MEDICO-BIOLOGICAL SCIENCES
ORIGINAL ARTICLES
PORTAL HYPERTENSIVE GASTROPATHY AS A PROGNOSTIC FACTOR FOR FATAL BLEEDING IN PATIENTS WITH LIVER CIRRHOSIS
Yashin S.S., Fedorina T.A.
Abstract: Objective. Definition of portal hypertensive gastropathy as a prognostic factor for fatal esophageal and gastric bleeding in patients with liver cirrhosis of various etiologies. Methods. The study was conducted on the results of clinical, laboratory and autopsy data of 66 patients with liver cirrhosis who died in the Samara City Clinical Hospital No. 1 named after N.I. Pirogov from July 2022 to May 2024. Statistical processing of the data was carried out using the Shapiro-Wilk test to determine the normality of the distribution of values in the sample, Fisher's exact test and Pearson's chi-square test to analyze contingency tables, Spearman's rank correlation coefficient to identify relationships between two studied values. Results. The study showed that the Child-Pugh and MELD-Na scores used to predict the onset of death are not applicable to predicting exclusively fatal bleeding. On the contrary, the presence of severe portal hypertensive gastropathy according to Baveno II indicates a high risk of fatal bleeding (p=0.045). The first Baveno II criterion has the highest diagnostic value (p=0.040). The onset of death from bleeding does not depend on the sex, age, and presence of viral hepatitis in patients. Conclusions. The severity of portal hypertensive gastropathy can be used as a diagnostic criterion and prognostic criterion for fatal esophageal and gastric bleeding in patients with liver cirrhosis.
Key words: portal hypertension, liver cirrhosis, portal hypertensive gastropathy, varicose veins of the esophagus and stomach
THE PATHOPHYSIOLOGICAL BASIS OF THE THERAPEUTIC EFFECTS OF FINGOLIMOD (FTY720), A MODULATOR OF SPHINGOSINE-1-PHOSPHATE RECEPTORS
Urakova M.A., Bryndina I.G.
Abstract: Objective. Analysis of the results of scientific research on the effectiveness of fingolimod (FTY720), a modulator of sphingosine-1-phosphate receptors. Methods. Collection, systematization and comparative evaluation of literature data and the results of our own research on the experimental and clinical study of fingolimod, a non-specific modulator of sphingosine-1-phosphate receptors. Results. The review article presents current evidence on the sphingomyelin cycle of intracellular metabolism of sphingolipids; localization and functioning of five isoforms of the sphingosine-1-phosphate receptor. The current information about the first non-selective modulator of sphingosine-1-phosphate receptors, fingolimod, is described in detail. According to the literature, the protective effect of fingolimod has been shown in the treatment of multiple sclerosis and cerebrovascular pathologies. According to the results of our own research, the differentiated effect of fingolimod on non-respiratory lung functions in autoimmune (experimental autoimmune encephalomyelitis, antiphospholipid syndrome) and vascular (cerebral ischemia, intracerebral hemorrhage) pathology of the brain has been shown. Conclusion. Fingolimod, as a non-selective modulator of sphingosine-1-phosphate receptors, has a wide spectrum of action in various pathologies, including autoimmune ones. The widespread use of sphingosine-1-phosphate receptors in the mammalian body and their involvement in the implementation of many biological processes open up great prospects for studying the potential therapeutic possibilities of fingolimod and other modulators of sphingosine-1-phosphate receptors.
Key words: sphingosine-1-phosphate receptor, fingolimod (FTY720), multiple sclerosis, stroke, antiphospholipid syndrome, non-respiratory lung functions
OPHTHALMIC HYPOTENSIVE ACTIVITY OF NEW CARBONIC ANHYDRASE INHIBITORS FROM THE CLASS OF SULFONAMIDE DERIVATIVES
Khokhlov A. L., Tyushina A. N., Fedorov V. N., Korsakov M. K., Vdovichenko V. P., Shetnev A.A., Popova A.A.
Abstract: Objective. Search for antiglaucoma agents among selective inhibitors of carbonic anhydrase II from the class of sulfonamide derivatives in experimental models of glaucoma. Methods. In this research were used 72 rabbits and 48 rats are for study 4 drugs (R1-4, R1-5, R1-10, R1-11). Intraocular pressure (IOP) determination was carried out on intact animals and on experimental models of glaucoma. The drug of comparison was dorzolamide. Results. In intact rabbits, IOP reduction was provided by R1-4, R1-5 and R1-10. When elevated IOP was corrected in rabbits by administration of R1-4, R1-5 and R1-10, the reduction was correspondingly on 9-24% and this reduction continued for at least 24 hours. With the administration of P1-11, the reduction in IOP was 24-28% with a duration of action of 8 hours. With the development of “adrenaline glaucoma” in rats, the administration of P1-4, P1-10 and P1-11 caused a decrease in IOP by 8-30%, with a duration of action of at least 24 hours. Conclusion. All four tested compounds in the “kaolin model” of glaucoma have greater ophthalmic hypotensive activity than when used in intact animals. Compared to dorzolamide, P1-4, P1-5 and P1-10 have approximately the same effect, but have a longer duration of action. The effectiveness of R1-11 is similar to the dorzolamide. In the model of adrenaline glaucoma, three compounds (R1-4, R1-10 and R1-11) had a longer duration of therapeutic effect than dorzolamide, and R1-5 was comparable to it. All tested compounds have greater or at least no less therapeutic efficacy than dorzolamide.
Key words: glaucoma, intraocular pressure, carbonic anhydrase, selective carbonic anhydrase inhibitors
THE EFFECT OF MELAXEN ON CYTOKINES CONTENT IN MICE WITH EXPERIMENTAL ULCERATIVE COLITIS
Liashev A.Yu., Mal G.S., Solin A.V., Serikov V.S., Antopol’skaya E.V., Lyashev Yu.D.
Abstract: Objective. Study of the pharmacological effect of melaxen on the pro- and anti-inflammatory cytokines content of in the colonic wall in mice with experimental ulcerative colitis. Methods. Ulcerative colitis was simulated by replacing drinking water with a 5% solution of dextran sodium sulfate in boiled water for 5 days. Animals were removed from the experiment on the 5th, 7th and 28th days. Melaxen was administered intragastrically at a dose of 0.5 mg/kg body weight in a volume of 0.3 ml once a day for 7 days from the onset of ulcerative colitis simulation. The reference drug sulfasalazine was administered intragastrically in a volume of 0.3 ml at a dose of 200 mg/kg body weight for 7 days. The content of IL-1β, IL-4, IL-6, IL-10, IL-17 in the homogenate of the medial colon was determined by ELISA. Results. An increase in the IL-1β, IL-6 and IL-17 concentration was found on the 5th-7th days of disease development in mice with ulcerative colitis compared to the naïve group. The IL-4 content decreased on the 5th-7th days of the experiment, while the IL-10 concentration, on the contrary, increased. The IL-6 concentration was significantly higher than in naïve mice on the 28th day. The melaxen administration caused a decrease in IL-1β by 36.6 and 40.4%, IL-6 by 43.2% (only on day 5), IL-17 by 45.6 and 42.6%. A further decrease in the IL-1β and IL-6 concentration was shown on the 28th day. The melaxen administration caused an increase in the anti-inflammatory IL-4 and IL-10 concentrations on the 5th-7th days compared to the control group. No effect of melaxen on the content of anti-inflammatory cytokines has been established in chronic colitis. The pharmacological effect of melaxen is higher than sulfasalazine one. Conclusion. The corrective melaxen effect on the inflammatory cytokines production is apparently associated with the suppression of the Th1 lymphocytes activity.
Key words: ulcerative colitis, melaxen, proinflammatory and anti-inflammatory cytokines, mice
MODERN TRENDS IN THE STRUCTURE OF UTI PATHOGENS IN PREGNANCY AND THEIR ANTIBIOTIC RESISTANCE
Stepankova E.A., Suhorukova A.O.
Abstract: Objective. To study the etiological structure and antimicrobial susceptibility of pathogens of urinary tract infection in pregnancy. Methods. Within the framework of our own prospective study, we determined the structure of UTI pathogens in pregnant women and analysed their antimicrobial susceptibility of 155 isolates isolated from pregnant women with various forms of UTI. The online antibiotic resistance data analysis and sharing platform AMRcloud was used to analyse the data. Results. The main causative agents of urinary tract infections in pregnant women were microorganisms of the order Enterobacterales (94.6%), including E. coli was the causative agent in 46.4% of pregnant women. Maximum microbiological activity against E. coli was demonstrated by fosfomycin (100.0%), nitrofurantoin (100.0%) and cephalosporins of II-IV generations, which is consistent with the data of other epidemiological studies. There was a low level of sensitivity of E. coli isolates to amoxicillin/clavulanate (86.6%), trimethoprim/sulfamethoxazole (78.9%) and ciprofloxacin (84.6%). Conclusion. The results of the study suggest that the main causative agents of UTIs in pregnant women are Enterobacteriaceae and the most frequent uropathogen is Escherichia coli. Fosfomycin, nitrofurantoin and III-IV generation cephalosporins may be the starting empirical therapy for UTIs in pregnant women. The data of our own prospective study generally did not differ from the results of nationwide epidemiological studies.
Key words: pregnancy, urinary tract infection, uropathogens, antibiotic, antimicrobial resistance
REVIEWS
PHARMACOLOGICAL NEUROPROTECTION IN ISCHEMIC BRAIN LESIONS (PART 4. JUSTIFICATION OF THE CHOICE AND PHARMACODYNAMICS OF AGENTS FOR ACTIVATING ENDOGENOUS NEUROPROTECTION MECHANISMS)
Novikov V.E., Levchenkova O.S.
Abstract: Objective. Evaluation of the effectiveness of pharmacological neuroprotection and the prospects for its clinical use in ischemic brain lesions. Methods. Collection, systematization and analysis of literature data and the results of our own research on the experimental and clinical study of pharmacological neuroprotection in ischemic brain lesions. Results. The fourth part of the work presents a pharmacotherapeutic justification for the choice and pharmacodynamics of drugs for stimulating physiological (endogenous) neuroprotection mechanisms. The results of experimental and clinical studies of the effectiveness of pharmacological neuroprotection, implemented by activating the physiological mechanisms of cell adaptation to ischemia/hypoxia, are discussed. A comparative assessment of the effectiveness and safety of the use of various pharmacotherapeutic agents of biological and synthetic origin in model conditions of ischemia/hypoxia and the prospects for their clinical use in cerebrovascular insufficiency is carried out. Conclusion. Effective anti-ischemic pharmacotherapy for both acute cerebral circulatory disorders and chronic cerebrovascular insufficiency should be combined and aimed not only at blocking pathological reactions of the ischemic cascade, but also at activating endogenous adaptation mechanisms, and be carried out consistently. The choice of means of implementing pharmacological neuroprotection by activating physiological adaptation mechanisms depends on the period of neuroprotection and the intended targets for pharmacological action.
Key words: cerebral ischemia, pharmacological neuroprotection, pharmacological targets, endogenous adaptation mechanisms
THE USE OF LOCAL ANESTHETICS IN DENTAL PRACTICE
Danilov A.I., Konovalov I.V., Goncharova O.A., Kolpanosova A.A., Kochetkova E.A., Antoshina T.Yu.
Abstract: Objective. To highlight the most pressing issues of the use of local anesthetics in dental practice. Methods. Based on domestic and international scientific publications, information is provided on clinical pharmacology and the possibilities of using local anesthetics in dental practice. Results. With local injection anesthesia, pain sensitivity is blocked at the site of injection of the anesthetic (infiltration anesthesia), as well as in the area of innervation of this nerve or part of it (conduction or regional anesthesia). Local anesthetics reduce or completely eliminate the flow of pain impulses from the site of intervention into the central nervous system by acting on sensitive nerve endings or fibers. Conclusions. Local anesthesia is the most widely used method of anesthesia in dental practice. This type of anesthesia is indicated in all cases when performing dental interventions accompanied by a painful reaction. It is contraindicated only in one case - if the patient is intolerant of local anesthetic.
Key words: local anesthesia, dental practice, safety profile, oral cavity
CLINICAL MEDICINE
ORIGINAL ARTICLES
MANIFESTATIONS OF POSTCOVID SYNDROME IN PATIENTS WITH A HISTORY OF CARDIOVASCULAR PATHOLOGY IN THE WORK OF A PRIMARY CARE PHYSICIAN
Afanasenkova T.E., Dubskaya E.E., Baburina A.V.
Abstract: Objective. To study the features of the course, depending on the severity of postcovoid syndrome, in patients with cardiovascular pathology who have suffered a new coronavirus infection. Methods. 218 patients were selected by random sampling among patients who underwent COVID-19 and underwent in-depth medical examination for the period from January to December 2023. The criteria for inclusion in the study were patients who had a coronavirus infection in 2022, with a history of controlled hypertension of stage 1-3; stable angina pectoris of functional class 1-2, chronic heart failure of stage 1-2a, functional class 1-2. Depending on the severity of the disease, the patients were divided into two groups. The first group consisted of patients with mild severity - 184 people (84%). Their treatment for COVID-19 was carried out on an outpatient basis. Patients with moderate and severe degrees of severity who received hospital care, 34 people (16%), made up the second observation group. In each group, a comparison of pathological conditions caused by the influence of a new coronavirus infection on the aggravation of the course was carried out. Results. An analysis of the development of pathological conditions in the studied patients after coronavirus infection showed that complications from the cardiovascular system were more often recorded in the two observation groups. Conclusions. Comorbidity is a trigger for the intensification of existing pathological processes. Most likely, the treatment and rehabilitation of people with postcovid syndrome are focused on cardiopulmonary consequences.
Key words: coronavirus infection, postcovid syndrome, cardiovascular pathology
QUALITY OF LIFE AS A CRITERION FOR THE EFFECTIVENESS OF REHABILITATION OF PALLIATIVE PATIENTS WITH CHRONIC HEART FAILURE
Shevtsova V.I., Pashkova A.A., Shevtsov A.N.
Abstract: Objective. Evaluation of the effectiveness of the rehabilitation program offered to patients with CHF based on the dynamics of the integral indicator of quality of life and body composition indicators. Methods. An open randomized controlled experimental study involved 120 patients with CHF and different body composition (isolated disorders of the fat and muscle components, sarcopenic obesity, weight loss and sarcopenia), randomly distributed into 2 groups: experimental and control. Within six months, patients from the experimental group, in addition to standard treatment methods, underwent the proposed rehabilitation program, which includes a diet with protein intake of at least 1 g / kg of body weight, as well as a set of physical exercises selected individually taking into account the condition of the patient's muscular component and respiratory gymnastics. The patients underwent bioimpedance measurements to assess their body composition. The MLHFQ questionnaire was used to assess the quality of life, highlighting three aspects: disease, palliative status and social adaptation. Results. Statistically significant differences in muscle mass, IMM/BMI, and quality of life indicators were found in patients of the experimental group before and after rehabilitation. Negative dynamics of indicators was also found in patients who are not undergoing cardiac rehabilitation. Conclusion. Cardiorehabilitation can be used in the provision of palliative care as a tool that improves the body composition of patients with CHF, as well as their quality of life.
Key words: chronic heart failure, cardiac rehabilitation, quality of life, palliative care
ANALYSIS OF ADVERSE REACTIONS OF BASIC THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS
Bazina I.B., Kozyrev O.A., Khydyrova A.A., Kokhankova E.S., Katerinkina V.S., Krechikova D.G.
Abstract: Objective. To study the prevalence and structure of adverse reactions to basic anti-inflammatory drugs in patients with rheumatoid arthritis, the nature of the influence of basic drugs on basic laboratory parameters over time.Methods. Materials from medical histories of patients who were treated in the rheumatology department of the Clinical Hospital "Smolensk RZD-Medicine" with a diagnosis of rheumatoid arthritis were studied. Laboratory and instrumental examinations and treatment were carried out in accordance with the standards of medical care. Statistical analysis was performed using SPSS 20.0. Descriptive statistics methods were used.Results. 75 patients aged 45-78 years were examined, among them there were 6 men (8%), 69 women (92%). Methotrexate, as the main basic drug, was prescribed to 70 patients (93,3%), 5 patients received glucocorticoids and hydroxychloroquine, since they had contraindications to the prescription of other basic drugs. The dose of oral methotrexate is 7.5-15 mg/week. After a year, 48 out of 70 patients (68,6%) were switched to other basic drugs. The most common adverse reactions to methotrexate were frequent infections (25%) and the development of toxic hepatitis (20.8%). The leading comorbidities were arterial hypertension (64%) and coronary artery disease (24%). A significant increase in AST and ALT (p≤0,05; p≤0.001), a decrease in Er (p≤ 0,001), and glomerular filtration rate (p ≤ 0,05), a decrease in the level of rheumatic factor (p ≤ 0.001) and C-reactive protein (p ≤ 0,05).Conclusion. The main basic drug was methotrexate. A high incidence of adverse reactions was revealed. During 1 year of treatment, the toxic effect of basic drugs on kidney, liver, and erythropoiesis was established. The use of basic drugs should be carried out strictly taking into account contraindications, concomitant diseases and the development of adverse reactions.
Key words: basic anti-inflammatory drugs, methotrexate, adverse reactions
STRUCTURAL AND DYNAMIC ANALYSIS OF DISABILITY AMONG THE CONTINGENT OF THE TERRITORIAL POPULATION OF THE CHILD POLYCLINIC
Bogdanyants M.V., Bezrukova D.A., Shmeleva A.Y., Tretyakova M.V., Temerev I.A., Minakova G.M.
Abstract: Objective. To study the state of disability, assess the dynamics and structure of overall and primary disability of the attached child population during the period of 2020-2022. Methods. Calculation of relative and absolute values, mathematical and statistical analysis of data using tabular and graphical methods with the use of built-in programs was performed. Results. It was found that over the last three years, there has been a tendency for an increase in overall disability rates (by 1.1 times) and primary disability among children (by 1.4 times). In the structure of overall disability, children aged 10-14 years (33.1%) and 5-9 years (30.7%) represent the largest share. Conclusion. The greatest increase in overall disability was noted in the adolescent age group - by 30.4%, and in primary disability - among children aged 0 to 4 years (by 55.9%) and 5 to 9 years (by 25.4%). Gender differences were identified: the rates of overall and primary disability among boys were higher than among girls by 1.2 and 1.4 times, respectively.
Key words: children with disabilities, general and primary disability, structure, dynamics, trends
CONSTITUTIONAL FEATURES OF THE COURSE OF ULCER DISEASE IN SCHOOL-AGED CHILDREN
Kharitonov D.V.
Abstract: Objective. To study some constitutional features of achieving incomplete clinical and endoscopic remission of peptic ulcer disease in children. Methods. We examined 174 children aged 12-17 years with gastric ulcer disease (GU) and/or duodenal ulcer disease (DU). All examined patients underwent fibroesophagogastroduodenoscopy (FEGDS) upon admission, on the 12th, 21st, and, if indicated, on the 30th or 45th day from the start of standard etiopathogenetic therapy. All patients were tested for Helicobacter pylori (Hp), which in 100% of cases confirmed the presence of carriage of this infection in children. All patients were determined by constitutional status using the Pignet index. Results. It was found that asthenic children (52,9%) suffered from GU and/or DU (p<0.05) more frequently than normosthenic children (31,03%) or hypersthenic children (16,07%). Incomplete clinical and endoscopic remission against the background of standard therapy was achieved most quickly in patients with GU and asthenic type of constitution (on the 21st day - in 95,8% of patients, on the 30th day - in 100%). This was achieved somewhat more slowly in children with normosthenic somatotype (on the 21st day - in 86,7%, on the 30th day from the beginning of treatment - in 100% of patients). Prolonged (slower) achievement of incomplete clinical and endoscopic remission was determined in hypersthenics (on the 21st day from the start of standard therapy - in 41,7% of children, on the 30th day - in 83,3%; and only on the 45th day - in 100% of patients). A similar pattern was observed in children with DU, as well as in combination with DU. Conclusion. Thus, the course of peptic ulcer disease has features in children with different types of constitution, which must be taken into account when choosing the tactics of patient management.
Key words: peptic ulcer, constitution, children
NOAH-LAKSOVA SYNDROME IN THE PRACTICE OF A NEONATOLOGIST
Kashirskaya E.I., Simonyan A.M., Molev D.A., Azhkamalov S.I., Demidova R.A.
Abstract: Objective. Present a clinical case of a rare orphan disease using the example of Noah-Laksova syndrome, identified by characteristic phenotypic features. Methods. Based on literature data, the work describes in detail the latest scientific research on the results of studying Noah-Laksova syndrome. An analysis was carried out of the anamnestic data of the clinical case described in the article, materials from the inpatient chart, and the results of clinical and additional studies. Results. A case of a severe rare disease leading to the death of the patient is described. A diagnostic search algorithm is demonstrated. The characteristic phenotypic features and clinical manifestations of the syndrome are given. Due to the progression and improvement of medical care in neonatal practice, an increase in the life expectancy of patients with Noah-Laksova syndrome has been noted. Conclusion. The clinical example presented in the article shows the possibilities of diagnosing a rare orphan disease without genetic verification. In this case, the diagnosis of Noah-Laksova syndrome was made on the basis of striking and specific phenotypic features.
Key words: child, Noah-Laksova syndrome, orphan disease, phenotypic features
ANGIOSARCOMA OF THE LIVER IN A CHILD AGED ONE MONTH
Dmitriev I.V., Shisterova O.A., Moiseenkova S.D., Ignatova N.B., Abrosimov S.Yu.
Abstract: Objective. To show the features of the clinical course and morphological manifestations of liver angiosarcoma in children at the end of the newborn period. Methods. The data of the medical documentation of the fatal case of a child with angiosarcoma of the liver at the age of one month were analyzed. Published data from domestic and foreign sources on vascular tumors have been studied. In the analysis, special attention is paid to the differential diagnosis of liver angiosarcoma with other tumors. Results. A girl aged 1 month from the first pregnancy, who had anemia, COVID-19, gestational diabetes mellitus. The first birth at 39 weeks of pregnancy in a head presentation. The child has an Apgar score of 8/8 points; weight - 4020 g, height - 56 cm. She was discharged on the 5th day with a weight of 3820 g. in a satisfactory condition with a diagnosis of Chronic intrauterine hypoxia. A large newborn. On an outpatient basis, the child was regularly examined by a pediatrician: the condition is satisfactory. According to the mother: on the 17th, a single liquefied stool, worried at night, bloating appeared. In the morning, on the 18th, sluggish, refusal to eat, loose stools 3 times during the day. She was taken to the hospital on the 18th, where her condition was assessed as extremely serious upon admission. The liver protrudes from under the edge of the costal arch +5.0 cm. Sent to the intensive care unit with a diagnosis of severe mechanical jaundice? Congenital pathology of GBS? Atresia of the ZHVP? Clinical, laboratory and instrumental studies, post-syndrome therapy were carried out. The condition worsened and on the 19th at 08:50 the child was taken on a ventilator. Despite intensive therapy, the child died on the 19th at 11-30. On autopsy, a liver weighing 285 grams. (norm - 139 g) with multiple nodes from 0.2 to 2.0 cm in diameter in all its lobes. Microscopically, using immunohistochemical examination, the diagnosis of angiosarcoma was established. Conclusions. A feature of the presented clinical case is the presence of angiosarcoma of the liver in a child at the age of 1 month with an extremely rapid onset of death. Most likely, this was due to the development of a lightning-fast form of liver failure in the child with an increase in multiple organ failure and progression of cerebral edema. This case clearly demonstrates the difficulties in the diagnosis and treatment of this type of tumor, which is confirmed by the analysis of the literature data. Even with an adequate amount of biopsy and surgical material, it is not always easy to accurately determine the type of tumor. But even after determining the type of vascular tumor, there are no absolute guarantees that its development in a particular patient will correspond to its classical characteristics. There is still a lot to be done in this direction. The same applies to the development of clinical classifications of angiosarcomas with stages and, accordingly, the determination of optimal methods of their treatment.
Key words: angiosarcoma of the liver, child, differential diagnosis
DENTAL DEVICES AND TECHNOLOGIES THAT PREVENT COLD DAMAGE TO TEETH
Urakov A.L., Reshetnikov A.P., Reshetnikov Ya.A., Pozhilova E.V., Novikov V.E., Gabdrafikova K.R., Gabdrafikov R.R., Gabdrafikov D.R.
Abstract: Objective. Analysis of the effectiveness of dental devices and technologies that prevent cold damage to teeth. Methods. Collection and analysis of literature data and the results of our own research on the study of dental resistance to cold influences and the development of dental devices and technologies that prevent cold damage to teeth. Results. Inhaling cold air with an open mouth at low ambient temperature threatens tooth damage, which is accompanied by toothache and ends with mechanical damage to the teeth due to the crystallization of water, which is part of their tissues. The risk of tooth damage increases with an increase in frost, wind, snowfall and the duration of inhaling cold air with an open mouth. The pathogenesis of cold injuries of teeth and a list of modern devices and technologies aimed at preventing cold lesions of teeth are considered. The essence of various technologies and their effectiveness in conditions of exposure to cold air on teeth are discussed. The features of thermal insulation of healthy teeth, as well as teeth with braces installed on them, are noted. Conclusion. The use of special decorative thermal insulation stickers on teeth provides thermal insulation of teeth when inhaling frosty air and prevents cold injuries to teeth. The introduction of such dental devices into everyday practice in order to prevent cold damage to tooth enamel and the development of cold toothache in polar explorers, oil workers, gas workers and other specialists working outdoors in winter in conditions of northern latitudes, the Arctic, Antarctica and/or highlands, as well as in military personnel when performing combat missions and athletes Those involved in winter sports seem to be an important medical and social task.
Key words: teeth, cold injuries of teeth, prevention, thermal insulation dental stickers
PROBLEMS AND PROSPECTS OF USING HYBRID ENDOPROSTHESES IN THE TREATMENT OF KNEE OSTEOARTHRITIS
Kamushadze G.K.
Abstract: Objective. To explore the problems and prospects of using hybrid endoprostheses (HE) in the treatment of knee osteoarthritis, focusing on their effectiveness and safety compared to traditional metal endoprostheses. Methods. A review of the scientific literature published from 2018 to 2023 was conducted. Clinical indicators such as revision surgery rates, osseointegration, and complication risks were analyzed to assess the efficacy of HEs compared to traditional metal endoprostheses. Results. HEs, which combine metals, polymers, and ceramics, demonstrate significant advantages, such as a reduction in revision surgery rates, improved osseointegration, and enhanced biomechanical properties. However, unresolved issues remain, including aseptic loosening and infectious complications, which necessitate further technological improvements. Additionally, the high production cost of HEs limits their widespread clinical use. Conclusions. HEs have the potential to improve the treatment of knee osteoarthritis by enhancing clinical outcomes. However, further research and development of new technologies are required to reduce production costs and minimize complications, thereby broadening their clinical application.
Key words: knee osteoarthritis, hybrid endoprostheses, osseointegration, revision surgery, nanomaterials, biocompatibility, orthopedic surgery, infectious complications
MICROSURGICALTRAINING ON THE NEUROVASCULAR BUNDLE OF CHICKEN THIGH AS THE BASIC ELEMENT OF NEUROSURGERY RESIDENCY PROGRAMME
Goryaynov S.A., Shelyakin S.Yu., Maslova N.N., Titov O.Yu.
Abstract: Objective. To develop microsurgical simulation model in a microneurosurgical laboratory for resident training. Methods. The first stage was isolation of the neurovascular bundle of the chicken thigh, the second stage was microneurosurgical training itself (end-to-end and end-to-side anastomoses of an artery, end-to-end nerve anastomosis, end-to-side anastomosis of a vein). All manipulations were performed under microscope (4-timemagnification) using microsurgical techniques. The following factors were considered: tightness, patency, the need for additional sutures and their number. End-to-end anastomoses were performed on the artery, vein and nerve, as well as end-to-side anastomosis between the artery and vein. A total of 15 arterial and 15 venous anastomoses were performed. Results. during their residency training in the specialty "neurosurgery" residents sequentially performed isolation of a neurovascular bundle on the chicken thigh followed by stitching end-to-end arterial anastomosis and end-to-side arteriovenous anastomosis, as well as end-to-end nerve suture under a microscope using microsurgical technique. At the end, the technique has improved, the speed of anastomosis performance has increased alongside with the accuracy and quality of work, and the tightness of vascular microanastomosis has also grown. Conclusions. Simulation training on a chicken thigh is a useful tool for developing microsurgical skills during residency training in the specialty "neurosurgery".
Key words: microsurgical training, microvascular anastomosis, chicken thigh
CORRELATION BETWEEN DIFFUSION TENSOR MRI METRICS AND CLINICAL ASSESSMENT OF MOTOR DEFICIT IN PATIENTS WITH ISCHEMIC STROKE
Gizatullin R.R., Baykov D.E., Akhmadeeva L.R., Baykova G.V.
Abstract: Objective. To analyze the potential efficacy of diffusion tensor MRI by comparing fractional anisotropy and diffusion coefficient index values in corticospinal tracts of patients who have suffered a cerebral stroke, with the aim of predicting motor deficit regression and guiding further treatment strategies. Methods. An analysis was conducted on two groups of patients. The first group consisted of patients with ischemic stroke, exhibiting motor deficits. The second group included patients without motor deficits and no history of cerebrovascular accidents. Clinical methods for assessing motor deficits were applied to both groups. The obtained results were compared with diffusion tensor MRI data during the construction of corticospinal tract models to identify patterns indicating the degree of central nervous system suppression and potential for motor deficit regression. Results. A consistent relationship was found between the indices of fractional anisotropy in the corticospinal tracts, functional independence scales, and scales reflecting motor deficits. Further Spearman analysis revealed a strong correlation between these parameters, with rs greater than 0.80, demonstrating a link between the state of the corticospinal tract and motor deficit in ischemic stroke survivors. Conclusion. Diffusion tensor MRI with the construction of corticospinal tract models and determination of fractional anisotropy values could become a useful tool for assessing the condition of brain conduction pathways in patients who have suffered a cerebral stroke.
Key words: stroke, motor deficit, diffusion tensor MRI, corticospinal tract, fractional anisotropy
ANALYSIS OF MRI NORMALIZATION TECHNIQUES AND ROI SEGMENTATION TOOLS DURING ROUTINIZATION OF RADIOGENOMIC APPROACH TO GLIOMAS IMAGING
Maslov N.E., Valenkova D.A., Trufanov G.E., Moiseenko V.M.
Abstract: Objective. To discover additional radiomic IDH status predictors in adult-type diffuse gliomas that can be potentially applicable under conditions of primary diagnosis. Methods. Retrospective comparative statistical analysis of radiomic features extracted from 46 brain MRI in adult-type diffuse gliomas with known IDH status using HistogramMatching, ScaleIntensity preprocessing techniques and LevelTracing, GrowingFromSeeds segmentation tools. Results. The most effective combination of preprocessing/segmentation tools has been established - ScaleIntensity and LevelTracing, respectively. 5 reliable radiomic IDH status predictors revealing ROIs’ textural heterogeneity at the voxel level were identified. Conclusion. The possibility of developing a statistically reliable multiparametric IDH status predictive model based on traditional MRI data has been proved under conditions of small and technically heterogeneous sample. Presumably the use of relatively unified preprocessing methods and operator-dependent segmentation tools is preferred. The revealed radiomic features probably illustrate the degree of tumors’ morphological heterogeneity. Machine learning principles are planned to be introduced into the process of the predictive model creation.
Key words: glial tumors, morphological heterogeneity, neuroimaging, radiogenomics, radiomics, MRI, IDH status
REVIEWS
ACUTE PANCREATITIS AND MODERN DIAGNOSTIC POSSIBILITIES
Lukashev A.D., Kurochkin S.V., Malkov I.S., Mavlyashova D.R.
Abstract: Objective. review, analysis of modern literature sources devoted to the topic of diagnosis of acute pancreatitis. Methods. A search and review of modern original publications in the field of scientific medicine, among domestic and foreign authors, devoted to the study of the prevalence and radiological diagnosis of acute pancreatitis was carried out. Results. The prevalence of acute pancreatitis is estimated, the main radial methods of its diagnosis are listed, the main ones are: computed tomography, magnetic resonance imaging and ultrasound. Advantages and disadvantages of the main radial methods were considered. Promising methods of early detection of pancreonecrosis were determined and analyzed: CT-perfusion and MR-perfusion. Conclusion. The analysis of the literature shows that acute pancreatitis is a common disease, associated with a lightning course and with the presence of severe complications, which often lead to death. Thus, OP is a potentially fatal disease, the mortality rate of which varies depending on the severity. Therefore, early diagnosis of OP and determination of its severity is an important part of treatment. In this review, various radial imaging modalities that allow timely diagnosis of OP with high accuracy were evaluated: CT, MRI, MRCP, ultrasound imaging, ERCP. Thus, an integrated and multimodal approach in the application of these imaging modalities is the key to effective treatment of this disease.
Key words: acute pancreatitis, computed tomography, magnetic resonance imaging, ultrasonography
CEREBRAL HEMODYNAMICS IN ACUTE CEREBROVASCULAR ACCIDENTS AND APPROACHES TO ITS DIAGNOSIS
Terekhov A.D., Kuznetsov A.A., Khalepo O.V.
Abstract: Objective. To systematize the literature data on the pathogenesis and diagnostics of cerebral hemodynamic disorders occurring in acute cerebrovascular accident (CVA) of the hemorrhagic type. Methods. Analysis of data from domestic and foreign studies devoted to the pathogenesis and diagnostics of cerebral hemodynamic disorders occurring in acute cerebrovascular accident of the hemorrhagic type. Results. One of the most significant complications of the hemorrhagic type of CVA is the development of delayed cerebral ischemia, the main pathogenesis link of which is spasm of the cerebral main arteries, which also extends to the microcirculation system. The severity of irreversible complications of hemorrhagic stroke and their consequences are determined by hemodynamic disorders at the level of the microcirculatory bed vessels that provide transcapillary exchange and maintain tissue homeostasis. The state of cerebral microcirculation in pathological conditions can be maintained for some time due to the mechanisms of self-regulation of cerebral circulation. However, if the compensatory reserve of the autoregulation system is exhausted, the system will lose the ability to maintain the constancy of cerebral hemodynamics in conditions of acute intracranial hemorrhage. At the same time, an important contribution to the pathogenesis is made by hemoglobin biodegradation and the formation of free radicals, which trigger a complex of contractions of cerebral artery smooth muscle cells and a violation of vasodilatory activity due to prostacyclin/thromboxane A2 imbalance or oxyhemoglobin-induced inhibition of acetylcholine-mediated vasodilation. Proliferative vasculopathy, immunoreactive and inflammatory processes have also been postulated as possible mechanisms of vasospasm, microthrombosis and the development of delayed cerebral ischemia. Delayed cerebral ischemia can progress to cerebral infarction, which determines disability and high mortality. The problem of non-invasive assessment of the state of cerebral microcirculation remains unresolved, since currently the methods of studying peripheral circulation, developed primarily to assess microcirculation in the skin, do not allow non-invasively obtaining information about the state of cerebral microcirculation, which makes the problem of developing a set of indirect criteria of cerebral microhemodynamics relevant. Conclusion. To date, there is no combined diagnostic method that includes an assessment of structural changes in brain tissue and the state of microcirculation, which is necessary for the temporal and spatial assessment of disorders in the hemorrhagic type of stroke, as well as for establishing the pathophysiological cascade of vasospasm development.
Key words: microcirculation, hemorrhagic stroke, subarachnoid hemorrhage, computed tomography, magnetic resonance imaging, high-frequency ultrasound dopplerography, laser Doppler flowmetry
PHARMACEUTICAL SCIENCES
ORIGINAL ARTICLES
3D PHARMACOPHORES OF CYCLOOXYGENASE-2 INHIBITORS OBTAINED FROM CRYSTALLIZED ENZYME-LIGAND COMPLEXES
Sauts A.V.
Abstract: Objective. Preparation of 3D (spatial) pharmacophores of cyclooxygenase-2 inhibitors based on crystallized ligand-enzyme complexes. Methods. To obtain 3D pharmacophores, Protein Data Bank structures were loaded, obtained using X-ray diffraction analysis of cyclooxygenase-2 complexes with ibuprofen, indomethacin, meloxicam, naproxen, flurbiprofen and their derivatives, diclofenac, lumiracoxib, meclofenamic, mefenamic, tolfenamic, flufenamic acid, rofecoxib, coxib and compounds N-{(Succinyl-podophyllotoxynyl) 4-butyl}-2-{1-(4-chlorobenzoyl)-5-methoxy-2-methyl-1H-indol-3-yl} acetamide, SC-558, S-ARN-2508, 5c-S, 23d-(R), 4,9-dihydro-3H-pyrido[3,4-b]indole. To validate the pharmacophores, a set of inhibitor structures and test “bait ligands” downloaded from the DUD-E chemical databases was used. Clustering was performed using the McQuitty method. Validation of pharmacophores was performed using ROC analysis. Pharmacophore extraction, clustering, competition, pooling, and validation were performed in software Schrodinger Suite. Results. Two promising 3D pharmacophores were obtained and approved, one of which contains two aromatic rings, the second an aromatic ring and an acceptor bond. The largest pharmacophores obtained are structurally similar to rofecoxib, naproxen and its derivatives. Conclusion. The results of the work are of practical significance at the stage of virtual screening in the development of new selective non-steroidal anti-inflammatory drugs, as well as assessing the potential anti-inflammatory activity of existing compounds.
Key words: pharmacophore, cyclooxygenase-2, nonsteroidal anti-inflammatory drugs
DEVELOPMENT AND VALIDATION OF THE METHODOLOGY FOR QUANTITATIVE DETERMINATION OF FLAVONOIDS IN NOOTROPIC GRANULES CONTAINING POLYEXTRACT OF ALFREDIA PONTICA (ALFREDIA CERNUA L.)
Shatalova T.A., Semenova N.N., Dukkardt L.N., Michnik L.A., Krikova A.V.
Abstract: Objective. Research on the development and validation of a technique for the quantitative determination of flavonoids in granules of Alfredia cernua L. polyextract. Methodology. Granules of polyextract of Alfredia cernua L. were used in the studies. For the quantitative determination of the sum of flavonoids we chose the method of differential spectrophotometry based on the determination of the products of the complexation reaction with aluminum (III) chloride. The method for quantitative determination of the sum of flavonoids in the herb Alfredia cernua L. was taken as a basis. Validation of the method was carried out according to the indicators provided by the State Pharmacopoeia of the 15th edition. Results. Granules of polyextract from the lower leaves of Alfredia cernua L., which have a nootropic effect, were used as an object of research. The flavonoid complex of Alfredia polyextract was studied and the predominance of isoquercitrin was revealed, which determines the cerebroprotective and nootropic effects of Alfredia cernua preparations. Differential spectrophotometry at an analytical wavelength of 410 nm was proposed as a technique for quantitative analysis. Calculations of the quantitative content of the sum of flavonoids were carried out in terms of isoquercitrin. The flavonoid sum content of alfredia polyextract granules was (10.59±0.33) mg in 1 sachet packet. Validation of the quantification methodology was carried out. The average acceptability value (the average percentage of openability adjusted by 100%) is in the range of 97-102%, the average percentage of openability was 99.93%, and the relative standard deviation does not exceed 3%, which corresponds to the RSD value optimal for this method of analysis. Studies were conducted on the internal laboratory repeatability (precision) and stability of the technique when working on devices of different brands. At the same time, comparable results were obtained. The mean acceptability value (mean opening percentage adjusted to 100%) ranged from 97-102%, the mean opening percentage was 99.93%, and the relative standard deviation did not exceed 3%, which corresponds to the RSD value optimal for this method of analysis. Intra-laboratory repeatability (precision) and stability of the methodology when operated on different brands of instruments were investigated. Comparable results were obtained. Conclusions. We have developed techniques for qualitative and quantitative analysis of Alfredia cernua L. polyextract granules. For qualitative analysis of flavonoid complex and isoquercitrin, we propose to use cyanidin assay and TLC technique. Differential UV-spectrophotometry, based on the determination of the reaction products of complexation of flavonoids with aluminium (III) chloride at an analytical wavelength of 410 nm, was proposed for the quantitative analysis of the amount of flavonoids in the pellets of polyextract of Alfredia cernua L. The results of the studies showed that the developed methodology for the quantitative determination of flavonoids in terms of isoquercitrin in the preparation of Alfredia cernua L. meets the requirements of GF 15 edition.
Key words: Alfredia cernua L., polyextract, granules, flavonoids, isoquercitrin, qualitative and quantitative analysis, differential UV spectrophotometry, validation
ECOLOGICAL AND HYGIENIC STUDIES OF THE QUALITY OF HERBAL MEDICINAL RAW MATERIALS IN THE URBANIZED TERRITORIES OF THE MIDDLE STRIP OF RUSSIA ON THE EXAMPLE OF THE WASTELAND OF FIVE-LEAF GRASS
Dyakova N.A.
Abstract: Objective. Studying the peculiarities of accumulation of the most significant toxic elements and biologically active substances in medicinal plant raw materials using the example of a wasteland of five-lobed grass of the synanthropic flora of the middle strip of Russia, as well as analyzing the relationship between these processes. Methods. More than 50 samples of five-lobed grass pustyrnik harvested in various urbocenoses of the middle strip of Russia were analyzed, in which the content of toxic elements and main groups of biologically active substances was determined. Results. The presence of significant physiological barriers preventing the accumulation of ecotoxicants in the motherwort of five-lobed grass has been identified, which is especially noticeable for elements such as lead, mercury, arsenic, cadmium, cobalt and chromium. The motherwort of five-leaf grass is also able to selectively concentrate some heavy metals included in the active centers of enzyme systems (copper and zinc). The raw material of five-lobed motherwort collected in a number of urbocenoses is characterized by an increased content of flavonoids in terms of rutin, which is probably explained by the fact that the key enzyme for the synthesis of flavonoids - phenylalanine ammiacliase - has a pronounced stress inducibility. However, near some production plants and along high-traffic roads, we took samples with a content of flavonoids reduced relative to other samples of raw materials in terms of rutin. In the same samples, the lowest content of extractives extracted by 70% alcohol was noted, which suggests that with excessive toxic influence of pollutants, it is also possible to inhibit the secondary synthesis of metabolites in plants. Conclusion. A moderate positive effect on the accumulation of flavonoids in the pustyrnik of five-lobed grass was noted for mercury and zinc. Nickel had a moderate negative effect on the content of extractives extracted by 70% alcohol.
Key words: Leonurus quinquelobatus, heavy metals, arsenic, flavonoids, extractives
DEVELOPMENT OF A TECHNIQUE FOR THE QUANTITATIVE DETERMINATION OF FLAVONOIDS IN RED-STEMMED BUCKWHEAT GRASS (FAGOPYRUM RUBRICAULIS)
Mitishev A.V., Fednina A.S., Rodina O.P., Elistratov D.G., Makartseva M.G., Kurdyukov E.E.
Abstract: Objective. It is to develop methods of quantifying the amount of flavanoids in red-stemmed buckwheat grass. To make research for the selection of optimal parameters for the extraction of the ground part of raw materials in order to obtain extracts with a high content of biologically active substances. Methods. The object of the study is the red-stemmed buckwheat grass. Various extractants were used in the extraction process (purified water and ethyl alcohol 40%, 70% and 95%). Confirmation of the presence of flavonoids in the raw materials was carried out according to State Pharmacopoeia XV. Results. Qualitative reactions have shown that all extracts of red-stem buckwheat contain flavonoids. It was found that aluminum chloride leads to a bathochromic shift in the electronic absorption spectrum of red-stem buckwheat extracts with an absorption maximum similar to a solution of SS rutin (410 nm). Therefore, we selected rutin as the standard sample. It was found that the most effective extractant is ethyl alcohol with a concentration of 40%. Also it was found that the maximum extraction of flavonoids from the raw material takes place within 30 minutes. After statistical processing of data from five parallel measurements, it was revealed that the content of the sum of flavonoids, in terms of rutin, is 9.32-10.71%. Conclusion. The presence of flavonoids in red-stem buckwheat grass has been proven using qualitative reactions. It was revealed that the content of flavonoids in the raw materials of raw materials, when using various extractants, varies in the range from 1.72 to 10.71%. Optimal parameters have been established (extractant - ethyl alcohol 40%, the ratio of "raw material - extractant" is 1:25; extraction time is 30 minutes) for maximum extraction of flavonoids from the red-stemmed buckwheat herb. A method for quantifying the sum of flavonoids in terms of rutin has been developed.
Key words: grass, Fagopyrum rubricaulis, red-stemmed buckwheat, spectrophotometry, flavonoids
PHARMACOGNOSTIC STUDY OF MEDICINAL PLANT RAW MATERIAL PLANTAGINIS ARENARIAE HERBA (PLANTAGO ARENARIA WALDST. & KIT.)
Zemlyanskaya I.V., Yanitskaya A.V., Sarkisyan I.K., Beskrylova D.V., Gasanova E.G.
Abstract: Objective. The aim of the work is pharmacognostic study of medicinal plant raw material "Plantaginis arenariae herba", carrying out macro- and microscopic analysis, determination of its content of polysaccharides and flavonoids. Methods. The study of morphological and anatomical features was performed in accordance with OFS.1.5.1.0002 and OFS.1.5.3.0003 of the State Pharmacopoeia of the Russian Federation XV edition. Flavonoids content was determined by differential spectrophotometry, polysaccharides content was determined gravimetrically. Results. A detailed description of morphological and microscopic features of raw materials of "Plantaginis arenariae herba" was made. The content of the main active substances in the raw material of "Plantaginis arenariae herba" was determined, the content of polysaccharides was 10.7%, flavonoids 1.04%. Conclusion. Raw material "Plantaginis arenariae herba", growing in the Volgograd region accumulates a sufficient amount of active substances, which is not inferior to the indicators of plantain fleabane, and can be considered as a source of medicinal plant raw materials.
Key words: Plantago arenaria, Plantago indica, Plantago psyllium, polysaccharides, flavonoids, medicinal plant raw material
MODERN ASPECTS OF COMPARATIVE ANATOMO-MORPHOLOGICAL ANALYSIS OF THE HERBS OF SPECIES OF THE GENUS YARROW (ACHILLEA L.)
Vaskova A.I., Ryzhov V.M., Kurkin V.A., Korchikov E.S., Tarasenko L.V.
Abstract: Objective. Study of morphological and anatomical features of species of the genus Yarrow ( Achillea L.) using modern microscopic and statistical methods for inclusion in pharmacopoeial article 2.5.0101.18 ‘Yarrow herb’ of the State Pharmacopoeia of the Russian Federation. Methods. The above-ground part (herb) of species of the genus Yarrow growing in the Samara region and other regions of the Russian Federation - common yarrow ( Achillea millefolium L.), cartilaginous yarrow ( Achillea cartilaginea Ledeb. ex Rchb.), noble yarrow ( Achillea nobilis L.) - was studied. Raw materials were collected during the period of mass flowering of the plant 2021-2023. Light and polarising microscopy were chosen as research methods. Conclusion. As a result of the morphological-anatomical analysis, statistical processing was carried out and parameters of the following traits were determined: Number of flowers in the elementary inflorescence basket: the average number of flowers in the elementary inflorescence basket should be not less than 12 and not more than 15; Length and width of leaf spikes: length from the centre of the base to the apex of the spike varies from 62.9±0.1 µm to 63.4±0.1 µm, width at the base of the spike varies from 54.6±0.2 µm to 55.0±0.2 µm, shape wedge-shaped.
Key words: yarrow, Achillea L., herb, morphological and anatomical analysis
STUDYING ASPECTS AND MONITORING THE CIRCULATION OF HERBAL PRODUCTS CONTAINING SPINY ARTICHOKE EXTRACT ON THE PHARMACEUTICAL MARKET OF CRIMEA
Cokalo I.E., Miroshnichenko N.V., Sheremeteva A.V.
Abstract: Objective. The purpose of the study is to study the Crimean market of hepatoprotective agents containing prickly artichoke extract. Methods. The Crimean pharmacy assortment of hepatoprotective drugs with artichoke leaves extract is mainly represented by manufacturers in Russia (71.5%) and Europe and the USA (28.5%). They are in solid dosage form: tablets (57.1%) and capsules (42.9%). Popular domestic supplements for daily use have a favorable price from 300 to 700 rubles, i.e. There is a budget option. Results. The technological solution of the dosage form in capsules for biologically active substances of plant origin makes it possible to improve their pharmacokinetics and increase bioavailability for the body. It also makes it possible to add a complex of active ingredients into a capsule without the influence of technological factors on the quality of the finished product during the shelf life. Conclusions.The information obtained is the basis for the further development of promising dosage forms and their further introduction into the production cycle.
Key words: spiny artichoke extract, hepatoprotectors of plant origin, development of promising dosage forms, introduction into production
RESEARCH ON STANDARDIZATION OF RAW MATERIALS - ERODIUM CICUTARIUM HERB
Damdinova Yu.P., Privalova E.G., Posokhina A.A.
Abstract: Objective. The purpose of this work is to establish the requirements for authenticity, the indicators of grinding, the content of impurities and the quantitative determination of biologically active compounds for a new plant raw material - the herb Erodium cicutarium . Methods. The establishment of quality indicators and testing of medicinal plant raw materials was carried out on the basis of the requirements of the general pharmacopoeia articles included in the State Pharmacopoeia of the XV edition, namely the requirements of sections 1.5.3. Methods of analysis of medicinal plant raw materials, medicinal products of plant origin and Section 1.2.2.2. Testing for the maximum content of impurities. The quantitative determination method was developed on the basis of the spectrophotometric method, the spectral characteristics were evaluated on the SF-2000 spectrophotometer (Russia) in cuvettes with a layer thickness of 10 mm. Results. Studies have been conducted on the standardization of whole, crushed and powdered raw materials - the herb Erodium cicutarium . Authenticity indicators have been developed, including morphological, anatomical and diagnostic signs, as well as qualitative reactions confirming the presence of tannins and flavonoids. The normative indicators included in the section «Tests» are proposed: humidity for whole and crushed raw materials - no more than 11%, for powder - no more than 10%, total ash - no more than 4%, ash insoluble in hydrochloric acid - no more than 1%, the content of foreign impurities: browned and yellowed parts of raw materials - no more than 3%, organic impurities - no more than 1%, mineral - no more than 0,5%, the grinding of raw materials - according to the results of sieve analysis, depending on the type of raw material. The quantitative analysis of active substances is proposed to be carried out by spectorophotometry under selected optimal conditions, as a result of which norms for the quantitative content of flavonoids are proposed. Conclusion. The results obtained are the basis of the draft pharmacopoeia article, and the possibility of expanding the range of herbal preparations.
Key words: Erodium cicutarium, standardization, authenticity, anatomical features, quantitative analysis
RESEARCH OF THE REGIONAL MARKET OF HYPOALLERGENIC INFANT NUTRITIONAL RPODUCTS IN THE REPUBLIC OF TATARSTAN
Izrafilova V.A., Egorova S.N.
Abstract: Objective. Conducting an analysis regional level of the range of hypoallergenic nutritional products for infants under one year of age fed with infant formulas, at the regional level. Methods. Data from the State Registry of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Rospotrebnadzor) of the Russian Federation and price lists of organizations conducting wholesale trade of medicines and other pharmacy products in the Republic of Tatarstan were used as the research material. The study used methods of structural analysis, documentary research, grouping and graphical methods. Results. During the analysis of the State Registry of Rospotrebnadzor of the Russian Federation pertaining to hypoallergenic preventive nutritional products for infants fed with infant formulas and price lists of organizations conducting wholesale trade of medicines and other pharmacy products in the Republic of Tatarstan, a database of hypoallergenic preventive nutritional products for infants suffering from allergic diseases was created and analyzed. Conclusion. The domestic market of hypoallergenic infant nutritional products for infants under one year of age who are fed with infant formulas is characterized by a sufficient number of products that effectively reduce the risk of developing food allergies in infants of the first year of life, and includes a large proportion of imported products.
Key words: food allergy, hypoallergenic nutrition of infants
ASSESSMENT OF PROSPECTS FOR THE DEVELOPMENT AND AUTHORIZATION OF PRODUCTION OF HIGH-TECH MEDICINES
Taube A.A., Shigarova L.V., Flisyuk E.V., Narkevich I.A.
Abstract: Objective. Exploring methods to stimulate the development of drugs to treat unsatisfactory medical experiences. Methods. Information-analytical methods, methods of analysis and synthesis, logical methods, dividing the general into parts, extrapolation. Results. The stages of development of new medical technologies using regenerative medicine drugs have been identified. The main problem in the production of such drugs is small batches, which leads to high costs. The second problem in bringing ATMP to the market is the small number of patients and difficulties in conducting clinical trials. To solve the problem of conducting clinical trials, as well as the availability of new medical technologies, professional communities have created patient registries by disease profile, and are conducting long-term planning of clinical trials within the framework of registration and post-registration studies. The design and patient inclusion criteria are formulated in advance at an early stage of development through consultation with regulatory authorities. The EMA and FDA have reached an agreement to conduct joint scientific consultations on the development of gene and cell therapy drugs. At the current stage, the main problems that hinder progress in the development of new technologies of gene and cell therapy are being solved - high cost, unaffordable for a number of healthcare systems; restrictions on the number of subjects in clinical trials, leading to problems with the evidence base, technology transfer and production scaling. The next trend in the development of the HTLP market is the approval of expanded indications for use. Conclusion. High-tech drugs require complex regulation and separate requirements for the development and use of these drugs. The modern vector of scaling production and development processes requires specific approaches to managing the risks of using VTLP. From a commercial point of view, allogeneic drugs are more effective. Autologous drugs are necessary to solve personalized therapeutic problems. In the near future, global convergence of regulation of the circulation of drugs for regenerative medicine is expected, which is necessary to consolidate efforts to increase its availability and safety.
Key words: regenerative medicine, Advanced Therapy Medicinal Products, gene therapy medicines, somatic-cell therapy medicines, tissue-engineered medicines, technology transfer, production scaling, CAR-T
ANNIVERSARIES
ON THE 100th ANNIVERSARY OF HIS BIRTH PROFESSORS, DOCTORS OF MEDICAL SCIENCES LEV SOLOMONOVICH RACHMILEVICH
Evseev A.V., Pravdivcev V.A., Putenkova L.Y.U., Sosin D.V., SHalaeva O.E., Pavlyuchenkova O.V., Stepanov D.V., Mosin O.A.
Abstract: Lev Solomonovich was born on January 18, 1925 in Saratov. In 1943, he graduated from high school and entered the Saratov Medical Institute, the medical faculty, which he graduated with honors in 1948. An active social activist, a member of the student scientific society, a friend for his classmates - he chose this position in life immediately after starting his studies. After graduating from the university, Lev Solomonovich entered graduate school at the Department of Normal Physiology of the Media. After defending his candidate's dissertation (1951) in the academic council of the Saratov Medical Institute in 1952, according to the distribution of the Ministry of Health of the RSFSR, he was sent to the Smolensk Medical Institute to work as an assistant in the Department of Normal Physiology. From 1957 to 1970, Lev Solomonovich was an associate professor of the department. During this period, along with intensive scientific activity, including work on his doctoral dissertation, he worked intensively in the pedagogical and public fields.
Key words: Lev Solomonovich Rachmilevich
MISCELLANEA
DEVELOPMENT OF GENERAL MEDICAL PRACTICE (FAMILY MEDICINE) IN THE SMOLENSK REGION
Afanasenkova T.E., Dubskaya E.E., Golovanova E.D.
Abstract: Objective. General practice is one of the forms of organization of primary health care. The purpose of the study: to highlight the features of training specialists in the discipline "General medical practice (family medicine)" and the development of medical care in the profile "General practitioner (family doctor)" in Smolensk and the Smolensk region. Methods. The study analyzes the features of the organization and work of the Department of General Medical Practice, outpatient therapy with a course of geriatrics at the Faculty of Additional Professional Education, where specialists in the discipline "General Medical Practice (family Medicine)" are trained. Results. A general practitioner (family doctor) is a specialist who is widely oriented in the main medical specialties and is able to provide multidisciplinary outpatient care for the most common diseases and urgent conditions. Conclusion. General practice is one of the forms of organization of primary health care. The appeal of modern Russian healthcare to the experience of zemstvo medicine is a recognition of its merits and the dictates of the time.
Key words: general practitioner, family doctor, general medical practice