Хронические цереброваскулярные заболевания: вопросы диагностики и лечения
Хронические цереброваскулярные заболевания: вопросы диагностики и лечения
Щукин И.А., Лебедева А.В., Бурд С.Г. и др. Хронические цереброваскулярные заболевания: вопросы диагностики и лечения. Consilium Medicum. 2016; 18 (2): 85–94. DOI: 10.26442/2075-1753_2016.2.85-94
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Shchukin I.A., Lebedeva A.V., Burd S.G. et al. Chronic cerebrovascular disease: diagnosis and treatment questions. Consilium Medicum. 2016; 18 (2): 85–94. DOI: 10.26442/2075-1753_2016.2.85-94
Хронические цереброваскулярные заболевания: вопросы диагностики и лечения
Щукин И.А., Лебедева А.В., Бурд С.Г. и др. Хронические цереброваскулярные заболевания: вопросы диагностики и лечения. Consilium Medicum. 2016; 18 (2): 85–94. DOI: 10.26442/2075-1753_2016.2.85-94
________________________________________________
Shchukin I.A., Lebedeva A.V., Burd S.G. et al. Chronic cerebrovascular disease: diagnosis and treatment questions. Consilium Medicum. 2016; 18 (2): 85–94. DOI: 10.26442/2075-1753_2016.2.85-94
В статье рассмотрены основные вопросы клиники, диагностики и лечения хронической ишемии головного мозга (ХИМ). Приведены результаты наблюдательной программы «Фезам (пирацетам + циннаризин) для коррекции умеренных когнитивных и астенических расстройств у пациентов с ХИМ», в ходе которой выяснено, что Фезам оказывает благоприятное влияние в отношении умеренных когнитивных расстройств, астенических расстройств, легких и умеренных эмоциональных нарушений. Позитивное влияние комбинации на астеническое расстройство и выраженность эмоциональных нарушений носит дозозависимый характер – наилучший эффект достигается при использовании высокодозной терапии Фезамом (2 капсулы 3 раза в день) продолжительностью 90 дней. Более молодые пациенты (от 50 до 64 лет) отвечают на высокодозную терапию Фезамом лучше, чем пациенты старшей возрастной категории (65–80 лет).
In the article the basic questions of clinic, diagnosis and treatment of chronic cerebral ischemia (CCI). The results of the observation program "Fezam (piracetam + cinnarizine) for the correction of moderate cognitive and asthenic disorders in patients with HIM", during which found that Fezam has a beneficial effect against mild cognitive impairment, asthenic disorders, light and moderate emotional disturbances. The positive impact of the combination on the severity of asthenic disorders and emotional disorders is dose dependent – the best effect is achieved by using high-dose Fezam (2 capsules 3 times a day), duration 90 days. Younger patients (50 to 64 years) respond to high-dose therapy Fezam better than patients older age category (65–80 years).
1. Батышева Т.Т., Матвиевская О.В., Маневич Т.М., Бойко А.Н. Фезам в лечении хронической усталости у больных молодого возраста с очаговым поражением головного мозга. Справ. поликлин. врача. 2005; 4. / Batysheva T.T., Matvievskaia O.V., Manevich T.M., Boiko A.N. Fezam v lechenii khronicheskoi ustalosti u bol'nykh molodogo vozrasta s ochagovym porazheniem golovnogo mozga. Sprav. poliklin. vracha. 2005; 4. [in Russian]
2. Бойко А., Лебедева А., Щукин И. и др. Новые подходы к ведению пациентов с хронической ишемией головного мозга и умеренными когнитивными расстройствами. Врач. 2014; 12: 54–9. / Boiko A., Lebedeva A., Shchukin I. i dr. Novye podkhody k vedeniiu patsientov s khronicheskoi ishemiei golovnogo mozga i umerennymi kognitivnymi rasstroistvami. Vrach. 2014; 12: 54–9. [in Russian]
3. Бойко А.Н., Кабанов А.А., Еськина Т.А. и др. Эффективность Фезама у больных с хронической ишемией мозга. Журн. неврологии и психиатрии им. С.С.Корсакова. 2005; 105 (1): 36–4. / Boiko A.N., Kabanov A.A., Es'kina T.A. i dr. Effektivnost' Fezama u bol'nykh s khronicheskoi ishemiei mozga. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2005; 105 (1): 36–4. [in Russian]
4. Дюкова Г.В. Астенический синдром: проблемы диагностики и терапии. Эффективная неврология и психиатрия. 2012; 1: 16–22. / Diukova G.V. Astenicheskii sindrom: problemy diagnostiki i terapii. Effektivnaia nevrologiia i psikhiatriia. 2012; 1: 16–22. [in Russian]
5. Сборник среднемосковских показателей деятельности медицинских организаций ДЗМ за 2013–2014 гг. / Sbornik srednemoskovskikh pokazatelei deiatel'nosti meditsinskikh organizatsii DZM za 2013–2014 gg. [in Russian]
6. Табеева Г.Р., Азимова Ю.Э. Цереброваскулярные расстройства в пожилом возрасте. Практ. медицина. 2010; 1–56. / Tabeeva G.R., Azimova Iu.E. Tserebrovaskuliarnye rasstroistva v pozhilom vozraste. Prakt. meditsina. 2010; 1–56. [in Russian]
7. Charidimou A et al. Cerebral amyloid angiopathy with and without hemorrhage: Evidence for different disease phenotypes. Neurology 2015; 84: 1206–12.
8. Bennett DA, Wilson RS, Gilley DW, Fox JH. Clinical diagnosis of Binswanger’s disease. J Neurol Neurosurg Psychiatry 1990; 53: 961–5.
9. Bornebroek M et al. Hereditary cerebral hemorrhage with amyloidosis Dutch type (AbetaPP 693): decreased plasma amyloid-beta 42 concentration. Neurobiol Dis 2003; 14 (3): 619–23.
10. Brandao F, Cadete-Leite A, Andrade JP et al. Piracetam promotes mossy fiber synaptic reorganization in rats withdrawn from alcohol. Alcohol 1996; 13: 239–49.
11. Broekaert A, Godfraind T. A comparison of the inhibitory effect of cinnarizine and papaverine on the noradrenalineand calcium-evoked contraction of isolated rabbit aorta and mesenteric arteries. Eur J Pharmacol 1979; 53 (3): 281–8.
12. Caplan LR. Binswanger’s disease – revisited. Neurology 1995; 45: 626–33.
13. Chang T-S, Lin VC-H. Melanogenesis inhibitory activity of two generic drugs: cinnarizine and trazodone in mouse B16 melanoma cells. Int J Molecular Sci 2011; 12, (12): 8787–96.
14. Chung YA, Hyun O J, Kim JY et al. Hypoperfusion and Ischemia in Cerebral Amyloid Angiopathy Documented by 99mTc-ECD Brain Perfusion SPECT. J Nucl Med 2009; 50 (12): 1969–74.
15. Cohen SA, Müller WE. Effects of piracetam on N-methyl-D-aspartate receptor properties in the aged mouse brain. Pharmacology 1993; 47: 217–22.
16. Eckert GP, Cairns NJ, Müller WE. Piracetam reverses hippocampal membrane alterations in Alzheimer’s disease. J Neural Transm 1999; 106: 757–61.
17. Fassoulaki A, Kostopanagiotou G, Kaniaris P, Varonos DD. Piracetam attenuates the changes in the surface potential of the phosphatidylcholine monolayer produced by alcohols. Acta Anaesthesiol Belg 1985; 36: 47–51.
18. Haasler T, Homann G, Duong Dinh TA et al. Pharmacological modulation of transmitter release by inhibition of pressure-dependent potassium currents in vestibular hair cells. Naunyn-Schmiedeberg’s Archives of Pharmacology 2009; 380 (6): 531–8.
19. Herrschaft H. The effect of piracetam on global and regional cerebral blood flow in acute cerebral ischemia of man. MedKlin 1978; 73: 195–202.
20. Ichiro Akiguchi et al. MRI features of Binswanger’s disease predict prognosis and associated pathology. Ann Clin Transl Neurol 2014; 1 (10): 813–82.
21. Lo´pez MG, Moro MA, Castillo CF et al. Variable, voltage-dependent, blocking effects of nitrendipine, verapamil, diltiazem, cinnarizine and cadmium on adrenomedullary secretion. Br J Pharmacol 1989; 96 (3): 725–31.
22. Levy E, Lopez-Otin C et al. Stroke in Icelandic patients with hereditary amyloid angiopathy is related to a mutation in the cystatin C gene, an inhibitor of cysteine proteases. J Exp Med 1989; 169 (5): 1771–8.
23. Medeiros YS, Calixto JB. Influence of calcium entry blockers and calmodulin inhibitors on 5-hydroxytryptamine-,potassium- and calcium-induced contractions in humanumbilical artery in-vitro. J Pharm Pharmacol 1991; 43 (6): 411–6.
24. Melkas S, Putaala J, Oksala NK et al. Small-vessel disease relates to poor poststroke survival in a 12-year follow-up. Neurology 2011; 76: 734–9.
25. Mingeot-Leclercq M-P, Lins L, Bensliman M et al. Piracetam inhibits the lipid-destabilising effect of the amyloid peptide Aâ C-terminal fragment. Biochim Biophys Acta 2003; 1609: 28–38.
26. Mondadori C, Schmutz M. Synergistic effects of oxiracetam and piracetam in combination with antiepileptic drugs. Acta Neurol Scand 1986; 74 (Suppl. 109): 113–6.
27. Moriau M, Crasborn L, Lavenne-Pardonge E et al. Platelet anti-aggregant and rheological properties of piracetam. Arzneimittelforschung 1993; 43: 110–8.
28. Müller WE, Eckert GP, Eckert A. Piracetam: Novelty in a unique mode of action. Pharmacopsychiatry 1999; 32 (Suppl. 1): 2–9.
29. Müller WE, Koch S, Scheuer K et al. Effects of piracetam on membrane fluidity in the aged mouse, rat and human brain. Biochem Pharmacol 1997; 53: 135–40.
30. Müller WE. Age related quantitative and qualitative receptor changes and pharmacological reactivity. In: Racagni G, Mendlewicz J, Eds. Treatment of age-related cognitive dysfunction: Pharmacological and clinical evaluation. Int Acad Biomed Drug Res 1992; 2: 35–40.
31. Oh U, Gupta R, Krakauer JW et al. Reversible leukoencephalopathy associated with cerebral amyloid angiopathy. Neurology 2004; 62 (3): 494–7.
32. Olpe H-R, Steinmann MW. The activating action of vincamine, piracetam and hydergine on the activity of the noradrenergic neurons of the locus coeruleus. Behav Neural Biol 1981; 33: 249–51.
33. Olszewski J. Subcortical arteriosclerotic encephalopathy. Review of the literature on the so-called Binswanger's disease and presentation of two cases. World Neurol 1962; 3: 359–75.
34. Paula-Barbosa MM, Brandao F, Pinho MC et al. The effects of piracetam on lipofuscin of the rat cerebellar and hippocampal neurons after long-term alcohol treatment and withdrawal: A quantitative study. Alcohol Clin Exp Res 1991; 15: 834–8.
35. Peuvot J, Schank A, Deleers M, Brasseur R. Piracetam-induced changes to membrane physical properties. A combined approach by 31P nuclear magnetic resonance and conformational analysis. Biochem Pharmacol 1995; 50: 1129–34.
36. Pezzini A, Del Zotto E, Volonghi I et al. Cerebral amyloid angiopathy: a common cause of cerebral hemorrhage. Curr Med Chem 2009; 16 (20): 2498–513.
37. Pilch H, Müller WE. Piracetam elevates muscarinic cholinergic receptor density in the frontal cortex of aged but not of young mice. Psychopharmacology 1988; 94: 74–8.
38. Reuse-Blom S. Microcirculation of the pial vessels in the rabbit. Acta Cardiol 1979; 34: 35–6.
39. Sato M, Heiss WD. Effect of piracetam on cerebral blood flow and somatosensory evoked potential during normotension and hypotensive ischemia in cats. Arzneimittelforschung 1985; 35: 790–2.
40. Schwartz RB, Jones KM, Kalina P et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol 1992; 159 (2): 379–83.
41. Raghuvanshi S, Pathak K. Recent Advances in Delivery Systems and Therapeutics of Cinnarizine: A Poorly Water Soluble Drug with Absorption Window in Stomach. J Drug Delivery 2014.
42. Staekenborg SS, van Straaten EC, van der Flier WM et al. Small vessel versus large vessel vascular dementia: risk factors and MRI findings. J Neurol 2008; 255: 1644–51.
43. Turner D, Lurie Y, Finkelstein Y et al. Pediatric cinnarizine overdose and toxicokinetics. Pediatrics 2006; 117 (5): e1067–e1069.
44. Valzelli L, Bernasconi S, Sala A. Piracetam activity may differ according to the age of the recipient mouse. Int Pharmacopsychiatry 1980; 15: 150–6.
45. Waegemans T, Wilsher CR, Danniau A et al. Clinical efficacy of piracetam in cognitive impairment: A meta-analysis. Dement Geriatr Cogn Disord 2002; 13: 217–24.
46. Weller RO, Preston SD, Subash M, Carare RO. Cerebral amyloid angiopathy in the aetiology and immunotherapy of Alzheimer disease. Alzheimers Res Ther 2009; 1 (2): 6.
________________________________________________
1. Batysheva T.T., Matvievskaia O.V., Manevich T.M., Boiko A.N. Fezam v lechenii khronicheskoi ustalosti u bol'nykh molodogo vozrasta s ochagovym porazheniem golovnogo mozga. Sprav. poliklin. vracha. 2005; 4. [in Russian]
2. Boiko A., Lebedeva A., Shchukin I. i dr. Novye podkhody k vedeniiu patsientov s khronicheskoi ishemiei golovnogo mozga i umerennymi kognitivnymi rasstroistvami. Vrach. 2014; 12: 54–9. [in Russian]
3. Boiko A.N., Kabanov A.A., Es'kina T.A. i dr. Effektivnost' Fezama u bol'nykh s khronicheskoi ishemiei mozga. Zhurn. nevrologii i psikhiatrii im. S.S.Korsakova. 2005; 105 (1): 36–4. [in Russian]
4. Diukova G.V. Astenicheskii sindrom: problemy diagnostiki i terapii. Effektivnaia nevrologiia i psikhiatriia. 2012; 1: 16–22. [in Russian]
5. Sbornik srednemoskovskikh pokazatelei deiatel'nosti meditsinskikh organizatsii DZM za 2013–2014 gg. [in Russian]
6. Tabeeva G.R., Azimova Iu.E. Tserebrovaskuliarnye rasstroistva v pozhilom vozraste. Prakt. meditsina. 2010; 1–56. [in Russian]
7. Charidimou A et al. Cerebral amyloid angiopathy with and without hemorrhage: Evidence for different disease phenotypes. Neurology 2015; 84: 1206–12.
8. Bennett DA, Wilson RS, Gilley DW, Fox JH. Clinical diagnosis of Binswanger’s disease. J Neurol Neurosurg Psychiatry 1990; 53: 961–5.
9. Bornebroek M et al. Hereditary cerebral hemorrhage with amyloidosis Dutch type (AbetaPP 693): decreased plasma amyloid-beta 42 concentration. Neurobiol Dis 2003; 14 (3): 619–23.
10. Brandao F, Cadete-Leite A, Andrade JP et al. Piracetam promotes mossy fiber synaptic reorganization in rats withdrawn from alcohol. Alcohol 1996; 13: 239–49.
11. Broekaert A, Godfraind T. A comparison of the inhibitory effect of cinnarizine and papaverine on the noradrenalineand calcium-evoked contraction of isolated rabbit aorta and mesenteric arteries. Eur J Pharmacol 1979; 53 (3): 281–8.
12. Caplan LR. Binswanger’s disease – revisited. Neurology 1995; 45: 626–33.
13. Chang T-S, Lin VC-H. Melanogenesis inhibitory activity of two generic drugs: cinnarizine and trazodone in mouse B16 melanoma cells. Int J Molecular Sci 2011; 12, (12): 8787–96.
14. Chung YA, Hyun O J, Kim JY et al. Hypoperfusion and Ischemia in Cerebral Amyloid Angiopathy Documented by 99mTc-ECD Brain Perfusion SPECT. J Nucl Med 2009; 50 (12): 1969–74.
15. Cohen SA, Müller WE. Effects of piracetam on N-methyl-D-aspartate receptor properties in the aged mouse brain. Pharmacology 1993; 47: 217–22.
16. Eckert GP, Cairns NJ, Müller WE. Piracetam reverses hippocampal membrane alterations in Alzheimer’s disease. J Neural Transm 1999; 106: 757–61.
17. Fassoulaki A, Kostopanagiotou G, Kaniaris P, Varonos DD. Piracetam attenuates the changes in the surface potential of the phosphatidylcholine monolayer produced by alcohols. Acta Anaesthesiol Belg 1985; 36: 47–51.
18. Haasler T, Homann G, Duong Dinh TA et al. Pharmacological modulation of transmitter release by inhibition of pressure-dependent potassium currents in vestibular hair cells. Naunyn-Schmiedeberg’s Archives of Pharmacology 2009; 380 (6): 531–8.
19. Herrschaft H. The effect of piracetam on global and regional cerebral blood flow in acute cerebral ischemia of man. MedKlin 1978; 73: 195–202.
20. Ichiro Akiguchi et al. MRI features of Binswanger’s disease predict prognosis and associated pathology. Ann Clin Transl Neurol 2014; 1 (10): 813–82.
21. Lo´pez MG, Moro MA, Castillo CF et al. Variable, voltage-dependent, blocking effects of nitrendipine, verapamil, diltiazem, cinnarizine and cadmium on adrenomedullary secretion. Br J Pharmacol 1989; 96 (3): 725–31.
22. Levy E, Lopez-Otin C et al. Stroke in Icelandic patients with hereditary amyloid angiopathy is related to a mutation in the cystatin C gene, an inhibitor of cysteine proteases. J Exp Med 1989; 169 (5): 1771–8.
23. Medeiros YS, Calixto JB. Influence of calcium entry blockers and calmodulin inhibitors on 5-hydroxytryptamine-,potassium- and calcium-induced contractions in humanumbilical artery in-vitro. J Pharm Pharmacol 1991; 43 (6): 411–6.
24. Melkas S, Putaala J, Oksala NK et al. Small-vessel disease relates to poor poststroke survival in a 12-year follow-up. Neurology 2011; 76: 734–9.
25. Mingeot-Leclercq M-P, Lins L, Bensliman M et al. Piracetam inhibits the lipid-destabilising effect of the amyloid peptide Aâ C-terminal fragment. Biochim Biophys Acta 2003; 1609: 28–38.
26. Mondadori C, Schmutz M. Synergistic effects of oxiracetam and piracetam in combination with antiepileptic drugs. Acta Neurol Scand 1986; 74 (Suppl. 109): 113–6.
27. Moriau M, Crasborn L, Lavenne-Pardonge E et al. Platelet anti-aggregant and rheological properties of piracetam. Arzneimittelforschung 1993; 43: 110–8.
28. Müller WE, Eckert GP, Eckert A. Piracetam: Novelty in a unique mode of action. Pharmacopsychiatry 1999; 32 (Suppl. 1): 2–9.
29. Müller WE, Koch S, Scheuer K et al. Effects of piracetam on membrane fluidity in the aged mouse, rat and human brain. Biochem Pharmacol 1997; 53: 135–40.
30. Müller WE. Age related quantitative and qualitative receptor changes and pharmacological reactivity. In: Racagni G, Mendlewicz J, Eds. Treatment of age-related cognitive dysfunction: Pharmacological and clinical evaluation. Int Acad Biomed Drug Res 1992; 2: 35–40.
31. Oh U, Gupta R, Krakauer JW et al. Reversible leukoencephalopathy associated with cerebral amyloid angiopathy. Neurology 2004; 62 (3): 494–7.
32. Olpe H-R, Steinmann MW. The activating action of vincamine, piracetam and hydergine on the activity of the noradrenergic neurons of the locus coeruleus. Behav Neural Biol 1981; 33: 249–51.
33. Olszewski J. Subcortical arteriosclerotic encephalopathy. Review of the literature on the so-called Binswanger's disease and presentation of two cases. World Neurol 1962; 3: 359–75.
34. Paula-Barbosa MM, Brandao F, Pinho MC et al. The effects of piracetam on lipofuscin of the rat cerebellar and hippocampal neurons after long-term alcohol treatment and withdrawal: A quantitative study. Alcohol Clin Exp Res 1991; 15: 834–8.
35. Peuvot J, Schank A, Deleers M, Brasseur R. Piracetam-induced changes to membrane physical properties. A combined approach by 31P nuclear magnetic resonance and conformational analysis. Biochem Pharmacol 1995; 50: 1129–34.
36. Pezzini A, Del Zotto E, Volonghi I et al. Cerebral amyloid angiopathy: a common cause of cerebral hemorrhage. Curr Med Chem 2009; 16 (20): 2498–513.
37. Pilch H, Müller WE. Piracetam elevates muscarinic cholinergic receptor density in the frontal cortex of aged but not of young mice. Psychopharmacology 1988; 94: 74–8.
38. Reuse-Blom S. Microcirculation of the pial vessels in the rabbit. Acta Cardiol 1979; 34: 35–6.
39. Sato M, Heiss WD. Effect of piracetam on cerebral blood flow and somatosensory evoked potential during normotension and hypotensive ischemia in cats. Arzneimittelforschung 1985; 35: 790–2.
40. Schwartz RB, Jones KM, Kalina P et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol 1992; 159 (2): 379–83.
41. Raghuvanshi S, Pathak K. Recent Advances in Delivery Systems and Therapeutics of Cinnarizine: A Poorly Water Soluble Drug with Absorption Window in Stomach. J Drug Delivery 2014.
42. Staekenborg SS, van Straaten EC, van der Flier WM et al. Small vessel versus large vessel vascular dementia: risk factors and MRI findings. J Neurol 2008; 255: 1644–51.
43. Turner D, Lurie Y, Finkelstein Y et al. Pediatric cinnarizine overdose and toxicokinetics. Pediatrics 2006; 117 (5): e1067–e1069.
44. Valzelli L, Bernasconi S, Sala A. Piracetam activity may differ according to the age of the recipient mouse. Int Pharmacopsychiatry 1980; 15: 150–6.
45. Waegemans T, Wilsher CR, Danniau A et al. Clinical efficacy of piracetam in cognitive impairment: A meta-analysis. Dement Geriatr Cogn Disord 2002; 13: 217–24.
46. Weller RO, Preston SD, Subash M, Carare RO. Cerebral amyloid angiopathy in the aetiology and immunotherapy of Alzheimer disease. Alzheimers Res Ther 2009; 1 (2): 6.
1 ГБОУ ВПО Российский национальный исследовательский медицинский университет им. Н.И.Пирогова Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
2 ГБУЗ Городская клиническая больница №1 им. Н.И.Пирогова Департамента здравоохранения г. Москвы. 117049, Россия, Москва, Ленинский просп., д. 8;
3 ГБУЗ Городская поликлиника №166 Департамента здравоохранения г. Москвы. 155551, Россия, Москва, Домодедовская ул., д. 9;
4 ГБУЗ Городская поликлиника №218 Департамента здравоохранения г. Москвы. 129642, Россия, Москва, пр. Шокальского, д. 8;
5 ГБУЗ Городская клиническая больница им. С.С.Юдина Департамента здравоохранения г. Москвы. 115487, Россия, Москва, ул. Академика Миллионщикова, д. 1;
6 ГБУЗ ГБ г. Московский Департамента здравоохранения г. Москвы. 142784, Москва, Московский, 1-й мкр., д. 54
*ivashchukin@gmail.com
1 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
2 N.I.Pirogov City Clinical Hospital №1 of the Department of Health of Moscow. 119049, Russian Federation, Moscow, Leninskii pr-t., d. 8;
3 Сity Clinic №166 of the Department of Health of the Russian Federation. 155551, Russian Federation, Moscow, Domodedovskaia ul., d. 9;
4 Сity Clinic №218 of the Department of Health of the Russian Federation. 129642, Russian Federation, Moscow, pr. Shokal'skogo, d. 8;
5 S.S.Yudin City Clinical Hospital of the Department of Health of Moscow. 115487, Russian Federation, Moscow, ul. Akademika Millionshchikova, d. 1;
6 Moskovsky City Hospital of the Department of Health of Moscow. 142784, Federation, Moscow, Moskovsky, 1-i mkr., d. 54
*ivashchukin@gmail.com