на стереотаксическое радиохирургическое лечение. Токарев А.С., Степанов В.Н., Шатохина Ю.И., Чувилин С.А., Евдокимова О.Л., Рак В.А., Крылов В.В.

Pages 1203. Радиохирургическое лечение опухолей головного мозга и экстракраниальных локализаций на аппарате Novalis TX с навигационной системой BrainLab. Опыт областного онкологического диспансера. Железин О.В., Володин А.Н., Канищева Н.В., Скамницкий Д.В., Шлякова М.Н.

Pages 1204. Первый опыт радиохирургического лечения пациентов с интракраниальной патологией на аппарате «Гамма-нож» в НИИ скорой помощи им. Н.В. Склифосовского. Токарев А.С., Крылов В.В., Рак В.А., Евдокимова О.Л., Койнаш Г.В., Сокольвак О.А., Степанов В.Н., Шатохина Ю.И., Чувилин С.А., Синкин М.В., Рожнова Е.Н.

Pages 1205. Ранние результаты лечения метастатического поражения головного мозга на аппарате «Гамма-нож» в режиме гипофракционирования. Токарев А.С., Евдокимова О.Л., Рак В.А., Сокольвак О.А., Крылов В.В.

Pages 1206. Чрескожная криоабляция опухолей печени: технические аспекты и непосредственные результаты. Балахнин П.В., Шмелев А.С., Шачинов Е.Г., Мелдо А.А., Мацко Д.Е., Моисеенко В.М.

Pages 1207. Роль лучевой терапии в лечении болезненных костных метастазов рака молочной железы. Бахмутский Н.Г., Порханов В.А., Василенко И.Н., Бодня В.Н., Ширяев Р.П.

Pages 1208-1209. Профилактическое облучение головного мозга как прогностический фактор при локальной стадии мелкоклеточного рака легких. Бахмутский Н.Г., Порханов В.А., Бодня В.Н., Ширяев Р.П.



№13, 2017. Неврология

Pages 930-934. Обновленная стратификация риска и план минимизации рисков развития натализумаб-ассоциированной прогрессирующей мультифокальной лейкоэнцефалопатии. Хачанова Н.В., Давыдовская М.В., Евдошенко Е.П.

Summary: Updated risk stratification and risk management plan for Natalizumab-associated progressive multifocal leukoencephalopathy
Khachanova N.V.1,2, Davydovskaya M.V.1,2, Evdoshenko E.P.2,3

1 Russian National Research Medical University named after N.I. Pirogov, Moscow
2 Center of Clinical Trials and Health Technology Assessment of Moscow Department of Healthcare
3 City Clinical Hospital №31, Saint-Petersburg

Natalizumab is approved for the treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). As a rule, the drug is recommended for patients with aggressive course of MS or in case of ineffective therapy with immunomodulating drugs of the first line. The expected benefits of treatment should exceed the possible risks, especially with regard to the development of a serious complication in the form of progressive multifocal leukoencephalopathy (PML). The group with the highest risk of PML includes patients who receive natalizumab for more than 24 months, who have a seropositive JCV antibody status, and previously received immunosuppressive therapy (IST). Studies have shown that early detection of PML and the urgent treatment of "asymptomatic" PML (which reaches 90% according to some authors) can lead to better outcomes.
The report of the European Medical Agency in April 2016 and the issuance of a new medication guide for natalizumab served as a basis for reviewing the previous recommendations on natalizumab treatment managment plan, including MRI monitoring schedule and risk stratification algorithm. This algorithm will allow an individualized approach to PML risk assessment in seropositive patients wishing to continue treatment with natalizumab for more than 24 months.
Key words: progressive multifocal leukoencephalopathy, natalizumab, JCV antibody, active multiple sclerosis.
For citation: Khachanova N.V., Davydovskaya, M.V. Evdoshenko E.P. Updated risk stratification and risk management plan for Natalizumab-associated progressive multifocal leukoencephalopathy // RMJ. 2017. № 13. P. 930–934.

Pages 935-939. Болевые синдромы в области туловища и конечностей. Пизова Н.В.

Summary: Pain syndromes in the regions of the trunk and the extremities
Pizova N.V.

Yaroslavl Medical University

The article contains d