[The development of health preservation technologies: from individual to family approach].

The actuality of considered problem is in the fact that many medical social problems of preserving and improving population health can be resolved by the family and with its support. The purpose of the study is to substantiate scientifically priority of family approach in development of National health preservation system in actual conditions. MATERIALS AND METHODS: The national and foreign electronic databases were investigated to find publications concerning transformation of matrimonial relations, effect of family on health and need in health preservation technologies at each stage of its development. RESULTS: It is demonstrated that implementation of family-oriented technologies of health preservation based on knowledge of trends in family health, matrimonial relations and demographic shifts in its structure is one of the priority directions of preserving and strengthening population health. Moreover, in modern socioeconomic conditions, the categories of families that are in special need of medical social protection and health preservation such as socially problematic families, families where violence is practiced, families of the unemployed and migrants are shown up. Hence, one of the priority scientific tasks is to substantiate conceptual model of health preservation technologies for various types of families. CONCLUSION: The family and its health should become priority object of medical observation and research studies from the standpoint of public health and health care.

Long-term assessment of clinical outcomes and disease progression in patients with corrected Tetralogy of Fallot.

OBJECTIVE: Understanding changes of right ventricular (RV) geometry and function in repaired Tetralogy of Fallot (rToF) patients can improve decision-making for pulmonary valve replacement. Therefore, we aimed to assess the magnitude and clinical correlations of RV changes in rToF patients. PATIENTS AND METHODS: Clinical and MRI data of rToF patients who underwent repeated cardiac magnetic resonance imaging (MRI) at two centers between December 2003 and September 2020 were analyzed together with anatomical factors, including RV outflow tract obstruction, pulmonary artery branch stenosis, and tricuspid regurgitation. Adverse cardiac events and/or NYHA class worsening were documented and correlated with MRI changes. QRS length was reported at each MRI. RESULTS: Two-hundred-and-nineteen rToF patients (53% males, aged 20.2 ± 10.1 years) were enrolled. An increase of ventricular dimensions, except LVEDVi, and worsening of right and left ejection fractions were found over an average period of 5 years of follow-up. These changes were statistically significant but within 10% of the initial value. No significant changes were reported on a year-to-year basis, except in a small group of patients (6%) in whom no predictive factors were identified. Despite similar RV dimensions at the first examination, younger patients had a higher RV ejection fraction and a different annual rate of change of ventricular dimensions compared to older ones. Patients with arrhythmias (20%) were more frequently older and had larger RV dimensions but showed no significant correlations with MRI changes/years. CONCLUSIONS:  Changes in RV dimensions and function occur rarely and very slowly in rToF patients. A small percentage of patients experience a significant worsening in a short time interval without any recognized risk factors. Arrhythmias appear to occur in a small percentage of cases in the late follow-up.

[The medical social problems and methods of diagnostic of cognitive disorders in patients taking "Spice"].

The article presents the results of pilot study implemented to determine cognitive disorders in patients taking "Spice". The purpose of research is to identify targets of psychological correction interventions to prevent cognitive deficiency in patients addicted to synthetic cannabinoids. The pilot sampling consisted of 30 patients taking "Spice". The control group consisted of 30 healthy individuals. Along with social consequences, one of the important focuses of the study was investigation of cognitive sphere of patients. A number of pathopsychologic tests was applied. The study established that patients demonstrated disorders of various functions of memory, attention, mental pace and thinking. In particular, disorders of short-term, long-term and mediate memory and mental tempo were revealed. Also, reduced activity of attention took place. The distortion and decreasing of generalization and poor prehension occurred reliably more often as compared with control group. The established cognitive disorders in patients taking "Spice" can be considered as targets for psychological correction interventions to prevent cognitive deficiency in patients addicted to synthetic cannabinoids.

[The priority directions of forming and supporting healthy life-style in megalopolis conditions].

The activities related to formation and maintenance of healthy life-style of population are to be carried out in accordance with the Strategy of prevention of chronic non-communicable diseases. The purpose of the study is to analyze current trends in the formation of healthy life-style of Moscow residents and to determine priority areas of its maintenance. Materials and methods. The analysis of the lifestyle of the Moscow population in conditions of actual infrastructure of urban environment was carried out as exemplified by two administrative Okrugs. According to dispenasarization data the prevalence risk factors of chronic non-communicable diseases. in Moscow residents was investigated. The Results. It is demonstrated that in actual conditions, the population is be provided with recommendations concerning development of stress resistance, proper diet and physical activity enhancement using really existing integrated prevention space. The specialists involved into issues of citizens following healthy life-style in their professional activities are to rely on the results of both study of characteristics of self-preservation behavior of population and analysis of the state of prevention infrastructure in particular municipality.

SypHer3s: a genetically encoded fluorescent ratiometric probe with enhanced brightness and an improved dynamic range.

We designed a genetically encoded ratiometric fluorescent probe, SypHer3s, with enhanced brightness and optimized pKa, which responds to pH changes in different cellular compartments. SypHer3s was successfully utilized for imaging the pH dynamics in mitochondria of living neurons and in quantitative pH measurement in zebrafish embryos.

[A clinical observation of an extensive chondroma of oro- and laryngopharynx]. / Klinicheskoe nabliudenie obshirnoi khondromy roto- i gortanoglotki.

This article was designed to report a rare case of oropharyngeal chondroma in a 31 year-old male patient. Computed tomography revealed an encapsulated cystic-solid tissue mass having the clear-cut contours with multiple diffuse foci of calcification in the tissue thickness. The neoplasm was morphologically characterized as a chondroma. The tumour was removed with the use of the modified Lauers-Balon procedure with the dissection of the lower jaw.

Adhesion molecule increases in sleep apnea: beneficial effect of positive airway pressure and moderation by obesity.

BACKGROUND: Elevated levels of intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) may contribute to cardiovascular disease and are associated with obstructive sleep apnea (OSA) and obesity. The relationship between OSA and obesity in determining ICAM-1 and VCAM-1 levels, and the effect of treatment, is unclear. OBJECTIVE: Our aim was to study whether positive airway pressure (PAP) usage resulted in changes in ICAM-1 and VCAM-1 after 2 years within 309 OSA patients from the Icelandic Sleep Apnea Cohort, and determine how obesity affected such changes. SUBJECTS/METHODS: The mean body mass index (BMI) was 32.4±5.1 kg m(-2); subjects had moderate-to-severe OSA (apnea-hypopnea index=45.0±20.2) and 79% were male. There were 177 full PAP users (⩾4 h per night and ⩾20 of last 28 nights), 44 partial (<4 h per night or <20 nights) and 88 nonusers. RESULTS: ICAM-1 (P<0.001) and VCAM-1 (P=0.012) change was significantly different among the PAP groups. The largest ICAM-1 differences were among the most obese subjects (P<0.001). At follow-up, nonusers had increased ICAM-1 compared with decreased levels in full users. All groups had increased VCAM-1, but nonusers had a significantly larger increase than full users. CONCLUSIONS: Within moderate-to-severe OSA patients, PAP usage prevents increases in adhesion molecules observed in nonusers after 2 years. For ICAM-1, the largest effect is in the most obese subjects. As OSA and obesity commonly coexist, the usage of PAP to limit increases in adhesion molecules may decrease the rate of progression of OSA-related cardiovascular disease.

[Induction and protective properties of antibodies against muramyl peptides of gram-negative bacteria].

AIM: Characterize the role of humoral immune response in mechanisms of action of muramyl dipeptide immune stimulators. MATERIALS AND METHODS: Mice were immunized by a complex of muramyl peptides (CMP) obtained from Salmonella typhi peptidoglycan and consisting of 3 components: 1) N-acetyl-D-glucoasminyl-(beta1- > 4)-N-acetyl-D-muramoyl-L-alanyl-D-isoglutaminyl-meso-diaminopimelic acid (GMtri); 2) N-acetyl-D-glucosaminyl-(beta1- > 4)-N-acetyl-D-muramoyl-L-alanyl-D-isoglutaminyl-meso-diaminopimeloyl-D-alanine (GMtetra) and 3) GMtetra dimer (diGMtetra), in which monomeric residues of GMtetra are linked by an amid bond between carboxyl group of terminal D-alanine of one of GMtetra residues and omega-amino group of meso-diaminopimelic acid of the other GMtetra residue. RESULTS: Immunization resulted in a multifold increase of IgM, IgG1 and IgG2a titers against CMP. Antibodies were directed against the whole molecule of diGMtetra and did not recognize its fragments. Sera of mice immunized with CMP protected the mice from lethal infection with Gram-negative (S. typhimurium) but not Gram-positive (Staphylococcus aureus) microorganisms. CONCLUSION: Induction of protective antibodies may present a novel mechanism of action of muramyl dipeptide immune stimulators.

A reporter system for replication-competent gammaretroviruses: the inGluc-MLV-DERSE assay.

Although novel retroviral vectors for use in gene-therapy products are reducing the potential for formation of replication-competent retrovirus (RCR), it remains crucial to screen products for RCR for both research and clinical purposes. For clinical-grade gammaretrovirus-based vectors, RCR screening is achieved by an extended S(+)L(-) or marker-rescue assay, whereas standard methods for replication-competent lentivirus detection are still in development. In this report, we describe a rapid and sensitive method for replication-competent gammaretrovirus detection. We used this assay to detect three members of the gammaretrovirus family and compared the sensitivity of our assay with well-established methods for retrovirus detection, including the extended S(+)L(-) assay. Results presented here demonstrate that this assay should be useful for gene-therapy product testing.

[Treatment outcome of chemotherapy with superselective cerebral artery catheterization in vegetative state patients].

The purpose of the study is to assess the impact of superselective neurotransmitter metabolic therapy in patients in a vegetative state. Superselective intraarterial infusion was conducted on 26 patients with relevant international criteria for the diagnosis of vegetative state. Comprehensive assessment of neurologic symptoms and severity of low metabolism on PET scan allowed to select the vascular pool, for the catheter installation. The catheter was placed either in the carotid or the vertebrobasilar pool. Infusion of neurotransmitter agents was conducted for 7 days continuously. Control of the level of metabolism of labeled glucose in the brain (PET) was performed within 2 weeks after arterial infusion. 14 out of 26 patients showed a positive trend of changes in energy metabolism of the brain. However, only 7 out of 14 patients showed further recovery of consciousness. The data confirms that the delivery path and a combination of medications play a definite role in the effectiveness of vegetative state therapy.

[Structural and functional disorders of erythrocyte cell membrane in patients with Crohn's disease].

Investigation of erythrocyte membrane in patients with Crohn's disease detected the changes in asymmetry of its molecular components, abnormalities in normal functioning of membrane-associated enzymes and energy-dependent processes in the cell. The mechanism of damaging effect on the cell membrane was caused by the excessive blood accumulation of a composite complex of low-molecular substances, compounds of quinone and carbohydrate nature, peptides, modified forms of nucleotides. The revealed changes make it possible to assess the severity of endogenous intoxication and cell membrane disorder, which take place not only in the course of the disease acute attack, but also retain during the period of incomplete clinical and endoscopic remission.

[Personal anxiety and ischemic heart disease].

AIM: To study correlations between personal anxiety (PA) as one of the leading psychosocial factors and ischemic heart disease (IHD). MATERIAL AND METHODS: The third screening (1994) of the program MONICA and subprogram MOPSY-MONICA-psychosocial covered a random representative sample of males at the age of 25-64 years living in Novosibirsk. The response was 82% (657 responders, mean age 44.3 +/- 0.4 years). Statistical analysis was based on the SPSS-10 software package. RESULTS: Prevalence of PA as an indication of social stress in a male population of 25-64-year-olds is very high especially in young age groups. PA is maximal among persons with elementary education and workers. Persons with PA experience strong stress in job and in family settings. An IHD rate is higher among PA patients. High PA is often associated with depression, high hostility, cachexia, sleep problems, low social support. PA patients have a negative opinion of their health but their attempts to improve it are insufficient. The proportion of those who quit smoking, reduce the number of cigarettes, keep diet, restrict physical activity grow in PA persons. CONCLUSION: PA is prevalent among male population especially in young persons. A PA level correlates with social status. IHD occurs more frequently in PA persons. High PA often associates with other psychosocial factors.

[Study based on the WHO Monika program on the connection between psychosocial risk factors and ischemic heart disease in men aged 25-64 in Novosibirsk]. / Izuchenie na osnove programmy BOZ monika sviazi psikhosotsial'nykh faktorov riska s ishemicheskoi bolez'niu serdtsa u muzhchin v vozraste 25-64 let v Novosibirske.

AIM: To study correlations between coronary heart disease (CHD) and psychosocial risk factors. MATERIAL AND METHODS: CHD affected more frequently workers engaged in hard physical labour, in poorly educated persons; the least CHD morbidity was recorded in managers and highly educated persons. CHD males think of their health much worse than males free of CHD. The former smoked much more before CHD diagnosis, but when CHD comes they quit and reduce smoking much more frequently. This fact explains why smokers are encountered among CHD patients two times less frequently than in CHD-free males. In spite of stronger motivation for adequate diet, CHD males changed their nutrition pattern only in 3.7%. CHD males sleep worse: good sleep was registered in CHD-free males two times more frequently. Psychological risk factors such as personal anxiety, sleep disorders were reported much more frequently in CHD patients proving the fact of social stress involvement in development of CHD. So-called coronary behavior was observed in both groups of males with the same rate. Thus, the coronary behavior is not associated with CHD. CONCLUSION: Development of CHD is associated not with the behavior but its components (depression, anxiety, etc.).

[10-year dynamics of attitude to health problems in the male population of Novosibirsk (epidemiological study based on the WHO MONICA program)]. / 10-Letniaia dinamika otnosheniia k voprosam zdorov'ia muzhchin populiatsii Novosibirska (épidemiologicheskoe issledovanie na osnove programmy BOZ MONIKA.

AIM: To evaluate changes for a decade in the attitude of men in Novosibirsk to health problems. MATERIAL AND METHODS: WHO program MONICA has covered males aged 25-64 years (a representative sample from the population in one of the districts of Novosibirsk city). A total of 3 trials were made (in 1984, 1988 and 1994) which included questioning, registration of ECG, arterial pressure, height, body mass, biochemical tests of the blood. RESULTS: Attitude of men to their health depended on their age. There was a trend to evaluate their health as more and more poor in men at the age of 25-43 and 35-44 years. In the group of 45-54-year-olds positive assessment of health was encountered 1.9 times more frequently, but the difference was not significant. At the age 55-64 years a growing number of men tend to assess their health as good. Since 1994 alcoholics among the elderly men grew in number as a response to the social and economic crisis. CONCLUSION: The change in health evaluation from negative to positive in older men may relate to less intensive work.

[WHO MONICA program-based study of awareness of their health and health attitude in males and females aged 25-64 years from Novosibirsk]. / Izuchenie na osnove programmy VOZ MONIKA informirovannosti o svoem zdorov'e i otnoshenii k nemu u muzhchin i zhenshchin v vozraste ot 25 do 64 let v Novosibirske.

AIM: To assess the attitude of the Novosibirsk population towards its health, its readiness to participate in preventive measures and to implement guidelines for changing lifestyle. MATERIALS AND METHODS: A random representative sample of males and females (a total of 2400 individuals) aged 24 to 64 years from one of the Novosibirsk districts was examined within the framework of the second screening of the MONICA program studying the trends and monitoring cardiovascular diseases and the "MOPSY-MONICA-psychosocial" subprogram. The examination included the conventional procedures described in the MONICA project. Sleep disorders, health self-assessment, and attitude to smoking were studied by means of the questionnaire "Awareness and Attitude towards Health" adapted to the studied population. RESULTS: More than 60% of the males and 85% of the females reported that they were not quite healthy or ill, only 7% of the individuals had their health examined although almost 100% noted that they were most likely to fall ill with a serious disease within 5-10 years. The males were more optimistic in their assessments than were the females. With age, the frequency of assessments, such as "not quite healthy" and "ill", concern about their health, and participation in prophylactic examinations increased. 45% of the respondents reported about the high level of stress in their working place. The opportunity of the examinees to have a rest at home was extremely little. Family stress was significant for both sexes. The females showed a more negative attitude towards smoking than did the males (55% of the males and 5% of the females were smokers). The males more frequently considered that they did not need to alter dietary habits and to do exercises than did the females. A total of 2.4% of the males and 2.5% of the females changed their dietary habits for their health. Only 50% of the males and 31% of the females slept well or very well, this parameter decreased with age. CONCLUSION: Despite a positive motivation in the context of prophylaxis, there are negative trends in both social and behavioral characteristics of the population. The most intensive measures for altering the behavioral characteristics of the population and for softening the impact of stress on the population are required at the governmental level.

Saccular aneurysms of meningeal artery: case report.

OBJECTIVE AND IMPORTANCE: A rare observation of double saccular aneurysms of the meningeal artery is presented. CLINICAL PRESENTATION: This 22-year-old man was referred to the Neurosurgical Institute with a suspicion of an aneurysm of the anterior communicating artery. Bilateral angiography of the carotid arteries was performed 1 week after the subarachnoid hemorrhage, but the aneurysms were not visualized. Routine angiography of both carotid arteries and selective studies of the left vertebral artery were performed again, and angiography of the right carotid artery revealed an aneurysm. The patient's neurological state at the time of admission was normal. Fundoscopic examination revealed papilledema and conjunctival injection of the left eye. INTERVENTION: The patient was treated using a right pterional approach. One aneurysm had caused spontaneous subarachnoid hemorrhage. The aneurysms were removed using a direct approach, with histological examination of dura matter fragment containing both aneurysms. The results of the patient's 2-week follow-up examination were normal. Follow-up angiography of the right carotid artery showed absence of the aneurysm with a clip on the branch of meningeal artery. CONCLUSION: Saccular aneurysms of the meningeal artery can be manifested by subarachnoid hemorrhage, and intradural arterial aneurysms are similar to saccular cerebral vessel lesions structurally.

[The effect of hemodilution on the indices of aerobic metabolism and water metabolism in children with congenital heart defects operated on under artificial circulation]. / Vliianie gemodiliutsii na pokazateli aérobnogo metabolizma i vodnogo obmena u detei s vrizhdennymi porokami serdtsa, operirovannykh v usloviiakh iskusstvennogo krovoobrashcheniia.

The majority of pediatric cardiosurgery centers make use of cardiopulmonary bypass (CPB) with low hematocrit, and therefore we deemed it interesting to investigate the pathological effects of hemodilution on patients. Specifically, we studied the effect of hemodilution on aerobic and water metabolism in children with congenital heart disease subjected to CPB. Two groups of patients were examined. In the studied group (n = 12, mean age 7.1 +/- 1.1 years) the blood-fluid ratio in primary filling of the CPB device was 1:6.2 +/- 0.7 and minimal hematocrit during myocardial ischemia 18 +/- 0.7%. Control group consisted of 7 patients aged 8.3 +/- 0.6 years, with the above values 1:2.8 +/- 0.4 and 22 +/- 1.6%, respectively. The groups were similar as regards the initial status of patients, level of hypothermia, and duration of myocardial ischemia. Gas content in venous blood was the criterion of aerobic metabolism. Fluid accumulation in the extravasal space during and after surgery was assessed by bioelectroimpedance measurements of the total extracellular extravasal fluid (EEF). Monitoring showed a decrease of hematocrit during CPB to 18 +/- 0.7%, saturation of venous blood with oxygen within 70-75%, and oxygen content 37-43 mm Hg. In the main group a manifest increase of EEF was observed as early as during the early postperfusion period; this increase is probably one of the main components in the detrimental effect of hemodilution. Redistribution of fluid after CPB leads to expressed interstitial edemas and impairs the function of vital organs. That is why signs of cardiorespiratory failure were observed in the main group. Thus, one of the main problems in CPB with low hematocrit is fluid accumulation in the extravasal space.

Pilot study of intraoperative high dose rate brachytherapy for head and neck cancer.

PURPOSE: To develop a new technique, intraoperative high dose rate brachytherapy (IOHDR), to deliver localized radiation therapy intraoperatively to head and neck tumors at sites inaccessible to intraoperative electron beam radiotherapy (IOEBRT) in the skull base region. METHODS: After maximal surgical resection, afterloading catheters spaced 1 cm apart embedded in custom surface applicators made of foam or silicone were placed on resected tumor beds. IOHDR was delivered in a shielded operating room using preplanned dosimetry with a nominal 10 Ci iridium-192 source in an HDR micro-Selectron afterloader. Twenty-nine patients (20 males, 9 females) ranging in age from 9 to 80 years (median = 61) were irradiated intraoperatively for advanced head and neck tumors at sites inaccessible to IOEBRT. Six patients who had previously received external beam radiation (EBRT) ranging from 50 to 75 Gy, were given 15 Gy of IOHDR only. Twenty-three patients who had no prior radiation received 7.5 to 12.5 Gy IOHDR, and 45 to 50 Gy EBRT was planned post-operatively; however, six of these patients did not complete the planned EBRT. Doses to normal tissues were reduced whenever possible by shielding with lead or by displacement with gauze or retractors. Treatment time ranged from 3.8 to 23 min (median = 6.5 min). Five patients received concurrent cis-platinum based chemotherapy. RESULTS: Twenty-nine patients treated to 30 sites had local tumor control of 67% and crade survival of 72%, with the follow-up ranging from 3 to 33 months (median = 21 months). In the group of 17 previously unirradiated patients who had completed full treatment (IOHDR and EBRT) to 18 sites, the local tumor control was 89%, and all of these patients survived. Tumor control in the six previously unirradiated patients who did not complete EBRT was 50% with a crude survival of 50%. In the group of six previously irradiated patients treated by IOHDR only, the local tumor control was 17% with a crude survival of 17%. No intraoperative complications were noted. The delayed morbidity included cerebrospinal fluid (CSF) leak with bone exposure (1), chronic subdural hematoma (1), septicemia (1), otitis media (1), and severe xerostomia (1). We cannot comment on long-term morbidity due to the relatively short follow-up period of 21 months. CONCLUSIONS: It is feasible to deliver IOHDR, with acceptable toxicity, to skull base tumors at sites inaccessible to IOEBRT. The use of IOHDR as a pre-radiotherapy boost produced excellent local control and survival in the selected group of patients who had no previous radiation therapy. The use of exclusive IOHDR in the previously irradiated group resulted in poor outcome, possibly due to the limitations on re-irradiation doses and/or volumes determined by normal tissue tolerance or because these patients have inherently radioresistant tumors. Higher IOHDR doses, additional EBRT, and/or chemotherapy should be considered for this group. The use of IOHDR as a pre-EBRT boost to maximize local control has a promising future in the treatment of carefully selected patients with advanced skull base tumor.