Vol 79, No 12 (2004)

Immune system and gastrointestinal diseases
Lazebnik L.В., Tsaregorodtseva Т.М., Parfenov A.I.
Terapevticheskii arkhiv. 2004;79(12):5-9
Psychovegetative aspects of mechanic failure of the cardiac muscle in an acute period oftransmural myocardial infarction
Parfenyuk V.К., Mailer К.S.
Aim. To study psychoemotional, typological personality characteristics and vegetative status of patients with mechanical complications of acute transmural myocardial infarction (Ml). Material and methods. 107patients with acute transmural Ml were divided into three groups depending on the kind of mechanical myocardial failure (MMF) or its absence. The control group consisted of 20 healthy patients. The patients were examined for psychoemotional and typological features of personality and vegetative tone. Results. Introverts were prevalent among Ml patients with MMF. A psychological picture of the examinees was made. The study group patients displayed vegetative dysfunction syndrome. A cognitive component of high anxiety in patients with postinfarction MMF was specified. Conclusion. A cognitive component of anxiety in patients with acute transmural MI and MMF differs from that of patients with an uncomplicated course of the disease being hardly responsive to conventional therapy. Somatic component of anxiety in such patients manifests with vegetative dysfunction syndrome and demands prescription of beta-adrenoblockers as early as possible.
Terapevticheskii arkhiv. 2004;79(12):9-12
Assessment of myocardial viability and recovery ofthe left ventricular function in postmyocardial infarction patients
Volutskene E., Ivashkyavichene L., Grabauskene V., Lautsyavichus A.
Aim. To evaluate prognostic significance of myocardial viability (MV) depending on treatment policy in postmyocardial infarction (PMI) patients. Material and methods. The study included 196 patients (172 males, 24 females, age 30-75, mean age 53 ± 8.6 years). Standard stress dobutamine echocardiography was made 14 ± 6 days (8-21 days) after macrofocal MI. Reperfusion therapy was made in 138 (70%) patients. X-ray contrast coronary angiography was performed in all the patients as the criterion of the immediate effect of reperfusion was achievement of residual stenosis of Ml-related coronary artery < 50%. Late after Ml (18 ± 7 months after Ml) a comparative analysis of the left ventricular function was made in three groups of patients depending on the clinical response to the treatment. MV criterion was based on a fall in the index of infarction zone wall movement (IZWM) under low-dose dobutamine stress test reflecting contractile reserve of the infarction zone (CR). Left ventricular function recovery was judged by a decrease in initial IZWM index 18 months later vs the initial IZWM 14 days later. Thus contractile reversibility of the infarction zone (CRIZ) was determined. LV function was also assessed by the index of left ventricular end diastolic volume (L VED V), by the index of left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF). Results. 18 months after MI, CRIZ was higher in group 1 (after effective reperfusion) and group 3 (after myocardial revascularization) compared to group 2 (medication only): 0.33 ± 0.01, 0.39 ± 0.02 and 0.23 ± 0.01, respectively. LVEDV and LVESV in group 1 and 3 diminished while LVEF increased. LVEDV in group 2 remained elevated though EF rose considerably. Conclusion. Recovery of LV contractile function depends much on reestablishment of adequate myocardial perfusion by reperfusion therapy or myocardial revascularization. Chronic myocardial hypoperfusion leads to LV remodeling. CRIZ proved a significant prognostic criterion of the IZWM index 18 months after MI only in patients given effective reperfusion therapy.
Terapevticheskii arkhiv. 2004;79(12):12-17
Effects of exercise on markers of hemostatic activation inyoung survivors of myocardial infarction
Vitsenya M.V., Noeva E.A., Titaeva E.V., Dobrovolsky A.B.
Aim. To study the effect of exercise on markers of endothelial impairment, platelet activation, thrombin formation, fibrinolysis in patients who survived myocardial infarction (MI) at young age. Material and methods. The levels of fibrinogen (F), Willebrand factor (WF), beta-thromboglobulin (BTG), fragment 1+2 of prothrombin activation (F 1+2), antigen of tissue plasminogen activator (TPA), D-dimer at rest as well as BTG, F 1 = 2, WF, TPA antigen and its activity in treadmill test (TT) were compared in 25 patients younger than 35 years who survived Q-myocardial infarction (Q-MI) > 6 months before (group 1), 10 of whom had unaffected or little affected coronary arteries as shown by coronaroangiography (subgroup Ш) while 15 had stenosing coronary atherosclerosis (subgroup 1A); in 20 patients who had Q-MI at the age of 40-55 years (group 2); in 10 healthy patients under 35 years of age (group 3). Results. Initial concentrations of F, F 1 + 2 and TPA antigen were significantly higher than in healthy subjects. F and TPA antigen were higher in subgroup 1A than in subgroup 1H. D-dimer was higher in group 2 vs 1. TT raised concentration of BTG in all the groups, induced a stable trend of F 1+2 rise in patients of subgroup IE (p = 0.059), raised WF only in group 3, TPA antigen at peak stress in all the patients being in group 1 higher than in healthy controls and in subgroup 1A than in subgroup 1H. TPA antigen was more active at the peak stress in group 1 than in group 2 but the differences became insignificant in analyzing only patients who reached submaximal load by heart rate. Conclusion. Stenosing coronary atherosclerosis in patients after MI at young age is associated with high F and TPA levels. Elevated F 1+2 was registered at exercise test in young patients free of coronary obstruction. TPA levels were raised higher by exercise in patients with stenosing atherosclerosis of the coronary arteries. TPA activity induced by exercise depended more on exercise intensity than on the age of the patients.
Terapevticheskii arkhiv. 2004;79(12):17-23
A clinical courseof coronary heart disease after pacemaker implantation andoptimization of the pacing regime
Iskenderov B.G., Minkin A.A., Vakina T.N.
Aim. To study effects of pacemaker implantation on the course of coronary heart disease (CHD) with stable angina pectoris and choice of optimal regimen of pacing. Material and methods. A total of 154 CHD patients with a pacemaker were examined. All the patients had angina of effort of functional class 11-IV. Results. The symptoms of the disease improved in 72 (46.8%) patients (group I): the number of anginal attacks decreased, exercise tolerance increased, the dose of antianginal medicines went down. Pain attacks became more frequent, response to nitroglycerin changed in 30 (19.5%) patients of group 2. This was explained by 1.5-2-fold enhancement of heart rate by pacemaker raising myocardial oxygen consumption and psychocardial syndrome. In 52 (33.8%) patients of group 3 anginal attacks characteristics did not change. Conclusion. To optimize coronary reserve, frequency of electroimpulses must be reprogrammed to adjust to afunctional class of angina and chronic cardiac failure as well as pacing regime. In particular, low coronary reserve demands optimal frequency of 55-65 imp/min while congenital cardiac failure -75-85 imp/min.
Terapevticheskii arkhiv. 2004;79(12):23-27
The role of hypersympathycotony in development of arterial hypertensionin patients with metabolic syndrome: potential of pathogenetically sound therapy
Ametov A.S., Demidova T.Y., Smagina L.V.
Aim. To assess hypotensive efficacy and metabolic neutrality of moxonidine (physiotenz) - a selective agonist of imidasoline receptors - in patients with mild and moderate arterial hypertension (AH) associated with diabetes mellitus (DM) type 2. Material and methods. Follow-up and treatment were conducted in 30 hypertensive diabetics (mean age 52.43 ± 4.65 years). Mean duration of DM and AH was 4.77 ± 2.69 and 6.93 ± 2.98 years, respectively. The study was made of lipid exchange, glycemia, levels of glycosylated hemoglobin (GH), fasting and postprandial immunoreactive insulin. Hypotensive efficacy was examined by 24-h monitoring of arterial pressure after 16 weeks of therapy. Results. Mean 24-h systolic arterial pressure fell by 8.02%, diastolic arterial pressure - by 6.47%. The drug had a good effect on a 24-h profile of arterial pressure: a significant decrease of day and night pressure load index, lowering of initially high 24-h variability of systolic and diastolic arterial pressure, normalization of two-phase profile of arterial pressure. Carbohydrate metabolism improved also: GH, glycemia, immunoreactive insulin decreased. There was a significant trend to a change in qualitative composition of blood lipids - a decrease in lipoproteins atherogenic fractions and a rise in HDLP. Conclusion. Physiotens is a highly effective hypotensive drug for use in mild and moderate AH in DM of type 2.
Terapevticheskii arkhiv. 2004;79(12):27-32
Practical prevention and treatment of cardiovascular diseases in patients with diabetesmellitus type 2 in an endocrinological department
Daurbekova L.V., Orlov V.A., Gilyarevsky S.R., Abirova E.S., Murzabekova L.I.
Aim. To analyse retrospectively quality of medical correction of modified risk factors (RF) and treatment of cardiovascular diseases (CVD) in patients with diabetes mellitus type (DM) 2 admitted to specialized endocrinological departments. Material and methods. Analysis of medication policy of CVD RF was made retrospectively for 250 patients treated in endocrinological departments of Moscow hospital in 2003. Results. Arterial hypertension, coronary heart disease were diagnosed in 93.2 and 87.2% examinees. History of myocardial infarction and brain stroke was in 8.4 and 6% patients. Statins were prescribed in 2.4% cases. Examination for dyslipidemia was not satisfactory. ACE inhibitors were prescribed in 71.2% patients. Aspirin was prescribed (18%) primarily by the cardiologist. Conclusion. Quality of medical prophylaxis of CVD RF in DM type 2 patients in the departments does not satisfy modern clinical recommendations.
Terapevticheskii arkhiv. 2004;79(12):32-36
Carotid atherosclerosis detectability in patients with coronary heart diseaseand arterial hypertension
Astanina I.A., Dudko V.A., Vorozhtsova I.N.
Aim. To assess detectability of carotid atherosclerosis in patients with coronary heart disease (CHD) and arterial hypertension (AH) by the data of ultrasonic screening, to study location and detectability of atherosclerotic lesion of common carotid arteries, internal carotid arteries, external carotid arteries in correlation with basic disease. Material and methods. Ultrasonic screening of brachyocephalic arteries was made in 469 patients: with CHD (n = 239), AH (n = 230) including patients with concomitant postinfarction cardiosclerosis (PICS) and moderate chronic cerebrovascular failure (CCVF). Results. Ultrasonic angiography detected atherosclerotic carodid artery lesion in patients with CHD and PICS (81.6%) or CCVF (76.9%) or angina pectoris (64.2%). In hypertension subjects carotid artery atherosclerosis was encountered in 28.1%. Conclusion. It is justified to make ultrasonography of carotid arteries in all patients with CHD and AH irrespective of age, gender, underlying clinical diagnosis
Terapevticheskii arkhiv. 2004;79(12):36-39
Vasoregulating activity of the endothelium and pulmonary hypertension
Karoli N.A., Rebrov A.P.
Aim. To examine vasoregulating endothelial activity in patients with bronchial asthma (BA) with pulmonary hypertension (PH) and free of PH. Material and methods. A total of 62 BA patients aged between 19 and 52 entered the trial. They were divided into two groups: 44 with PH and 18 free of it. The control group consisted of 35 healthy sub- jects. Vasoregulating activity of the vascular wall was studied by tests with reactive hyperemia (endothelium-dependent dilation) and 0.05 mg nitroglycerin (endothetium-dependent dilation). Results. It was found that BA patients with PH have a dilated brachial artery, abnormal endotheliumdependent vasodilation of the brachial artery. The artery is low sensitive to shift tension. These changes in functional activity of brachial artery endothelium in BA patients with PH are associated with impaired pulmonary hemodynamics, right ventricular diastolic dunction.
Terapevticheskii arkhiv. 2004;79(12):39-44
Echocardiography - prognosis of the course of infectious endocarditisand long-term survival in this disease
Maslov S.V., Lobanov M.Y., Kovalev Y.R.
Aim. To determine prognostic opportunities of echocardiography (ECG) in infectious endocarditis (IE) basing on the assessment of microbial vegetations size and degree of valvular failure. Material and methods. Of 114 patients with definite IE (72 male, 42 female), 90 ones had primary and 24 secondary endocarditis. The prospective study included all the survivors in the IE active stage -78 patients. Results. Vegetations > 1 cm in size were detected in 50.8%patients, < 1 cm - in 49.2%. Hospital lethality in vegetations > 1 cm and < 1 cm was 25.8 and 16.1%, respectively. Thromboembolism rate was 81 and 64.2%, respectively. One-year survival was 78.7 and 71.4%, two-year survival 66.5 and 61.7%, three-year survival 66.5 and 49.4%, five-year survival - 51.7 and 32.9% in vegetations < 1 cm and > 1 cm, respectively. Valvular regurgitation of the first degree was in 17.5%, of the second degree - in 41.9%, thirdfourth degree - in 36.6% patients. Hospital lethality in mitral valve failure was 32.1%, in aortic and tricuspid failure - 17.8 and 11.4%, respectively. Conclusion. EchoCG was most effective for predicting thromboembolism and cardiac failure. Valvular regurgitation of the third-fourth degree significantly correlates with severe cardiac failure. ECG is less informative for predicting hospital lethality.
Terapevticheskii arkhiv. 2004;79(12):44-48
Clinical response to "Gincor-Fort" in the treatment of chronic venous insufficiency invaricosity
Zhukov B.N., Kukolnikova E.L.
Aim. Assessment of clinical efficacy and tolerance of the drug Ginkor-Fort in patients with chronic venous insufficiency (CVI) in varicosity in compensation stage. Material and methods. Thirty patients with compensated CVI free of trophic ulcers of the legs received Ginkor-Fort 1 capsule twice a day for one month. The efficacy of the drug was assessed by subjective appraisal of the patients, physical examination data and results of repeated measurements of the leg at the malleolus level. Results. A course of Ginkor Fort produced a considerable improvement in 27 (90%) patients. Improvement of the condition occurred in 3 (10%) patients. Side effects were absent, the treatment was well tolerated. All the patients completed a one-month Ginkor-Fort course. Conclusion. Ginkor Fort is a highly effective and safe flebotonic drug. Its high anti-inflammatory, anesthetic, lymphodraining and flebotonic effects noticeably and rapidly raise life quality of patients with varicosity.
Terapevticheskii arkhiv. 2004;79(12):48-51
Bronchoobstructive syndrome in bronchoectasias
Bondarchuk V.V., Korovina O.V., Sobchenko S.A., Mineev V.N.
Aim. To specify mechanisms of bronchial obstruction in bronchoectasia (BE). Material and methods. Clinical, x-ray, bronchological and spirographic examinations with broncholytic test were made in 26 BE patients aged 16-66 years (14 males, 12 females). The membrane-receptor complex of erythrocytes was based on the effect of adrenoantagonist propranolol on osmotic erythrocytic resistance (obsidan test) and effect of adrenoagonist adrenalin on dynamics of ESR. Results. Allergological anamnesis was detected in 69% of BE patients, hereditary atlergological anamnesis - in 22%, membrane-receptor changes characteristic for atopic condition by obsidan test - in 46%, fractional erythrocytic sedimentation with adrenalin - in 42%. Bronchoobstruction syndrome occurred in 37% cases with mean values FEV1 46 ± 6.2%, MSVS0 17.4 ± 3%, MSV75 14.4 ± 0.9%. The broncholytic test detected a mean increment of FEV, by 12.2 ± 3.1%. Latent bronchospasm was revealed in 33% patients with BE. Conclusion. The correlation analysis suggests that among mechanisms of bronchial obstruction in bronchoectasia, bronchospasm is of great importance especially in allergological anamnesis pathogene- sis of which involves disorders of membrane-receptor complex.
Terapevticheskii arkhiv. 2004;79(12):51-53
Phenomenon of hyperexpression of rybosomiccistrons in bone marrow hemopoietic elements in bronchialasthma
Mineev V.N., Mamaev N.N., Ivanovа V.V., Nesterovich I.I., Gindina T.L.
Aim. To study expression of ribosomic cistrons (RC) of bone marrow hemopoietic elements (BMHE) in bronchial asthma (BA). Material and methods. A total of 37 bronchial asthma (BA) patients were examined. Of them, 20 ones had allergic BA (ABA) and 10 - nonallergic BA (NABA). Seven patients received systemic glucocorticoid hormones (SGH). Control included cells of bone marrow from 7 healthy donors. Transcription and maturation of pre-rRNA in BMHE were analysed using bone marrow samples obtained during the sternal puncture (a modified method of Howell and Black). Results. RC activity was high. It depended on BA variant and the disease phase. In ABA high RC activity persisted in remission. GCH suppress RC activity rise. The maximal effect of GCH suppressive action was seen in myeloid lineage, minimal - in erythroid one. The effect is absent in more mature erythroid cells and bone marrow lymphocytes. Conclusion. The phenomenon of RC activity rise in myeloid, erythroid and lymphoid lineages of the bone marrow of BA patients may reflect contribution of the bone marrow to formation of BA pathogenesis.
Terapevticheskii arkhiv. 2004;79(12):53-58
Endothelium and platelets in pregnant women with chronicglomerulonephritis and therapeutic efficacy of acetylsalicylicacid and dipiridamol
Rogov V.A., Shilov Е.М., Kozlovskaya N.L., Gordovskaya N.В., Sidorova I.S., Krylova M.Y., Artemyeva V.B.
Aim. To estimate platelet and endothelial condition in pregnant women with chronic glomerulonephritis (CGN), prognostic value of these changes and efficacy of acetylsalicylic acid (ASA) and dipiridamol in prevention of unfavourable outcomes of pregnancy in CGN. Material and methods. The examination covered 74 CGN pregnant patients, 14 non-pregnant CGN patients, 11 pregnant women with preeclampsia, 19 healthy pregnant women. The levels offlbronectin, endothelin -1,2, 6-keto-PGFla, thromboxane B/TxB^ secretory beta-thromboglobulin in the blood, activity of intrathrombocytic lactatedehydrogenase (LHG), platelet aggregation. ASA (125 mg/day) was given to 33 CGN pregnant women in combination with dipiridamol (150-225 mg/day). Control group consisted of 32 CGN pregnant women. Results. Content of fibronectin, endothelin, TxB2 and beta-thromboglobulin in blood plasm, aggregation with ADP in CGN pregnant women were higher than in healthy pregnant women and nonpregnant CGN patients. Plasmic 6-keto-PGFla was low. Preeclampsia was accompanied with elevated fibronectin, TxB2 and beta-thromboglobulin, hyperactive LDH. Platelet aggregation was suppressed. Blood beta-thromboglobulin directly correlated with systolic and diastolic arterial pressure, 24-h proteinuria and blood creatinine. Reverse Correlation was seen in blood beta-thromboglobulin with albuminemia, glomerular filtration rate, body mass of the newborn and term of labor. A direct correlation was found between the activity of intrathrombocytic LDH and systolic and diastolic arterial pressure, a weak reverse correlation - between platelet count in capillary blood and systolic pressure, platelet aggregation with ADP and terms of labor. Of the highest prognostic value were the level of beta-thromboglobulin and fibronectin, the activity of intrathrombocytic LDH and platelet aggregation in response to ADP. ASA and dipiridamol reduced the risk of fetal retardation and fetal loss. Conclusion. Pregnant women with CGN have endothelial-thronbocytic dysfunction because of unidirectional influence of both CGN and pregnancy. We think that endothelial-platelet dysfunction connects renal impairment and placental failure in pregnant women with CGN deteriorating a gestational CGN and pregnancy complications. Correction of endothelial-platelet state with ASA and dipiridamol is effective in prevention of fetal retardation and fetal loss in pregnant women with CGN.
Terapevticheskii arkhiv. 2004;79(12):58-64
Antibodies to cyclic citrullinized peptide in rheumatoid arthritis
Aleksandrova E.N., Chemeris N.A., Karateev D.E., Novikov A.A., Brodetskaya K.A., Nasonov E.L.
Aim. To estimate a diagnostic value of antibodies to cyclic citmllinized peptide (CCP) in rheumatoid arthritis (RA). Material and methods. The study was made of 85 RA patients. Of them, 48 patients had early RA, i.e. of 8 month and less duration. The control group consisted of 35 patients with non-differentiated arthritis (NBA) and 8 healthy donors. Concentrations of CCP antibodies, rheumatoid factor (RF) IgM and RF IgA were measured with enzyme immunoassay (EIA). Results. The level of CCP antibodies in RA patients (76.3 ± 43.8; median 100.0 U/ml) was significantly higher than in NDA patients (25.1 ± 43.9; median 0.8 U/ml; p < 0.05) or in donors (0.38 ± 0.36; median 0.2 U/ml; p < 0.05). A correlation was found between the CCP antibodies level and that ofRF IgM (/ = 15.4; p = 0.001) and RF IgA (/ = 10.3; p = 0.001). Sensitivity (82%) and specificity (90%) of CCP antibodies in RA diagnosis was higher than these parameters for RF IgM and IgA (78%o, 86%> and 72%, 83%, respectively). Simultaneous tests for CCP antibodies, RF IgM and RF IgA led to a 93% specificity. CCP antibodies were detected in 50% patients seronegative by RF IgM and in 62% patients seronegative by IgA. Detection of CCP antibodies was closely associated with early RA (x2 = 30.8;p = 0.0001). Conclusion. The EI A for CCP antibodies is a sensitive and specific serological test for early RA diagnosis.
Terapevticheskii arkhiv. 2004;79(12):64-68
Clinical biological features of mixed myeloiddiseases
Gritsaev S.V., Abdulkadyrov K.M., Tiranova S.A., Kapustin S.L., Martynkevich I.S., Bessmeltsev S.S., Rugal V.I., Bakai M.P.
Aim. To characterize patients with mixed myeloid neoplasias with proliferation of neutrophils, platelets and eosinophils. Material and methods. Examination and treatment results were analysed for patients with atypical myeloid leukemia (n = 4), myelodysplastic syndrome (MDS, n = 1) and thrombocytosis, MDS and eosinophilia (n = I). The examination included morphological, histological, cytogenetic and molecular tests. Results. One patient with atypical chronic myeloid leukemia was prior diagnosed to have primarily MDS with a typical aberration of chromosome 5. Two other patients had an initial morphological picture of resistant anemia with blast excess, signs of myeloproliferation and extramedullar hemopoiesis. One and two months after the first examination they received transfusions of erythrocytic mass. Just then they were found to have splenomegaly and leukocytosis due to proliferating and maturating forms of neutrophils. The course of the disease in patients with MDS, thrombocytosis and normal karyotype and in patients with MDS, eosinophilia and combined chromosomal breaks including translocation (3;12)(q21;pl3) was characterized by resistance to standard programs of polychemotherapy and transformation into acute myeloblasts leukemia. Conclusion. In some cases atypical CML is a stage of a natural course of MDS. Some MDS variants with eosinophilia and thrombocytosis should be referred to the group of mixed myeloid neoplasias.
Terapevticheskii arkhiv. 2004;79(12):68-73
A case of effective use of alemtuzumab in a male patient with T-cell lymphoma
Sokolov A.N., Parovichnikova E.N., Isaev V.С., Ustinova Е.N., Shavlokhov V.S., Atopkov V.A., Model S.V., Tsyba N.N., Kaplanskaya I.В., Klyasova G.A., Aleksanyan M.Z., Vishnevskaya E.S., Togonidze D.K., Mirzoyan E.E., Savchenko V.G.
Terapevticheskii arkhiv. 2004;79(12):73-75
Neurohumoral aspects of energy metabolism regulation
Demidova Т.Y., Ametov A.S., Selivanova A.V.
Terapevticheskii arkhiv. 2004;79(12):75-78
Efficacy and tolerance of stepwise therapy withmovalis in rheumatic diseases
Tsvetkova E.S.
Terapevticheskii arkhiv. 2004;79(12):78-81
Chronic obstructive pulmonary disease in combination with cardiovascular diseases: treatment with inhalatory cholinolytic drugs1
Aisanov Z.R., Kalmanova E.N., Chuchalin A.G.
Terapevticheskii arkhiv. 2004;79(12):81-83
Current pathogenetic model of rheumatoid arthritis and its role inclinical practice
Suchkov S.V., Khitrov A.N., Naumova T.E., Ogneva E.A., Ageev V.A., Gabibov A.G., Alekberova Z.S.
Terapevticheskii arkhiv. 2004;79(12):83-88
Carvedilol(dilatrend) treatment in cardiac failure
Drapkina O.M., Klimenkov A.V., Jvashkin V.T.
Terapevticheskii arkhiv. 2004;79(12):88-90
An adverse effect of amiodaron on the skin
Reingardene D.I.
Terapevticheskii arkhiv. 2004;79(12):93-97
Low-molecular heparins in the treatment of non-iT elevation acute coronary syndrome
Komarov A.L., Panchenko E.P.
Terapevticheskii arkhiv. 2004;79(12):90-93
Cardiovascular status in patients with hypothyroidosis in the elderly
Garkunova L.V., Ametov A.S.
Terapevticheskii arkhiv. 2004;79(12):97-100
Rating system in medical education
Elgarov A.A., Elgarova L.V.
Terapevticheskii arkhiv. 2004;79(12):100-102

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