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BACKGRAUND: There is evidence of a multifactorial effect of SARS-CoV2 on carbohydrate metabolism with the development of hyperglycemia and the weighting of COVID19 even in people without DM.AIMS: Assess the prevalence of disorders carbohydrate metabolism (DCM) in hospitalized patients with a new coronavirus infection without a history of DM.MATERIALS AND METHODS: Patients with PCR-confirmed diagnosis of COVID19 aged 18-75 years (n=72) without a history of diabetes were examined. Observation was carried out from the moment of hospitalization to discharge. Patients were collected anamnesis data, laboratory and instrumental studies, HbA1c, fasting plasma glucose (FPG), postprandial glycemia.RESULTS: The prevalence of DCM (HbA1c≥6%) in 72 patients with COVID19 without a history of diabetes admitted to the hospital was 41,7%, while HbA1c ≥6,5% had 8,3%. The median HbA1c in the moderate-flow group was 5,7% [5,3–6,0], and in the severe-flow group it was 6,0% [5,8–6,2] (p=0,008). Participants were divided into groups according to the level of HbA1c≥6% and < 6%. The examined patients showed a high prevalence of risk factors for developing DM: age over 45 years — 83,3%, cardiovascular diseases — 46,3%, obesity — 50%. The study groups didn’t differ statistically in terms of risk factors for DM. In the group with HbA1c≥6%, FPG≥6,1 mmol / l on the second day and postprandial glycemia ≥7,8 mmol/l were observed in more cases than in the group with HbA1c1c was higher than in FPG (41,7% vs 29,2%, p=0,006). On the seventh day, the number of patients with FPG ≥ 6,1 mmol / l in the first group decreased from 39,1% to 4,4% (p=0,01), and in the second group-from 12,9% to 9,7% (p=1,0). There was a direct correlation between the level of HbA1c and C-reactive protein (r=0,271; p=0,048), and an inverse correlation with the content of lymphocytes in the blood (r=-0,25; p=0,068).CONCLUSIONS: In patients with a new coronavirus infection without a history of DM, a high prevalence of DCM was detected — 41,7%. Against the background of comparability of the studied groups by risk factors for DM, an increase in HbA1c, FPG and postprandial glycemia is a manifestation of transient hyperglycemia. Given the high prevalence of DCM, it can be assumed that SARS-CoV2 has diabetogenic properties.

BACKGROUND: Patients with Type 2 Diabetes (T2DM) and patients on maintenance hemodialysis (MHD) are at a high risk of adverse clinical course of COVID-19. To date, the causes of high mortality in these groups are not fully understood. Data about peculiarity of clinical course and Tocilizumab (TCZ) administration in patients with T2DM receiving MHD due to outcome of diabetic kidney disease (DKD) are not yet highlighted in current publications.AIMS: Identification of risk factors (RF) of adverse COVID-19 outcome and evaluation of TCZ administration in patients with T2DM receiving MHD due to DKD.MATERIALS AND METHODS: The patients treated in Moscow City Hospital No52 were included in retrospective observational study. The observation period was from 04.15 to 07.30 2020. The study endpoints were the outcomes of hospitalization — discharge or lethal outcome. Data were collected from electronic medical database. The following independent variables were analysed: gender, age, body mass index, time from the onset of symptoms to hospital admission, cardiovascular and general comorbidity (Charlson Index, CCI), cardiovascular event (CVE) during hospitalization, treatment in ICU, mechanical ventilation (MV), degree of lung damage according to CT data, level of prandial glycemia at admission, MHDassociated parameters (vintage, type of vascular access, frequency of complications). The autopsy reports were evaluated for the purpose of lethal structure investigation. In a subgroup treated TCZ the time from symptoms onset to TCZ administration and number of laboratory indicators were evaluated.RESULTS: 53 patients were included, mean age 68 ±9 y, males — 49%. General mortality in observation cohort was 45%, mortality in ICU — 81%, mortality on MV — 95%. High cardiovascular and general comorbidity was revealed (mean CCI — 8,3 ±1,5 points). The causes of outcomes according to autopsy reports data: CVE 37,5% (among them — acute myocardial infarction during hospitalization), severe respiratory failure — 62,5%. The independent predictors of lethal outcome were: MV (OR 106; 95% CI 11,5–984; р CONCLUSIONS: The number of RF of adverse COVID-19 outcome in patients with T2DM receiving MHD due to DKD are identified. CVE is one of the leading causes of mortality in study cohort. According to our experience the preventive (instead of rescue) strategy of TCZ administration should be used.

The first case of COVID-19 was diagnosed in St. Petersburg on March 2, 2020; the period of increase in the incidence lasted for 10 weeks, the maximum rates were recorded in mid-May, and subsequently there was a statistically significant decrease in the incidence.Objective: to determine the level and structure of community immunity to SARS-CoV-2 among the population of St. Petersburg during the period of intensive spread of COVID-19.Materials and methods. Selection of volunteers for the study was carried out through interviewing and randomization. The exclusion criterion was active COVID-19 infection at the time of the survey. 2713 people aged 1 to 70 years and above were examined for the presence of specific antibodies to SARS-CoV-2. Antibodies were detected by enzyme immunoassay.Results and discussion. Studies have shown that in St. Petersburg, in the active phase of COVID-19 epidemic, there was a moderate seroprevalence to SARS-CoV-2, which amounted to 26 %, against the background of a high frequency (84.5 %) of asymptomatic infection in seropositive individuals who did not have a history of COVID-19 disease, positive PCR result and ARI symptoms on the day of examination. The maximum indicators of herd immunity were established in children 1–6 years old (31.1 %), 7–13 years old (37.7 %) and people over 70 years old (30.4 %). Differences in the level of seroprevalence in the age groups of 18–49 years are statistically significant. The highest level of seroprevalence was found among the unemployed (29.7 %), healthcare workers (27.1 %), education sector (26.4 %) and business sector personnel (25 %). In convalescents, COVID-19 antibodies are produced in 75 % of cases. In individuals with positive result of PCR analysis carried out earlier, antibodies are detected in 70 % of the cases. The results of the study of herd immunity to SARS-CoV-2 are essential to forecast the development of the epidemiological situation, as well as to plan measures for specific and non-specific prevention of COVID-19.

According to accumulated clinical data, one of the causes of severe damage to lung epithelial cells associated with SARS-CoV-2 (2019-nCoV) is an acute, timely underestimated "cytokine storm" (cytokine cascade, hypercytokinaemia) with characteristic signs of an expressed hyper-inflammatory syndrome with subsequent polyorganic failure. The study presents the results of the analysis of the effectiveness of tocilizumab therapy (TCZ) in patients (n = 181) of different age groups with developed pneumonia caused by SARS-CoV-2. The aim of the study was to evaluate the effectiveness of TCZ therapy in patients of different age groups with developed pneumonia in the frame of COVID-19. Methods. Patients (n = 181) with community-acquired pneumonia caused by coronavirus SARS-CoV-2 are included in a one-center, non-randomized, prospective study to evaluate the effectiveness of TCZ therapy conducted at the State Public Health Institution "City Clinical Hospital No.52" of the Moscow City Health Department. Patients were divided into 3 age subgroups – up to 50 years, 50–70 years and over 70 years. Patients with community-acquired SARS-CoV-2-induced pneumonia receiving non-invasive oxygen support and patients who had artificial lung ventilation (ALV) were given a single dose of 400 mg of TCZ in addition to basic therapy. Results. There are no significant differences between age groups in the severity of pneumonia according to the data of the computed tomography (CT), however, a more severe condition and a higher mortality rate (p < 0.001) were reliably observed in patients over 70 age compared to the other age groups. After TCZ treatment in patients of each age group, the severity of the condition assessed on the National Early Warning Score (NEWS2) has been significantly reduced compared to the baseline. Conclusion. According to the data of the pilot study the efficacy and safety of TCZ in patients of all presented age groups with COVID-associated pulmonary tissue lesion and signs of "cytokine storm" was demonstrated. At the same time, patients up to 50 years after the therapy of TCZ managed to achieve greater clinical efficiency compared to patients in other groups. According to the severity of the state and laboratory criteria, the lowest clinical efficacy of TCZ therapy was observed in patients over 70 years of age; as a consequence, the highest mortality rate was observed in the same group. At the same time, the TCZ therapy has not had a positive impact on the change of laboratory values and the severity of the disease in case of unfavorable outcome.

Guidelines on treatment of patients with arterial hypertension comorbid with metabolic disorders and diabetes mellitus type 2

According to key diabetic studies, the early use of metformin glucose lowering therapy is associated with a reduced risk of developing micro- and, in the long term, 10-year follow-up, macrovascular complications and cardiovascular mortality. Short-term studies results on combined glucose lowering therapy with metformin suggests that combination therapy can have several advantages on the one side from the effectiveness of glycemic control and on another side from positive effect on the development of complications of type 2 diabetes. The question of the start time of combined hypoglycemic therapy remains open. According to the results of recent large-scale studies, real world evidence data, careful glycemic control during the first year from the moment of diagnosis of type 2 diabetes is crucial for further management of the disease and slow the progression of complications. However, due to the fact that the clinical benefits of early combination therapy were not demonstrated in randomized clinical trials, this approach, despite the theoretical background, was not recommended for widespread use in international guidelines for the treatment diabetes patients. Russian algorithms on the treatment diabetes patients recommend combined glucose lowering therapy at the start of treatment at a HbA1c level of 1% higher than the target. A 5-year VERIFY study results were demonstrated long-term sustained glycemic control in combination with vildagliptin + metformin prescribed for native diabetes patients with relatively low HbA1c values, as well as the advantages of this approach in comparison with the standard strategy for phased intensification of monotherapy. The results of the VERIFY study provided a wealth of information to discuss early treatment intensification, the clinical benefits of this approach and a possible review of the treatment strategy for native diabetes patients.

Material and methods An open-labeled, randomized, active-controlled multicenter trial of favipiravir in out- and hospitalized patients with mild to moderate COVID-19 was conducted Eligible patients were aged 18-60 years and had laboratory confirmed by PCR test infection of SARS-CoV-2 Patients were randomly assigned in a 2:1 ratio to receive either favipiravir (1800 mg BID on day 1, followed by 800 mg BID for 9 days), or standard of care (SOC) treatment (umifenovir + intranasal interferon alpha-2b, or hydroxychloroquine for up to 10 days) In needed, patients received concomitant symptomatic medication The co-primary outcomes were the time to clinical improvement and the time to viral clearance Results and discussion It was found that the median time to clinical improvement was 6 0 [interquartile range (IQR) 4 0;9 3] days in favipiravir group and 10 0 (IQR 5 0;21 0) days in SOC group;the median difference was 4 days [hazard ratio (HR) 1 63;95% confidence interval (CI) 1 14-2 34, p=0 007] The rate of clinical improvement in the favipiravir group on day 7 was 1 5-fold higher compared to SOC: 52 7% vs 35 7% [risk ratio (RR) 1 50;95% CI 1 02-2 22;p=0 020] Despite an absence of statistically significant difference between the median time to viral elimination, the rates of viral elimination on day 3 and day 5 were significantly higher in favipiravir group: on the day 3 viral elimination was observed for in 71 4% of patients, who received favipiravir vs 57 1% in SOC group (RR 1 27;95% CI 0 99-1 64;p=0 030), on the day 5 81 2 vs 67 9%, respectively (RR 1 22;95% CI 1 00-1 48;р=0 022) Favipiravir was well tolerated: most of the adverse events (AE) were mild The most common AEs were asymptomatic hyperuricemia, transient elevation of ALT & AST, and gastrointestinal disorders (diarrhea, nausea, abdominal pain) Цель исследования - оценка эффективности и безопасности фавипиравира для лечения новой коронавирусной инфекции (COVID-19) легкого и среднетяжелого течения Материал и методы Проведено открытое рандомизированное многоцентровое клиническое исследование с активным контролем у амбулаторных и госпитализированных пациентов с COVID-19 легкого и среднетяжелого течения В исследовании приняли участие 168 пациентов в возрасте 18-60 лет с подтвержденной инфекцией SARS-CoV-2 (методом полимеразной цепной реакции мазков из рото- и носоглотки) Пациенты были рандомизированы в соотношении 2:1 в группы терапии фавипиравиром (по 1800 мг 2 раза в 1-й день, по 800 мг 2 раза в день - со 2-го по 10-й дни) либо стандартной терапии (умифеновир + интраназальный интерферон альфа-2b или гидроксихлорохин, длительность - до 10 дней) Пациенты также получали необходимую сопутствующую симптоматическую терапию Комбинированная первичная конечная точка включала оценку медиан времени до улучшения клинического статуса и элиминации вируса Результаты и обсуждение Установлено, что в группе фавипиравира клиническое улучшение наступало на 4 дня быстрее, чем в группе стандартной терапии: медианы времени до клинического улучшения составили 6,0 [межквартильный диапазон (МКД) 4,0;9,3] дня и 10,0 (МКД 5,0;21,0) дней соответственно [hazard ratio (HR) 1,63;95% доверительный интервал (ДИ) 1,14-2,34, р=0,007] Частота клинического улучшения на 7-й день в группе фавипиравира была в 1,5 раза выше по сравнению с группой стандартной терапии: 52,7 против 35,7% [risk ratio (RR) 1,50;95% ДИ 1,02-2,22;р=0,020] Достоверной разницы медиан времени до элиминации вируса не наблюдалось Однако частота элиминации вируса на 3-й и 5-й день в группе фавипиравира была значимо выше: на 3-й день она наблюдалась у 71,4% пациентов в группе фавипиравира против 57,1% в группе стандартной терапии (RR 1,27;95% ДИ 0,99-1,64;р=0,030), а на 5-й день у 81,2 против 67,9% соответственно (RR 1,22;95% ДИ 1,00-1,48;р=0,022) Фавипиравир хорошо переносился пациентами, а большинство нежелательных явлений имели легкую степень тяжести Среди наиболее частых нежелательных явлений отмечали бессимптомную гиперурикемию, транзиторное повышение уровней аланин- и аспартат-аминотрансферазы и желудочно-кишечные нарушения (диарея, тошнота, боль в животе) Полученные результаты подтверждают преимущество фавипиравира по сравнению со стандартной этиотропной терапией при применении у пациентов с COVID-19 легкого и среднетяжелого течения

The paper studies the matter related to the use of an interactive computer simulator in Mathematics course when using blended learning technology in the current university education. As an example, the authors describe the original computer software Integral Test 1.0, designed to practice the antiderivative skills and academic performance rating when studying the topic Function Integration of one real variable. A special feature of this software, which distinguishes it from standard diagnostic programs favourably, is that a student is not asked to choose the correct answer from several suggested options. He needs to enter the answer on his own in the field intended for this purpose. The antiderivative is typed from the keyboard as a string according to the customary rules, and the software visualizes the answer in the traditional form and verifies it. Using such a simulator allows one to actualize a component of the interactive mode of blended learning technology. Students have an opportunity to work out their computing skills without a teacher’s supervision. The authors present the results of an experiment that was conducted among first-year students majored in Engineering for two years. The experiment confirmed the effectiveness of using an interactive computer simulator in blended mathematics study. In particular, the quality of academic performance in the experimental group increased by 8.7%.

June 19, 2018 the meeting of the Scientific Advisory Board took place in Moscow, chaired by Professor G.R. Galstyan, (co-chair - A.V. Zilov) devoted to the discussion of the possibilities of improving the results of treatment of diabetes mellitus (DM) by consideration of «variability of glycemia» (VG) as an additional criterion of the glycemic control effectiveness (especially of insulin therapy) as well as one of the goals of treatment in patients with unstable glycemia. The purpose of the working meeting was to develop a strategy for the introduction of VG as a predictor and an additional criterion in assessing the effectiveness and safety of hypoglycemic therapy to improve the pharmacotherapy of diabetes and reduce cardiovascular and total mortality. Aims: - to conduct a comprehensive data analysis of the relationship between VG and adverse DM outcomes, such as hypoglycemia, micro-and macrovascular complications, cardiovascular and total mortality; - to accumulate and analyze published data and the experience of decrease of VG and improving outcomes of diabetes on the background of different versions of insulin therapy; - to compare existing methods of glycaemia monitoring and VG assessment, their validity and availability in real practice in the context of limited budget; - to analyze the informativeness, clinical and prognostic significance of various parameters of VG assessment and determine their reasonable «minimum» for a comprehensive assessment of VG as a criterion for evaluating the effectiveness of treatment of DM and predictors of negative diabetes outcomes. The following reports were heard during the discussion: Glycemic variability: clinical and prognostic value. Types of glycemic variability. (Alexey V. Zilov, MD, PhD in Medicine, Assistant Professor). Methods of assessment of variability of glycemia in clinical trials and routine practice (Tatiana N. Markova, MD, PhD in Medicine, Professor). Current international and national recommendations on glycemic monitoring (Gagik R. Galstyan, MD, PhD in Medicine, Professor). Peculiarities of glycemic variability and its evaluation among children and adolescents (Alisa V. Vitebskaya, MD, PhD in Medicine).19 июня 2018 г. в Москве состоялось заседание Научно-консультативного совета под председательством д.м.н., профессора Г.Р. Галстяна и к.м.н., доцента А.В. Зилова, посвященное обсуждению возможностей улучшения результатов лечения сахарного диабета (СД) путем использования вариабельности гликемии (ВГ) в качестве дополнительного критерия эффективности контроля гликемии (в первую очередь, на фоне инсулинотерапии), а также одной из целей лечения у пациентов с нестабильной гликемией. Целью рабочей встречи была выработка стратегии внедрения ВГ в качестве предиктора и дополнительного критерия при оценке эффективности и безопасности сахароснижающей терапии с целью совершенствования фармакотерапии СД и снижения общей и сердечно-сосудистой смертности при этом заболевании. Задачи: – провести комплексный анализ данных о взаимосвязи между ВГ и неблагоприятными исходами СД, такими как гипогликемия, микро- и макрососудистые осложнения СД, сердечно-сосудистая и общая смертность; – аккумулировать и проанализировать опубликованные данные и имеющийся опыт снижения ВГ и улучшения исходов СД на фоне различных вариантов инсулинотерапии; – сравнить существующие методики мониторинга гликемии и оценки ВГ, их валидность и доступность в реальной практике в условиях ограниченных ресурсов здравоохранения; – проанализировать информативность, клиническую и прогностическую значимость различных параметров оценки ВГ и определить их обоснованный «минимум» для комплексной оценки ВГ в качестве критерия оценки эффективности лечения СД и предикторов негативных исходов СД. В рамках дискуссии были заслушаны следующие доклады: – Вариабельность гликемии: Клиническое и прогностическое значение. Виды вариабельности гликемии. (к.м.н., доцент Зилов А.В.). – Методы оценки вариабельности гликемии в клинических исследованиях и рутинной практике (д.м.н., профессор Маркова Т.Н.). – Действующие международные и национальные рекомендации по мониторингу гликемии (д.м.н., профессор Галстян Г.Р.). – Особенности вариабельности гликемии и ее оценки у детей и подростков (к.м.н. Витебская А.В.).

The Scientific Advisory Board, chaired by Professor G. R. Galstyan (cochair - A.V. Zilov), met in Moscow on 19 June 2018 to discuss the possibilities of improving the results of diabetes mellitus (DM) treatment by considering glycaemic variability (GV) as an additional criterion for effective glycaemic control (especially in patients receiving insulin therapy) and as one of the goals of treatment in patients with unstable glycaemia. The purpose of the working meeting was to develop a strategy for the introduction of GV as a predictor and as an additional criterion for assessing the effectiveness and safety of hypoglycaemic therapy to improve the pharmacotherapy of diabetes and reduce cardiovascular and total mortality. The aims of the working meeting were to conduct a comprehensive data analysis of the relationship between GV and hypoglycaemia; to gather and analyse published data and the experience of decrease in GV and improved outcomes of diabetes against the background of different types of insulin therapy; to compare existing methods of glycaemia monitoring and GV assessment and examine their validity and availability in real practice in the context of limited budget and to analyse the informativeness and clinical and prognostic significance of various parameters of GV assessment and to determine their reasonable ‘minimum’ for a comprehensive assessment of GV as a criterion for evaluating the effectiveness of DM treatment and the predictors of negative diabetes outcomes. The following reports were presented during the discussion: ‘Glycemic variability: clinical and prognostic value. Types of glycemic variability’ (Candidate of Medical Sciences, assistant Professor Zilov A.V.); ‘Methods of assessment of variability of glycemia in clinical trials and routine practice’ (PhD, Professor Markova T. N.); ‘Current international and national recommendations on glycemic monitoring’ (PhD, Professor Galstyan G. R.) and ‘Peculiarities of glycemic variability and its evaluation among children and adolescents’ (Candidate of Medical Sciences Vitebskaya A.V.).

In 2008 the Food and Drug Administration has revised approval process for new antidiabetic agents and introduced a requirement to demonstrate the cardiovascular safety in an international multicenter trial. Currently cardiovascular outcome trials of dipeptidyl peptidase-4 (DPP-4) inhibitors (SAVOR-TIMI53, EXAMINE and TECOS), sodium-glucose cotransporter 2 inhibitors (EMPAREG, CANVAS), glucagon-like peptide-1 receptor agonists (ELIXA, EXSCEL LEADER and SUSTAIN-6), ultralong-acting and insulin (DEVOTE) have been completed. The trials confirmed cardiovascular safety of these glucose-lowering medications, and in addition, EMPA-REG OUTCOME (empagliflozin), CANVAS (canagliflozin) and LEADER (liraglutide) have also demonstrated cardioprotective effect of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. These data led to the changes of clinical guidelines for the management of type 2 diabetes.

Variants of artistic reconstruction of the events of the Great Patriotic War in modern mass literature are considered. The material is multi-genre texts of the 2000s: an alternative version of the history of the Great Patriotic War, free-thinking fantasies in a mystical spirit, a postmodern historical melodrama, a fantasy novel, a military-fantasy action movie. Particular attention is paid to the national bestsellers of the 2000s: novels by A. Turgenev (V. Kuritsyn) “Sleep and Believe: Blockade novel” and I. Boyashov “Tanker, or “The White Tiger.” It is shown that A. Turgenev in his work combines the legends of the besieged time with the cliches of a spy novel and love melodrama, I. Boyashov is the author of the story of the duel of a Russian tanker and a German miracle tank in the form of modern fantasy. The article affirms the idea that with the leave of the generation of front-line soldiers, the war moves from living memory into a repository of plots and images for literature and art, and becomes fertile material for constructing a different reality. It is hypothesized that mass literature, reconstructing the facts and events of the recent past, is involved in modeling and rethinking the ideological and value orientations of society and the formation of a new identity.

Currently, an urgent task for food enterprises of the Russian Federation is to improve the quality and safety of their products through the introduction of a system for analyzing critical control points (HACCP). This is important not only for the health of the population, but also for enhancing the advantages of products. The article presents materials concerning implementation of the principles of HASSP on the enterprise JSC «MOROZKO». Theoretical aspects of system of HASSP are given, problems are analyzed and recommendations about their minimization in the conditions of implementation of technical regulations of the Customs union 021/2011 «About safety of food products» are developed. Data of sanitary and microbiological control at veterinary and sanitary examination of the cooled and frozen meat of different software suppliers are provided to the normalized indicators in compliance with normative requirements of meat and meat products. Need of carrying out monitoring of microbiological indicators for critical control points is proved. On the basis of monitoring of microbiological indicators of raw materials, water, air, the equipment, overalls, hands of workers the assessment of risk of microbial contamination of finished goods by pathogenic microorganisms and microorganisms - activators of damage of raw materials and products is carried out. The quantitative composition of microflora was determined during air monitoring in the workshops of the enterprise. Comparative analysis of the influence of disinfection of different types of the equipment on its sanitary states by washout method from the equipment is carried out.

The variety of tissue cells express receptors of vitamin D. The possible causative connection between lack of vitamin D and a number of inflammatory diseases such as bronchial asthma has stimulated interest in the potentially positive effects of vitamin D in the theraputic schemes. Conflicting data was demonstrated by numerous studies concerning the relationship of vitamin D and development of asthma . Most of them stress attention on the lack of studies with targeting population excluding subclasters and phenotypes of bronchial asthma, especially groups associated with low levels of vitamin D obesity, COPD and asthma, atopic patients. The question of prescribing of vitamin D in asthma, in the case of laboratory-proven deficiency or lack of vitamin D can be an option in therapy.

Chronic kidney disease (CKD) is a general concept that involves renal tissue regardless of the aetiology of the leading disease. CKD occurs in one out of every two patients with diabetes mellitus (DM) and appreciably limits the duration and quality of life. CKD can be diagnosed by glomerular filtration rate (GFR), which is recognised as the most representative indicator of the quantity and total workload of nephrons. However, the decrease in GFR occurs at an advanced stage of nephropathy and causes irreversible renal damage, which ultimately requires substitutive renal therapy and, thereby, increases the expense. In this regard, clinical trials have been conducted to identify the biomarkers of CKD reflecting renal damage at earlier stages of the disease. This article presents an overview of modern methods for the diagnosis of CKD and preclinical markers of kidney injury in patients with DM.

The formation of an effective financial and investment model of engineering production requires the organization of capital cost management. This article is intended to consider the extent to which the features of the investment behaviour of Russian engineering enterprises affect the cost of capital.

Aldosterone levels increase in clinical practice may be due to primary or secondary hyperaldosteronism. Secondary hyperaldosteronism (CAA) is a clinical syndrome caused by increased synthesis of renin juxtaglomerular apparatus of the kidneys in response to lower perfusion pressure in the afferent glomerular arteriole. This mechanism leads to activation of the renin-angiotensin-aldosterone system with a consequent increase in systemic blood pressure. Clinically manifested CAA secondary (systemic) arterial hypertension, the most common form of parenchymal renal disease and renal vascular lesions. Renovascular diseases are a heterogeneous group of pathologies, which includes atherosclerosis of renal arteries, the most common cause; fibromuscular dysplasia (FMD); other more rare diseases, accompanied by a narrowing of the lumen of the renal vessels. Some authors consider the possibility of including a group of renovascular disease presence of multiple renal arteries. Тhe article presents the clinical cases of secondary hyperaldosteronism, caused by FMD and abnormal amounts of the renal arteries, manifested hypertension and increased levels of aldosterone in the blood. Carrying out a detailed search of the diagnostic determination of the ratio of aldosterone to plasma renin helped eliminate endocrine genesis of the disease and to identify the true cause of aldosteronism.

We performed an estimation of body fat using ultrasound, magnetic resonance imaging (MRI) and anthropometry in 60 patients with different types of body weight (BW). Correlation of waist circumference (WC), thickness of subcutaneous fat and visceral fat with components of the metabolic syndrome was studied comparatively between ultrasound and MRI measurements. We noted a preferential increase in the thickness of visceral fat compared with subcutaneous with increasing degree of BW. Significant increase in adipose tissue and the development of metabolic disorders occurs in overweight, making it the state close to obesity. During a routine ultrasound of the abdomen it is advisable to determine the thickness of subcutaneous and visceral fat separately.

This article considers the urgent problem of literary genre analysis of the modern prose. Under the conditions of overall distrust to an open word, archaic models and plot structures provide a modern writer with an opportunity to speak about the most important matters, avoiding pathos, rhetoric and didactics. The articles studies the works by V. Makanin about the Chechen war based on intuition and movement of free thought of the writer developing in parable forms. Modern parable is a reaction to the word closed in the literary field, on literocentricity; it displays artistic expression in a broader context returning ethical and didactic components to the word. The use of parables leads to almost unlimited opportunities of multi-level reading, it activates the living, intellectual and spiritual experience of the reader to the utmost Статья посвящена актуальной литературоведческой проблеме жанрового анализа современной прозы. В условиях тотального недоверия к открытому слову архаические модели и сюжетные структуры предоставляют современному писателю возможность сказать о самом главном, избегая пафоса, риторики и дидактики. В качестве объекта исследования избраны произведения В. Маканина о чеченской войне, которые строятся с опорой на интуицию и движение свободной мысли художника, развертывающейся в притчевых формах. Современная притча – реакция на замкнутое в литературном поле слово, на литературоцентричность; она выводит художественное слово в более широкий контекст, возвращая слову этическую, учительную составляющую. Притчевость предоставляет практически неограниченные возможности для многоуровневого прочтения, предельно активизирует житейский, интеллектуальный и духовный опыт читателя

The objective of the present work was to study the prevalence of obesity among 271 residents of the Chuvash Republic taking account of their sex and ethnic background. Simultaneously, genetic predisposition to obesity was assessed from the presence or absence of this condition in 955 blood relatives of the probands using Edwards' coefficient of genetic determination and coefficient of association. Results of the study suggest higher prevalence of obesity in women than in men and in Russians compared with Chuvashes. Genetic determination of obesity was found to be independent of sex and type of fat distribution. The risk of developing obesity proved to be significantly higher in the probands from families in which both parents were obese than from those with only one obese parent.

Diffraction gratings designed on the basis of the geometrical properties of 1D quasicrystalline structures are considered. It is shown that the diffraction peak position is highly stable against small perturbations of the grating profile when the periodic pattern of the alternating elements comprising the profile remains unchanged. The fractal character of the diffraction patterns is also preserved during perturbations, with the fractal geometry obeying the principle of the Golden ratio.

We study mass-loss and wind momentum rates of 29 Galactic O-type stars with luminosity classes I, III and V by means of a pure Hα profile analysis and investigate to what extent the results compare to those originating from a state-of- the-art, complete spectral analysis. Our investigation relies on the approximate method developed by Puls et al. (1996) which we have modified to account for the effects of line-blanketing. Effective temperatures and gravities needed to obtain quanti- tative results from such a simplified approach have been derived by means of calibrations based on most recent spectroscopic NLTE analyses and models of Galactic stars by Repolust et al. (2003) and Martins et al. (2002). Comparing (i) the derived wind- densities to those determined by Repolust et al. (2003) for eleven stars in common and (ii) the Wind-momentum Luminosity Relationship (WLR) for our sample stars to those derived by other investigations, we conclude that our approximate approach is actually able to provide consistent results. Additionally, we studied the consequences of "fine tuning" some of the direct and indirect parameters entering the WLR, especially by accounting for different possible values of stellar reddening and distances. Combining our data set with the corresponding data provided by Herrero et al. (2002) and Repolust et al. (2003) we finally study the WLR for the largest sample of Galactic O-type stars gathered so far, including an elaborate error treatment. The established disagreement between the theoretical predictions and the "observed" WLRs being a function of luminosity class is suggested to be a result of wind clumping. Different strategies to check this hypothesis are discussed, particularly by comparing the Hα mass-loss rates with the ones derived from radio observations.

Passive ring laser resonator of square size with a side 3. 1 m is created in Sternberg State Astronomical Institute for the determination of the Earth angular rate. This work deals with the construction of resonator and mode-matchingsystem, estimation of the resonator parameters, influence of the temperature variations on the mode structure,control of the resonator perimeter, influence of the nonpianarity and light polarization on the quality factor and, thus, on the accuracy of the Earth rotation measurements.Keywords: laser gyroscope, Earth rotation. 1. INTRODUCTIONGreat attention is paid now to the determination of the Earth's angular rate 12 and the universal time UT1-UTC,connected with it, with high precision and time resolution. This work was stimulated by the progress of observingtechnique and by the analysis methods. During the last 15 years the accuracy of determination of UT1-UTC was increased by 1000 times. High accuracy and time resolution of observation is important for study of the effects of thetides in the atmosphere and oceans on the Earth rotation.

The passive ring laser resonator of square size with a side equal to 3.1 m is created in Sternberg State Astronomical Institute for the determination of the Earth angular rate. This work deals with the construction of the resonator and mode-watching system, estimation of the resonator parameters, the influence of the temperature variations on the mode structure, the control of the resonator perimeter, the influence of the nonplanarity and the light polarization on the quality factor and, thus, on the accuracy of the Earth rotation measurements.

The article investigates the possibility of using the method of expanding the field of a diffracted wave in free-space TEMpl modes in order to compute the diffraction of laser radiation. The calculation algorithm for the diffraction in both the near and far zones reduces to two operations: determination of the expansion coefficients and summation of the amplitudes of the TEMpl modes in the observation plane. A comparison is made between the theoretical curves characterizing the field distribution of the diffracted-wave field, as calculated by the proposed method, and the experimental dependences for the near and far zones.

The issues of rehabilitation of patients with rheumatism are currently becoming the leading ones in assessing the effectiveness of treatment, its clinical usefulness. Among the methods that improve the quality of the therapy and consolidate the achieved effect, staged treatment in a hospital and in a sanatorium has proven itself very positively. However, the criteria for such treatment are not always objective enough, which makes it difficult to judge the degree of rehabilitation of patients after hospitalization and after sanatorium treatment.