Saint Petersburg, Russia

St. Petersburg State Medical Academy
Saint Petersburg, Russia

The St. Petersburg I. I. Mechnikov State Medical Academy is a public university located in St. Petersburg, Russian Federation. The SPSMA is one of the oldest and largest Russian Higher Medical Schools. Over its 100 years of history, the Academy remains a leading institution of Russia in medicine and training specialists in preventive and clinical medicine. It is often called the Second Medical College in St. Petersburg because of its renaming in 1920 , relative to Saint Petersburg State Medical University, which is called the First Medical College. The university is currently constructing the largest infectious diseases hospital in Saint Petersburg, a title formerly claimed by the Botkin hospital.The NWSMU has a long tradition of educating Russian and international students. More than 35,000 physicians graduated from the university. Since beginning the international program in 1947 there have been more than 3500 international graduates from more than 50 countries. Currently there is a total student population of over 5,000. There are plans to unite SPSMA with other schools to form a North-Western State Medical University. Wikipedia.

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Genovese M.C.,Stanford University | Durez P.,Catholic University of Leuven | Richards H.B.,Novartis | Supronik J.,NZOZ Centrum Medyczne Artur Racewicz | And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Objective: To assess the safety and efficacy of secukinumab, a fully human monoclonal anti-interleukin-17A antibody, in patients with rheumatoid arthritis (RA). Methods: Patients (n=237) with inadequate response to methotrexate were randomly assigned to receive monthly subcutaneous injections of secukinumab 25 mg, 75 mg, 150 mg, 300 mg or placebo. The primary endpoint was the American College of Rheumatology 20% response (ACR20) at week 16. Results: Demographics and baseline characteristics were comparable across all treatment groups. The primary efficacy endpoint was not achieved: the proportion of ACR20 responders at week 16 with secukinumab 25-300 mg was 36.0-53.7% versus placebo (34%). Disease activity score in 28 joints (DAS28)- C-reactive protein (CRP) was a secondary endpoint and clinically relevant decreases with secukinumab 75-300 mg were reported versus placebo. Serum high sensitivity CRP levels at week 16 were significantly reduced with secukinumab 75 mg, 150 mg and 300 mg doses versus placebo. The safety profile of secukinumab was consistent with that seen with other biological agents. Most adverse events (AE) were mild to moderate in severity. Infections were slightly more frequent with secukinumab than placebo. Six serious AE were reported: secukinumab 75 mg (one), secukinumab 300 mg (four) and placebo (one). Conclusions: ACR20 response rates differed between secukinumab 75 mg, 150 mg and 300 mg doses and placebo; however, the primary efficacy endpoint was not achieved. Greater decreases in DAS28 were observed with secukinumab 75 mg, 150 mg and 300 mg than placebo. There were no unexpected safety signals and no specific organ-related toxicities. Further trials with secukinumab in the treatment of RA are warranted.

Clave P.,Autonomous University of Barcelona | Clave P.,Institute Salud Carlos III | Acalovschi M.,Spitalul Clinic Adulti | Triantafillidis J.K.,General Hospital of Nikea Agios Panteleimon | And 4 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2011

Aliment Pharmacol Ther 2011; 34: 432-442 Summary Background Otilonium bromide (OB) is a spasmolytic agent that blocks L-Type Calcium channels in human colonic smooth muscle. Aim To study the efficacy of OB in symptom control in irritable bowel syndrome (IBS). Methods A total of 356 patients (46.16 ± 19 years, 71% female) with IBS participated in a double-blind, randomised, parallel placebo-controlled phase IV study. OB (40 mg t.d.s.) or placebo was administered for 15 weeks, and follow-up was extended 10 additional weeks. Results Otilonium bromide (n = 179) and placebo (n = 177) groups had comparable demographics, symptom severity and IBS subtype. Both OB and placebo reduced abdominal pain and IBS symptoms. The effect of OB was significantly greater than placebo in the reduction of weekly frequency of episodes of abdominal pain at the end of treatment period (primary endpoint, -0.90 ± 0.88 vs. -0.65 ± 0.91, P = 0.03), reduction of abdominal bloating (-1.2 ± 1.2 vs. -0.9 ± 1.1, P = 0.02) and global efficacy by patient assessment (1.3 ± 1.1 vs. 1.0 ± 1.1, P = 0.047). Intensity of abdominal pain, proportion of patient responders, safety and quality of life scores were similarly affected by OB and placebo. During follow-up, the therapeutic effect of OB remained greater than placebo in terms of withdrawal rate due to symptom relapse (10% vs. 27%, P = 0.009), global efficacy of treatment and relapse-free probability (P = 0.038). Conclusions This placebo-controlled double-blind study shows that otilonium bromide is safe, well tolerated and superior to placebo in reducing the frequency of abdominal pain, severity of abdominal bloating and protecting from symptom relapse in IBS. These results further confirm that patients with IBS can improve during and following treatment with otilonium bromide. © 2011 Blackwell Publishing Ltd.

Sieper J.,Rheumatology | Lenaerts J.,REUMA Instituut | Wollenhaupt J.,Klinik fur Rheumatologie und Klinische Immunologie | Rudwaleit M.,Rheumatology | And 7 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Objective To investigate whether biologic-free remission can be achieved in patients with early, active axial spondyloarthritis (SpA) who were in partial remission after 28 weeks of infliximab (IFX)+naproxen (NPX) or placebo (PBO)+NPX treatment and whether treatment with NPX was superior to no treatment to maintain disease control. Method Infliximab as First-Line Therapy in Patients with Early Active Axial Spondyloarthritis Trial (INFAST) Part 1 was a double-blind, randomised, controlled trial in biologic-naïve patients with early, active, moderate-tosevere axial SpA treated with either IFX 5 mg/kg+ NPX 1000 mg/d or PBO+NPX 1000 mg/d for 28 weeks. Patients achieving Assessment of Spondylo Arthritis international Society (ASAS) partial remission at week 28 continued to Part 2 and were randomised (1:1) to NPX or no treatment until week 52. Treatment group differences in ASAS partial remission and other efficacy variables were assessed through week 52 with Fisher exact tests. Results At week 52, similar percentages of patients in the NPX group (47.5%, 19/40) and the no-treatment group (40.0%, 16/40) maintained partial remission, p=0.65. Median duration of partial remission was 23 weeks in the NPX group and 12.6 weeks in the notreatment group ( p=0.38). Mean Bath Ankylosing Spondylitis Disease Activity Index scores were low at week 28, the start of follow-up treatment (NPX, 0.7; no treatment, 0.6), and remained low at week 52 (NPX, 1.2; no treatment, 1.7). Conclusions In axial SpA patients who reached partial remission after treatment with either IFX+NPX or NPX alone, disease activity remained low, and about half of patients remained in remission during 6 months in which NPX was continued or all treatments were stopped.

Jain S.M.,TOTALL Diabetes Hormone Institute | Mao X.,Eli Lilly and Company | Escalante-Pulido M.,Instituto Mexicano del Seguro Social IMSS | Vorokhobina N.,St. Petersburg State Medical Academy | And 2 more authors.
Diabetes, Obesity and Metabolism | Year: 2010

Aims: To compare two progressive approaches [once-daily insulin glargine plus ≤3 mealtime lispro (G+L) vs. insulin lispro mix 50/50 (LM50/50) progression once up to thrice daily (premix progression, PP)] of beginning and advancing insulin in patients with type 2 diabetes (T2D) and inadequate glycaemic control on oral therapy, with the aim of showing non-inferiority of PP to G+L.Methods: Patients were randomized to PP (n = 242) or G+L (n = 242) in a 36-week, multinational, open-label trial. Dinnertime insulin LM 50/50 could be replaced with insulin lispro mix 75/25 if needed for fasting glycaemic control.Results: Baseline haemoglobin A1c (HbA1c) were 9.5% (PP) and 9.3% (G+L); p = 0.095. Change in A1C (baseline to endpoint) was -1.76% (PP) and -1.93% (G+L) (p = 0.097) [between-group difference of 0.17 (95% confidence interval: -0.03, 0.37)]. Non-inferiority of PP to G+L was not shown based on the prespecified non-inferiority margin of 0.3%. A1C was lower with G+L at weeks 12 (7.8 vs. 7.9%; p = 0.042), 24 (7.4 vs. 7.6%; p = 0.046), but not at week 36 (7.5 vs. 7.6%; p = 0.405). There were no significant differences in percentages of patients achieving A1C ≤7%, overall hypoglycaemia incidence and rate or weight change. Total daily insulin dosages at endpoint were higher with PP vs. G+L (0.57 vs. 0.51 U/kg; p = 0.017), likely due to more injections (1.98 vs. 1.79; p = 0.011).Conclusions: Both treatments progressively improved glycaemic control in patients with T2D on oral therapy, although non-inferiority of PP to G+L was not shown. Higher insulin doses were observed with PP with no between-treatment differences in overall hypoglycaemia or weight gain. © 2010 Eli Lilly and Company.

Sieper J.,Rheumatology | Lenaerts J.,REUMA Instituut | Wollenhaupt J.,Klinik fur Rheumatologie und klinische Immunologie | Rudwaleit M.,Rheumatology | And 7 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Objectives: To assess whether combination therapy with infliximab (IFX) plus nonsteroidal anti-inflammatory drugs (NSAIDs) is superior to NSAID monotherapy for reaching Assessment of SpondyloArthritis international Society (ASAS) partial remission in patients with early, active axial spondyloarthritis (SpA) who were naïve to NSAIDs or received a submaximal dose of NSAIDs. Methods: Patients were randomised (2?:?1 ratio) to receive naproxen (NPX) 1000 mg daily plus either IFX 5 mg/kg or placebo (PBO) at weeks 0, 2, 6, 12, 18 and 24. The primary efficacy measure was the percentage of patients who met ASAS partial remission criteria at week 28. Several other measures of disease activity, clinical symptoms and patient-rated outcomes were evaluated. Treatment group differences were analysed with Fisher exact tests or analysis of covariance. Results: A greater percentage of patients achieved ASAS partial remission in the IFX+NPX group (61.9%; 65/105) than in the PBO+NPX group (35.3%; 18/51) at week 28 (p=0.002) and at all other visits (p<0.05, all comparisons). Results of most other disease activity and patient-reported endpoints (including Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, multiple quality of life measures and pain measures) showed greater improvement in the IFX+NPX group than the PBO+NPX group, with several measures demonstrating early and consistent improvement over 28 weeks of treatment. Conclusions: Patients with early, active axial SpA who received IFX+NPX combination treatment were twice as likely to achieve clinical remission as patients who received NPX alone. NPX alone led to clinical remission in a third of patients. © 2013 BMJ Publishing Group Ltd & European League Against Rheumatism.

Manrique-Garcia E.,Karolinska Institutet | Sidorchuk A.,Karolinska Institutet | Sidorchuk A.,St. Petersburg State Medical Academy | Hallqvist J.,Karolinska Institutet | And 2 more authors.
Journal of Epidemiology and Community Health | Year: 2011

Background: A negative socioeconomic gradient is established for coronary heart disease (CHD) mortality and survival, while socioeconomic patterning of disease incidence is less well investigated. To study socioeconomic inequalities in the incidence of acute myocardial infarction (AMI), the major component of CHD, a meta-analysis was undertaken to summarise existing evidence on the issue. Methods: A systematic search was performed in PubMed and EMBASE databases for observational studies on AMI incidence and socioeconomic position (SEP), published in English to April 2009. A randomeffects model was used to pool the risks estimates from the individual studies. Results: Among 1181 references, 70 studies fulfilled the inclusion criteria. An overall increased risk of AMI among the lowest SEP was found for all three indicators: income (pooled RR 1.71, 95% CI 1.43 to 2.05), occupation (pooled RR 1.35, 95% CI 1.19 to 1.53) and education (pooled RR 1.34, 95% CI 1.22 to 1.47). The strongest associations were seen in high-income countries such as USA/Canada and Europe, while the results were inconsistent for middle and low-income regions. Conclusion AMI incidence is associated with low SEP. The nature of social stratification at the level of economic development of a country could be involved in the differences of risk of AMI between social groups.

Agardh E.,Karolinska Institutet | Allebeck P.,Karolinska Institutet | Hallqvist J.,Uppsala University | Hallqvist J.,Karolinska Institutet | And 3 more authors.
International Journal of Epidemiology | Year: 2011

Background: We conducted a systematic review and meta-analysis, the first to our knowledge, summarizing and quantifying the published evidence on associations between type 2 diabetes incidence and socio-economic position (SEP) (measured by educational level, occupation and income) worldwide and when sub-divided into high-, middle- and low-income countries. Methods: Relevant case-control and cohort studies published between 1966 and January 2010 were searched in PubMed and EMBASE using the keywords: diabetes vs educational level, occupation or income. All identified citations were screened by one author, and two authors independently evaluated and extracted data from relevant publications. Risk estimates from individual studies were pooled using random-effects models quantifying the associations. Results: Out of 5120 citations, 23 studies, including 41 measures of association, were found to be relevant. Compared with high educational level, occupation and income, low levels of these determinants were associated with an overall increased risk of type 2 diabetes; [relative risk (RR)=1.41, 95% confidence interval (CI): 1.28-1.51], (RR=1.31, 95% CI: 1.09-1.57) and (RR=1.40, 95% CI: 1.04- 1.88), respectively. The increased risks were independent of the income levels of countries, although based on limited data in middle- and low-income countries. Conclusions: The risk of getting type 2 diabetes was associated with low SEP in high-, middle- and low-income countries and overall. The strength of the associations was consistent in high-income countries, whereas there is a strong need for further investigation in middle- and low-income countries. Published by Oxford University Press on behalf of the International Epidemiological Association. © The Author 2011; all rights reserved.

Reznik A.G.,St. Petersburg State Medical Academy
Kardiologiya | Year: 2010

We studied morphological changes of myocardium and content of glucose, potassium, calcium, sodium in pericardial fluid in persons who died suddenly of myocardial infarction at its prenecrotic stage at prehospital phase. It was established that acute myocardial infarction at prenecrotic stage can run in 2 morphological forms - either with transmural or with subendo- or epicardial localization of ischemic process in left ventricular wall. Transmural injury is characterized by large volume of ischemic damage of the left ventricle, generalized spasm of arterial system of the heart, changes of cardiomyocytes with derangement of their energy metabolism and contractile capacity. In subendo-or epicardial localization foci of ischemic injury alternated with areas of normal blood supply. Similar character of disturbances of rheological properties of blood with thrombosis of microcirculatory bed and of number of markers of ventricular fibrillation between these two forms create preconditions for increase of the zone of necrosis in myocardium and cause high risk of development of rhythm disorders.

Dubinina E.E.,Bekhterev St Petersburg Psychoneurological Research Institute | Dadali V.A.,St. Petersburg State Medical Academy
Biochemistry (Moscow) | Year: 2010

The role of lipid peroxidation product 4-hydroxy-trans-2-nonenal (4-HNE) in functional activity of cells under normal and different pathological conditions is discussed. Different pathways of 4-HNE metabolism in tissues are analyzed, with particular focus on the role the glutathione system in this process. 4-HNE is implicated in regulation of cell growth, proliferation, differentiation, and apoptosis. 4-HNE and metabolic products of other antioxidants (carotenoids) resemble each other in chemical nature of the product and influence general pathways of signal transduction. Manifestation of 4-HNE toxicity under oxidative stress conditions is regarded as a link to many diseases whose pathogenesis is connected with modifications of proteins and nucleic acids. © 2010 Pleiades Publishing, Ltd.

Konstantinov V.O.,St. Petersburg State Medical Academy
Cardiovascular Therapy and Prevention (Russian Federation) | Year: 2011

Aim: To study potential therapeutic approaches to the management of coronary heart disease (CHD) patients with hypercholesterolemia (HCH), who receive statins, but do not achieve target levels of total cholesterol (TCH) and low-density lipoprotein cholesterol (LDL-CH) in daily clinical practice.Material and methods: The research project "Treat To Goal" is an observational study, involving 10 clinical centres in 6 Russian cities. In total, the study included 712 patients with CHD and HCH (386 men and 324 women; mean age 59 years), who received statins as secondary prevention measure, but did not achieve target levels of TCH and LDL-CH.Results: In order to achieve target TCH levels, the lipid-lowering therapy was modified as follows: 42,4 % patients were administered a new statin; in 32,1 %, the "old" statin dose was titrated; in 25,5 %, statin therapy was combined with ezetimibe. The target TCH levels were achieved, respectively, in 33,5 %, 37,4 %, and 50,4 % of the patients. All three types of therapy modification were well tolerated and safe.Conclusion: Combined lipid-lowering therapy with ezetimibe and statins is the optimal treatment option for Russian patients with CHD and HCH, who otherwise cannot achieve the target levels of blood lipids.

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