[New clinical guidelines for COPD - a paradigm shift: A review].

Chronic obstructive pulmonary disease is now one of the most common noncommunicable diseases and the main causes of morbidity, disability and mortality in the world. In recent years, new approaches to epidemiology, diagnosis, classification (categorization), evaluation of phenotypes, as well as characterization and assessment of the severity of сhronic obstructive pulmonary disease exacerbations have emerged. Modern approaches to starting and subsequent drug therapy have changed significantly. This is largely due to the results of recently conducted major clinical trials, demonstrated high efficacy of triple fixed combinations, including inhaled glucocorticosteroids, long-acting beta-agonists and long-acting anticholinergic drugs. The use of non-medication methods (smoking cessation, physical activity and respiratory rehabilitation) and modern approaches to the treatment of respiratory failure and antibiotic therapy remain important. In terms of their significance, all these updates have a significant impact on real clinical practice and can be considered as a novel paradigm of the approaches to the diagnosis and management of this disease.

[Results of clinical studies of the efficacy and safety of the use of ethylmethylhydroxypyridine succinate in patients with chronic cerebral ischemia]. / Rezul'taty klinicheskikh issledovanii effektivnosti i bezopasnosti primeneniya preparatov etilmetilgidroksipiridina suktsinata u patsientov s khronicheskoi ishemiei golovnogo mozga.

Chronic cerebral ischemia (CCI) is a common syndrome that, in the absence of adequate therapy, is characterized by a progressive course, an increase in cognitive, emotional, motor and other disorders, eventually leading to persistent disability of the patient. In the treatment of patients with CCI, the use of drugs with a multimodal neuroprotective effect is indicated. The results of the analysis of a series of clinical trials of the drugs Mexidol and Mexidol FORTE in patients with CCI are presented. The effects in relation to cognitive, emotional, asthenic, vegetative and other manifestations of CCI are considered. It is concluded that it is advisable to consistently use the drugs Mexidol and Mexidol FORTE in such patients.

[Peculiarities of Mild Asthma in Russia: the Results of SYGMA2 Study].

AIM: Patients with mild asthma may experience severe exacerbations. This analysis was conducted to investigate regional peculiarities of mild asthma population in Russia. MATERIALS AND METHODS: The SYGMA2 is a double-blind multinational study involving adult patients with mild asthma (n=4176). We conducted an open-label descriptive analysis of the baseline characteristics of the Russian group (n=579) of SYGMA2 trial comparing to SYGMA2 population from other countries. The subanalysis was descriptive only, and no hypothesis were tested. RESULTS: The Russian population of patients with mild asthma was comparable to the rest of countries in terms of demographic characteristics, smoking status and duration of asthma. The spirometric parameters in the Russian group was slightly worse than in the other population. At the study entry 48% of Russian patients had symptom control on maintenance therapy, but 52% were uncontrolled on short-acting bronchodilators. While in other countries this ratio was inverse (55/45%). More patients with mild asthma in the Russian group had at least one severe exacerbation in the previous year (30.1% vs 20.7% in other countries). CONCLUSION: We revealed a delayed prescription of controller therapy and overuse of short-acting bronchodilators in the Russian group of mild asthma patients, that may increase risk of asthma non-control and severe exacerbation.

[Efficacy and safety of ethylmethylhydroxypyridine succinate in patients with chronic cerebral ischemia]. / Effektivnost' i bezopasnost' primeneniya etilmetilgidroksipiridina suktsinata u patsientov s khronicheskoi ishemiei golovnogo mozga.

Chronic cerebral ischemia (CCI) is a common cerebrovascular syndrome, the development of which is associated with a high risk of increasing cognitive, behavioral, and motor disorders, and the formation of a patient's dependence on others. Timely start of treatment can slow down the course of the disease, make it more favorable. The review considers the possibility of using the domestic neuroprotector mexidol in patients with CCI. The results of a series of clinical studies on the use of ethylmethylhydroxypyridine succinate (mexidol) in patients with CCI are analyzed. The effectiveness of the drug in relieving cognitive, affective and motor disorders is noted. Information about the good tolerance of mexidol is presented.

[The efficacy of ethylmethylhydroxypyridine in the rehabilitation treatment of poststroke patients]. / Effektivnost' primeneniya etilmetilgidroksipiridina suktsinata v vosstanovitel'nom lechenii patsientov, perenesshikh ishemicheskii insul't.

The analysis of the clinical efficacy and safety of ethylmethylhydroxypyridine succinate (mexidol) in the complex of rehabilitation measures in patients after ischemic stroke (IS) shows that course treatment with mexidol improves the recovery of neurological functions, decreases neurological deficit, cognitive disorders, including memory impairment, and manifestations of asthenic syndrome, increases the level of social adaptation and improves the psycho-emotional state of patients, reduces spasticity, increases motor and speech activity, praxis, reliably eliminates the ignoring syndrome. There is a decrease in the level of total cholesterol and low-density b-lipoproteins in the blood, and decrease in the severity of hypercoagulation. The results of the studies have convincingly shown the efficacy of mexidol at all stages of rehabilitation treatment of patients with IS.

[Efficacy and safety of ethylmethylhydroxypyridine succinate in patients with ischemic stroke]. / Effektivnost' i bezopasnost' primeneniya etilmetilgidroksipiridina suktsinata u patsientov s ostrym ishemicheskim insul'tom.

Stroke is still the most significant problem of the modern medicine and the leading cause of mortality and morbidity. There is the great experience of neuroprotection in patients with stroke in the Russian Federation. In clinical practice it's important to follow conditions, where neuroprotection will have maximum safety and effectiveness. The clinical trials of ethylmethylhydroxypyridine succinate (mexidol) in patients with acute ischemic stroke are described in the present review. Early management (in the first 6 hours) with mexidol significantly improve recovery dynamic and stroke outcome. Therapy with mexidol increases neurological recovery, improves vital activity and quality of life of patients with stroke. Furthermore, mexidol demonstrates high safety profile.

Correction of oxidative stress in patients with chronic cerebral ischemia.

A pilot study of the effect of the antioxidant drug ethylmethylhydroxypyridine malate on indicators of oxidative stress in patients with chronic cerebral ischemia. At 6 day course administration investigated the antioxidant in these patients significantly accelerates the process of generation of superoxide anion radical, established by lucigenin-depended chemiluminescence that probably regulate a feedback mechanism oxidase systems. This increases the activity of superoxide dismutase, and reduced the concentration of secondary peroxidation product - malondialdehyde, making reasonable use of antioxidants in the treatment of this pathology.

[Mutations of the Epstein-Barr virus LMP1 gene mutations in Russian patients with lymphoid pathology and healthy individuals].

Epstein-Barr virus (EBV) is an etiological agent of a number of benign and malignant human diseases, such as infectious mononucleosis (IM), Hodgkin's lymphoma (HL), and non-Hodgkin's lymphoma (NHL). EBV latent membrane protein 1 (LMP1) gene (recognized as a viral oncoprotein) of various clinical and geographical origin was found to have different types of amino acid mutations affecting its biological activity. Since there was no information on the strain differences in LMP1 of EBV persisting in Russia, the authors made a sequence analysis of LMP1 samples amplified from the biological materials of Russian patients with IM, HL, and NHL and healthy individuals. The studies have shown that LMP1 variants of Russian origin are a mixed heterogeneous group containing both the earlier characterized and presumably new genetic variants. Among the point amino avid substitutions, the mutations S366T, F106Y, 185L, and E328Q associated with the enhanced transforming activity of a LMP1 molecule and its reduced cytotoxicity. There was no specific association between the certain Russian variants of LMP1 and the specific forms of the disease (IM, HL, and NHL).

[A clinicoeconomic model of basic therapy for bronchial asthma].

The paper is dedicated to analysis of the most wide-spread variants of bronchial asthma (BA) basic therapy. The analysis was based on the results of a large (1362 patients from 34 Russian cities) pharmacoepidemiological study. Different models of pharmacotherapy were assessed on the basis of clinical data (the frequency of symptoms), the risk of BA exacerbation, the volume of public health resources used, and the cost of treatment. The results of the study showed that the use of set combinations of inhaled glucocorticosteroids and long-acting , beta2-adrenostimulators was most effective and rational from economic perspective under real clinical conditions.

[New methods of stroke prevention in patients with chronic brain ischemia stages II-III, accompanied by hypercholesterolemia].

The problem of cerebrovascular diseases prevention is currently urgent not only in neurology, but in the community as a whole, because of the leading rates of vascular diseases in population disability and mortality. Hypercholesterolemia is one of the corrected risk factors for the development of the given diseases. The results of the study of 109 patients with CBI, II-III stages, treated with the drug liprimar and a new physiotherapeutic device, the neutralizer of free radicals, for cholesterol level optimization are presented.

[Methodological bases of early psychosocial rehabilitation of poststroke patients in neurological hospital].

Based on the principles of rehabilitation elaborated by M.M. Kabanov (partnership, multidirectional nature and intergrity of psychosocial efforts), the authors have worked out a model of a complex team (neurologist, psychiatrist, psychotherapist and all medical personnel of the neurological unit) biopsychosocial approach to early psychosocial rehabilitation of patients who survived acute) ischemc attack. During the period of 2001-2004, comorbid mental disorders of psychotic (36%) and neurosis-like (64%) types were found in 356 patients (132 male, 224 female aged 40-59 years, 60-79 years and over 80 years. The model of organization of psychiatric/psychotherapeutic care ("interaction-attachment") is presented. Using combined psychopharmacotherapy (sonapax, neuleptil, haloperidol, coaxil, cipramil, phenazepam, xanax, mexidol, nootropil, etc) and an adequate psychotherapy basing on the principle of simultaneous biological and social action on poststroke patients (or persons socially significant for them and unit personnel), it was possible to raise quality of neurological as well as psychopharmacological and psychotherapeutic, in case of comorbid mental disorders, care that proved to be a main factor of early inpatient stage of psychosocial rehabilitation. As a result, there was an improvement of quality of life of poststroke patients in disease-modified conditions of their further biopsychosocial being.

[Current principles in the organization of emergency surgical care in a large city]. / Sovremennye printipy organizatsii ékstrennoi khirurgicheskoi pomoshchi v usloviiakh krupnogo goroda.

The specific character of emergency surgical care requires a concentration of highly skilled specialists of various profiles on the basis of multi-type hospitals and using expensive modern, highly informative and less invasive methods of diagnosis and treatment. The using of multi-type hospitals for emergency medical care will allow the intensification of treatment, wide application of less invasive technologies that will result in the appearance of incentives and conditions to shorten the number of bed-days, restriction of groundless hospitalization and to improve the tariff politics in the system of compulsory medical insurance.

[Structural and functional features of Epstein-Barr virus LMP-1 gene in patients with anaplastic carcinoma of the nasopharynx in Russia]. / Strukturnye i funktsional'nye osobennosti gena LMP-1 virusa Epshteina-Barr u bol'nykh nedifferentsirovannym rakom nosoglotki v Rossii.

Epstein-Barr virus (EBV) is known to be closely associated with the development of anaplastic nasopharyngeal carcinoma (NPC) in some malignancy endemic regions in South-East Asia. LMP1 gene is one of the EBV latent genes, which encodes a latent membrane protein. LMP1 gene is thought to be a classical oncogene since it morphologically transforms cells in vitro and induces tumors in experimental animals in vivo. LMP1 is one of a few genes which is expressed in NPC tissues. It was first shown that C-terminus of LMP1 gene obtained from NPC patients in South-East Asia contained a deletion of 30 base pairs (bp). However, this deleted LMP1 gene was then found in the EBV isolates persisting among healthy virus carriers and patients with other EBV-associated abnormalities from both NPC endemic and non-endemic regions. The aim of this investigation was to accomplish a molecular biological analysis of EBV LMP1 genes obtained from Russian NPC patients. To this end, the authors isolated and sequenced the LMP1 clones amplified from the tumor tissues from 7 NPC patients at the N. N. Blokhin Russian Cancer Research Center and primary blood lymphocytes (PBL) from 6 healthy donors. As a result, the authors could not find the deletion of the above-mentioned 30 bp in NPC LMP1 clones, but could in one healthy donor (PBL-2). A functional analysis revealed no significant differences between LMP1 variants with or without 30 bp deletion in their capacity to activate NF kappa B and jun/AP-1 transcription factors. Nevertheless, Russian NPC-derived LMP1 variants as compared with those from PBLs featured some specific amino acid exchanges. These data indicate that the 30 bp deletion of LMP1 gene is not a factor that predisposes to NPC in Russia.

[Bladder foreign body in a 4-year-old girl]. / Inordnoe telo mochevogo puzyria u devochki 4 let.

The specific feature of this case presented is the prolonged clinical manifestations of cystitis despite long-term and diversified antibacterial therapy. Repeated ultrasonography was justifiable in this cases since it could reveal a cause of protracted cystitis. Thus, in the young child long-term dysuria and urinary infection may be caused by a bladder foreign body.

[Functional furosemide loading test. Practical use in children with kidney diseases]. / Funktsional'naia nagruzochnaia proba s furosemidom. Prakticheskoe ispol'zovanie u detei s zabolevaniiami pochek.

Diuretic and aciduretic reactions were compared in healthy children and children with various renal diseases using furosemide loading test. Diuresis, urinary pH, urinary excretion of titered acids and ammonium, and ammonium coefficient were evaluated in healthy controls, patients with chronic and acute renal insufficiency, convalescents after acute renal insufficiency and acute postinfection glomerulonephritis, patients with chronic pyelonephritis, interstitial nephritis, lipoid nephrosis, hematuric chronic glomerulonephritis, and patients with a solitary kidney. Diuresis, urinary pH, ammonium excretion, and ammonium coefficient are proposed as the main test parameters. Patients with the distal tubular acidosis syndrome formed a special group by the results of urinary pH measurements during the third hour of furosemide action. The test helps evaluate the severity of disease and predict its course.

[Use of gas-current coagulation in the local treatment of gunshot wounds]. / Primenenie gazotokovoi koaguliatsii dlia mestnogo lecheniia pri ognestrel'nykh ranakh.

The article is devoted to the using of gas-current coagulation for treatment of gunshot wounds in experiment. A new technology of physical action on biological tissues allows the simultaneous performing of hemostasis, sterilization of the wound surface, dissection and evaporation of the tissue. The isolation of the wound surface from unfavorable aggressive factors of the environment due to the layer of thermal necrosis results in shortening the 1 phase of the wound process and in earlier development of its second phase. Healing proceeds by the type of productive inflammation. The use of the gas-current coagulation during the performing of the primary surgical treatment of gunshot wounds allowed to considerably reduce its time, improve its quality, substantially lessen the amount of infectious complications, considerably improve the indices of the wound process and results of treatment.