Vol 69, No 5-6 (2014)
- Year: 2014
- Published: 25.05.2014
- Articles: 20
- URL: https://vestnikramn.spr-journal.ru/jour/issue/view/34
- DOI: https://doi.org/10.15690/vramn695-6
РATHOPHYSIOLOGY: CURRENT ISSUES
PERSPECTIVE ОF USE ОF AGONISTS OF ADENOSINE AND OPIOID RECEPTORS FOR PREVENTION OF REPERFUSION DAMAGES OF HEART. ANALYSIS OF EXPERIMENTAL AND CLINICAL DATA
Abstract
In Russia inhospital lethality after acute myocardial infarction is 16,5–16,7%. The part of patients perishes even after recanalisation of infarctrelated coronary artery as a result of reperfusion cardiac injury. Experimental data indicate that adenosine receptor agonists and opioids can prevent reperfusion damages of heart that is mimic postconditioning phenomena. Data of clinical observation show that adenosine during intravenous infusion or intracoronary administration during thrombolysis or percutaneous coronary intervention exert infarct reducing effect and eliminate manifestation of «no-reflow» phenomenon. Clinical data indicate that morphine is able to prevent cardiac reperfusion injury in human. Thus, analysis of published data testifies that adenosine and opioid receptor agonists can be prototype for development of drugs for prophylaxis of reperfusion heart injury.
Annals of the Russian academy of medical sciences. 2014;69(5-6):5-13
5-13
IMMUNE DYSFUNCTION АND COGNITIVE DEFICIT IN STRESS AND PHYSIOLOGICAL AGING (PART I): PATHOGENESIS AND RISK FACTORS
Abstract
The concept of stressful cognitive dysfunction, which is under consideration in this review, allows picking out several therapeutic targets.
The brain, immune and endocrine systems being the principal adaptive systems in the body permanently share information both in the form of neural impulses and soluble mediators. The CNS differs from other organs due to several peculiarities that affect local immune surveillance. The brain cells secluded from the blood flow by a specialized blood-brain-barrier (BBB) can endogenously express pro- and anti-inflammatory cytokines without
the intervention of the immune system. In normal brain the cytokine signaling rather contributes to exclusive brain function (e.g. long-term
potentiation, synaptic plasticity, adult neurogenesis) than serves as immune communicator. The stress of different origin increases the serum
cytokine levels and disrupts BBB. As a result peripheral cytokines penetrate into the brain where they begin to perform new functions. Mass intrusion
of biologically active peptides having a lot of specific targets alters the brain work that we can observe both in humans and in animal experiments.
In addition owing to BBB disruption dendritic cells and T cells also penetrate into the brain where they take up a perivascular position. The changes observed in stressed subject may accumulate during repeated episodes of stress forming a picture typical of the aging brain. Moreover long-term stress as well as physiological aging result in hormonal and immunological disturbances including hypothalamic-pituitary-adrenal axis depletion, regulatory T-cell accumulation and dehydroepiandrosterone decrease.
The brain, immune and endocrine systems being the principal adaptive systems in the body permanently share information both in the form of neural impulses and soluble mediators. The CNS differs from other organs due to several peculiarities that affect local immune surveillance. The brain cells secluded from the blood flow by a specialized blood-brain-barrier (BBB) can endogenously express pro- and anti-inflammatory cytokines without
the intervention of the immune system. In normal brain the cytokine signaling rather contributes to exclusive brain function (e.g. long-term
potentiation, synaptic plasticity, adult neurogenesis) than serves as immune communicator. The stress of different origin increases the serum
cytokine levels and disrupts BBB. As a result peripheral cytokines penetrate into the brain where they begin to perform new functions. Mass intrusion
of biologically active peptides having a lot of specific targets alters the brain work that we can observe both in humans and in animal experiments.
In addition owing to BBB disruption dendritic cells and T cells also penetrate into the brain where they take up a perivascular position. The changes observed in stressed subject may accumulate during repeated episodes of stress forming a picture typical of the aging brain. Moreover long-term stress as well as physiological aging result in hormonal and immunological disturbances including hypothalamic-pituitary-adrenal axis depletion, regulatory T-cell accumulation and dehydroepiandrosterone decrease.
Annals of the Russian academy of medical sciences. 2014;69(5-6):14-22
14-22
CHEMILUMINESCENT AND ENZYME ACTIVITY OF NEUTROPHILS IN PATIENTS WITH WIDESPREAD PURULENT PERITONITIS DEPENDING ON THE OUTCOME OF DISEASE
Abstract
Background: Aim was to study the chemiluminescent activity and the activity of NAD- and NADP-dependent dehydrogenases of neutrophils
depending on the outcome of the widespread purulent peritonitis (WPP). Patients and methods: 51 patients with a mean age of RSE 54,2±19,2 years were observed. As a control 75 healthy people of similar age range were examined. Lucigenin- and luminol-dependent chemiluminescence activity and activity of NAD(P)-dependent dehydrogenases peripheral blood neutrophils were studied. Results: In patients with a favorable outcome of WPP the maximum intensity increased and the magnitude of the activation index of lucigenine-dependent spontaneous chemiluminescence reduced.
Regardless to the outcome of WPP in patients with increased activation index and maxima of the luminol-dependent spontaneous and zymosaninduced chemiluminescence. At the unfavorable outcome of the disease in neutrophils NAD- dependent isositrate dehydrogenase and anaerobic lactate dehydrogenase reaction activity increased. Regardless to the outcome WPP in patients neutrophils aerobic reaction of lactate dehydrogenase, glucose-6-phosphate dehydrogenase and NADP-dependent glutamate dehydrogenase activity reduced but levels of NADH-dependent reaction of malate dehydrogenase, NADH-dependent glutamate dehydrogenase and NADP-dependent isocitrate dehydrogenase activity increased. Conclusion: With the reduction of the intensity of plastic processes and imbalances enzymatic activity in nitrogen metabolism in patients with WPP at unfavorable outcome of the disease increases the activity of enzymes that characterize the level of anaerobic and aerobic respiration. In the absence of marked changes in the activity of enzymes that characterize the level of energy processes in cells of patients with favorable outcome of the WPP, increases the intensity of spontaneous lucigenin-dependent chemiluminescence and reduced neutrophil activation index.
depending on the outcome of the widespread purulent peritonitis (WPP). Patients and methods: 51 patients with a mean age of RSE 54,2±19,2 years were observed. As a control 75 healthy people of similar age range were examined. Lucigenin- and luminol-dependent chemiluminescence activity and activity of NAD(P)-dependent dehydrogenases peripheral blood neutrophils were studied. Results: In patients with a favorable outcome of WPP the maximum intensity increased and the magnitude of the activation index of lucigenine-dependent spontaneous chemiluminescence reduced.
Regardless to the outcome of WPP in patients with increased activation index and maxima of the luminol-dependent spontaneous and zymosaninduced chemiluminescence. At the unfavorable outcome of the disease in neutrophils NAD- dependent isositrate dehydrogenase and anaerobic lactate dehydrogenase reaction activity increased. Regardless to the outcome WPP in patients neutrophils aerobic reaction of lactate dehydrogenase, glucose-6-phosphate dehydrogenase and NADP-dependent glutamate dehydrogenase activity reduced but levels of NADH-dependent reaction of malate dehydrogenase, NADH-dependent glutamate dehydrogenase and NADP-dependent isocitrate dehydrogenase activity increased. Conclusion: With the reduction of the intensity of plastic processes and imbalances enzymatic activity in nitrogen metabolism in patients with WPP at unfavorable outcome of the disease increases the activity of enzymes that characterize the level of anaerobic and aerobic respiration. In the absence of marked changes in the activity of enzymes that characterize the level of energy processes in cells of patients with favorable outcome of the WPP, increases the intensity of spontaneous lucigenin-dependent chemiluminescence and reduced neutrophil activation index.
Annals of the Russian academy of medical sciences. 2014;69(5-6):23-28
23-28
EXPRESSION OF APOPTOSIS MARKERS IN ADHESIONS IN THE ABDOMINAL CAVITY UNDER THE EXPERIMENTAL CONDITIONS
Abstract
Background: Our aim was to study the expression of markers of caspase-dependent and caspase-independent apoptosis pathway activation in the process of repair in case of damage of the serous membrane of the abdominal cavity. Materials and methods: On the experimental model of adhesions in the abdominal cavity (male rats Wistar, n =40) in dynamics from 2 hours to 30 days after injury to the peritoneum studied marker expression proapoptosis (Bcl-x) and anti-apoptosis (Bcl-2), and PARP-1. Results: It was found that in the conditions of traumatic injury of the peritoneum apoptosis and anti-apoptosis occur in parallel. In the initial period of the anti-apoptosis mechanisms prevail, and in later periods dominated phenomena proapoptosis. PARP-1 activation indicates an increase in the frequency of DNA damage cells, and the duration of this process stimulates cell death by caspase-independent pathway. Together, these processes result in the elimination of a large number of cells, especially fibroblast of zone connective tissue formation in an aseptic area of inflammation in the peritoneal injury. We first established that in the case of peritoneal injury marker expression of anti-apoptosis in the damage zone has the character of the two-wave with maximum expression at 1-third day of the pathological process with repetitive peak on the 14th day. Сonclusion: Identifying key parts of apoptosis in the formation of adhesions in the abdominal cavity, which can be used for the development of drugs for the prevention of adhesions.
Annals of the Russian academy of medical sciences. 2014;69(5-6):29-33
29-33
CARDIOLOGY: CURRENT ISSUES
MORPHOLOGICAL AND FUNCTIONAL FEATURES OF CIRCULATORY SYSTEM IN RETIRED AND ACTIVE ELITE ATHLETES
Abstract
Regular physical activity over a long period of time increases the output of the cardiovascular system. That leads to development of a normal
(physiological) athlete’s heart. Bradycardia, cardiac hypertrophy, and arterial hypotension are three major characteristics of a normal athlete’s heart. Changes in parameters of cardiovascular system and features of heart remodeling are determined by type, frequency, and duration of a physical activity. Excessive levels of physical activity could result in development of a pathologic athlete’s heart, negatively affect hearts metabolism, and increase the risk of both atherosclerosis and myocardial infarction. Autopsy studies have shown that atherosclerosis, which leads to development of an ischemic heart disease, is often found in both young and elderly athletes. 56% of sudden deaths in all athletes were due to cardiovascular problems. Reports of ischemic heart disease in athletes of all ages have increased over the past few years. Echocardiographic features and clinical outcomes of stable angina and myocardial infarction in retired professional athletes are not well studied. Further studies are needed to improve diagnosis, prevention, treatment, and rehabilitation in elite athletes with ischemic heart disease.
(physiological) athlete’s heart. Bradycardia, cardiac hypertrophy, and arterial hypotension are three major characteristics of a normal athlete’s heart. Changes in parameters of cardiovascular system and features of heart remodeling are determined by type, frequency, and duration of a physical activity. Excessive levels of physical activity could result in development of a pathologic athlete’s heart, negatively affect hearts metabolism, and increase the risk of both atherosclerosis and myocardial infarction. Autopsy studies have shown that atherosclerosis, which leads to development of an ischemic heart disease, is often found in both young and elderly athletes. 56% of sudden deaths in all athletes were due to cardiovascular problems. Reports of ischemic heart disease in athletes of all ages have increased over the past few years. Echocardiographic features and clinical outcomes of stable angina and myocardial infarction in retired professional athletes are not well studied. Further studies are needed to improve diagnosis, prevention, treatment, and rehabilitation in elite athletes with ischemic heart disease.
Annals of the Russian academy of medical sciences. 2014;69(5-6):34-39
34-39
GENETIC DEPENDENCY OF BLOOD PRESSURE AND HEART RATE IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY
Abstract
Background: The aim of the study was to determine the effect of gene polymorphisms Arg389Gly ADRβ1 gene and T393C gene GNAS1 on the level of heart rate (HR), systolic and diastolic blood pressure (SBP and DBP) in hypertensive patients according to body mass index (BMI). Patients and methods: The study involved 166 patients with hypertension and 90 healthy individuals. Patients of the main group was divided according to BMI into three subgroups: I subgroup — with normal body weight, II subgroup — overweight, III subgroup — obesity. Gene polymorphism is determined using polymerase chain reaction and subsequent analysis of restriction fragments. Results: Patients from subgroups II and III, who had presence of genotypes Arg389Arg, Arg389Gly, had higher HR, SBP than in patients with genotype Gly389Gly (p =0,010 and p =0,001; p =0,010 and p =0,001, respectively). In the analysis of DBP, the dependence of its level of polymorphism Arg389Gly of ADRβ1 gene was found only in I subgroup (p <0,001). During the analysis of polymorphism T393C of GNAS1 gene only in patients from III subgroup was found a higher heart rate in patients with T393T genotype relatively to C393C genotype, but this difference was not statistically significant (p =0,191). Conclusion: There is a direct correlation between HR and SBP in hypertensive patients with overweight and obesity from polymorphism Arg389Gly of ADRβ1 gene, in hypertensive patients with normal body weight from this polymorphism depends DBP. Clinical manifestations of hypertension do not depend on polymorphism T393C of GNAS1 gene.
Annals of the Russian academy of medical sciences. 2014;69(5-6):40-46
40-46
OUTCOMES AFTER ONE-STAGE REPAIR OF COARCTATION OF THE AORTA AND COMBINED INTRACARDIAC LESIONS IN INFANTS
Abstract
Background: The aim of the study was to compare the outcomes of hypothermic circulatory arrest (GCA) and selective cerebral perfusion (SCP). Patients and methods: Nine patients were treated at the Bakoulev Center for Cardiovascular Surgery. All congenital heart diseases were repaired simultaneously. Group 1 (n =4) included infants who were treated using an HCA, and the patients who underwent repair with the use of SCP were in group 2 (n =5). Results: One patient (25%) in group 1 died in the period of thirty days after the repair. Moderate heart failure and respiratory failure occurred postoperatively with no significant difference between two groups. Recoarctation was a frequent (75%) complication after the «end to end» anastomosis creating. One patient (25%) was reoperated on day 3 after the primary repair. Two other patients (50%) were treated by balloon angioplasty. There was relatively high (75%) incidence of a prolonged open sternotomy in group 1. Conclusion: There were similar results in HCA and SCP groups. A tendency for frequent prolonged open sternotomy application after HCA surgery as well as occurrence of the recoarctation after «end to end» anastomosis creating was found.
Annals of the Russian academy of medical sciences. 2014;69(5-6):47-51
47-51
CLINICAL POLYMORPHISMS AND APPROACHES OF ARRHYTHMIAS TREATMENT IN A FAMILY WITH P.DELKPQ1505-1507 DELETION IN SCN5A GENE
Abstract
Background: The aim of the study was to analyze spectrum of manifestation and treatment response in large family with rhythm disturbances caused by p.delKPQ1505-1507 mutation in SCN5A gene. Patients and methods: We had under our observation 18 members of large Iranian family with various combination of inherited arrhythmic syndromes. Careful cardiological examination, genetic councelling and venous blood sampling for molecular genetic study were performed for family members. Mutation screening in SCN5A gene was performed using bidirectional Sanger sequencing. Results: Here by we show the observation of Iranian family with known mutation p.delKPQ 1505-1507 in SCN5A gene, who display not only LQ–TS phenotype but also some of the carriers of this mutation have had LQ–TS and Brugada syndrome (combine phenotype), interestingly. Conclusion: The overlapping phenotype associated with high risk of sudden cardiac death may require complex approaches to antiarrhythmic therapy, surgical treatment and prevention of sudden cardiac death in the family.
Annals of the Russian academy of medical sciences. 2014;69(5-6):52-59
52-59
THE ROLE OF ALFA-2-BETA-ADRENORECEPTOR IN DEVELOPMENT OF VENTRICULAR CONDUCTION DISTURBANCE
Abstract
Background: The purpose of this study was to investigate association between the genetic polymorphism I/D of gene α2β-adrenoreceptor (ADRA2B) and hereditary disorders of ventricular conduction. Patients and methods: In this study, 102 people with complete left bundle branch block (45,71±1,852 years) — 46 females and 56 males, and 86 people with complete right bundle branch block (34,59±1,86 years) — 41 females and 45 males. The study was approved by Ethic Committee of the KrasSMU. All participants were included in the study after written informed consent form. Cardiological examination included clinical examination, electrocardiography, echocardiography, Holter monitoring, stresstest, koronaroangiografy and radionuclide method of a myocardium and molecular and genetic researches. Results: Statistically, significant prevalence of a homozygous genotype of DD on rare allele gene ADRA2B in both groups in comparison with group of control is established. The reliable dominance of the homozygous rare genotypes (D allele) of gene ADRA2B were detected in all groups. Conclusion: Polymorphism DD of a gene ADRA2B is a genetic predictor of predisposition to the blockade of the right and left bundle branch block.
Annals of the Russian academy of medical sciences. 2014;69(5-6):60-64
60-64
PEDIATRICS: CURRENT ISSUES
MAINTENANCE AND HEALTH PROMOTION OF ADOLESCENT – PLEDGE OF SUSTAINABLE DEVELOPMENT OF SOCIETY AND STATE (CURRENT STATUS OF THE ISSUE)
Abstract
The article presents submitted data of population dynamics of adolescent (10-17 years old) in Russian Federation over the period of 1995—2012. In the presence of reduction by 8,2 million of adolescent population the top-priority task of adolescent health and life maintenance was declared. The article deals with physical growth and development statistics of schoolchildren of 15-19 years old: as opposed to peers of 80-es increase of length, body weight and circumference of chest as well as reduction of muscle strength is observed. On the ground of the data analysis of authoritative statistical reporting the increase of morbidity rate by factor of 1,4 was detected over the last 10 years. It has been established that the true morbidity level is above the authoritative by the factor of 1,5. The number of adolescent at the age of 10-15 referred to 1st and 2nd health groups decreased almost on 20%, at the same time pathological processes become chronic. The reproductive and mental health of adolescent at the age of 15-17 years was analyzed over the last 10 years. The rate of mental health disorders in adolescent living in country is more than in the peers living in cities by the factor of 1,2-1,4. The rate of period disorders, salpingitis and oothecitis increased in girls under 10 years and ones at the age of 15-17. The rate and structure of child disability was analyzed. It was fixed that leading causes of adolescent disability are mental disorders, diseases of nervous system, congenital anomalies. The most commonly encountered seed of physical dysfunction is capacity to study. It is demonstrated that there is misreporting on both child disability in totally and adolescent disability in Russian Federation. After the analysis of particular provisions of legislation concerning medical and social issues of child disability the week points were detected. The morbidity rate of adolescent was studied: primary cause of death in adolescent is extrinsic factor (more than 70%), the leading one is suicide. Road traffic accidents and accidental poisoning comes then. The medical and social consequences of high morbidity, disability and mortality rates of adolescent were considered as labour, reproductive and military potential of society and state. Short-term and long-term plans focused on decrease of morbidity, disability and mortality rates of adolescent were formulated on the basis of submitted data. search for solution is supposed to be nationwide and local as well (public health service, education, social protection).
Annals of the Russian academy of medical sciences. 2014;69(5-6):65-70
65-70
PECULIARITIES OF PHYSICAL GROWTH AND BODY COMPOSITION OF PRETERM INFANTS, RECEIVED DIFFERENT TYPES OF FEEDING, AT THE DISCHARGE FROM HOSPITAL
Abstract
Background: This article is devoted to a research and practice problem — optimization of feeding preterm infants. Patients and methods: 80 preterm infants of different GA with perinatal pathology were included in the study group. Anthropometric figures of weight and length z-scores and also BMI of preterm infants, received different types of feedings, at the discharge are presented. All patients’ body composition (Fat free mass and Fat mass) was estimated by air plethysmography. Results: Less mass and length at the discharge in preterm infants, received breast feeding (including fortified milk), in comparison with the infants, received mixed and formula feeding, were found out. At the same time, preterm infants received breast feeding had more optimal body composition (less fat mass), than the infants received formula feeding. Conclusion: Personalised approach to human milk fortifiers prescription is explained. Important practical value of methodology for estimating body composition by air plethysmography is established.
Annals of the Russian academy of medical sciences. 2014;69(5-6):71-80
71-80
CLINICAL CASE OF TREATMENT OF HEPATIC HAEMANGIOMA BY PROPRANOLOL IN THE NEWBORN
Abstract
Clinical observation of conservative treatment of the left hemi-liver haemangioma by propranolol in the full-term newborn with initial symptoms of cardiac failure is presented. Extensive hepatic haemangioma was diagnosed prenatally on the 23–24th week of a gestation. After the birth the clinical diagnosis was confirmed by means of ultrasound investigation (the size — 50×30 mm) and by the data of computer tomography. The starter dose of propranolol made 0.5 mg/kg per day with further increase to 1,5 mg/kg per day; the preparation was prescripted at the age of 2 days of life. Episodes of decrease in cardiac rate to 95 b/min are noted among side effects. The child was dismissed for out-patient observation at the age of 12 days of life in a stable state. The positive dynamics is registered during ultrasound investigation in 6 months after initiation of treatment: lesion was significantly decreased in the size, and there was a considerable decrease in a blood flow. Treatment by propranolol in a dose of 1,5 mg/kg per day was continued. Modern data on possible mechanisms of propranolol effect at haemangiomas in children, regimen, side effects and complications are provided in discussion. It is noted that this drug can be considered as the agent of choice in the treatment of infantile haemangiomas in children of difficult localization since the neonatality period.
Annals of the Russian academy of medical sciences. 2014;69(5-6):81-85
81-85
SECOND-GENERATION COLON CAPSULE IN SMALL BOWEL AND COLON DISORDERS IN PEDIATRICS
Abstract
Background: Aim of the study was to assess the diagnostic yield of second-generation colon capsule in pediatric gastrointestinal diseases. Patients and methods: Five patients with different symptoms of gastrointestinal diseases were included in the study. Among them were: suspicion on diffuse polyposis, intestinal bleeding, lymphangiectasia and inflammatory bowel disease. Image interpretation was made by experienced capsule users, previously trained on small bowel capsule and first generation colon capsule. Lesions or abnormal changes of the mucosa identified on capsule endoscopy served as indications for colonoscopy or esophagogastroduodenoscopy with biopsy or polypectomy if needed. Results: Standard white light endoscopy was made in all children without any adverse events. Second-generation colon capsule allows diagnosing Crohn’s disease in small intestine and colon, limphangiectasia of the ileum, single rectosigmoid polyp and diffuse polyposis of the colon. Conclusion: Second-generation colon capsule can be used as non-invasive screening method in children without serious complications, thus allowing differentiating indications for traditional white light endoscopy, which is usually made under general anesthesia in pediatrics.
Annals of the Russian academy of medical sciences. 2014;69(5-6):86-90
86-90
SHORT MESSAGES
THE INFLUENCE OF THE BUPIVACAINE EPIDURAL ANESTHESIA ON THE RABBIT MYOMETRIUM CONTRACTILE ACTIVITY AND THE FUNCTIONAL STATE OF THE FETUSES IN INDUCED LABOR
Abstract
Background: The influence of bupivacaine (0,5% — 1 ml) epidural anesthesia (EA) on 15 pregnant rabbit females induced in labor by oxytocin on the 30th day of pregnancy in chronic experiment was conducted. Materials and methods: 26 pregnant rabbit females took part in the investigation. 11 females were included in the control group and 15 — to the main group. Both groups retrospectively were divided in two on the fact of the delivery during the experiment. For each 5-minute interval the contractile activity of the myometrium (number of uterine contractions, duration and amplitude of the one uterine contraction), functional state of fetuses and female (ECG) were evaluated Registration of the parameters was carried out simultaneously with the help of electrodes which were administrated in the myometrium, to the fetuses and females on the 28th day of pregnancy. Results: It was shown that EA influence on the myometrium contractile activity and functional state of fetuses and female depends on the female delivery readiness. Conclusion: In the case of the optimal one short-term increase of the contractile activity (on the 15th minute after EA) with no significant fetal heart rate changes were observed. In the case of its absence no significant influence was revealed. Moderate female tachycardia in both groups under EA was registered more pronounced in delivery one group.
Annals of the Russian academy of medical sciences. 2014;69(5-6):91-97
91-97
PSYCHOLOGICAL FEATURES OF MOTHERS BRINGING UP DISABLED CHILDREN
Abstract
Background: Research objective was to define psychological makers of mothers bringing up disabled children for scientific justification of the family psychotherapy branches. Patients and methods: 60 mothers bringing up children of early age with infantile cerebral palsy and 50 mothers of children with compensation of perinatal affections of the central nervous system by the 1 life year are surveyed. Personal characteristics, family orientations of mothers, child and mother relations, awareness of mothers on the children health state and the attitude to their rehabilitation were studied by means of psychological techniques. Results: It is found out that the mothers bringing up disabled children more often have emotional disorders, negative attitude to divorce and give the leading role in a family to the husband less often they show hypoguardianship of the child than the mothers of children with compensation of perinatal affections of the central nervous system. Mothers are less satisfied with the child development, they are more often worried about disorders of development of movements, speech and mental development delay, small appetite of the child, they feel helplessness in rehabilitation more often, note the ambiguity of its prospects. They understand that their child needs the help of the qualified experts: neurologist, orthopaedist, logopedist, psychologist, but they aren't satisfied with communication with them more often, underestimate own role in rehabilitation. Conclusion: The revealed characteristics prove the necessity and define the main directions of family psychotherapy — correction of mother's emotional disorders, child and parental relations, increase of medical and psychological competence that allows to increase efficiency of rehabilitation.
Annals of the Russian academy of medical sciences. 2014;69(5-6):98-101
98-101
CLINICAL MANAGEMENT OF DISORDERS HEMOSTASIS-RELATED WITH OBSTETRIC COMPLICATIONS
Abstract
Background: The aim of the study was the reduction of adverse pregnancy outcomes in women with gestational and genetically determined changes in the hemostatic system. Patients and methods: The study group comprised 98 patients with obstetric complications on the background of changes in the parameters of coagulation screening. In 63 pregnant women, hemostatic disorders were not corrected, in 35 patients medical tactic defined clinical situation and the results of laboratory and instrumental studies of the hemostatic system. Results: Hereditary thrombophilia detected in 85% of patients with obstetric complications. Carriage of the rare allele of MTHFR-677 2-fold increased risk of adverse pregnancy outcomes; heterozygous carriers of polymorphism PAI-1 — 1,5 times more. The prognostic parameters thrombelastographic (sensitivity 80%, specificity 82%) were higher than in laboratory tests. To determine the most predictive of adverse pregnancy outcome has a density of fibrin clot — the maximum amplitude. Conclusions: In women with obstetric complications associated with disturbances in the hemostatic system, medical diagnostic tactics using thrombelastographic evaluates all stages of coagulation and fibrinolysis, allows you to select a reasonable pathogenetic anticoagulant therapy and reduce the number of adverse pregnancy outcomes.
Annals of the Russian academy of medical sciences. 2014;69(5-6):102-106
102-106
ENDOTHELIAL DYSFUNCTION INDICATORS IN PATIENTS WITH DIABETIC FOOT SYNDROME
Abstract
Background: In recent years, scientists have become increasingly interested in the role of the endothelium in the pathogenesis of vascular lesions of various origins, including diabetic patients. Therefore, the aim of the study was to investigate the expression of endothelial dysfunction in patients with diabetic foot syndrome (DFS), by examining the levels of nitric oxide, endothelin-1 levels in the serum, as well as lower limb microcirculation by laser doppler flowmetry. Patients and methods: It was examined 72 patients with diabetic foot syndrome with I-IV degree of lesion (by Meggit-Wagner classification). Neuropathic form was diagnosed in 32 people, ischemic — 40 patients. The function of endothelium was studied on the basis of the determination of enzyme-linked immunosorbent NO and endothelin-1 in peripheral blood serum, as well as to assess the state of the microcirculation of the lower limbs by laser doppler flowmetry, using apparatus LACK-02 (Russia). Results: Patients with DFS are marked with endothelial dysfunction, the severity of which depends on the type of diabetes, glycemic level and pathogenic forms of destruction. This is manifested by secretion reducing of vasodilators (NO) and increased synthesis of vasoconstrictors (endothelin-1), which leads to disruption of peripheral hemodynamic. Characteristic changes in the microcirculation are a dramatic violation of endothelium-dependent regulation mechanism, the redistribution of blood towards the nutritional circulation. Also it is showed a significant reduction in reserve capacity of the capillary bed in response to the sample and the occlusal restoration of blood flow during reactive hyperemia. Conclusion: Development of endothelial dysfunction and changes in peripheral hemodynamic in patients with DFS contributes to the emergence and prolongation of necrotic lesions, as well as violation of reparative processes.
Annals of the Russian academy of medical sciences. 2014;69(5-6):107-110
107-110
NATURAL NEUROTROPIC AUTOANTIBODIES IN BLOOD SERUM OF EPILEPSY PATIENTS
Abstract
Background: The purpose of research was to determine the level of natural neurotropic autoantibodies in blood serum of patients with idiopathic and symptomatic epilepsies. Patients and methods: 43 epilepsy patients (27 males and 16 females) at the age of from 16 till 70 years (average age 43,1±1,02 years) were studied — 11 patients with idiopathic epilepsy (group I) and 32 patients with symptomatic epilepsy (group II). By the method of immunoenzymatic analysis and original idiotype-antiidiotype test-system ELI-N-Test (Russia) in blood serum of the patients the levels of autoantibodies (aAB) to brain proteins-antigens (NF-200, GFAP, MBP and S100β) and to receptors of neuromediators (glutamate, GABA, dopamine, serotonin and choline-receptors) we determined. Results: All groups of epilepsy patients differed from control group by as individual levels, as degree of deviations of the studied immunological parameters. Serum levels of neurotropic aAB to NF-200, GFAP, MBP and S100β, as well as to receptors of neuromediators (glutamate, GABA, dopamine, serotonin and choline-receptors) were noted to increase. The features of immune disturbances depended on the form and severity of epilepsy. Conclusion: Autoimmune processes have the certain place in the pathogenesis of epilepsy. The degree and duration of increase in the levels of neurotropic aAB have the prognostic significance for the evaluation severity degree of epilepsy course that could be an additional criterion in the integrated diagnosis and timely correction of treatment for epilepsy.
Annals of the Russian academy of medical sciences. 2014;69(5-6):111-116
111-116
EVALUATION OF POSSIBILITY OF USING NEW FINANCIAL INSTRUMENTS FOR SUPPORTING BIOMEDICAL PROJECTS
Abstract
Analysis of selection criteria on projects of Russian medical research centers for funding in Russian scientific fund and Federal program «Research and innovations» was done. It was noted that a high degree of uncertainty of such concepts as «priority direction», «applied» and «search» research and «industrial partner» in regards to research of biomedical theme. Analysis of classified «Medicine and health care» «Forecast of scientifictechnological development of Russian Federation till 2030 year» were completed.
Annals of the Russian academy of medical sciences. 2014;69(5-6):117-123
117-123
INFORMATIZATION OF PERSONALIZED ADAPTATION MEDICINE PROGRAMS
Abstract
State of art of personalized monitoring programs informatization and improvement of human adaptation abilities as one of the preferred direction of personalized (individualized, personalized) medicine which is focused on disclosure of potential and adaptive capabilities of human body and increase of life expectancy by means of directed patient-associated diagnostic and treatment effects on the basis of genetic influences of exogenous and regional factors are described. Biomedical concepts which are the background of monitoring and improvement of the implementation of human adaptation abilities that are designed by experts in the field of aerospace medicine and are the foundation of personalized non-drug medicine are defined: occupational health, preventive health changes cascade concept, concept of similar conditions, biological age, health-related quality of life concept, software risk-metric health information concept and telecommunication technologies for monitoring of human health information technology certification. The characteristics of the present stage of development of personalized non-drug medicine are issued.
Annals of the Russian academy of medical sciences. 2014;69(5-6):124-128
124-128