Vol 68, No 11 (2013)

EDITORIAL
TOPICAL ISSUES OF BIOLOGICAL SAFETY UNDER CURRENT CONDITIONS. PART 2. CONCEPTUAL, TERMINOLOGICAL, AND DEFINITIVE FRAMEWORK OF BIOLOGICAL SAFETY
Onishchenko G.G., Smolenskii V.Y., Ezhlova E.B., Demina Y.V., Toporkov V.P., Toporkov A.V., Lyapin M.N., Kutyrev V.V.
Abstract

In accordance with the established conceptual base for the up-to-date broad interpretation of biological safety, and IHR (2005), developed is the notional, terminological, and definitive framework, comprising 33 elements. Key item of the nomenclature is the biological safety that is identified as population safety (individual, social, national) from direct and (or) human environment mediated (occupational, socio-economic, geopolitical infrastructures, ecological system) exposures to hazardous biological factors. Ultimate objective of the biological safety provision is to prevent and liquidate aftermaths of emergency situations of biological character either of natural or human origin (anthropogenic) arising from direct and indirect impact of the biological threats to the public health compatible with national and international security hazard. Elaborated terminological framework allows for the construction of self-sufficient semantic content for biological safety provision, subject to formalization in legislative, normative and methodological respects and indicative of improvement as regards organizational and structural-functional groundwork of the Russian Federation National chemical and biological safety system, which is to become topical issue of Part 3.

 

Annals of the Russian academy of medical sciences. 2013;68(11):4-11
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OBSTETRICS AND GYNAECOLOGY: CURRENT ISSUES
CELLS OF IMMUNE SYSTEM OF MOTHER АND TROPHOBLAST CELLS: CONSTRUCTIVE COOPERATION FOR THE SAKE OF ACHIEVEMENT OF THE JOINT PURPOSE
Ailamazyan E.K., Stepanova O.I., Sel'kov S.A., Sokolov D.I.
Abstract

In the present review modern data about change of morfo-functional properties of a trophoblast during pregnancy, and also about influence of the cytokines produced by cells of a microenvironment, including leucocytes of mother, on a functional state of trophoblast is cited. Features of interaction between trophoblast and immune cells of mother are described within physiological pregnancy and within pregnancy complicated by preeclampsia.

 

Annals of the Russian academy of medical sciences. 2013;68(11):12-21
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CLINICAL-ANAMNESTIC AND MOLECULAR-GENETIC FACTORS IN DIFFERENT FORMS OF HYPERTENSION AND ITS RELATIONSHIP TO COURSE AND PREGNANCY OUTCOMES
Chulkov V.S., Vereina N.K., Sinitsyn S.P., Dolgushina V.F.
Abstract

Aim: to assess of the relationship of clinical and molecular genetic factors in the course and outcome of pregnancy in different forms of hypertension in pregnant women. Patients and methods: a total of 125 pregnant women who were divided into the following groups: with chronic hypertension (n =45), with gestational hypertension (n =20), with pre-eclampsia (n =10), superimposed preeclampsia upon chronic hypertension (n =15) and 35 women without hypertension in control group. Results: in pregnant women with chronic hypertension and superimposed preeclampsia upon chronic hypertension were observed higher incidence of overweight and obesity, smoking before pregnancy and family history of hypertension and thrombosis, the course and outcomes of pregnancy characterized by higher frequency of obstetric complications, higher frequency of polymorphisms of genes identified the renin-angiotensin system, folate cycle and endothelial function. Conclusions: Molecular-genetic factors, combined with the factors of cardiovascular risk may make some contribution to the phenotypic realization of pregnancy complications and adverse pregnancy outcomes in pregnant women with different forms of hypertension.

 

Annals of the Russian academy of medical sciences. 2013;68(11):22-25
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CARDIOLOGY: CURRENT ISSUES
THE PREDICTION OF ATRIAL FIBRILLATION IN PATIENTS WITH ARTERIAL HYPERTENSION
Grigoriadi N.E., Vasilets L.M., Tuev A.V., Ratanova E.A., Khlynova O.V., Agafonov A.V.
Abstract

Aim. To study the parameters of the structural and functional state of the myocardium in patients with hypertension, to determine their prognostic value on the risk of atrial fibrillation (AF). Patients and methods: the study involved 72 people: patients with hypertension and AF, with isolated hypertension and apparently healthy individuals. All of them performed echocardiography, blood pressure monitoring and monitoring of cardiogram. Results: the dilatation of left atrial was founded: patients with the atrial fibrillation on the background of hypertension observed the most pronounced changes in the left atrial. In patients with hypertension without arrhythmias and in combination with atrial fibrillation severe left ventricular hypertrophy was observed. Left ventricle systolic function in groups has been stored but in patients with atrial fibrillation on the background of hypertension was significantly lower. The risk of atrial fibrillation in patients with hypertension prognostic value are the only values of the age, the volume index of the left atrial to the body surface area and left ventricular ejection fraction. Conclusions. The risk of AF in hypertension occurs over the age of 55 and each subsequent year increases it in 1,2 times,  it increases with an index value of the left atrial to the body surface over 29 ml/m2 and with a decrease in left ventricular ejection fraction less than 58%.

 

Annals of the Russian academy of medical sciences. 2013;68(11):26-29
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SEVERAL MEDICAL AND SOCIAL FACTORS WHICH MAY INFLUENCE IN-HOSPITAL MORTALITY IN PATIENTS WITH MYOCARDIAL INFARCTION
Kruchkov D.V., Kheraskov V.Y., Maksimov S.A., Artamononva G.V.
Abstract
Aim: to study the medical and social aspects of in-hospital mortality after myocardial infarction (MI) in the cardiology center of a major industrial city in Western Siberia. Patients and methods: the material of the study was the database of patients with acute coronary syndrome (19 283 patients), formed by a continuous method retrospectively. The volume of the study were 6463 patients with MI for 2006–2011. Results: in-hospital mortality of patients with MI was 11,8%, with MI complicated by cardiogenic shock — 87,4%, in the primary MI — 7,4%, during the second MI — 22,1%. In-hospital mortality in MI depends on the age of the patients: in group of patients of working age mortality was 4,7%, the retirement age — 12,4%, old age — 22,7%. In the working-age group mortality in men is almost three times higher than in women. The mortality of patients with MI without reperfusion was 13,4%, in the case of reperfusion therapy — 9,2%. Conclusions: hospital mortality depends on the patient's age, type of MI (primary or repeated), the severity of the condition, applied treatments.

 

Annals of the Russian academy of medical sciences. 2013;68(11):30-33
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PEDIATRICS: CURRENT ISSUES
CENTRAL MOTOR PATHWAYS IN CHILDREN WITH MULTIPLE SCLEROSIS
Voitenkov V.B., Komantsev V.N., Skripchenko N.V., Ivanova G.P., Surovtseva A.V., Klimkin A.V.
Abstract

Aim: to evaluate motor pathways involvement in children with multiple sclerosis. Patients and methods: we used transcranial magnetic stimulation method. 9 children with relapsing-remitting multiple sclerosis (mean duration 1,68 years) and 20 controls were enrolled. Results: in most of the cases findings in multiple sclerosis group were abnormal. More often polyphasic changes of the motor evoked potentials (MEP) shape (78% of the cases) and elevation of MEP threshold (88%) were seen. Conclusions: transcranial magnetic stimulation demonstrated high sensitivity in children with multiple sclerosis. Main neurophysiologic findings in multiple sclerosis in children may reflect altering membrane excitability of motor neurons and demyelinating lesions. Axonal damage in children with multiple sclerosis are less apparent.

 

Annals of the Russian academy of medical sciences. 2013;68(11):34-37
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DEVELOPMENT OF MOTOR FUNCTIONS AND MANUAL ABILITIES IN PEDIATRIC PATIENTS WITH SPASTIC CEREBRAL PALSY AFTER BOTULINUM TOXIN TREATMENT AND COMPLEX REHABILITATION
Klochkova O.A., Kurenkov A.L., Namazova-Baranova L.S., Mamed'yarov A.M., Zherdev K.V.
Abstract

Aim: to investigate the dynamic of general motor function and manual abilities in children with spastic forms of cerebral palsy (CP) after complex rehabilitation combined with single and repeated injections of botulinum toxin A (BTA). Patients and methods: the article presents 18 month follow-up of 52 patients with mono- and bilateral spastic forms of CP after single and multiple injections of botulinum toxin A and complex rehabilitation/ Patients received totally 74 injection sessions: 17 (32,7%) children — twice, 5 (9,6%) children — three times. Motor development assessment was done according to the GMFCS and GMFMS-88 scales and centile curves of normal motor development connected with these scales, hand function was classified according to the MACS scale. For the first time results of botulinum toxin therapy and rehabilitation were compared with the natural motor development of patients with different levels of motor disturbances according to centile tables. Results: patients with bilateral cerebral palsy improved slowly than hemiparetic and changes lasted for longer period. Level according to the MACS scale didn’t depend on the gestational age of the patients, was higher in children with hemiparesis and changed for 1 level in 4 (7,7%) patients after the first botulinum toxin A injections.

 

Annals of the Russian academy of medical sciences. 2013;68(11):38-48
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THE EVALUATION NEUROPSYCHOLOGICAL DEVELOPMENT IN PRETERM INFANTS WITH HYPOXIC BRAIN INJURY
Mikhalenko I.V., Mikhalev E.V.
Abstract

We observed 164 preterm newborns with moderate and severe hypoxic brain injury and 25 healthy newborns, who were included into control group. The clinical, laboratory and diagnostic data were analyzed and determined levels of neurospecific enolase in serum, levels of vascular endothelial growth factor in serum and levels of brain-derived neurotrophic factor in serum during the neonatal period followed with assessment of mental development by the method of Zhurba in the control time. Revealed that additional predictors of adverse mental outcomes in preterm newborns with severe hypoxic brain injury under one year were the intrauterine growth hypotrophic of III level type, the high level of neurospecific enolase in serum and low level of vascular endothelial growth factor in serum in 1 month after delivery.

 

Annals of the Russian academy of medical sciences. 2013;68(11):49-53
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NOSOCOMIAL RESPIRATORY SYNCYTIAL VIRUS BRONCHIOLITIS IN PRETERM INFANTS: CHARACTERISTICS OF THE COURSE, TREATMENT АND PREVENTION IN CLINICAL PRACTICE
Ovsyannikov D.Y., Degtyarev D.N., Ryumina I.I., Krsheminskaya I.V., Orlovskaya I.V.
Abstract
Objective: to study the clinical, laboratory and radiological features of the course of nosocomial bronchiolitis respiratory syncytial viral (RSV ) etiology and effectiveness of the therapy in preterm infants in the neonatal hospital conditions. Patients and Methods: We analyzed case histories of 10 hospitalized patients who had RSV etiology bronchiolitis established by RIF / PCR in neonatal Moscow hospitals in  2011-2013. Results: RSV infection in hospitalized preterm infants with and without bronchopulmonary dysplasia runs hardly, requiring treatment in the intensive care unit, oxygen therapy and  lungs mechanical ventilation. The respiratory failure is the symptom of the of RSV bronchiolitis severity. X-ray picture of the disease is characterized by peribronchial changes, emphysematous swelling , segmental infiltration and bronchial obstruction (atelectasis, hypoventilation ). The frequency of bacterial complications of RSV bronchiolitis is low. In clinical practice newborns with severe RSV bronchiolitis are treated with antibiotics, bronchodilators, steroids. The timely isolation of patients can prevent the extention of the infection in the hospital. Conclusions: The preventive measures are needed to prevent the extention of RSV in neonatal hospitals, including specific immune prophylaxisof RSV infection in children at risk .


Annals of the Russian academy of medical sciences. 2013;68(11):54-59
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HEALTH CARE MANAGEMENT: CURRENT ISSUES
THE NUMBER OF LIFE YEARS LOST (DALYS) DUE TO PREMATURE MORTALITY IN THE POPULATION OF TOMSK REGION IN 2012
Kobyakova O.S., Deev I.A., Nesvetailo N.Y., Boikov V.A., Shibalkov I.P., Naumov A.O., Kulikov E.S., Starovoitova E.A., Mazeina S.V.
Abstract

Aim: to calculate the index of years of life lost population due to premature death in the Tomsk region in 2012, and the contribution of various groups of diseases in the total indicator DALY among males and females.  Materials and methods: in the calculation of DALY used the number and the gender and age structure of the population of Tomsk region by 01.01.2012, according to Rosstat. To conduct the calculation of DALY used the methodology presented by the world Bank in the report «Investing in health» in 1993 According to the methodology, the DALY is the number of years of life of the population, lived with disability or other health problems, and lost due to premature death. Results: the total loss of DALYs in the Tomsk region by the end of 2012 amounted 112,3, per 1000 population (11,6±8,9). In the structure of DALYs by cause of death 1st place is occupied by diseases of the circulatory system, 2nd injury and poisoning, 3rd neoplasms. Conclusions: the indicator DALY in the Tomsk region are significantly lower than the Russian Federation as a whole (according to S.A. Leonov - 1.25 times, according to G. Yang - 2 times). The relatively low level of DALYs in the Tomsk region is associated with favourable compared with other regions of the age structure (younger populations). It should also be noted that more than 70% of population live in urban areas, where, as is known, the availability of medical care are higher than in rural.

Annals of the Russian academy of medical sciences. 2013;68(11):60-64
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LAWS AND REGULATIONS AFFECTING THE DEVELOPMENT OF NATIONAL SERVICE OF CLINICAL TOXICOLOGY
Khubutiya M.S., Luzhnikov E.A., Tadzhiev I.Y., Kabanova S.A., Gol'dfarb Y.S.
Abstract

In the formation and development of the national specialized toxicological service the important role was played by legislative initiatives, distinguished with continuity and improvement of the quality of care in acute poisoning, principles of interaction of units of service. Since the beginning of the organization of specialized toxicological service in the country, without taking into account the regional regulations, there were published over thirty ones, impact and significance of which can be very positively evaluated by formed a unique and authoritative national school of clinical toxicology, with its wealth of organizational, methodological and diagnostic and treatment practices, valuable scientific and human resources.

Annals of the Russian academy of medical sciences. 2013;68(11):66-72
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SHORT MESSAGES
EFFICIENCY AND SAFETY OF HUMAN MONOCLONAL ANTIBODIES TO TNF-Α IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS IN PRIMARY AND SECONDARY INEFFECTIVENESS OF OTHER BIOLOGICALS
Alexeeva E.I., Baranov A.A., Mitenko E.V., Bzarova T.M., Valieva S.I., Denisova R.V., Isaeva K.B., Chistyakova E.G., Sleptsova T.V., Taibulatov N.I., Zelikovich E.I., Kurilenkov G.V.
Abstract
Purpose: To evaluate the safety and efficiency of adalimumab in children with severe refractory JIA with primary  inefficiency,  partial effect or loss of the effectiveness of other biologicals. Patients and methods: The article presents the results of the retrospective observational study of the efficacy and safety of adalimumab in 68 patients aged 10 (3, 17) years with various embodiments of JIA , with the primary inefficiency or partial or loss of the effectiveness of other biologicals. JIA diagnosis established on the basis of criteria ILAR (International League of Associations for Rheumatology).
Results: Efficacy was assessed during 1 year in 68 and  2 years -  in 56 patients . At the 24th week we observed the  improvement by criteria AKR in 100 , 91 and 74 % of patients , respectively, and at the 52 th week - in 100 , 96 and 90 % , respectively. Inactive disease status was recorded in 55.8, 66,1 and 98.2 % of study participants after  6 months, 1 and 2 years, respectively. Remission was achieved in 55.8 and 96.4 % of patients after 1 and 2 years of observation, respectively. Conclusions: Adalimumab was effective and well tolerated by patients with primary inefficiency, partial and  loss of efficiency of other biologicals. In clinical practice, patients with non-systemic JIA transition to the second TNF-α blocker can restore the biological effect of the first drug without increasing the frequency of infectious AEs.


Annals of the Russian academy of medical sciences. 2013;68(11):73-82
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INDIVIDUAL PRECONSCIOUS AFFECTIVE BIASES TO THREATENING AND APPETITIVE FACIAL STIMULI AND CARDIOVASCULAR STRESS-REACTIVITY
Aftanas L.I., Pavlov S.V., Brak I.V., Korenek V.V.
Abstract

Aim: to investigate cardiovascular stress-reactivity in association with individual preconscious affective biases to threatening and appetitive facial stimuli. Patients and methods: preconscious affective biases were assessed in healthy individuals (n =38, mean age M =28,10 years, 1SD =8,64) using a modified (masked) version of a pictorial emotional Stroop task (backward masking of the angry, fearful and joyful faces). Results: it was revealed that individual preconscious bias to speeded up perception of angry faces correlates significantly with heightened anxiety, lowered platelet serotonin (5-HT) levels, sustained central overactivation of at rest (as indexed by lowered delta, theta, and beta-1 EEG power over frontal, central and posterior cortical areas) and exaggerated arterial blood pressure stress-reactivity during re-experiencing of personally relevant anger. Conclusions: considering uncovered associations, individuals with preconscious bias to speeded up perception of angry faces may be regarded as having enhanced risk to fall sick with essential hypertension, yet this perceptive bias could be seen as a putative neurobehavioral predictor of the risk.

 

Annals of the Russian academy of medical sciences. 2013;68(11):83-93
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THE STUDY OF MATURATION OF THE AUDITORY ANALYZER RABBIT ACCORDING DISTORTION-PRODUCT OTOACOUSTIC EMISSIONS
D'yakonova I.N., Ishanova Y.S., Rakhmanova I.V.
Abstract

Aim: In our chronic experiment to  register changes of acoustic response of Distortion-Product Otoacoustic Emissions (DPOAE) of intact rabbits in postnatal ontogenesis for the purpose of getting normative data which can be used for studying impact of pathological factors on auditory function and maturation of activity of outer hair cell in ontogenesis. Materials and methods: Study of otoacoustic emissions used mature chinchilla rabbits with a 19 day life of up to 3 months. Results: in the course of ripening were obtained functional activity of outer hair cells of the cochlea. Conclusion: normative data obtained allow us to study using a rabbit model, the pathological effects of agents on the maturation of the outer hair cells of the cochlea in the experiment.

Annals of the Russian academy of medical sciences. 2013;68(11):94-97
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AGE-RELATED CHANGES OF THE PITUITARY FOLLICULO-STELLATE CELLS IN RATS IN CHRONIC STRESS
Kapitonova M.Y., Ullah M., Kuznetsov S.L., Khlebnikov V.V., Nor-Ashikin M., Ahmad A.
Abstract

Folliculo-stellate cells are known as S-100 protein immunopositive cells of the anterior lobe of pituitary gland which are not secreting hormones and are presumed to be organ specific stem cells of the adenohypophys. Their role in adaptation of the body to stress remains unclear. Aim: to evaluate dynamics of folliculo-stellate and hormone-producing cells in rats of different age in chronic stress exposure. Materials and methods: Sprague-Dawley rats aged 1, 3, 6 and 12 months were exposed to chronic immersion immobilization stress. Histological section of the pituitary glands were stained immunohistochemically with subsequent image analysis. Results: in control rats S-100 protein-immunopositive cells increased in number with age and negatively correlated with the number of ACTH-positive cells. In experimental animals aged 1 and 3 months volume density of S-100 protein-immunoreactive cells significantly decreased and negatively correlated with ACTH-positive cells, while in 6 month old rats it was only slightly decreased and in 12 months old animals showed tendency to increase. Conclusions: results of the study demonstrating capacity of the folliculo-stellate cells to contribute to the plasticity of the hypothalamo-hypophyseo-adrenal axis in chronic stress exposure at different age.

 

Annals of the Russian academy of medical sciences. 2013;68(11):98-102
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VEGFRS IN NEOPLASTIC ANGIOGENESIS AND PROSPECTS FOR THERAPY ОF BRAIN TUMORS
Korchagina A.A., Shein S.A., Gurina O.I., Chekhonin V.P.
Abstract

Glioblastoma (GBM) is the most common type of primary brain cancer that characterized by poor prognosis due to the rapid progression, active angiogenesis, enhanced tumor cell invasion and the emergence of resistance toward conventional therapy. In this connection, nowadays, new approaches for selective inhibition of crucial steps in tumor progression are actively developing. The key feature of tumor growth and development is angiogenesis. VEGF and its receptor VEGFR2 play the pivotal role in regulation of tumor vessel formation. Therefore, VEGFR2, as the main receptor of VEGF’s pro-angiogenic signal transducer, is a promising molecular target for anti-angiogenic therapy. There is evidence that inhibitors of VEGF and VEGFR2 reduce endothelial cell proliferation, migration and survival that lead to regression of vessel density and decrease vascular permeability, thereby slowing tumor growth. Currently, a number of VEGFR2 inhibitors are under clinical trials (ramucirumab, cediranib) and several were approved (sunitinib, sorafenib). Despite the promising results of preclinical studies, the efficacy of antiangiogenic drugs in the clinical practice is significantly lower, mainly, due to rapid adaptation of malignant cells that consists of alternative pro-angiogenic pathways activation, recruitment of endothelial progenitor cells from bone marrow and increasing of the invasive growth. Given the diversity of pro-angiogenic mechanisms, enhancement of the efficacy of tumor therapy could be achieved by specific inhibition of VEGFR2 functions that will be supplemented by other antiangiogenic drugs (anti-VEGF,-PlGF,-HIF1α). In addition, multitargeting therapy should focus on the combined inhibition of angiogenesis, invasion, metastasis, proliferation and survival of tumor cells.

 

Annals of the Russian academy of medical sciences. 2013;68(11):104-114
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WHICH PATIENTS WITH OVARIAN CANCER SHOWS THE COMBINATION OF TRABECTEDIN WITH PEGYLATED LIPOSOMAL DOXORUBICIN
Khokhlova S.V., Cherkasova M.V., Orel N.F., Limareva S.V., Bazaeva I.Y., Gorbunova V.A.
Abstract

Given the high rate of recurrence of ovarian cancer, the search for new therapeutic strategies are topical issue. According to various studies the effectiveness of drug treatment relapse depends on the platinum-free interval, increasing in proportion to its duration. If therapy is platinum-resistant recurrent ovarian cancer is a standard approach, the treatment of platinum-sensitive recurrent algorithm is not fully defined. Comparison of platinum and non-platinum combinations revealed the advantage of combined platinum- treatment for patients with platinum-free interval of more than 6 months without an increase in life expectancy. Non-platinum combination of trabectedin with pegylated liposomal doxorubicin has shown comparable efficacy with an advantage in overall survival in patients with platinum-free interval of 6–12 months. A platinum-free interval prolongation by the use of non-platinum mode increases the efficiency of subsequent platinum-based therapy, increasing the life expectancy of patients . Currently under study molecular markers and prognostic factors allowing to define a group of patients who have the greatest benefit from the use trabectedin with pegylated liposomal doxorubicin as second-line chemotherapy.

 

Annals of the Russian academy of medical sciences. 2013;68(11):115-121
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