The conceptual model of sustainable development of the rubal sector

On the one hand, the relevance of the studied issue is determined by growing lag of rural territorial units in socioeconomic development, and one the other by their significance in such important aspects of the country, as ensuring food supply security, preservation of the available land, production, ecological, demographic and human potential. The aim of the article is to develop the conceptual model of sustainable development of rural areas, which is based on the system of indicators of quality of living of rural population. The leading method for studying this issue is modeling, which allows to consider it as a targeted and organized process of formation of the concept of sustainable development of the rural sector of the regional economy using the example of the studies of experience of sustainable development of the Kinel-Cherkassky municipal district of the Samara region. The results: the analysis of consistence and tendencies of development of agrarian potential of rural areas of the Samara region was carried out for the purpose of implementation of the conceptual model of sustainable development and assessment of further prospects in the production sphere of the village; the main reasons for disproportion in sustainable development of rural areas of the Samara region are identified. The materials of this article can be used for theoretical conclusions, methodological developments and working knowledge in activities of bodies of the regional government and local self-government when developing the concept and programs of sustainable development of rural municipalities. © 2016 Belyaeva et al

High calcium score in an 83-year-old patient with non-ST elevation acute coronary syndrome and nonobstructive coronary artery disease: a case report

Currently, multi-slice computed tomography (MSCT) coronary angiography is a leader in the diagnosis of coronary artery disease in patients with non-ST elevation acute coronary syndrome of low or moderate risk. High coronary calcium score (CCS) obtained by MSCT indicate a high probability of obstructive coronary artery disease. In the presented case of an 83-year-old patient with unstable angina, the CCS was 1394, and hemodynamically significant stenoses were detected. However, according to selective coronary angiography, no hemodynamically significant coronary lesions were found. High CCS suggests poor image quality in MSCT coronary angiography. High CCS is detected in most people over 70 years of age. Obviously, in this patient, a high CCS is mainly determined by age. Most studies on CCS did not include patients over 80 years of age. When deciding whether to perform MSCT coronary angiography, it is necessary to take into account the individual characteristics of a particular patient, which may affect the interpretation of results

Первые результаты 6-летнего динамического наблюдения пациента с ранним псориатическим артритом, леченного в рамках стратегии «Лечение до достижения цели»

The paper characterizes the basic principles of a treat-to-target (T2T) strategy for spondyloarthritis, including psoriatic arthritis (PsA). The data from observational cohort studies suggest that inadequate therapy for PsA increases the risk of structural progression. The results, obtained in the international randomized controlled Tight Control of Psoriatic Arthritis (TICOPA) trial and the Russian open-label observational REMARCA study, have justified the necessity of using the T2T strategy for early-stage PsA. The authors have analyzed their own results of a 6-year follow-up study of a patient with early PsA, in whom the T2T strategy was used.В статье приводится характеристика основных принципов стратегии «Лечение до достижения цели» («Treat to target», T2T) при спондилоартритах, включая псориатический артрит (ПсА). Данные наблюдательных когорт свидетельствуют о том, что отсутствие адекватной терапии ПсА увеличивается риск структурного прогрессирования. На основании результатов, полученных в международном рандомизированном контролируемом исследовании TICOPA, а также Российском открытом наблюдательном исследовании РЕМАРКА, обоснована необходимость использования стратегии Т2Т на ранней стадии ПсА. Проанализированы собственные результаты 6-летнего наблюдения за пациентом с ранним ПсА, при лечении которого была применена стратегия Т2Т

Pathology of mammary glands in women with reproductive disorders and chronic endometritis

Background. The last decades are devoted to the search for various factors leading to the development of benign breast diseases, which are the risk of breast cancer. In gynecological diseases, the frequency of benign processes in the mammary glands increases to 76-97.8 %. Aims: this research is devoted to the study of the prevalence and structure of breast pathology in women with chronic endometritis and reproductive disorders. Materials and methods. The study included patients with reproductive disorders: 50 patients with histological verification of the diagnosis of chronic endometritis and 50 patients without chronic endometritis. Hormonal examination was carried out using radioimmunoassay and immunoenzymatic methods. Methods of mathematical statistics implemented Statistica 6.1 (USA) were used parametric criteria: Student's t-test and Fisher's F-criterion, the nature of the distribution was estimated using the methods of Kolmogorov - Smirnov with a significance level smaller and equal to 5 % (p < 0.05). To confirm the fact that the observed differences between the products of A x D and B x C are not random, we used the х2 criterion. Results and conclusions. In women with chronic endometritis, the pathology of the mammary glands is characterized by the presence of ectasia of the ducts of the mammary gland; clinically, it is manifested by lactorrhea. Benign dysplasia of mammary glands is accompanied by the presence of hyperestrogenia, hypoprogesteronemia, which is typical for ovarian dysfunction. It is possible to use a pathogenetically reasonable combination correction: anti-inflammatory therapy and the use of gestagens in women with reproductive disorders and chronic endometritis

SOCIO-PSYCHOLOGICAL CHARACTERISTICS OF FIRST-YEAR STUDENTS OF IRKUTSK STATE UNIVERSITY IN ACCORDANCE WITH THE DIFFERENT FIELDS OF STUDY

For the first time the results of social and psychological characteristics of the first-year students were obtained. We performed the estimation of adaptation potential of the first-year students during their studies at the university and depending of the fields of their study (humanitarian, scientific or physico-mathematical). The peculiarities of motivation of the goal achievement need in the first-year students of different fields of study were determined. It was found that most of first-year students (53 %) had an average needs-based motivation and were characterized by low adaptive capacity (66,6 %) and low-neuro mental stability (41,6 %). During the research we used multilevel personality questionnaire "Adaptivity" of A.G. Maklakov and S.V. Chermyanin and test-questionnaire "Goal achievement need" of Y.M. Orlov

EVALUATION OF LIPID PROFILE COMPONENTS IN FOREIGN STUDENTS STUDYING AT THE IRKUTSK STATE MEDICAL UNIVERSITY

Background. A socially significant order for the training of foreign specialists, including the promotion of Russian education on the international market, certainly requires the organization of the process of students’ adaptation to the educational and information environment of the university. Particular attention deserves the components of the lipid profile, which are part of the overall adaptation syndrome.Aim: to study the features of the lipid profile in foreign students studying at the Irkutsk State Medical University.Methods. In total, 100 students of the medical profile of the Irkutsk State Medical University were enrolled in full-time study: 58 students (36 males and 22 females) were students of Russian nationality and 42 students (32 males and 11 females) – Indian students. Levels of lipid status indicators were determined with the help of Cormay kits on the automatic analyzer BTS-330 using the photometry method.Results. Hindu young men had statistically significantly higher values of triacylglycerols, very low-density lipoproteins and lower levels of high-density lipoproteins in comparison with young Russians. In the groups of girls of Indian origin, the changes concerned increased levels of triacylglycerols and very low-density lipoproteins in comparison with Russians. Gender differences were found only among Russian students – in the form of increased values of cholesterol and low-density lipoproteins in the group of girls compared to boys.Conclusion. The established functional changes in lipid metabolism in foreign students characterize the stress of the adaptive resources of the body, which, probably, can be due to the irrationality of nutrition

Post hoc анализ результатов сравнительного наблюдательного клинического исследования КОЛИБРИ у пациентов с остеоартритом коленных сустаков и мелких суставов кистей

Objective: to evaluate the effectiveness of therapy with AMBENE®Bio (AB) in comparison with the comparator drug (bioactive concentrate of small marine fish, BCSMF) in patients with osteoarthritis (OA) of large and small joints in routine clinical practice.Patients and methods. KOLIBRI multicenter, observational, non-randomized, comparative study included 233 patients with OA of the small hand joints (HJ) or knee joints (KJ) from three Russian centers (two in Moscow and one in Tula). Patients with a generalized form of OA were excluded from the analysis. The remaining patients were divided into two groups depending on the localization of OA. The first group included 174 patients with knee OA, 105 of them received AB, and 69 received the reference drug (BCSMF) according to the same regimen. The second group consisted of 21 women with HJ OA: 13 patients were prescribed AB, and 8 — the reference drug.The duration of the study averaged 330±14 days, the total number of visits was 4. The main indicator of effectiveness was the dynamics of pain during movement according to VAS (0—100 mm) 30±7 days after the start of treatment compared with the baseline value. All patients underwent radiography of the HJ and KJ, as well as ultrasound of the involved joints.Results and discussion. Both drugs provided significant clinical improvement in patients with OA, which is consistent with other studies with similar design and long follow-up. These data confirm the symptom-modifying properties of the presented group of combined drugs in the OA treatment. The Russian injectable drug AB in OA was not inferior in effectiveness to the foreign BCSMF. According to the OMERACT-OARSI criteria, 85.2% and 88.9% of patients, respectively, responded to treatment with AB and the reference drug. In both groups, half of the patients managed to stop further use of non-steroidal anti-inflammatory drugs (NSAIDs) on a regular basis.Conclusion. The use of AB was accompanied not only by a decrease in the severity of clinical symptoms of OA, but also by a decrease in the daily requirement for NSAIDs almost by 2 times.Цель исследования — оценить эффективность терапии препаратом АМБЕНЕ®Био (АБ) в сопоставлении с препаратом сравнения (биоактивный концентрат из мелких морских рыб, БКММР) у пациентов с остеоартритом (ОА) крупных и мелких суставов в рутинной клинической практике.Пациенты и методы. В многоцентровое наблюдательное нерандомизированное сравнительное исследование КОЛИБРИ включено 233 пациента с ОА мелких суставов кистей (СК) или коленных суставов (КС) из трех российских центров (два — в Москве и один — в Туле). Из анализа были исключены пациенты с генерализованной формой ОА. Остальные больные были разделены на две группы в зависимости от локализации ОА. В первую группу вошли 174 пациента с ОА КС, 105 из которых получали АБ, а 69 — препарат сравнения (БКММР) по той же схеме. Вторая группа состояла из 21 женщины с ОА СК: 13 пациенткам был назначен АБ, а 8 — препарат сравнения.Длительность исследования составила в среднем 330±14 дней, общее число визитов — 4. Основным показателем эффективности была динамика боли при движении по ВАШ (0—100 мм) через 30±7 дней после начала лечения по сравнению с исходным значением. Всем пациентам выполнялись рентгенография СК и КС, а также УЗИ пораженных суставов.Результаты и обсуждение. Оба препарата у пациентов с ОА обеспечивали существенное клиническое улучшение, что согласуется с данными других работ со схожим дизайном и длительным сроком наблюдения. Эти данные подтверждают симптом-модифицирующие свойства представленной группы комбинированных препаратов для лечения ОА. Отечественный инъекционный препарат АБ при ОА не уступал по эффективности зарубежному БКММР. Согласно критериям OMERACT-OARSI ответили на лечение АБ и препаратом сравнения 85,2 и 88,9% пациентов соответственно. В обеих группах у половины больных удалось отказаться от дальнейшего использования на постоянной основе нестероидных противовоспалительных препаратов (НПВП).Заключение. Применение АБ сопровождалось не только уменьшением выраженности клинической симптоматики ОА, но и снижением суточной потребности в НПВП примерно в 2 раза

СЛУЧАЙ РАЗВИТИЯ ИНТРАМУРАЛЬНОЙ ГЕМАТОМЫ ЛЕВОГО ПРЕДСЕРДИЯ ПОСЛЕ ПРОВЕДЕНИЯ ЧРЕСКОЖНОГО КОРОНАРНОГО ВМЕШАТЕЛЬСТВА

Left atrial Intramural hematoma (LAIH) is rare complication cardiac invasive procedures. The article analyses the mechanism of formation of this pathology. The case of the LAIH after percutaneous coronary intervention (PCI) is presented. The patient complained of intensive chest pain. When performing ECHO, LAIH was found. LAIH occupied a large part of the cavity left atrium. The conservative supervision of the patient was chosen despite the compession of the left inferior pulmonary vein and symptoms of the acute heart failure. The successful symptomatic treatment was conducted. Taking into consideration the recent PCI dual antiplatelet therapy was not interrupted. LAIH gradually regressed. Five weeks after the desease began, the patient was discharged from the hospital. Nine months after almost full lysis of LAIH was observed. The discussion section is devoted to the issues of diagnosis, the choice of medical tactics, the necessity of surgical treatment and the stop of antitrombotic theatment.Интрамуральная гематома левого предсердия (ИГЛП) – редко встречающееся осложнение вмешательств на сердце. В статье рассматриваются механизмы формирования этой патологии. Представлен случай развития ИГЛП после проведения чрескожного коронарного вмешательства (ЧКВ). По окончании процедуры больной пожаловался на интенсивные боли в груди. При проведении ЭхоКГ выявлена ИГЛП, занимающая большую часть полости левого предсердия (ЛП). Несмотря на компрессию левой нижней легочной вены и симптомы острой сердечной недостаточности, была выбрана консервативная тактика ведения, проводилось успешное симптоматическое лечение. Учитывая недавнее ЧКВ, двойная дезагрегантная терапия не прерывалась. ИГЛП постепенно уменьшалась в размерах. Через пять недель от начала заболевания пациент был выписан из стационара, через девять месяцев наблюдался практически полный лизис ИГЛП. Раздел обсуждения посвящен вопросам диагностики, выбора лечебной тактики, целесообразности проведения хирургического лечения и отмены антитромботической терапии

Диагностическая эффективность перфузионной компьютерной томографии миокарда с чреспищеводной электрокардиостимуляцией у больных с исходным диагнозом «острый коронарный синдром»

Introduction. Computed tomography angiography (CTA) is widely used to detect atherosclerotic changes in coronary arteries (CA). However, the method is limited by the impossibility to perform functional assessment of detected stenoses. Perfusion computed tomography of the myocardium (PCT) can be used for this purpose.Aim of the study. To assess diagnostic accuracy of PCT of the myocardium with transesophageal electrocardiostimulation (TEES) and stress-echocardiography (stress-echoCG) with veloergometry (VEM) in detection of transient ischemia in patients with initial diagnosis of “acute coronary syndrome” (ACS) with borderline stenoses (50–75%) in CA in relation to measurements of fractional flow reserve (FFR).Materials and Methods. The study included 30 patients with the initial diagnosis of ACS with borderline (50–75%) stenoses in CA according to CTA or coronary angiography (CAG). Subsequently, they underwent myocardial PCT with 320-row detector with TEES, as well as stress-echoCG with VEM. Invasive FFR measurement was used as a reference method. FFR value &lt; 0.8 indicated hemodynamic significance of stenosis. Myocardial perfusion was assessed visually. Regional myocardial contractility of the left ventricle was assessed by stress-echoCG.Results. All patients were examined according to the stated protocol. PCT with TEES revealed FFR-significant stenoses with sensitivity, specificity, prognostic value of positive result and prognostic value of negative result 56, 93, 90, 65% respectively, stress-echoCG with VEM 62, 93, 91, 68% respectively.Conclusion. Myocardial PCT with TEES enables to detect perfusion defects associated with transient ischemia, and the diagnostic accuracy of the method in comparison with FFR is comparable with the already well-proven stress-echoCG. The use of PCT with TEES in combination with CTA can be considered as a promising diagnostic tool in patients without known coronary anatomy and with suspected ACS.Введение. Компьютерная томографическая ангиография (КТА) широко используется для выявления атеросклеротических изменений в коронарных артериях (КА). Однако метод ограничен невозможностью проведения функциональной оценки выявленных стенозов. С этой целью может использоваться перфузионная компьютерная томография миокарда (ПКТ).Цель исследования. Оценить диагностическую точность методов ПКТ миокарда с чреспищеводной электрокардиостимуляцией (ЧПЭС) и стресс-эхокардиографии (стресс-ЭхоКГ) с велоэргометрией (ВЭМ) в выявлении преходящей ишемии у больных с исходным диагнозом «острый коронарный синдром» (ОКС) с пограничными стенозами (50–75%) в КА по отношению к измерениям фракционного резерва кровотока (ФРК).Материалы и методы. В исследование были включены 30 больных с исходным диагнозом ОКС с пограничными (50–75%) стенозами в КА по данным КТА или коронарной ангиографии (КАГ). Впоследствии им были выполнены ПКТ миокарда на томографе с 320-рядным детектором с ЧПЭС, а также стресс-ЭхоКГ с ВЭМ. В качестве референтного метода использовалось инвазивное измерение ФРК. Значение показателя ФРК &lt; 0,8 указывало на гемодинамическую значимость стеноза. Перфузия миокарда оценивалась визуально. При проведении стресс-ЭхоКГ оценивалась региональная сократимость миокарда левого желудочка.Результаты. Все больные обследованы согласно заявленному протоколу. ПКТ с ЧПЭС выявила ФРК-значимые стенозы с чувствительностью, специфичностью, прогностической ценностью положительного результата и прогностической ценностью отрицательного результата 56, 93, 90, 65% соответственно, стресс-ЭхоКГ с ВЭМ 62, 93, 91, 68% соответственно.Выводы. ПКТ миокарда с ЧПЭС позволяет выявить дефекты перфузии, ассоциированные с преходящей ишемией, а диагностическая точность метода при сравнении с ФРК сопоставима с уже хорошо зарекомендовавшей себя стресс-ЭхоКГ. Использование ПКТ с ЧПЭС в комбинации с КТА можно рассматривать как перспективный диагностический инструмент у больных без известной коронарной анатомии и с подозрением на ОКС