[Management of patients with insomnia and polymorbidity. A draft of the clinical guidelines]. / Vedenie patsientov s insomniei pri polimorbidnoi patologii. Proekt klinicheskikh rekomendatsii. Obshcherossiiskaya obshchestvennaya organizatsiya «Rossiiskoe obshchestvo somnologov¼.

Insomnia is a serious and widespread public health problem, but is often undetected and patients do not receive needed treatment. Insomnia is often comorbid with other diseases and conditions, such as arterial hypertension, type 2 diabetes mellitus, pain syndromes, anxiety and depressive disorders, etc. A separate problem is drug-induced insomnia, when patients develop symptoms due to other diseases treatments. Insomnia has a negative effect on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and decreased quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so clinical guidelines draft for the evaluation and treatment of insomnia in multimorbid patients is proposed. Diagnostic methods are reviewed and recommendations are given for the treatment of acute and chronic insomnia and features of the treatment of insomnia in multimorbid patients. A clinical algorithm has been proposed to determine treatment tactics in multimorbid patients.

[Management of patients with insomnia and polymorbidity: expert consensus]. / Vedenie patsientov s insomniei pri polimorbidnoi patologii: konsensus ekspertov.

Sleep disorders are becoming increasingly important due to the high comorbidity with other diseases and a significant impact on the patient's quality of life. Insomnia is the most common sleep disorder both in the general population and in patients with multimorbid pathology. Its prevalence in the general population is 6-15%, while in patients with somatic diseases it increases up to 20-40% and can reach 90% in patients with comorbid mental disorders. Another problem is the development of drug-induced insomnia. Insomnia has negative impact on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and a worse quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so it is extremely important to identify and correct these disorders in the early stages, therefore recommendations for the diagnosis of insomnia in polymorbid patients are proposed. Modern methods of treating acute and chronic insomnia and features of insomnia treatment in polymorbid patients are also discussed.

[Evaluation of the effectiveness of surgical treatment of recurrent urethral stricture].

INTRODUCTION: The recurrent course of the disease stricture is a complex problem for both the patient and the operating surgeon and requires an integrated approach to treatment only in expert centers. PURPOSE OF THE STUDY: To assess the effectiveness of methods of surgical treatment of recurrent urethral strictures. MATERIALS AND METHODS: At the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov, an analysis of the results of surgical treatment of patients with recurrent urethral stricture from 2012 to 2020 was carried out. This work included patients who underwent surgical treatment for recurrent urethral stricture. A total of 120 men were involved in the work. The median length of the stricture was (min-max) - 2 (0.5-16 cm). In 95 (79.1%) patients, stricture of the bulbous urethra, in 15 (12.5%) - in the penile urethra, in 2 (1.7%) patients had panurethral stricture, in 6 (5.0%) - membranous urethra and in 2 (1.7%) - meatus. All patients were divided into two groups: with recurrent urethral stricture after primary DVIU (group I, n=77) and recurrent urethral stricture after primary urethroplasty (group II, n=43). Depending on the method of surgical treatment of recurrent urethral stricture, patients in group I were divided into 4 subgroups. Repeated DVIU + 3 months Autocatheterization - 16 (20.8%) patients; End-to-end urethroplasty - 37 (48.1%) patients; one-stage urethroplasty with a buccal graft or skin graft - 22 (28.6%) patients; multistage urethroplasty or perineostomy - 2 (2.5%) patients. Group II was also divided into 4 subgroups. DVIU - 17 (39.5%) patients; end-to-end urethroplasty - 6 (13.9%) patients; one-stage urethroplasty with a buccal graft or skin graft - 9 (20.9%) patients; multistage urethroplasty - 11 (16.7%) patients. Median Qmax - 4.68 ml/sec. Preoperative cystostomy was observed in 31 (25.8%) patients. RESULTS: The median follow-up was 24 months (range 12 to 76 months). Depending on the method of surgical treatment of recurrent urethral stricture, the effectiveness of DVIU according to strict indications was 75.7%. End-to-end urethroplasty showed an efficiency of -88,4%. One-stage augmentation urethroplasty had an efficiency of -77,4%, and multi-stage urethroplasty showed an efficiency of 84.6%. The IPSS value for the observation period 2 years was 2.6+/-0.9 points. The average value of Qmax at the time of observation was 19.4+/-7.1 ml/sec. The effectiveness of the treatment was 82%. During the follow-up period, a relapse was noted in 22 (18%) patients. The overall effectiveness of the treatment of recurrent urethral stricture, taking into account the treatment of recurrent cases of disease recurrence, was 97.5%. CONCLUSIONS: Urethroplasty is the treatment of choice for recurrent urethral strictures, which has been shown to be more effective than DVIU. However, the results of urethroplasty for recurrent strictures are worse than for primary strictures.

Environment-induced overheating phenomena in Au-nanowire based Josephson junctions.

Unlike conventional planar Josephson junctions, nanowire-based devices have a bridge geometry with a peculiar coupling to environment that can favor non-equilibrium electronic phenomena. Here we measure the influence of the electron bath overheating on critical current of several bridge-like junctions built on a single Au-nanowire. Using the Usadel theory and applying the two-fluid description for the normal and superconducting components of the flowing currents, we reveal and explain the mutual influence of the neighbouring junctions on their characteristics through various processes of the electron gas overheating. Our results provide additional ways to control nanowire-based superconducting devices.

[The place of riociguat in the treatment of patients with pulmonary arterial hypertension associated with systemic connective tissue diseases].

Pulmonary hypertension (PH) can develop in different systemic autoimmune rheumatic diseases (SARD), such as systemic scleroderma (SSD), systemic lupus erythematosus, rheumatoid arthritis, and mixed connective tissue disease In most cases, patients with SARD develop WHO group I PH (pulmonary arterial hypertension associated with systemic connective tissue diseases, PAH-SCTD). General prevalence of this pathology reaches 15 cases per million adults. Most cases of PAH-SCTD are induced by SSD. Survival of PAH-SCTD patients is generally lower than survival of patients with other forms of LAH. Treatment of any SARD, including in LAH, implies a complex approach using glucocorticoids, disease-modifying anti-rheumatic drugs (cyclophosphamide, methotrexate, azathioprine, and others), and genetically engineered biologics. Specific targeted therapy is indicated for most patients with PAH-SCTD. The representative of a new class (soluble guanylate cyclase (sGC) stimulators), riociguat, has been approved for the treatment of PAH. This drug has a unique double mechanism of action: (i) sGC sensibilization to endogenous nitric oxide (NO) by stabilizing the NO-sGC bond; and (ii) direct, NO-independent sGC stimulation. For patients with PAH-SCTD, riociguat is the major alternative to phosphodiesterase-5 inhibitors both as monotherapy and combination therapy.

Anomalous magneto-resistance of Ni-nanowire/Nb hybrid system.

We examine the influence of superconductivity on the magneto-transport properties of a ferromagnetic Ni nanowire connected to Nb electrodes. We show experimentally and confirm theoretically that the Nb/Ni interface plays an essential role in the electron transport through the device. Just below the superconducting transition, a strong inverse proximity effect from the nanowire suppresses superconducting correlations at Nb/Ni interfaces, resulting in a conventional anisotropic magneto-resistive response. At lower temperatures however, the Nb electrodes operate as superconducting shunts. As the result, the magneto-resistance exhibits a strongly growing hysteretic behavior accompanied by a series of saw-like jumps. The latter are associated with the penetration/escape of individual Abrikosov vortices that influence non-equilibrium processes at the Nb/Ni interface. These effects should be taken into account when designing superconducting quantum nano-hybrids involving ferromagnetic nanowires.

[A clinical case of visceral toxocariasis as a cause of eosinophilic polyserositis].

The aim of the present report is to describe a clinical case of toxocariasis. 37-year - old man was admitted to Pirogov Municipal Clinical Hospital No.1 in Moscow. He was presented with intense generalized abdominal pain. Three months before the described hospitalization, the patient had acute bronchitis, then pneumonia. During the examination there were found hyperthermia, ascites, shortness of breath, sweating, hypereosinophilia. Patient lost 8 kilos over the last 6 months. There were arisen many hypotheses, however, after a more detailed survey about patient's life it turned out that he travelled a lot. So that the parasitosis became the main conjecture, which later was confirmed by serological tests.

[Pineamin increased pineal melatonin synthesis in elderly people].

It was investigated the influence of polypeptide complex Pineamin on the 6-sulfatoxymelatonin (aMT6S) excretion in urine by ELISA test of 55 elderly patients with diminished melatoninsynthesis pineal gland function. Pineamin in course dose 100 mg has increased night level of aMT6S urine excretion in 1,9 times in comparison with relevant value untreated. Similar effect was obtained early for medical drug Epithalamin. Epithalamin also restored melatonin level in human and animals during aging. Thus, Pineamin and Epithalamin have similar stimulate effect on melatonin synthesis in elderly people pineal gland.

[The problem of cardiac safety of nonsteroidal anti-inflammatory drugs].

The paper considers an update on the mechanisms for the development of adverse reactions of nonsteroidal anti-inflammatory drugs on the cardiovascular system.

[Pulmonary hypertension in rheumatic heart disease: current approaches to diagnosis and therapy].

Pulmonary hypertension is a complex multidisciplinary problem in modern medicine. This review discusses its clinical and pathophysiological type associated with rheumatic heart disease. Current approaches to the pathogenesis and diagnosis of the disease are reflected; basic approaches to its treatment are discussed in terms of current clinical guidelines and new scientific achievements.

Gamma-ray spectrometry of ultra low levels of radioactivity within the material screening program for the GERDA experiment.

In present and future experiments in the field of rare events physics a background index of 10(-3) counts/(keV kg a) or better in the region of interest is envisaged. A thorough material screening is mandatory in order to achieve this goal. The results of a systematic study of radioactive trace impurities in selected materials using ultra low-level gamma-ray spectrometry in the framework of the GERDA experiment are reported.

[Postradiation and postchemotherapy complications in patients with urinary bladder cancer].

A comparison was made of chemoradiation lesions of lower urinary tract mucosa in urinary bladder (UB) cancer at stage T1-3N0-1MO and approaches to their treatment. An optimal algorithm of examination and treatment of the above patients with consideration of the disease stage and somatic status is proposed.

[Urodynamic changes of the lower urinary tracts and their correction in combined and complex treatment of neoplasms in organs of the small pelvic].

The authors believe that systematization and standardization of prophylaxis and treatment of urinary complications after radiotherapy for cancer of the lesser pelvis organs are necessary. We studied urinary bladder function, applied a complex of diagnostic procedures including combined urodynamic investigation in the course of radiotherapy. This promoted more effective therapy and higher life quality in the studied patients.

[Results of remote gamma-therapy in acromegaly patients]. / Rezultaty distantsionnoi gamma-terapii u bol'nykh akromegaliei.

A study was made of the condition of 44 acromegalic patients at various time after gamma-beam therapy. It has shown that therapeutic efficacy depends on initial sizes of adenomas and the level of growth hormone as well as on the time of observation. At late terms after therapy normalization of the level of growth hormone was observed in 41% of patients, clinical improvement in 44%, the absence of and effect in 15%. Radiation therapy resulted in a decrease in some hypophyseal functions in some of the patients and postradiation hyperprolactinemia in 56% of patients with the normal level of prolactin before therapy. The main shortcoming of radiation therapy was the length of time, necessary for achieving a therapeutic effect.