New interaction paradigm of ecological, social and economic structures of human activity

Realities of the XXI century demand searching and grounding measures on changing economic, political, and the main thing, ideological institutions that determine trends of evolution and managing vital human activity at national and over-national levels. Using synergetic approach, the authors made an attempt to synthesize conclusions and main theses of neo-institutionalism theory, onto-psychology, as well as results of biological evolution for determining the way to overcome global ecological crisis at nano-level and to form a model of the mankind's optimal evolution on the base of principle "priorities through parities", using DNAsymbol as a code of survival, through co-evolution of economy and ecology. The main problem, existing even in economically developed countries, is the realization of the fact that the paradigm of the stationary economy is the only condition for the mankind's survival. To solve this problem serious transformation of ideological institutions is necessary, at the expense of comprehensive and based on onto-psychological methods program of ecological literacy, that should harmonically blend with the presented by the authors triads of state strategic management and achieving the goal of development. It is the transformation of the national matrix, content and direction of which are set in order to ensure a balance of interests of all participants in ecological and economic development, will lay the necessary rules, both formal and informal, in the style of human behavior, social groups, the national economy. Realization of the program ecological literacy within the national policy on ecological development of the regions is one of the most important conditions for a natural, not imposed from the outside, prepare to use the paradigm of a sustainable economy as the basis of economic, political and ideological institutions of modern society, which is primarily the formation of a new paradigm of human device - devices nano-level decision-making, consumer behavior

Cognitive and Simulation Modeling of Regional Economic System Development

Sustainable development of regional economy is the declared as a strategic objective of the state. From these positions, studying of the regional socio-economic phenomena and processes, development of the corresponding research and managerial tools are actual tasks. Authors consider the regional economy as a complex hierarchical system. This requires identification of its state, structure, particularities in its development and governance. These factors are investigated using the means of simulation modeling. Authors suggest to use the developed cognitive and simulation modeling methodology, which is based on cognitive approach, the theory of hierarchical multilevel structures, fixed and fuzzy directed graphs. The study illustrates possibilities of cognitive-simulation modeling and foresight of the socio-economic system development at the regional level. Keywords: simulation modeling, regional development, sustainable development JEL Classifications: C63, R5

Аcinetobacter baumannii bv Tryptophandestruens bv nov. isolated from clinical samples

The aim of the study was to determine the taxonomic status of a group consisting of atypical strains of Acinetobacter baumannii, outline relevant characteristics and methods necessary for their identification. There were examined 10 strains of A. baumannii (6 of them primary comprised) bearing similar profile of atypical features isolated from clinical samples (urine, sputum) in 2017–2019 at the Military Medical Academy. Сlinical strains of typical A. baumannii (n = 36), Acinetobacter nosocomialis (n = 14), Acinetobacter pittii (n = 9) and 1 strain of Acinetobacter calcoaceticus isolated from the external environment were used in comparative studies. Atypical strains had the characteristics of A. calcoaceticus — A. baumannii (ACB) complex bacteria and were identified as A. baumannii. The utilization of substrates as the only carbon source was studied on a dense synthetic medium added with 0.2 % substrate during incubation for 72 hours at 37°C. Carbohydrate oxidation coupled to acid formation was detected on the Hugh–Leifson medium by using a micromethod. Aromatic amino acid biotransformation was carried out in liquid and dense nutrient media assessed in chromogenic reaction. The rpoB gene was used for strain genetic characterization. Amplification of two 940 and 1210 base pair (bp)-long fragments from the rpoB gene was performed by the routine polymerase chain reaction using primers with previously described sequences. Amplification products were sequenced by Sanger using Big Dye Terminator v3.1 (Applied Biosystems, USA) and capillary electrophoresis on an automatic sequencer ABI PRISM 3130 (Applied Biosystems, USA), followed by using methods for determining the similarity levels of sequenced fragments with the rpoB gene sequences of the reference strain A. baumannii ATCC 17978 (GenBank accession no. CP053098.1). It was found that all strains belonging to atypical A. baumannii spp. had a specific set of features that distinguish them from typical strains of A. baumannii as well as other types of the ACB complex: detected biotransformation of L-tryptophan (via anthranilate pathway) and anthranilic acid under unambiguous lack of such signs in other bacteria; lack of utilized sodium hippurate and L-arabinose being unambiguously evident in other bacteria; lack of utilized L-tryptophan, putrescine, L-ornithine being utilized in the majority of strains of belonging to other bacterial species. Genetic analysis showed that the control strains of typical A. baumannii displayed 99.20–99.21% similarity within the sequenced fragments of the rpoB gene with those from the rpoB gene of the reference strain. All 10 strains of atypical A. baumannii had similar features (99.20–99.21%). At the same time, parameters of control strains from other bacterial species significantly differed: A. nosocomialis (95.10–95.97%), A. pittii (94.63–94.92%), A. calcoaceticus (93.00%). Hence, the strains of atypical and typical A. baumannii are genetically homogeneous and belong to the same species. The data presented allow us to consider this group of atypical A. baumannii strains as a new biovar. We propose the name for this new biovar — tryptophandestruens (tryptophan-destroying) stemming from the Latin word destruens — destroying. Identification of A. baumannii bv. tryptophandestruens bacteria can be carried out in laboratory of any level by using tests for L-tryptophan biotransformation as well as sodium hippurate utilization

Migraine aura: retracting particle-like waves in weakly susceptible cortex

Cortical spreading depression (SD) has been suggested to underlie migraine aura. Despite a precise match in speed, the spatio-temporal patterns of SD and aura symptoms on the cortical surface ordinarily differ in aspects of size and shape. We show that this mismatch is reconciled by utilizing that both pattern types bifurcate from an instability point of generic reaction-diffusion models. To classify these spatio-temporal pattern we suggest a susceptibility scale having the value [sigma]=1 at the instability point. We predict that human cortex is only weakly susceptible to SD ([sigma]<1), and support this prediction by directly matching visual aura symptoms with anatomical landmarks using fMRI retinotopic mapping. We discuss the increased dynamical repertoire of cortical tissue close to [sigma]=1, in particular, the resulting implications on migraine pharmacology that is hitherto tested in the regime ([sigma]>>1), and potentially silent aura occurring below a second bifurcation point at [sigma]=0 on the susceptible scale

Modern approaches to diagnosis and treatment of urethral strictures: literature review and own experience

This article presents a literature review of modern methods of diagnosis and treatment for urethral strictures. In addition, the own results of a pilot study on the use of synthetic tissue-engineering structures as a material for urethroplasty substitution are presented as well

Перспективные направления лечения хронической сердечной недостаточности: совершенствование старых или разработка новых?

Unprecedented advances of recent decades in clinical pharmacology, cardiac surgery, arrhythmology, and cardiac pacing have significantly improved the prognosis in patients with chronic heart failure (CHF). However, unfortunately, heart failure continues to be associated with high mortality. The solution to this problem consists in simultaneous comprehensive use in clinical practice of all relevant capabilities of continuously improving methods of heart failure treatment proven to be effective in randomized controlled trials (especially when confirmed by the results of studies in real clinical practice), on the one hand, and in development and implementation of innovative approaches to CHF treatment, on the other hand. This is especially relevant for CHF patients with mildly reduced and preserved left ventricular ejection fraction, as poor evidence base for the possibility of improving the prognosis in such patients cannot justify inaction and leaving them without hope of a clinical improvement in their condition. The lecture consistently covers the general principles of CHF treatment and a set of measures aimed at inotropic stimulation and unloading (neurohormonal, volumetric, hemodynamic, and immune) of the heart and outlines some promising areas of disease-modifying therapy.Беспрецедентные достижения последних десятилетий в области клинической фармакологии, кардиохирургии и имплантационной аритмологии значительно улучшили прогноз у пациентов с хронической сердечной недостаточностью (ХСН), однако, к сожалению, сердечная недостаточность продолжает ассоциироваться с высокой смертностью. Решение этой проблемы видится одновременно в максимально полном применении в клинической практике всех актуальных возможностей непрерывно совершенствующихся методов лечения сердечной недостаточности, доказавших свою эффективность в рандомизированных контролируемых исследованиях (особенно при подтверждении результатами исследований реальной клинической практики), с одной стороны, а также в разработке и оперативном внедрении инновационных подходов к терапии ХСН – с другой. Больше всего в этом нуждаются пациенты с ХСН с умеренно сниженной и сохранной фракцией выброса левого желудочка, бедная доказательная база возможности улучшения прогноза у которых не может обосновывать бездействие и оставление их без надежды хотя бы на клиническое улучшение состояния. В лекции последовательно рассмотрены общие принципы лечения ХСН, комплекс мероприятий, направленный на инотропную стимуляцию и разгрузку (нейрогормональную, объемную, гемодинамическую и иммунную) сердца, а также обозначены некоторые перспективные направления болезнь-модифицирующей терапии

Резистентность к диуретикам у пациентов с хронической сердечной недостаточностью: механизмы, профилактика и преодоление

The authors analyzed the problem of diuretic resistance (DR) in patients with chronic heart failure (CHF). Most of the symptoms and signs of CHF are associated with hypervolemia and vascular congestion in the systemic and pulmonary circulation. The severity of the latter is the main factor which negatively affects the overall assessment of life satisfaction in patients with CHF. Since the patient, even at the incurable stage of CHF, primarily expects a rapid decrease in the severity of manifestations of decompensation from the prescribed therapy, achieving euvolemia is the essence of its short-term objective. Without diuretics, these immediate effects, according to which most CHF patients judge the qualifications of the doctor, are almost impossible to achieve. Unfortunately, apparently, not a single clinician was able to avoid disappointment in the effectiveness of CHF therapy associated with DR in their practice. As a rule, DR reflects the progressive course of CHF and is often associated with a poor prognosis. The review consistently covers the issues of terminology, diagnosis, pathogenesis, and prevention of DR, which aggravates CHF, and discusses measures aimed at restoring sensitivity to diuretics.Проанализирована проблема резистентности к диуретикам (РД) у пациентов с хронической сердечной недостаточностью (ХСН). Большинство симптомов и признаков ХСН связаны с гиперволемией и застоем крови в большом и малом кругах кровообращения. Выраженность последних является основным фактором, негативно влияющим на общую оценку удовлетворенностью жизнью пациентов с ХСН. Так как пациент даже в инкурабельной стадии ХСН в первую очередь ожидает от назначенной врачом терапии быстрого снижения выраженности проявлений декомпенсации, достижение эуволемии представляет собой суть ее краткосрочной задачи. Без диуретиков этих немедленных эффектов, по которым большинство пациентов с ХСН судят о квалификации врача, добиться практически невозможно. К сожалению, по-видимому, ни одному клиницисту не удалось избежать в своей практике разочарования в эффективности терапии сердечной недостаточности, связанного с РД. Как правило, РД отражает прогрессирующее течение ХСН и часто ассоциируется с неблагоприятным прогнозом. В лекции последовательно рассмотрены вопросы терминологии, диагностики, патогенеза и профилактики РД, отягощающей ХСН, а также обсуждается комплекс мероприятий, направленный на восстановление чувствительности к диуретикам

Новая коронавирусная инфекция (COVID-19) у больных туберкулёзом в Санкт-Петербурге

The aim of this work was to attempt to analyze the demographic structure, clinical and radiological forms of tuberculosis and COVID-19, as well as the course and outcome of the disease in patients with this coinfection in the light of a new and still poorly understood problem of the mutual influence of tuberculosis and COVID-19.Material and methods. Examination and treatment were carried out in the infectious-tuberculosis departments of the Botkin Clinical Infectious Disease Hospital. We examined 63 patients identified in the first seven months of the epidemic in the multimillion city of St. Petersburg (Russia). Tuberculosis, confirmed by conventional bacteriological and molecular genetic methods, had an active phase in all of them. The new coronavirus infection was verified by a positive polymerase chain reaction test for SARS-CoV-2.Results. Tuberculosis in 43 patients was detected simultaneously with COVID-19, in 20 people it preceded coronavirus infection. Disseminated forms of tuberculosis prevailed - 50.8%; in 36.5%, two or more organs and systems were affected, which is associated with a high proportion (54.0%) of HIV-positive patients with an advanced stage of the disease. Lung damage with COVID-19 was noted in 36.5%. Fatal outcomes ended in 20.6% of cases of coinfection, the structure of the causes of death is given.Conclusion. An assumption was made about the possibility of an aggravating effect of tuberculosis on COVID-19 in the case of severe or widespread forms of these diseases. The negative influence of HIV infection on the outcome of the disease has also been shown. Further follow-up is required to identify more reliable associations between tuberculosis and COVID-19. Цель: попытка выполнить анализ демографической структуры, клинико-рентгенологических форм туберкулёза и COVID-19, а также течения и исхода заболевания у пациентов с указанной коинфекцией в свете новой и пока малоизученной проблемы взаимного влияния туберкулёза и COVID-19.Материалы и методы. Обследование и лечение проводилось в инфекционно-туберкулёзных отделениях Клинической инфекционной больницы им. С.П. Боткина. Обследованы 63 пациента, выявленные в первые 7 месяцев эпидемии в многомиллионном городе Санкт-Петербурге (Россия). Туберкулёз, подтверждённый общепринятыми бактериологическими и молекулярно-генетическими методами, у всех имел активную фазу течения. Новая коронавирусная инфекция верифицирована положительным тестом полимеразно-цепной реакции на SARS-CoV-2.Результаты. Туберкулёз у 43 больных был обнаружен одновременно с COVID-19, у 20 человек он предшествовал коронавирусной инфекции. Преобладали диссеминированные формы туберкулёза – 50,8%; в 36,5% имело место поражение двух и более органов и систем, что связано с высокой долей (54,0 %) ВИЧ-положительных пациентов с продвинутой стадией заболевания. Поражение лёгких при COVID-19 отмечено в 36,5%. Летальным исходом завершились 20,6% случаев коинфекции, приведена структура причин смерти.Заключение. Сделано предположение о возможности отягощающего влияния туберкулёза на COVID-19 в случае тяжёлых или распространённых форм этих заболеваний. Показано также отрицательное влияние ВИЧинфекции на исход заболевания. Требуются дальнейшие наблюдения для выявления более более достоверных взаимосвязей туберкулёза и COVID-19.

КОКЛЮШ У ДЕТЕЙ – КЛИНИКО-ЭПИДЕМИЧЕСКАЯ ХАРАКТЕРИСТИКА В САМАРСКОЙ ОБЛАСТИ

Objective: to study the features of the clinical and epidemiological characteristics of whooping cough in children in the Samara region.Materials and methods: 389 cases of pertussis in the Samara region for 2015–2016 were analyzed.Results: it is shown that in spite of 95–98% vaccination coverage, in recent years there has been an increase in the incidence of whooping cough. Seasonality of morbidity remains. Among the children observed, the youngest children were not vaccinated against pertussis. The clinical picture of the disease remains typical with the classic course of catarrhal and spasmodic periods. Moderately severe forms of the disease predominate. Complications were noted mainly in unvaccinated children of the first year of life. The most frequent complications were pneumonia and apnea. There is a hypodiagnosis of pertussis in outpatient conditions. Infection often occurs under the mask of ARVI, while the sensitivity of the bacteriological method of diagnosis is zero. Of the methods for confirming the diagnosis, the most reliable is ELISA and PCR.Conclusion: these epidemiological and clinical features of pertussis current testify to the need to further improve methods of early diagnosis, especially express methods, etiopathagenetic treatment, specific prevention, antiepidemic measures in the foci of infection.Цель: изучить особенности клинико-эпидемической характеристики коклюша у детей в Самарской области.Материалы и методы: проанализированы 389 случаев коклюша в Самарской области за 2015–2016 гг.Результаты: показано, что, несмотря на 95–98% охват прививками, в течение последних лет наблюдается подъем заболеваемости коклюшем. Сохраняется сезонность. Среди наблюдавшихся детей преобладали дети младшего возраста, не привитые от коклюша. Клиническая картина заболевания остается типичной с классическим течением катарального и спазматического периодов. Преобладают среднетяжелые формы заболевания. Осложнения отмечались в основном у непривитых детей первого года жизни. Наиболее частыми осложнениями являлись пневмонии и апноэ. Имеет место гиподиагностика коклюша в амбулаторных условиях. Инфекция нередко протекает под маской ОРВИ, при этом чувствительность бактериологического метода диагностики равна нулю. Из методов подтверждения диагноза наиболее достоверным является ИФА и ПЦР.Заключение: указанные эпидемиологические и клинические особенности течения коклюша свидетельствуют о необходимости дальнейшего совершенствования методов ранней диагностики, особенно экспресс-методов, этиопатагенетического лечения, специфической профилактики, противоэпидемических мероприятий в очагах инфекции.