EFFECT OF COMBINED ADMINISTRATION OF L-ARGININE AND OMEGA-3 POLYUNSATURATED FATTY ACIDS ON THE SPECTRUM OF FREE AMINO ACIDS AND BIOGEN AMINES IN THE CORTEX OF LARGE HEMISPHERES OF RATS UNDERGOING SUBTOTAL CEREBRAL ISCHEMIA
Razvodovsky Yu.E., Smirnov V.Yu., Doroshenko E.M., Pereverzev V.A., Maksimovich N.E., Semenenya I.N.,
UDC: 616.441.577.112
Abstract: Objective. The aim of this study was to estimate the changes in the pool of free amino acids and their derivatives in the cortex of large hemispheres of rats undergoing subtotal cerebral ischemia (SCI) and treated with L-arginine and omega-3 polyunsaturated fatty acids (omega-3 PUFA). Methods . The experiment was held on 18 rats: 12 animals underwent bilateral filament occlusion of arteries carotid, in 6 cases L-arginine and omega-3 PUFAs were administered. The analyses of free amino acids and their derivates levels in the blood plasma extracts were carried out by reversed-phase HPLC. Results. Subtotal cerebral ischemia caused disturbances in the pool of free amino acids and their derivatives of the cerebral cortex: there was an increase in the content of aspartate,-alanine and-aminobutyric acid (a-ABA), as well as a decrease in the levels of glutamate, asparagine, threonine, tyrosine and a-aminoadipinate (a-AAA). Administration of omega-3 PUFA and L-arginine normalized a number of disorders in the cerebral cortex, including impaired levels of asparagine, AAA, threonine, a-ABA, methionine and 5-HIAA. Conclusions. Subtotal cerebral ischemia induces an imbalance in the pool of free amino acids and their derivatives in the cerebral cortex. The combined administration of L-arginine and omega-3 PUFA normalizes the levels of some amino acids and a number of integral indicators, such as the total content of essential amino acids, neuroactive amino acids, the total pool of amino acids.
Key words: аминокислоты, биогенные амины, кора больших полушарий, субтотальная ишемия головного мозга, L-аргинин, омега-3 ПНЖК
HOMOCYSTEINE AND OTHER LOW-MOLECULAR WEIGHT SULFUR-CONTAINING COMPOUNDS IN TISSUES OF RATS WITH THIOACETAMIDE LIVER DAMAGE
Novogrodskaya Ya.I.,
UDC: 577.112.386:616.36-004-099]-092.9
Abstract: Objective. Comparative characteristics of the pool of low-molecular weight sulfur-containing compounds and free amino acids metabolically bound to them in tissues of rats after thioacetamide liver damage. Methods . Cysteic, cysteinesulfinic, homocysteic and α-aminobutyric acids, serine, glycine, hypotaurine, taurine, methionine, cystathionine, ethanolamine in blood plasma, liver and kidney of rats were determined by reversed-phase HPLC from pre-column derivatization. Determination of homocysteine, cysteine, cyseinylglycine, γ-glutamylcysteine and glutathione in blood plasma, liver and kidney of rats was carried out by reversed-phase HPLC after pre-column derivatization with fluorescence detection. In blood plasma the activity of transaminases and γ-glutamyl transpeptidase, levels of cystathionine-β-synthase, endogenous hydrogen sulfide and total bilirubin were studied. Results. Administration of thioacetamide (TAA) for 1 month causes a decrease in the levels of cysteic, cysteinesulfinic and homocysteic acids, cystathionine, total glutathione, taurine and an increase in the levels of serine, glycine, methionine, cysteine, cysteinylglycine, γ-glutamylcysteine and hypotaurin in rat liver. Similar patterns were found when TAA was administered for 3 months. In both cases in blood plasma the concentrations of cystathionine-β-synthase, total bilirubin, serine, glycine, taurine, methionine and cysteinylglycine increased. Only 1 month of TAA administration led to a decrease in the levels of homocysteine, endogenous hydrogen sulfide and an increase in cysteinylglycine in blood plasma, in the kidneys an increase in serine and γ-glutamylcysteine levels was registered. Only 3 months of TAA administration caused an increased liver level of glutathione, in the kidneys - the levels of glutathione, glycine and in the blood plasma - the activity of γ-glutamyl transpeptidase and the level of endogenous hydrogen sulfide. Conclusion. Thioacetamide liver damage causes an imbalance in the levels of sulfur-containing compounds, which is not accompanied by marked hyperhomocysteinemia. The level of homocysteine in the liver and kidneys does not correlate with that in the blood plasma after administration of TAA for both 1 and 3 months. The main manifestations of thioacetamide liver damage in the pool of sulfur-containing compounds are a violation of the synthesis of glutathione, the dioxygenase pathway of cysteine oxidation and inhibition of taurine synthesis through the oxidation of hypotaurine in the liver. Administration of TAA for 1 month inhibits transsulfuration in rat liver.
Key words: низкомолекулярные серосодержащие соединения, гомоцистеин, плазма крови, печень, почки, тиоацетамид
METHODS OF ISOLATING NEVIRAPINE FROM SOLUTIONS AND BODY FLUIDS FOR THE PURPOSE OF CHEMICAL TOXICOLOGICAL ANALYSIS
Illarionova E.A., Gonchikova Yu.A., Kostenko E.S.,
UDC: 615.91
Abstract: Objective. Development of a new method for isolating nevirapine from aqueous solutions, urine and blood plasma for the purpose of chemical toxicological analysis. Methods . Liquid-liquid extraction was chosen as the isolation method. In the course of the experiment, the effect of such parameters as the nature of the organic solvent, the time and frequency of extraction, the pH of the medium, and the action of electrolytes on the degree of extraction of nevirapine was studied. As objects of research, we used aqueous solutions and biological fluids: urine, saliva, blood plasma. For identification and quantification, thin layer chromatography (TLC) and UV spectrophotometry were used. Statistical processing of the results was carried out with a confidence level of 95%. Results. The experiment on the isolation of nevirapine from aqueous solutions showed that the optimal organic solvent is dichloromethane, the extraction time is 3 minutes once. The medium is slightly alkaline, pH 8. The presence of electrolyte did not affect the results. Under the given conditions, the extraction rate averaged 88%. The developed technique was applied to isolate nevirapine from model mixtures of urine, saliva, and blood plasma. The release of the substance from the urine with increasing dosage averaged 71±4.8% (200 mg), 80±4.8% (400 mg) and 89±4.8% (600 mg). Nevirapine was isolated from saliva at concentrations of 65±4.3% (200 mg), 68±4.8% (400 mg), and 69±4.6% (600 mg). For blood plasma, the results were 68±4.8%, 71±4.9% and 76±4.9%, respectively. The relative experimental error does not exceed 4.6% for urine; 4.8% for saliva; 4.9% for blood plasma. Conclusions. A new method for the isolation of nevirapine from aqueous solutions and biological fluids, as well as a method for its identification and quantitative determination, has been developed. The validation assessment of the developed methods indicates their suitability for chemical and toxicological analysis.
Key words: ВИЧ, невирапин, жидкость-жидкостная экстракция, спектрофотометрия
DIABETES MELLITUS - APPROACHES TO EXPERIMENTAL MODELING AND MOLECULAR MARKER
Bon Elizaveta I., Lychkovskaya Maria A.,
UDC: 616.831.31-005.4.-092.913:618.33
Abstract: Objective. Generalization and systematization of literature data on the pathogenesis of diabetes mellitus, molecular markers and experimental models. Methods. The basis of this study was a review of the literature on this topic. Results. In most cases, the development of the autoimmune process plays a leading role in the pathogenesis of diabetes mellitus. This process usually lasts several years and is accompanied by the gradual destruction of the β-cells of the islets of Langerhans in the pancreas. A number of experimental models are used to model diabetes mellitus: surgical, dithizone, streptozocin, alloxan, dexamethasone. Insulin-like growth factor 1, protein S100β, basic myelin protein, neuroglobin protein, microRNA 23b-3p can act as molecular markers of diabetes mellitus. Conclusion. The search for new molecular markers, the development of new adequate models of diabetes mellitus will serve as a fundamental basis for detailing the pathogenesis necessary to improve the methods of prevention, diagnosis and correction of diabetes mellitus.
Key words: сахарный диабет, экспериментальное моделирование, молекулярные маркеры
DIFFICULTIES OF IN VIVO DIAGNOSIS OF WEGENER'S GRANULOMATOSIS IN INFECTIOUS (COVID-19) HOSPITAL
Myakonky R.V., Kaplunov K.O., Krayushkin S.I., Hasanov I.I., Dudkyna A.A.,
UDC: 616-002.7
Abstract: Objective. To increase the level of knowledge and a clinical alertness of the professional community in relation to this systemic disease, as well as to reduce the number of likely tactical and technical errors in the general medical network. Method. A comprehensive study of the materials of the patient's outpatient chart, the results of clinical and epidemiological, laboratory (general clinical, biochemical, serological, molecular genetic) and instrumental (ultrasound, radiography, CT, MRT) methods of research of the patient. The therapeutic and surgical methods of treating the patient are described in detail. Results. Granulomatosis with polyangiitis, also known as Wegener's granulomatosis, is a rare systemic disease characterized by necrotizing vasculitis of small and medium-sized vessels with damage to various organs, with frequent involvement in the pathological process of the respiratory tract and kidneys. This case is devoted to the description of a clinical case of granulomatosis with polyangiitis, diagnosed in Volgograd Regional Clinical Hospital No. 3, during the pandemic providing medical care to patients with new coronavirus infection COVID-19. The identified clinical and laboratory features of the course of the disease are described in detail with their subsequent critical analysis. Conclusion. It is concluded that due to the rare occurrence and the insufficient alertness of specialists of the general clinical medical network, the diagnosis of Wegener's granulomatosis currently causes significant difficulties and is not timely, which in turn hinders timely treatment and worsens the prognosis of this disease.
Key words: болезнь Вегенера, системный некротический васкулит, орфанные заболевания
MAGNETIC RESONANCE DIAGNOSIS OF EARLY-STAGE CHRONIC BRAIN ISCHEMIA USING TRANSCRANIAL ELECTRICAL STIMULATION
Chukhontseva E.S., Morozova T.G., Borsukov A.V.,
UDC: 615.849.1
Abstract: Objective. To show the possibilities of magnetic resonance diagnostics of early-stage chronic cerebral ischemia using transcranial electrical stimulation with monitoring. Method. Patients with early-stage chronic cerebral ischemia (ССI) aged 38 to 76 years were subjected to the analysis of complaints, anamnesis, magnetic resonance imaging of the brain using ASL-perfusion (Arterial spin label) and transcranial electrical stimulation with monitoring (TES). Results. The patients presented complaints typical of early-stage ССI. When evaluating the brain MRI according to the STRIVE (Standarts for Reporting Vascular Chаnges on Neurouimaging) criteria, 100% of the subjects did not have micro-hemorrhages and recent lacunar infarcts. Absolute values of the cerebral blood flow (CBF) at rest counted up to TES 52±3.6 ml/100g/min. After electrostimulation by the TETOS method on repeated MRI, a statistically significant increase in the speed of cerebral blood flow in the selected areas of interest is observed. Conclusion. Patients with early-stage ССI do not have all MR-signs of ССI according to the STRIVE criteria. A decrease in the rate of cerebral blood flow in these patients was revealed. There is an increase in blood flow in the selected study areas after exposure of TES.
Key words: хроническая ишемия головного мозга, ASL-перфузия, транскраниальная электростимуляция с обратной связью, церебральная перфузия
RESULTS OF GERD PROLONGED TREATMENT WITH PROTON PUMP INHIBITORS IN OUTPATIENTS
Russiianov V.V., Russiianov A.V.,
UDC: 616.329-002:615.036
Abstract: Objective. To follow the results of prolonged treatment with proton pump inhibitors (PPIs) in outpatients with various endoscopic forms of gastro-esophageal reflux disease (GERD). Methods. Patients with non-erosive forms of GERD were treated with proton pump inhibitors mean therapeutic doses for 4 weeks, in case of multiple erosions of the esophagus - for 8 weeks. Maintenance therapy with non-erosive forms of the disease was prescribed for up to 6 months, with erosive forms - up to 12 months. The control endoscopic study was conducted after the main course of treatment and after completion of maintenance therapy, then annually during 3 years. Esophagogastroduodenoscopy was performed on devices Karel STORZ (Germany) and Fujinon (Japan). 46 patients with erosive forms of the disease were examined for the presence of Helicobacter pylori (HP) in the gastric mucosa. Results. Results of the study showed that erosive forms of GERD were significantly more frequent in patients older than 40 years old, and non-erosive forms - in patients of younger age. Erosive forms of the disease occurred more frequently in patients with typical clinical symptoms, and non-erosive forms prevailed in the group with low-symptomatic and asymptomatic course of the disease. In patients with non-erosive forms of the disease positive endoscopic picture was observed after 4 weeks, and healing of erosions in erosive forms was observed after 8 weeks from the treatment start. Maintenance therapy with PPIs was carried out depending on the severity of the disease course. Further follow-up within three years showed that 78% of patients had no exacerbations of the disease, they were recommended therapy "on demand". Conclusions. Prolonged basic and maintenance therapy with PPIs in patients with various forms of gastroesophageal reflux disease leads to long-term remission of the disease.
Key words: гастроэзофагеальный рефлюкс, гастроэзофагеальная рефлюксная болезнь, эзофагогастродуоденоскопия, кислото-пептический фактор, ингибитор протонной помпы, Нelicobacter pylori
NEUROLOGICAL COMPLICATIONS AFTER CORONAVIRUS INFECTION
Simonenko V.V., Vakal T.N., Mikhalik D.S., Zhukov G.V., Nikolaenkova L.I.,
UDC: 616.8-008.64:578.834.1
Abstract: Objective. To present a clinical case of the diagnosis of neurological complications after coronavirus infection. Methods. The authors observed a female patient with a prolonged course of anxiety-depressive disorder combined with somatoform dysfunction of her autonomic nervous system after suffering from COVID-19. The authors analyzed Russian and foreign literature concerned the influence of coronavirus infection on the central and peripheral nervous systems. Results. The authors presented a clinical case of a prolonged course of anxiety-depressive disorder with somatoform dysfunction of the autonomic nervous system in a female patient who suffered from coronavirus pneumonia with 15% lung tissue damage. Practical recommendations from Russian literature on the psychosocial correction of the impact of coronavirus in various segments of the population are given. Conclusion. A new coronavirus infection can exacerbate the course of pre-existing depression and anxiety disorders of the central nervous system, or be complicated by such neuropsychiatric disorders. The multifaceted effects of coronavirus infection on the central and peripheral nervous system determine the need for a multidisciplinary approach to the treatment of COVID-19 and its complications with the obligatory participation of a neurologist.
Key words: коронавирус SARS-CoV-2, центральная нервная система, тревожно-депрессивное расстройство, клинический случай
VITAMIN D AND ALZHEIMERL'S DISEASE
Shnajder N.A., Donceva E.A., Nasyrova R.F.,
UDC: 616.831-003.8
Abstract: Objective. To analyze the role of vitamin D as a biomarker of Alzheimer's disease (AD). Methods. We searched English and Russian databases. The search depth was - 10 years (2010-2020). In addition, the review included earlier publications of historical interest. We analyzed full-text publications in Russian and English. Results. In recent decades, evidence has accumulated indicating a significant link between vitamin D and AD. In vitro, vitamin D stimulates macrophages that increase amyloid beta (Aβ) plaque clearance, reduce Aβ-induced cytotoxicity and apoptosis in primary cortical neurons, and affect Aβ-stimulation of inducible nitric oxide synthase, which modulates the inflammatory process associated with AD. Changes in the VDR and 1,25-MARRS genes associated with the action and metabolism of vitamin D. It leads to inefficient use of vitamin D, leaving neurons vulnerable to neurodegenerative changes. Vitamin D and its receptors VDR and PDIA3 may play an important role in the Aβ processing pathway in neurons. The vitamin D carrier, the DBP protein, has also been identified at reduced levels in plasma protein profiling in subjects with cognitive impairment and in AD patients compared to healthy controls. DBP inhibits Aβ aggregation and prevents neuronal death mediated by it in cultured hippocampal cells. Vitamin D may protect against cognitive dysfunction through its effects on neuroprotection, neurotransmission, synaptic plasticity, immune modulation, neuronal calcium regulation, and increased nerve conduction. Conclusions. Vitamin D plays an important role in the nutritional strategy for preventing the development of AD and reducing the rate of its progression. The mechanisms of the protective effect of vitamin D in AD continue to be actively studied. Long-term randomized clinical trials of vitamin D supplementation are needed in large populations of adults at high risk for neurodegeneration, including familial and sporadic AD cases.
Key words: витамин D, метаболизм, головной мозга, биомаркер, болезнь Альцгеймера
ADVANTAGES OF DIFFUSION-WEIGHTED IMAGES IN THE RADIATION DIAGNOSIS OF ALCOHOLIC LIVER DISEASE
Lozbenev F.S., Morozova T.G.,
UDC: 616.36-073.756.8
Abstract: Objective. To evaluate the advantages of diffusion-weighted imaging in radiological diagnosis of alcoholic liver disease (ALD). Method. Over the course of 2.5 years (2019 - 2021), 114 patients with ALD were examined. We conducted ultrasound examination (n=113) with clinical elastography of the liver (n=89), multislice spiral computed tomography (CT) of the liver (n=21), MRI with DWI of the liver (n=113). 47 (41.2%) patients underwent liver biopsy. Results. Throughout the entire observation period, 105 (92.1%) patients maintained a stable аpparent diffusion coefficient (ADC), which made it possible to indirectly judge the clinical form of ALD at the first stage of patient follow-up. Unstable ADC was observed in 9 (7.8%) patients: it was manifested by the transition from one clinical form to another; when diffusion was limited according to liver DWI data, elastography on admission was not recommended due to false positive results. Conclusion. On admission and in dynamic observation of patients with ALD, the restriction of liver diffusion on MRI in patients with ALD indicates an active process (r=0.889), there is no diffusion limitation - an inactive process (r=0.882). In dynamic observation of patients with ALD, restriction of liver diffusion on MRI, during treatment, without disturbing the abstinence regimen, is a prognostic criterion for the progression of ALD (AUROC=0.908 (95% CI: 0.875-0.911)). Sign of diffusion restriction according to the sequence of DWI of the liver during MRI, during treatment, is an early predictive criterion for abnormal abstinence in ALD (AUROC=0.889 (95% CI: 0.844-0.903)). Diagnostic and prognostic significance of DWI of the liver at MRI in patients with ALD is as follows: on admission for a qualitative assessment AUROC=0.844 (95% CI: 0.801-0.869), quantitative - AUROC=0.908 (95% CI: 0.875-0.911); with dynamic observation for a qualitative assessment AUROC=0.939 (95% CI: 0.901-0.955), quantitative - AUROC=0.919 (95% CI: 0.871-0.931).
Key words: диффузионно-взвешенные изображения, магнитно-резонансная томография, алкогольная болезнь печени
ASSESSMENT OF THE STATE OF THE AUTONOMIC NERVOUS SYSTEM IN FULL-TERM INFANTS: CROSS-SECTIONAL STUDY
Derevtsov V.V., Kozlova L.V., Ivanov D.O., Antonova L.K., Shcherbakova M.Yu., Bekezin V.V., Neudakhin E.V.,
UDC: 616-053.3:618.3-06:616-008.6:612.89
Abstract: Objective. Assessment of the state of the autonomic nervous system in early and full-term infants in comparison with each other and with practically healthy children. Methods. Under the supervision were 135 infants. 110 babies were born from mothers with an aggravated somatic and obstetric-gynecological history: 41 (gr. 1) in a period of 37-38 weeks, 69 (gr. 2) in a period of 39-42 weeks. The control group (gr. 3) consisted of 25 practically healthy children born to practically healthy mothers as a result of physiological birth in the period of 38-40 weeks. The children were examined in dynamics at the age of 1 (n=126), 3 (n=116), 6 (n=110), 12 (n=111) months. Cardiointervalography was carried out. Nonparametric methods of statistical analysis were used. Results. In children of gp. 1 and 2 for 2-3 days, 1 and 3 months the sympathies of 91-100% prevail and in comparison with children of gp. 3 by 2 times. At 3 months in children of gr. 1 in comparison with children of gr. 3 normal neurovegetative reactivity is less frequent by 2 times, in 43%. In children of gr. 2 normal neurovegetative reactivity of 59% prevails over the asymptotic 5-fold and hypersympaticotonic 2-fold. In 6 months children of gp. 1 in comparison with children of gp. 2 have less AM, 34 [29; 45] conventional units. In children of gp. 1 and 2 sympathicotonia prevails in 93 and 96%, and in comparison with children of gp. 3 in 2 times. In children of gr. 2 compared with gr. 3 normal neurovegetative reactivity is less frequent by 2 times. In children of gr. 1 and 2 hypersympathicotonic neurovegetative reactivity of 53 and 55% prevails over asymptotic reactivity by 5 and 4 times. In children of gp. 1 and 2 sympathicotonia prevails in 88 and 91% and in comparison with children of gp. 3 in 2 and 2 times. Conclusion. The peculiarities of sensitization and humoral status in children with allergic rhinitis and overweight or obesity (group 3) compared with children of other weight categories are the high frequency of registration of the monovalent type of sensitization (in 60% of children) and a decrease in serum immunoglobulins M and G.
Key words: вегетативная нервная система, ранние и полностью доношенные младенцы
RELATIONSHIP OF ECHOCARDIOGRAPHIC PARAMETERS AND MARKERS OF METABOLIC STATUS IN CHILDREN FROM MOTHERS WITH DIABETES MELLITUS
Prylutskaya V.A., Sukalo A.V., Ivanova E.V., Dzerkach T.A.,
UDC: 612.015.3-053.2-073:616.379-008.64
Abstract: Objective. To evaluate the relationship between echocardiographic parameters and markers of metabolic status in children born to mothers with type 1 diabetes mellitus (DM1). Methods. The study was conducted according to the "case-control" scheme and included a group of 107 children born to mothers with DM1 (group 1, Gr1), and 56 healthy infants born to women with normoglycemia during pregnancy, as a control group (group 2, Gr2). Results. It was revealed that the frequency of myocardial hypertrophy in Gr1 was 47.7%, which is statistically significantly higher in comparison with Gr2 (19.6%, χ=11.09, p=0.001). It was found that the size of the interventricular septum (p<0.001) and the posterior wall of the left ventricle (p<0.001) were larger in Gr1. The incidence of interventricular septal hypertrophy in infants born to women with glycated hemoglobin levels in the 2nd and 3rd trimesters of gestation of 6.5% or more was statistically higher than in infants born to mothers with target indicators of DM1 compensation. Higher concentrations of leptin and lower levels of cord blood adiponectin were found in newborn mothers with DM1 compared to children of the control group (p<0.001 and p=0.017, respectively). Correlations between the levels of leptin and adiponectin in the umbilical cord blood and the thickness of the interventricular septum were observed in newborns of Gr1. Conclusion. Maternal hyperglycemia has a significant impact on intrauterine growth and fetal development, determining not only the risk of congenital heart defects, but also the development of hypertrophic changes in the myocardium. Type 1 DM leads to changes in echocardiographic parameters of newborns, especially the thickness of the interventricular septum. The levels of glycated hemoglobin and adipocytokines can be considered as additional markers in the assessment and prediction of cardiac function in infants of mothers with DM1.
Key words: сахарный диабет, новорожденные, эхокардиография, гипертрофия миокарда, гликированный гемоглобин, лептин, адипонектин
CHRONIC GASTRODUODENITIS ASSOCIATED WITH H.PYLORI IN CHILDREN WITH DIFFERENT TYPES OF CONSTITUTION
Balko O.A., Sapozhnikov V.G.,
UDC: 616.33-002.2
Abstract: Objective. The research objective was to study the constitutional features of the course of chronic gastroduodenitis in children and their possible impact on the prognosis of the disease. Methods . 250 patients aged 4-17 years with a diagnosis of chronic gastroduodenitis were examined. All patients were divided into 3 constitutional groups according to the classification of M.V. Chernorutsky based on the Pignet index. Anamnestic data, objective inspection data and laboratory-instrumental studies were evaluated. Statistical processing of the obtained results was carried out, confidence level p<0.05. Results. It was revealed that asthenics are significantly more likely to suffer from chronic gastroduodenitis compared to normosthenics and hypersthenics. However, the course of the disease in this constitutional group is lighter with the development of predominantly superficial gastroduodenitis according to FGDS, in contrast to normosthenics and hypersthenics, which are prone to the development of hypertrophic and erosive damage to the mucosa of the stomach and duodenum. Conclusions. In spite of the fact that the constitutional norm of reaction marked defined somatotype does not change the essense of the disease, it allows to find out the constitutional and dependent symptoms of the disease giving to pathological process individual expression. As in development of the chronic gastroduodenit the heritable and constitutional factor is one of the major, and the clinical physician needs to consider it within the individual personified approach to the patient.
Key words: типы конституции, соматотип, хронический гастродуоденит, H. pylori, астеник, нормостеник, гиперстеник
DIFFERENTIAL-DIAGNOSTIC VALUE OF NON-CONTRAST ASL - LIVER PERFUSION IN MRI IN PATIENTS WITH VIRAL HEPATITIS
Simakina E.N., Morozova T.G.,
UDC: 616.36-073.756.8
Abstract: Objective. To evaluate the differential diagnostic value of non-contrast ASL - liver perfusion on MRI in patients with viral hepatitis (VH). Method. 115 patients with VH B, C and B + C were examined. The patients were divided according to the degree of activity and severity. Among them, 72 (64.3%) were men and 40 (35.7%) were women, 49.7±2.3 years. Ultrasound examination, clinical elastography, non-contrast ASL - liver perfusion with MRI, liver biopsy were performed. Results. An ASL - scale was developed for diffuse liver diseases of viral etiology. Type IV ASL- scale and hepatic artery blood flow (HBF) values from 151 to 50 ml / 100g / min indicate the presence of VH (AUROC=0.919 (95% CI 0.867-0.935)). Subtypes were developed for type IV ASL-map: normokinetic, hypokinetic, and hyperkinetic. During the dynamic follow - up of patients, criteria for assessing the risk of progression of liver fibrosis and the development of portal hypertension were developed based on quantitative and qualitative assessments of ASL-perfusion of the liver. Conclusion. Qualitative and quantitative indicators of contrast-free ASL - perfusion of the liver MRI in patients with VH are of differential diagnostic significance. ASL-perfusion map of type IV, blood flow in the hepatic artery (HBF) from 151 to 50 ml/100g / min are the differential diagnostic criterion for VH (AUROC=0.919 (95% CI 0.867-0.935)). Indicators of blood flow in the hepatic artery (HBF) and abdominal aorta (ABF) have high diagnostic and prognostic significance in assessing the risk of progression of the fibrous process (AUROC=0.885 (95% CI 0.857-0.902)) and the risk of portal hypertension (AUROC=0.909 (95% CI 0.875-0.915)). For patients with VH, diagnostic and prognostic significance of contrast - free ASL-perfusion of the liver: at admission - AUROC = 0.865 (95% CI 0.843-0.928), in dynamic follow - up - AUROC = 0.915 (95% CI 0.881-0.946).
Key words: ASL-перфузия, магнитно-резонансная томография, вирусные гепатиты
ANALYSIS OF THE RESULTS OF COMBINED SURGICAL TREATMENT OF CATARACTS COMPLICATED BY REFRACTIVE ERRORS
Kornienko I.A., Belova N.V., Mogilevtsev V.V.,
UDC: 617.741-004.1-036.7
Abstract: Objective. To evaluate the effectiveness of astigmatism correction when implanting toric IOLs (intraocular lenses) in patients during surgical treatment of cataracts complicated by astigmatism. Methods. A retrospective analysis of the medical records of patients with corneal astigmatism combined with cataracts who were treated at the Smolensk Regional Clinical Hospital and the Center for Family Ophthalmology in Smolensk from 2015 to 2020. All patients underwent cataract surgery using ultrasound phacoemulsification. In the postoperative period, the examination included an assessment of visual acuity, refractometry, and biomicroscopy, which allowed determining the position of the TIOL (toric intraocular lens) in the capsule of the natural lens according to the calculated parameters. Results. In the early postoperative period, there were no complications associated with the technique of surgery and the implantation of TIOL. When analyzing visual acuity, the following results were obtained: the values of visual acuity on average increased from 0.4 to 0.7 (on average 0.7), while the maximum was 0.8-0.9. Insufficiently high visual acuity in the postoperative period is explained by the presence of concomitant pathology in some patients: based on the anamnesis in (13.5%), the presence of moderate amblyopia (8.3%) and mild amblyopia (5.2%) was revealed. Biomicroscopy revealed that the position of the IOL axis in the capsule bag corresponds to the preliminary planned Onlain calculation in 100% of cases, which indicates a stable position of the IOL in the capsule bag without a tendency to rotation and violation of the planned refraction. Biomicroscopy revealed no changes in the position of the IOL in the late follow-up, which would lead to a violation of the planned refraction. Throughout the entire observation period, the TIOL remained transparent. The degree of astigmatism approached 0 dptr in 7 people-18.9%, in all other cases - 81.1%, it reached values from -0.1 to -1.25 dptr, which is close to the value of physiological astigmatism, which does not require additional correction and is well tolerated by patients. Conclusion. Combined surgical treatment of cataracts complicated by astigmatism using toric IOLs is a highly predictable, reliable, and effective method that allows for the rehabilitation of refractive and visual disorders of the visual organ with a high functional result in a single intervention.
Key words: торические интраокулярные линзы, катаракта, астигматизм, хирургическая коррекция
OPTIMIZATION OF COMPRESSION HEMOSTASIS IN ESOPHAGEAL VEIN BLEEDING
Fedoseev A.V., Budarev V.N.,
UDC: 616.36-004-005.1
Abstract: Objective. To reveal the drawbacks of compression hemostasis amenable to correction in bleeding from varicose veins of the esophagus and to propose a method for their elimination that can be implemented in a clinical setting. Methods. The control and study groups of patients were formed on the basis of the Ryazan Emergency Hospital. Each of them included 6 patients with ongoing bleeding from varicose veins of the esophagus against the background of portal hypertension and indications for the installation of an obturator probe. In the control group, a standard obturator probe was used, in the study group, a modernized one. The level of pain in the patient during the installation of the probe and the time required for the manipulation were taken into account. Results. A modernization of the Sengstaken-Blackmore obturator probe was developed, characterized by a reduced overall diameter and cross-sectional area. A statistically significant reduction in the time required to pass the probe through the patient's nasal passages has been proven. It was not possible to detect a decrease in the level of pain in the patients. Conclusions. The possibility of improving the method of compression hemostasis in bleeding from the veins of the esophagus by modernizing the Sengstaken-Blackmore obturator probe, leading to a simplified procedure for its installation in the patient's body, has been proven.
Key words: кровотечение из варикозно расширенных вен пищевода, зонд-обтуратор, компрессионный гемостаз
POSTOPERATIVE PREVENTION OF SCAR DEVELOPMENT THROUGH CELL TECHNOLOGIES IN PERSONS WITH CONSEQUENCES OF BURNS
Khodzhamuradov G.M., Davlatov A.A., Mirzoev M.N., Shaimonov A.Kh., Yunusov I.A., Shamsov N.Kh.,
UDC: 57.017.642:616-08, 616-089.844
Abstract: Objective. To study the effectiveness and features of the use of platelet-rich plasma injections of the patient's own blood in the postoperative period in patients who have undergone reconstructive plastic surgery on the extremities for the long-term consequences of burns. Methods. The article presents the first experience of using cellular technologies in 6 patients (aged 7 to 54 years) with the consequences of burns who underwent reconstructive plastic surgery in the department of reconstructive surgery in 2018. Serum obtained in the process of the "plasmolifting" technique was used as a cellular component. Results. It was found that the most optimal period from the point of view of achieving aesthetic improvements is the second week of the postoperative period. The method of administration of blood enriched with platelets and biologically active substances proved to be effective for the prevention of the development of repeated scars during their excision, as well as for the transplantation of free and non-free flaps in 5 (83.3%) cases. Conclusions. Plasmolifting is an effective method for improving the aesthetic parameters of surgical treatment in patients with the consequences of burns to the extremities.
Key words: последствия ожогов, реконструктивно-пластические операции, клеточные технологии, плазмолифтинг
IMMEDIATE RESULTS OF TREATMENT OF SKIN TUMORS IN THE ONCOSURGICAL DEPARTMENT OF THE SMOLENSK REGIONAL
Arakelyan M.A., Solovyov V.I., Zuj V.S.,
UDC: 16.006;616-5
Abstract: Objective. Evaluation of the results of treatment of precancerous and malignant skin diseases in the conditions of the oncosurgical department of the Smolensk Regional Clinical Hospital for the period from 2017-2019. Methods. The data of the official accounting and reporting medical documentation of the oncosurgical department of the OGBUZ SOKB (medical histories, operational journals) and the territorial cancer registry of the Smolensk region were used in the work. The groups of patients were divided by gender, age, localization of tumors and the method of treatment of precancerous and ZNO (malignant neoplasms) of the skin. Results. Among all patients treated in the oncology department of the OGBUZ SOKB in 2017-2019, patients with precancerous and malignant skin diseases accounted for 31%. Of these, skin ZNO occurred in 2/3 of cases and 1/3-patients with precancerous diseases. The peak incidence of this pathology occurred at the age of 60-80 years, and the main localization was the scalp and neck, which corresponds to the indicators for Russia. Conclusions. In the general structure of cancer incidence in the Smolensk region in recent decades, skin cancer and melanoma have consistently occupied the 1st place, and in 2017-2019. in women, this oncopathology is on the 2nd place, and in men - on the 4th. According to world statistics, there is an annual increase in skin heat, including in Russia, where this pathology occupies one of the leading places in the overall structure of morbidity.
Key words: предраковые заболевания кожи, рак кожи, заболеваемость, результаты лечения
ANALYTICAL ASSESSMENT OF THE NUMBER OF DEATHS UNDER THE INFLUENCE OF ALCOHOL
Semenov A.M., Lyakhov A.O., Makarov A.V.,
UDC: 613.81:616-036.886
Abstract: Objective. To investigate the number of fatal outcomes under alcohol poisoning for the period from 2011 till 2019 in Smolensk region. Methods. A retrospective analysis of fatal outcomes under alcohol poisoning according to the data of forensic medical examinations of corpses for the period from 2015 till 2019 performed in the Smolensk Regional Forensic Medical Bureau was carried out taking into account sex, age, causes of death, the level of ethyl alcohol in the blood. The responses were processed using the Microsoft Office Excel Pivot Tables option. Results. The analysis showed that during the time period from 2015 to 2019 in Smolensk region during forensic autopsies ethyl alcohol in blood was detected in 40.8% of cases, the number of violent deaths decreased by 8.44%, and the number of deaths from diseases increased by 6.15%. The rate of reduction in the frequency of alcohol intoxication in violent deaths was 22.8% by the end of the period studied. In non-violent deaths, a 6.6% increase in the frequency of alcohol intoxication was seen, which can be correlated with an overall increase in disease-related deaths. As a result of retrospective analysis, it was found that among those who died under alcohol intoxication, male corpses significantly prevailed (74.8%), versus female corpses (25.2%). The most frequent alcohol drinkers before death were those of the most able-bodied and active age, with a peak in the age group of 56 to 60 years. Conclusion. Summarizing the obtained data, we can conclude that over the last five years the number of alcohol intoxications detected during forensic medical examination of corpses remains high, that is why the problem of studying the influence of alcohol on the course of lethal outcomes is extremely relevant. At the same time in Smolensk region as a whole a positive dynamics of decreasing the share of alcohol intoxication in violent deaths and increasing in non-violent deaths has been established.
Key words: отравления, этиловый спирт, насильственная смерть, ненасильственная смерть
FEATURES OF SHOCK PATHOMORPHOLOGY
Dmitriev I.V., Dorosevich A.E., Abrosimov S.Ju.,
UDC: 616-001.365
Abstract: Objective. To specify common and private pathomorphological changes in different types of shock. Methods. Conceptual, process, situational, logical and systemic analysis. Results. General morphological changes of the most specific types of shock have been systematized. The features of pathomorphology related to certain types of shock, which are associated with their etiology, are represented. But the pathomorphological features of each shock appeared more vividly, if we consider the type of shock depending on the reason that caused its development, while comparing them with other types of shock. Conclusion. Diagnosis of shock, including posthumous, should be based on objective clinical, laboratory and morphological data with a subsequent assessment of its stage and severity. In case of shock, it is extremely important and also difficult to assess the complex of interconnected pathological processes, which often do not appear clinically at the first time. Therefore, a deeper understanding of pathomorphological changes in the organism in case of shock allows doctors purposefully carry out therapeutic measures taking into account the etiology of shock. In the case of the death of the patient, therapist should understand that all clinical data and the diagnosis of «shock» must be confirmed later by morphological data after autopsy while diagnosing the shock. The opposite is also true: a pathologist or a medical expert should take into consideration all available results of clinical studies while diagnosing shock and not rely only on morphological changes. Even if a certain type of shock is suspected, a number of pathological processes similar to shock (fat embolism, acute coronary insufficiency, comas of different genesis, etc.) should be excluded at first. Both clinicians and experts should take into account that if the patient dies in a few days or weeks after the shock, then it is possible to morphologically identify only the consequences of shock in the form of negative progression in organs changes.
Key words: шок, патоморфологические изменения, «шоковые» органы
APPLICATION OF SPECTROSCOPIC METHODS IN RESEARCH OF NEW FORMATIONS IN BIOLOGICAL TISSUES
Tsygankova E.A., Korneva Yu.S.,
UDC: 615.849.1
Abstract: Objective. To consider the application of optoelectronic methods for the study of neoplasms and the study of the composition of biological tissues. Methods. Conceptual, process, logical and systemic analysis. Results. Since the issue of the emergence and spread of oncology is still relevant in the modern world, the main task for healthcare is to minimize the number of patients. In this regard, the article describes methods for the timely detection of malignant cells in healthy tissue can significantly speed up. Conclusion. At present, there is a clear trend in the formation and development of instrumentation related to the use of parameters of the interaction of optical radiation with biological objects for the purposes of non-invasive diagnostics all over the world. Optical non-invasive diagnostics involves the use of optical radiation for intravital probing of the patient's tissues and organs in order to obtain diagnostic information about the structure of the body area under study from reflected light. Such devices are devices in which the levels and dynamics of accumulation of certain biochemical components over time - blood oxyhemoglobin, porphyrin compounds, NADH, etc. - are evaluated by optical methods in vivo in the areas of the patient's body available for examination. Thus, it was found that when irradiated with UV light, some human malignant tumors fluoresce in the orange-red region of the spectrum, which is explained by the presence of porphyrins in the tumors.
Key words: злокачественная опухоль, биологическая ткань, спектроскопия
PHARMACOLOGICAL STUDIES OF NEW DOSAGE FORMS WITH DIPIRIDAMOLE
Abdurakhmanov A.M., Stepanova E.F., Ogai M.A., Nam N.L., Pozdnyakov D.I., Barkaev G.S., Losenkova S.O.,
UDC: 615.451.454
Abstract: Objective. Pharmacological studies of the specific activity (severity of vasodilating and antiplatelet effects) of new dosage forms with dipyridamole (buccal gel and medicinal syrup). Methods. The study of the specific pharmacological activity of the developed dosage forms with dipyridamole was performed on male rabbits of the "California" breed. The severity of the vasodilating and antiplatelet effects of the buccal gel and drug syrup with dipyridamole in comparison with its tablet form (reference drug) was evaluated in animals without modeling the concomitant pathological process [4, 5]. Previously, blood samples were taken from rabbits to determine the initial indicators of platelet aggregation, and the initial blood flow rate in the central ear vein was evaluated. Further, in animals after 0.5 hours, 1 hour, and then for 15 hours with an hour interval, repeated blood sampling was performed to assess the aggregation activity of platelets, simultaneously determining the change in blood flow rate. Results. In the course of experimental studies of the effect of the developed dosage forms on platelet aggregation activity and blood flow rate, it was found that after a single administration of 0.5 % buccal gel and 0,5 % syrup with dipyridamole at a dose of 4 mg/kg of animal weight (in terms of dipyridamole), the degree of platelet aggregation significantly decreased in relation to the initial indicator and control, while the blood flow rate in relation to the initial level and control significantly increased. Conclusion. The results of pharmacological studies indicate that the buccal gel, dipyridamole syrup, and dipyridamole tablets 25 mg (Ozon LLC, Russia) showed comparable antiplatelet and vasodilating activity at the peak of the active component (0.5-2 hours). When using 0.5% buccal gel with dipyridamole, the vasodilating and antithrombotic effects were prolonged throughout the entire experiment.
Key words: дипиридамол, антитромбоцитарная активность, вазодилатирующая активность, буккальный гель, сироп
TECHNOLOGICAL RESEARCH ON THE CREATION OF MEDICAL-COSMETIC LOTION WITH DRY EXTRACT SMOKE TREE LEATHER
Lezhneva L.P., Temirbulatova A.M., Chakhirova A.A.,
UDC: 615.262.1
Abstract: Objective. Development of technology of dry extract smoke tree leather, followed by its introduction into the cosmetic lotion has antiseptic, cleansing and regenerative effect. Methods. When obtaining dry extract smoke tree leather as the method of extraction leaves used fractional maceration. To standardize the dry extract, the quantitative content of tannins and flavonoids was determined using spectrophotometric methods. The study of the antimicrobial activity of dry extract was carried out by diffusion in agar. Its wound-healing effect was studied on white Wistar rats using a histological method. Results. As a result of technological research, the optimal mode of extracting the leaves of skumpia leatherback is proposed: two-time extraction of raw materials with a degree of grinding 2-3 mm, purified water in a ratio of 1: 10 at a temperature of 90o-100o C for 60 minutes at each stage of the process. The technological scheme of dry skumpia extract, the yield of which from raw materials is not less than 28%, has been developed. Indicators of product standardization were established: description, solubility, authenticity, mass loss during drying, quantitative content of tannins and flavonoids. The optimal form for administration of a dry extract smoke tree - lotion. Based on microbiological studies of the dry extract, the composition of the lotion was determined and its quality indicators were recommended. Pharmacological study of dry extract smoke tree proved its regenerative properties. Conclusion. Lotion based on dry extract of skumpia leatherna is recommended as an effective antimicrobial, cleansing, wound healing agent for use in medicine and cosmetology.
Key words: скумпия кожевенная, сухой экстракт, лосьон
N.V. POPOV'S ROLE IN THE DEVELOPMENT OF RUSSIAN FORENSIC MEDICINE
Lunina N.F., Bulygina O.V.
UDC: 615.015+616-001.8
Abstract: Objective. To study the contribution of the founder of the Department of Forensic Medicine and Law, the head of the Department of Biological Chemistry of the Medical Faculty of Smolensk State University, Nikolai Vladimirovich Popov in the development of domestic hematology and forensic medical examination. Methods. Studying the materials of the family archive of Nikolai Vladimirovich Popov, archival materials, interviews. Description of the biography of the scientist based on these materials. Preparation for publication of an excerpt from a previously unpublished work “Forensic Hematology” in 8 volumes. Results. N.V. Popov is the founder and first head of the Central Forensic Medicine Laboratory. In 1925 - 1932 he organized the Department of Forensic Medicine and Law of the Medical Faculty of SSMU. N.V Popov was the organizer of the forensic medical examination service in the Western Region, Head of the joint department of forensic medicine of І and ІІ Moscow medical institutes, organizer and the first director of the institute of forensic medicine. Conclusion. It is concluded that N.V. Popov became the organizer of forensic science and practice in the Western region, and also was at the origins of the organization and formation of the theoretical base of the forensic medical service of the RSFSR.
Key words: судебная медицина, гематология, профессор Н.В. Попов
RELATIONSHIP BETWEEN VITAMIN D DEFICIENCY AND THE METABOLIC RISKS ASSOCIATED WITH OBESITY IN CHILDREN AND ADOLESCENTS (REVIEW)
Vinogradova E.V., Makarova O.Yu., Koroleva A.E., Bekezin V.V., Muravyev A.A.
UDC: 616.43/616.1/615.035.3
Abstract: The article presents a review of the literature data on the relationship of vitamin D deficiency with metabolic and cardiovascular risks associated with obesity in children and adolescents. Vitamin D, which is a hormone-like compound with a complex multi-stage metabolism and multi-organ effects, can rightfully be attributed to the number of micronutrients that play an important role in the pathogenesis of obesity. The combination of genomic and non-genomic mechanisms of the effect of active vitamin D metabolites on various parts of the pathogenesis of insulin resistance and its associated metabolic effects, as well as its significant role in the regulation of the immune response, lead to the fact that cholecalciferol deficiency can be considered as a serious predictor of the formation of severe forms and complications of obesity.
Key words: ожирение, витамин D, метаболические и кардиоваскулярные риски, дети и подростки
FEATURES OF THE COURSE OF BRONCHIAL ASTHMA IN OBESE CHILDREN
Yacheykina N.A., Alimova I.L., Plutenko E.V.
UDC: 616.248-056.52-053.2
Abstract: Objective. To evaluate the features of the course of bronchial asthma in obese children. Methods. 96 patients with bronchial asthma, in remission of the disease, aged from 7 to 17 years, were examined, of which the main group consisted of 35 children and adolescents with bronchial asthma, who are obese, the comparison group-61 patients with bronchial asthma and normal body weight. All the children had their height, body weight measured, anamnestic data collected, disease control and bronchial patency assessed, skin-scarification testing for household, epidermal, fungal, and food allergens, total IgE level and eosinophil count determined. Results. The age of diagnosis of bronchial asthma and the first onset of bronchial obstructive syndrome, the atopic inheritance in children with normal weight and obesity were comparable. Patients with bronchial asthma and obesity were more likely to use higher doses of inhaled glucocorticosteroids for basic therapy (17 (48.5%, p=0.003), and with a comparable volume of basic therapy, optimal control of the disease was observed in 14 (40%, p=0.009), uncontrolled course - in 6 (17%, p=0.048) and 13 (37.1%, p=0.02) - a positive test with salbutamol in remission of the disease. There were no differences in the content of total immunoglobulin E, sensitization to food, household, fungal and epidermal allergens between the groups. 4 (11.4%, p=0.016) patients of the main group had normal indicators of total IgE and negative results of skin-scarification tests. Conclusions. Comorbidity of bronchial asthma and obesity is accompanied by worse disease control.
Key words: бронхиальная астма, дети, ожирение