[Aerobic exercise and fatigue indices in rheumatoid arthritis patients in the health resort care setting]. / Aerobnye uprazhneniya i pokazateli ustalosti u bol'nykh revmatoidnym artritom v usloviyakh sanatorno-kurortnogo lecheniya.

Fatigue is one of the most common symptoms of rheumatoid arthritis (RA). There is strong evidence that physical activity is an effective way to reduce fatigue. OBJECTIVE: To evaluate the effectiveness of aerobic exercise (walking) to reduce fatigue in RA patients in the health resort setting. MATERIAL AND METHODS: The study involved 102 female patients with RA (age 54.38±11.3 years, body mass index 20-29 kg/m2, DAS28-ESR ≤3.2, with severe fatigue of VAS ≥50) who received 21 days of health resort treatment. The health-improving and therapeutic complex includes dosed physical activity, aerobic exercises (walking). Visual analog scale (VAS0-100) and Bristol Rheumatoid Arthritis Fatigue Scale-Numerical Rating Scale (BRAF-NRS V2) were used to assess fatigue, and the 50-meter walking test was used to evaluate the functional status of patients. RESULTS: A correlation between walking duration and the number of steps at a distance of 50 m (p<0.001) as well as between these indices and fatigue (p<0.001) was shown. A positive effect of a standard three-week medical rehabilitation program for patients with RA on fatigue NRS severity (p=0.003) and NRS effect (p=0.037), as well as on patients' functional status (reduced time spent on the 50-meter test, p=0.01) was demonstrated. When comparing groups of RA patients with low (group 1, <5000-6000 steps per day) and optimal (group 2, ≥7000-8000 steps per day) aerobic exercise, positive results were noted in the short term (at 3 weeks) (p<0.001). CONCLUSION: Aerobic exercise is a promising intervention for treating fatigue in rheumatoid arthritis patients. Medical rehabilitation in a resort setting is the best starting point to encourage performing regular physical activity, as well as the best way to develop exercise programs tailored to rheumatoid arthritis patients.

The Effect of TLR4 Blockade on Some Indicators of Systemic Inflammatory Response to Proteus mirabilis LPS in Rats.

The effects of TLR4 blocker on blood cell morphology, concentrations proinflammatory cytokines, and functional state of the liver and kidneys were studied in outbred male rats (n=60) after intravenous injection of 20 mg/kg LPS isolated from opportunistic Proteus mirabilis strain ATCC 51393. TLR4 blocker TLR4-IN-C34 was injected intravenously in a dose of 1 mg/kg/day over 3 days. Systemic inflammatory reaction induced by LPS was characterized by elevation of serum TNFα, IL-1ß, IL-6, erythrocyte sedimentation rate, leukocytosis, and thrombocytosis. Increased activity of hepatocyte enzymes (ALT, alkaline phosphatase, and lactate dehydrogenase), retention of nitrogen metabolites (urea and creatinine), elevated content of protein oxidation products, and enhanced protein catabolism were also observed. Administration of TLR4 blocker reduced parameters of inflammatory reaction and prevented the development of hypercatabolic syndrome; endotoxicosis and kidney function indicators approached the normal levels.

[Features of central hemodynamics in patients with community - acquired pneumonia depending on the course of the disease and cardiovascular comorbidity].

AIM: The study of intracardiac hemodynamics and blood flow in the pulmonary circuit in patients with community - acquired pneumonia, depending on the presence of concomitant pathology of the cardiovascular system and the severity of the pathological process. MATERIALS AND METHODS: In 43 patients with community - acquired pneumonia (22 men, 21 women, mean age 67±17 years), the functional state of pulmonary - cardiac hemodynamics was assessed by echodoplerography. All subjects were divided into 2 groups: 1st group - 25 patients with community - acquired pneumonia (mean age 49±18 years) without concomitant pathology of the cardiovascular system and 2nd group - 18 patients with community - acquired pneumonia (mean age 70.1±11 years) with concomitant cardiovascular disease. RESULTS: The main ultrasound parameters did not differ from the normal values in patients from the 1st group. In patients from the 2nd group there was a significant deterioration of several pulmonary - cardiac hemodynamics parameters, decrease of left ventricular ejection fraction, significant myocardial hypertrophy of the left ventricle and left atrium size increase. Regarding the right heart chambers it was revealed dilatation of the right ventricle, increasing of the estimated systolic pressure in the right ventricle, deterioration of right ventricle myocardial diastolic function, increase of the: RV/LV size ratio, LV eccentricity index, RV myocardium thickness, diameter of the pulmonary artery, velocity of pulmonary regurgitation and the area right atrium size. In addition, the amplitude of systolic displacement of the tricuspid valve ring and the intensity of inspiratory collapse of the inferior vena cava decreased. Correlation analysis of clinical and laboratory parameters, which are markers of endogenous intoxication, oxygen saturation of arterial blood (SpO2), separately for two groups of patients with community - acquired pneumonia, showed a reliable correlation with a number of informative and used in the practice echocardiography parameters of pulmonary cardiac hemodynamics, characterizing systolic (systolic movement amplitude of the tricuspid valve ring - TAPSE), as well as diastolic function (E/A of the right ventricle) of the heart. CONCLUSION: The relationship between the severity of pulmonary - cardiac hemodynamics disturbances in patients with community - acquired pneumonia, having comorbid pathology, contributing to the deterioration of pulmonary - cardiac hemodynamics and more severe course of the disease with markers of the inflammatory process and oxygen saturation of arterial blood decrease is revealed.

[General anesthesia influence on cochlear implant intraoperative testing]. / Vliianie obshchei anestezii na rezul'taty intraoperatsionnogo testirovaniia kokhlearnogo implanta.

In this article, we consider the influence of combined general anesthesia on the results of electrically-involved stapedial reflex threshold (esrt) registration. We pay a special attention to the anesthesia to exclude its influence on the esrt. This study included 52 patients with bilateral chronic neurosensory hearing impairment. We conducted a retrospective (from 2014 to 2016) and prospective (from 2017 to 2018) analysis of anesthesia protocols. Even though the inhaled anesthesia (sevoflurane in this case) has a depressive effect on esrt registration (the higher the minimal alveolar concentration of anesthetic agent, the higher the reflex threshold), our study shows a possibility of using it in an extended anesthesia monitoring. Inclusion of myorelaxants in cochlear implantation anesthesia protocol not only provides a safe anesthesia, but also does not prevent a timely intraoperative cochlear implant testing.

Efficacy of Arbidol in the prevention of virus-induced exacerbations of bronchial asthma and chronic obstructive pulmonary disease.

AIM: To assess the efficacy and safety of Arbidol in the influenza and ARVI preventing in patients with asthma and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: This study was an open label and prospective during epidemic period of 2016-2017 years. 100 outpatients aged 18 to 80 years with verified asthma and/or COPD, were enrolled to therapy group, and received oral umifenovir 200 mg once daily for 14 days and then 200 mg twice a week for 3 weeks.The medical records data for the same epidemic period of 2016-2017 seasons of the same patients during witch they received no prophylaxis was taken as a control. The data analysis was made by applying parametric and nonparametric statistical methods. RESULTS: Seasonal and post-exposure prophylaxis using umifenovir was associated with 2.6-times reduction in influenza and ARVI morbidity compared to control. In diseased patients (ARVI) of the therapy group the number of patients with mild illness prevailed (62.2%) and was significantly differed from control (37.1%). Severity of catarrhal symptoms and intoxication, was reduced with umifenovir prophylaxis course and were mild in 67.6% and 67.6% respectively of therapy group compared with 43.3% and 46.4% of control. Influenza and ARVI complications were only detected in control group (4 cases). The percentage of patients with incidents of underlying disease exacerbation was 42% in therapy group and 93% in control group. Also, exacerbation in the therapy group were mild in 59.5% and 34.4% in control group, while moderate exacerbation prevailed in control group and was in 59.1% of cases with was significantly higher then in therapy group (39.3%). Results in more frequent use of adjuvant in the control group compared with the therapy group (81.7% and 59.5% respectively). Patients of control group had a higher risk of hospitalizations due to underlying disease aggravation (11.8%), compared with therapy group (9.5%) but these differences were not significant. CONCLUSION: Seasonal and post-exposure prophylaxis with Arbidol reduce influenza and ARVI morbidity in patients with asthma and COPD during epidemic period, frequency and severity of chronic obstructive pulmonary disease aggravations resulting in decrease in the number of hospitalizations. Also, prophylaxis with Arbidol reduced the severity of catarrhal symptoms and intoxication.

[Additive technologies in neurosurgery]. / Additivnye tekhnologii v neirokhirurgii.

Modern achievements of technical progress, in particular additive technologies (ATs) and three-dimensional printing, have been increasingly introduced in neurosurgical practice. The increasing complexity of surgical interventions requires thorough planning of surgery and a high level of training of young neurosurgeons. Creation of full-scale three-dimensional models for planning of surgery enables visualization of the anatomical region of interest. Additive technologies are especially extensively used in reconstructive surgery of skull defects. ATs enable fast and efficient solving of the following tasks: - generation of accurate models of the skull and an implant; - development and fabrication of individual molds for intraoperative formation of implants from polymeric two-component materials (e.g., PMMA); - fabrication of individual implants from titanium alloys or polyetheretherketone (PEEK) for further use in surgery.

[The Effect of Cognitive Load on the Development of Muscle Fatigue].

The aim of our study was to examine the effect of cognitive load on the development of muscle fatigue. Sub- jects performed 250 maximal compressions of a handgrip dynamometer in response to the target acoustic stimulus. Stimuli were presented in three paradigms with different levels of cognitive load: (1) the reaction task with one type of signals (2) the acoustic stimuli recognition task with the 50% target and 50% non-target stimuli, where voluntary attention was involved, (3) the recognition task with the 17% target and 83% non tar- get stimuli, that led to the activation of voluntary and involuntary attention systems. As fatigue indicators amplitude of compression force in response to the target stimulus, the maximum voluntary contraction and rating of perceived exertion were used. Our results showed the reduced level of fatigue in experiment with the activation of voluntary and involuntary attention systems. Moreover, the activation of involuntary attention, accompanied by mismatch negativity in the EEG, enhanced the effect of voluntary attention.

[SELFLESSNESS OF BESIEGED LENINGRAD: PROBLEMS OF MOTHERHOOD AND CHILDHOOD (ON THE OCCASION OF THE 72ND ANNIVERSARY OF LIFTING THE SIEGE)].

A review of documents on the peculiarities of obstetric and gynecological care in besieged Leningrad is presented with special reference to the data about the number of children born during blockade and their health status in the first months of life, the work of maternity hospitals, their number and personnel. The term «military time amenorrhea¼ coined during blockade is discussed.

[Thrombectomy and plication of veins as a method of preventing pulmonary artery thromboembolism at a multidisciplinary surgical hospital].

The authors assessed efficacy and safety of the operation of plication of deep veins of lower extremities, pelvic veins, and the inferior vena cava as a method of preventing fatal pulmonary artery thromboembolism. A total of 48 patients were operated on. Of these, 23 patients belonged to traumatological-and-orthopaedical cohort, 3 to general surgical cohort, 4 to gynaecological, and 18 to vascular cohort (isolated deep vein thrombosis). The length of the floating head of the thrombus varied from 2 to 10 cm. The presence of a floating thrombus in traumatological, surgical and gynaecological patients, regardless of the length of the floating part was an absolute indication for thrombectomy and venous plication. Vascular patients were operated on in accordance with the National Guidelines (with the length of the thrombus floating portion of not less than 4 cm). In all cases, surgical management envisaged direct and indirect thrombectomy. Plication was always performed above the level of venotomy. It was shown that thrombectomy combined with plication of major veins is a reliable and safe method of prophylaxis, being in some cases the only possible method of preventing fatal pulmonary artery thromboembolism. The operation of plication makes it possible not to cancel a scheduled surgical intervention in patients with a detected floating thrombus of major veins. The operation of thrombectomy and plication above the level of the floating head of the thrombus may be considered an operation of choice in the conditions where there is no possibility to use endovascular methods of treatment (implantation of a cava filter, endovascular catheter thrombectomy), as well as in pregnant women. Restoration of the venous lumen occurs at safe terms spontaneously, not requiring repeat surgical intervention. Simultaneous plication of the vein does not complicate the course of the postoperative period of the main surgical intervention. Thrombectomy and plication do not lead to the development of severe chronic venous insufficiency.

[The influence of chronomagnetic therapy on the parameters of the quality of life in the patients presenting with the diseases of the musculoskeletal system at the balneological and health resort-based stage of the rehabilitative treatment].

UNLABELLED: The methods for the rehabilitative treatment play an important role in the management of the patients presenting with the diseases of the musculoskeletal system. One of these techniques is chronomagnetic therapy. AIM: The objective of the present study was to evaluate the influence of chronomagnetic therapy on the patient's quality of life. PATIENTS AND METHODS: The patients of the main group included 30 ones with osteoarthrosis, 30 with rheumatoid arthritis, 20 with ankylosing spondylitis, 6 with podagric arthritis, 6 with psoriatic arthritis, and 6 others with reactive arthritis. Each of these patients every day underwent 10 sessions of chronomagnetic therapy with the use of the Multimag apparatus («Kasimov Instrumental Plant¼, Ryazan). The patients of the comparison group (20 ones presenting with osteoarthrosis, 27 with rheumatoid arthritis, 15 with ankylosing spondylitis, 4 with podagric arthritis, 4 with psoriatic arthritis, and 4 subjects with reactive arthritis) received the identical chronomagnetotherapeutic treatment under the conditions of the «Vulan¼ balneological health resort located at Gelendzhik, Krasnodar Region. RESULTS: The patients of the main group presenting with osteoarthrosis were characterized by the most pronounced manifestations of the role physical and social behaviour and the associated enhancement of pain intensity. The patients with rheumatoid arthritis exhibited well apparent manifestation of role and emotional functioning as well as enhanced vitality. Positive dynamics of these characteristics (role physical and emotional functioning, vital activity) was documented in the patients of the comparison group presenting with osteoarthrosis, ankylosing spondylitis, and rheumatoid arthritis. In this group, the patients with osteoarthrosis, ankylosing spondylitis, and rheumatoid arthritis experienced the improvement of the major parameters of the quality of life characterizing the physical and mental components of the health status. CONCLUSION: The chronomagnetotherapeutic treatment at the stage of rehabilitation of the patients suffering from the diseases of the musculoskeletal system markedly improves the characteristics of physical health the disturbances of which may lead to the development of psycho-somatic disorders. Chronomagnetic therapy of the patients with the diseases of the musculoskeletal system under the conditions of a balneological health resort proved to be more effective in terms of improvement of the parameters of physical and mental health. The result of the subjective evaluation of the health status in such patients can be used as a marker of the effectiveness of chronomagnetic therapy and an indicator of remission of the disease.

Discovery of τ Neutrino Appearance in the CNGS Neutrino Beam with the OPERA Experiment.

The OPERA experiment was designed to search for ν_{µ}→ν_{τ} oscillations in appearance mode, i.e., by detecting the τ leptons produced in charged current ν_{τ} interactions. The experiment took data from 2008 to 2012 in the CERN Neutrinos to Gran Sasso beam. The observation of the ν_{µ}→ν_{τ} appearance, achieved with four candidate events in a subsample of the data, was previously reported. In this Letter, a fifth ν_{τ} candidate event, found in an enlarged data sample, is described. Together with a further reduction of the expected background, the candidate events detected so far allow us to assess the discovery of ν_{µ}→ν_{τ} oscillations in appearance mode with a significance larger than 5σ.

[Correlation between Sensory Gating P50, Mismatch Negativity, and Reaction Time].

This paper is about the correlation pre-attentive processes, such as P50 sensory gating (SG P50) and mismatch negativity (MMN) with each other and with sensorimotor reaction time (RT). SG P50 data were obtained in the standard paired-click paradigm, MMN was measured in the passive odd-ball paradigm sensorimotor reaction time was studied in an active odd-ball paradigm. Was obtained positive correlation sensory gating P50 with amplitude mismatch negativity, amplitude mismatch negativity with sensorimotor reaction time, sensory gating P50 with sensorimotor reaction time.

[Unconscious Acoustical Stimuli Effects on Event-related Potentials in Humans].

Unconscious perception essentially affects human behavior. The main results in this area obtained in experiments with visual stimuli. However, the acoustical stimuli play not less important role in behavior. The main idea of this paper is the electroencephalographic investigation of unconscious acoustical stimulation effects on electro-physiological activity of the brain. For this purpose, the event-related potentials were acquired under unconscious stimulus priming paradigm. The one syllable, three letter length, Russian words and pseudo-words with single letter substitution were used as primes and targets. As a result, we find out that repetition and alternative priming similarly affects the event-related potential's component with 200 ms latency after target application in frontal parietal and temporal areas. Under alternative priming the direction of potential amplitude modification nearby 400 ms was altered for word and semi-word targets. Alternative priming reliably increase ERP's amplitude in 400 ms locality with pseudo-word targets and decrease it under word targets. Taking into account, that all participants were unable to distinguish the applied prime stimuli, we can assume that the event-related potential changes evoked by unconscious perception of acoustical stimuli. The ERP amplitude dynamics revealed in current investigation demonstrate the opportunity of subliminal acoustical stimuli to modulate the electrical activity evoked by verbal acoustical stimulation.

[The influence of movement's observation on recuperation after physical fatigue].

The study aim was to investigate effects of mental activity, accompanied by mu-rhythm depression, on recuperation after physical fatigue. In a study participants performed 11 one minute bouts of static hand grip intermitted by 2 minutes restpauses. During pauses participants watched video with either dynamic hand grips (biological movements) or deformation of geometric figure (control). Obtained data showed there was a significant depression of mu-rhythm during biological movement's observation. There was significant fatigue of subjects in an exercise with physical activity, but there was no reliable influence of performed mental activity on recovery after fatigue.

[Are we ready for the growing threat of virus dependent cervical cancer and the initiation of screening in conditions of insurance medicine?].

The dynamics is presented of the rates of virus dependent diseases, in particular cervical cancer (CC), which are directly connected with the level of organization of screening and subsequent treatment of cancer. It is shown that in conditions of insurance medicine a reduction of examination rooms and female enrollment in cytology screening is observed. As a result, over the past 5 years, CC incidence in the Novgorod region increased 1.2 times, and in Russia as a whole, the proportion of such cases in female population under 29 years since 2000 increased 4.5 times (from 2.0% to 9%). The urgent task of cancer control is to restore examination rooms, to overcome disagreements between government institutions and medical departments, to increase coverage of women by cytology screening by means of formation of the program of individual accounting of women.

[The specificity of children and adolescent eating habits (data for schoolchildren in Moscow and Murmansk)].

Objective of the study is to evaluate the specificity of schoolchildren's eating behavior in the cities of Moscow and Murmansk. Dietary habits of 785 children 10-17 years old residing in two cities--Moscow (222 boys and 221 girls, 14.1 ± 1.9 years old) and Murmansk (183 and 159 correspondingly, 14.1 ± 1.8 years old)--were analyzed. The questionnaire included data on the meals ratio per day, frequency of vegetables and fruit intake, fast-food intake, hot meals, soft drinks, meat, fish and milk intake, usage of school cafeteria, regularity of breakfasts. Parents responded to questions concerning the materialsupport of family and education. It was found that more than half of schoolchildren (64.4%) had meals irregularly (3 times per day or less), only 50.9% received hot meals several times a day. Every third child (31.6%) has insufficient intake of vegetables and fruit, 11.8%--insufficient intake of meat dishes. Only 51.4% of schoolchildren consumed dairy products daily (one or several times a day). At the same time 19.5% of children used fast-food products several times a week or more often, 42.2%--carbonated drinks, and 22.7%--smoked food. Only 45.7% of schoolchildren regularly ate at school caf- eteria; 21.9% did it irregularly and 32.5%--did not attend school canteen at all. There were no significant differences between Moscow and Murmansk children as well as gender differences in the usage of school cafeteria. At the same time only 23.4% of children [26.3% in Moscow and 19.3% in Murmansk (significantly less, p = 0.032)] liked cafeteria food, 38.7% did not like and 37.9% had no certain answer. Less obese children (54.0%) have breakfast everyday than children with normal weight (75.4%, p = 0.019). Children of mothers with high and incomplete high education (89.4%) have more regular meat intake (3-4 times per week or more often) than the children of mothers with secondary, incomplete secondary and secondary special education (81.9%, p = 0.034). Schoolchildren feeding is often irregular, irrational and poorly balanced. Some of examined schoolchildren already had excessive body mass (20.7%), that may lead to metabolic and cardiovascular disturbances in young adult and mature age.

[Postoperative wound complications in cardiosurgery].

Presented in the article are the results of examination and treatment of 65 patients with infectious wound complications of the sternotomic injury after open heart surgery. The main risk factors for their development in our patients were as follows: obesity, chronic obstructive pulmonary disease, diabetes mellitus, severe heart failure, prolonged operation, sternal instability. The leading pathogenic microorganisms were Gram positive staphylococci. Treatment varied from prolonged antibiotic therapy with surgical debridement of the wound to subtotal resection of the sternum with various plastic reconstructive interventions. The scope of treatment was determined by the type and severity of infectious wound complications. Due to lack of standardized approaches in diagnosis, treatment and prevention this problem remains to be of current importance.

[Evaluation of condition and factors affecting activity effectiveness and visual performance of pilots who use night vision goggles during the helicopter flights].

According to analysis of questionnaire authors revealed factors, which affect activity effectiveness, and visual performance of pilots who use night vision goggles during the helicopter flights. These are: difficulty of flight tasks, flying conditions, illusion of attitude. Authors gave possible ways to reduce an impact of these factors.

[Effect of cardiovascular functional disorders on cerebral oxygenation in children].

The article deals with data of cerebral oximeter INVOS Somanetics (US) used for comparison the degree of brain oxygenation reduction, ejection fraction and stroke volume relative to age norms in children with dilated cardiomyopathy.

[A combination of dipeptidyl peptidase-4 inhibitor and metformin in the treatment of patients with type 2 diabetes mellitus: effective control of glycemia, weight, and quantitative body composition].

AIM: To study the impact of intensified therapy with the dipeptidyl peptidase-4 (DPP-4) inhibitor vilagliptin or sulfonylurea (SU) on the control of glycemia, weight, and quantitative body composition in patients with type 2 diabetes mellitus (DM-2) who have failed to achieve compensation during metformin monotherapy. SUBJECTS AND METHODS: Forty patients (mean age 55.0 (range 53.0-60.7) years; disease duration 2.0 (range 1.1-5.0) years) with poor glycemic control (7%