Vol 70, No 5 (2015)

PEDIATRICS: CURRENT ISSUES
Psychosomatic Aspects of Bronchial Asthma in Children
Krivonogova T.S., Shemyakina T.A., Babikova Y.A., Gavrilova A.N.

Abstract

Bronchial asthma is the most common chronic disease in children affecting 30% of the child population. The purpose of this review was to analyze and summarize the works of foreign and Russian authors who evaluated the impact of mental disorders on the course of asthma in children. The article presents the definition of asthma as a psychosomatic disease and relevance of the study against this background. The authors adduce the results of research studies which allow us to estimate the interaction between the degree of anxiety, accentuation of the nature, severity of asthma, and the duration of the disease. The existing publications demonstrate that the researchers' opinions are polarized regarding the cause-and-effect relationship between psychological disorders and controlled asthma. The authors came to a conclusion that early detection of psychopathological symptoms and appropriate psychotherapeutic administration would improve the efficacy of treatment in children with bronchial asthma and the social adaptation, adjust the system of family relations, and have a positive effect on the course of the disease.

Annals of the Russian academy of medical sciences. 2015;70(5):509-512
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Thyroid Adenomas in Children
Morozov D.A., Pimenova E.S., Mirokova E.D.

Abstract

According to the papers thyroid nodules are quite rare in the first two decades of life. However, there are some exceptions, relating to areas with an iodine deficiency or affected by radioactive fallout, where the risk of nodules and carcinomas is increased. Therefore, it is a great challenge for the physician to distinguish between benign and malignant lesions preoperatively, and not only in these areas of greater risk. The authors analyzed current works, which are devoted to diagnostics and treatment of adenomas of thyroid gland in children. This literature review is based on works dedicated to epidemiology, histotypes study, and methods of diagnostics, surgical treatment, prognosis and complications of this pathology. The current tendencies in surgical approaches, intraoperative monitoring of recurrent laryngeal nerve are also discussed. The actuality of this problem is connected with last decade increase of adenomas in structure of thyroid gland nodules, increase of number of patients with multiple adenomas and with polypathias: adenomas with nodular goiter, autoimmune thyroiditis and cancer in children. The difficulties of diagnostic of adenomas are related to the similar clinical symptoms, cytogenetic characteristics of growth of benign and malignant lesions of thyroid gland. Additionally there is no systematic review about thyroid adenomas in children recent years.

Annals of the Russian academy of medical sciences. 2015;70(5):513-518
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The Study of Psychological Characteristics of Children and Adolescents with Digestive Diseases
Sviridova T.V., Lazurenko S.B., Venger A.L., Komarova E.V., Potapov A.S., Buslaeva A.S.

Abstract

Objective: The present study was aimed at the psychological characteristics of children with different chronic diseases of the digestive system and the identification of key factors influencing the formation of their personality.

Methods: The continuous prospective study of psychological peculiarities of 125 patients (7−17 y.o.) with diseases of the digestive system who have been monitored at Scientific Centre of Children’s Health (Moscow) was performed. As research methods were used: analysis of medical and pedagogical documentation, participant observation, educational experiment, interview, questionnaires and projective methods.

Results: The study involved 125 patients aged 7–17 years (12.4 averagely) with diseases of the digestive system including teens — 68 (54%), primary school pupil — 57 (46%). The number of boys significantly prevailed over the number of girls (2:1). The study confirmed the existence of a close relationship and mutual influence of three factors: the physical condition, social situation of development, and individual psychological characteristics of children. According to the psychological characteristics the children can be combined in three groups: Group I (47 of 125 people; 37.6%) ― children with bad psychological status. This is most typical for children with active form of chronic diseases requiring intensive medical assistance (37 of 47 people; 78.7%). Group II (59 of 125 people; 47.2%) ― children with instable psychological condition, with risk of neurotization. This group mainly comprises patients with chronic diseases at the stage of unstable clinical remission with preserved or compensated functions of organism bodies and systems or with incomplete compensation of functions requiring long term supportive treatment (45 of 59 people; 76.3%). Group III ― patients with rather stable psychological condition (19 of 125 people; 15.2%). It comprises patients with rather stable psychological condition, anyway, with expressed psychological vulnerability in stress situation. Most children suffer from chronic diseases of different etiology at the stage of clinical remission with rare aggravations, with preserved or compensated functions, provided there are no aggravations of the basic disease (17 of 19 people; 89.5%).

Conclusion: Most children with diseases of the digestive system have the psychological difficulties, while their identity is often formed in the distorted social conditions. Therefore, these children need psychological and pedagogical support, as well the special psychological and pedagogical conditions for the realization of their mental and cognitive capacities. To put together a program of psychological and educational assistance we should take into account the child’s age at the moment of occurrence of the disease, etiology, duration and severity of the illness, the nature and degree of non-compliance of social environmental.

Annals of the Russian academy of medical sciences. 2015;70(5):519-525
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ONCOLOGY: CURRENT ISSUES
Vitamin D — A New Vector of Cancer Prevention?
Kobyakova O.S., Deev I.A., Tyufilin D.S., Kulikov E.S.

Abstract

Currently, a great number of research projects are focused on finding new treatment methods for cancer and carcinogenesis predictors, as well as the ways to dicrease cancer development risks. This article provides an overview of research on vitamin D as cancer prevention factor. The results of independent experiments and in vitro tests explaining the mechanisms of protective effect of vitamin D and its derivatives on cancer are illustrated. The review of epidemiological survey results obtained from different countries and various populations that were focused on the association of vitamin D use with various cancer pathologies incidence was performed.

Annals of the Russian academy of medical sciences. 2015;70(5):526-533
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Clinical and Immunological Features of Infectious Complications in Patients with Multiple Myeloma
Smirnova O.V., Manchuk V.T., Agilova Y.N.

Abstract

Background: Infectious complications — the leading cause of mortality in patients with multiple myeloma (MM), their appearance is regarded as an adverse prognostic factor in the course of the disease.

Objective: The aim of our study was to evaluate the clinical and immunological features of infectious complications in patients with G- immunochemical MM to find the most informative indicators in their forecasting.

Methods: A randomized controlled trial was made. All patients were divided into 3 groups for comparison: Group 1 (n =47) — MM patients, G-immunochemical variant with infection, Group 2 (n =54) — MM patients, G-immunochemical option no infectious complications, and Group 3 (n =125) — healthy volunteers. Research material was deoxygenated blood taken on admission of a patient to the hematology department before the pathogenetic treatment. Identification of G-variant was carried by immunofixation and electrophoresis. The immune status was assessed by indirect immunofluorescence. The concentration of IgA, M, E and G, and the levels of IL 2, IL 4, IL 8, TNF α, IFN γ in serum was determined by enzyme immunoassay. The activity of neutrophil granulocytes (NG) was studied by chemiluminescent analysis of spontaneous and induced production of reactive oxygen species. Statistical analysis was performed using the software STATISTICA v. 8.0 (USA).

Results: We analyzed data from 101 patients with MM and 125 healthy volunteers. The average age of MM patients was 60.53±6.78 years. The group of healthy volunteers was similar in sex and age to groups of patients with MM. In patients with MM in the presence of infectious complications the researchers detected combined secondary development of T and B cell immunodeficiency, changes in non-specific immunity depended on the stage of the disease, unidirectional irregularities in spontaneous and induced chemiluminescence activity NG in II stage disease and multidirectional irregularities in stage III (p =0.045). Prevalence of the content of proinflammatory cytokines on inflammatory (p <0.001) and the deviation of the immune response to Th1-type were detected.

Conclusion: the set of 6 informative indicators (the content of IL 4, IL 2, TNF α, IgG, the absolute number of CD4+ and CD19+ cells) enables the development of prediction method of infectious complications in patients with MM.

Annals of the Russian academy of medical sciences. 2015;70(5):534-540
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ENDOCRINOLOGY: CURRENT ISSUES
Epigenetic Aspects of Osteoporosis
Grebennikova T.A., Belaya Z.E., Rozhinskaya L.Y., Mel'nichenko G.A., Dedov I.I.

Abstract

This review describes the epigenetic regulation of osteoblastogenesis and osteoclastogenesis and its future implementation in the diagnosis and treatment of osteoporosis. A considerable part of the review is dedicated to the microRNAs (miRNAs). miRNAs are small regulatory factors that regulate gene expression, by post-transcriptional regulation of genes playing an important role in numerous cellular processes, including cell differentiation and apoptosis. Recently, a number of studies have revealed that miRNAs participate in bone homeostasis and their role in the pathogenesis of osteoporosis is practically evident. In this review, we highlight the miRNAs involved in bone remodelling and their roles in osteoporosis. miRNAs are stable molecules which make them promising potential markers for bone remodeling and osteoporosis.

Annals of the Russian academy of medical sciences. 2015;70(5):541-548
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Mathematical Modeling of the Blood Glucose Regulation System in Diabetes Mellitus Patients
Karpel’ev V.A., Filippov Y.I., Tarasov Y.V., Boyarsky M.D., Mayorov A.Y., Shestakova M.V., Dedov I.I.

Abstract

Interest in the mathematical modeling of the carbohydrate metabolism regulation system increases in recent years. This is associated with a «closed loop» insulin pump development (it controls an insulin infusion depending on the blood glucose level). To create an algorithm for the automatic control of insulin (and other hormones) infusion using an insulin pump it is necessary to accurately predict glycaemia level. So, the primary objective of mathematical modeling is to predict the blood glucose level changes, caused by the wide range of external factors. This review discusses the main mathematical models of blood glucose level control physiological system (simplified insulin–glucose system). The two major classes of models — empirical and theoretical — are described in detail. The ideal mathematical model of carbohydrate metabolism regulatory system is absent. However, the success in the field of blood glucose level control modeling and simulating is essential for the further development of diabetes prevention and treatment technologies, and creating an artificial pancreas in particular.

Annals of the Russian academy of medical sciences. 2015;70(5):549-560
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SCIENTIFIC REPORTS
In vitro Cultivation of Functioning Passaged Ciliated Epithelium for Trachea Tissue Engineering
Baranovsky D.S., Lyundup A.V., Parshin V.D.

Abstract

Background: Currently all tissue engineered trachea transplants had no ciliated epithelium until transplantation, and long-term temporary lack of mucociliary clearance leads to patients’ condition decline and reduced life quality in postoperative period. So, the need for a better cultivation method and studying ciliated epithelium growth characteristics in cell culture increased rapidly.

Objective: The aim of our study was to investigate cultivation of functionally complete passaged ciliated epithelium for trachea tissue engineering.

Methods: Human ciliated epithelium isolated from intraoperative bioptate was used for culturing in the special complex medium with morphological and functional characteristics evaluation.

Results: Ciliated epithelial cell-groups were obtained by culturing in the special complex medium. Generated cell-groups had ciliary activity and showed well-coordinated movement with functional characteristics similar to native epithelial tissue. The basic parameters of cell-activity were studied.

Conclusion: Thus our study provides a new insight for the problem of ciliated epithelium in vitro culturing as well as developing the optimal laboratory method.

Annals of the Russian academy of medical sciences. 2015;70(5):561-567
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Natriuretic Peptides: Role in Current Cardiology
Burnasheva G.A., Napalkov D.A.

Abstract

Natriuretic peptides were discovered in 50–70s of the XX century. BNP was more diagnostically and prognostically significant, as it is secreted directly into the ventricles of the heart. The studies demonstrated a high predictive value of increasing the level of BNP in acute decompensation of heart failure and in patients with chronic heart failure in a study of Val-HeFT. It was demonstrated that monitoring the level of NT-proBNP can be used for the selection of optimal therapy, affect the course and outcome of the disease, and reduce the cost of treatment. The next step in learning BNP was to undertake attempts of their use in the therapy of heart failure. Long-term therapy BNP (drug nesiritide) improved left ventricular remodelling in patients with stable heart failure. Currently the definition of the levels of BNP and NT-proBNP is used for the diagnosis and management of patients with heart failure.

Annals of the Russian academy of medical sciences. 2015;70(5):568-572
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Phylodynamic of HCV Populations
Kalinina O.V., Zhebrun A.B.

Abstract

Hepatitis C virus is an actual public health problem worldwide since its discovering in 1989. It is explained not only by the wide spreading and
frequent adverse outcomes of disease, the lack of effective preventive vaccine, but also by the high genetic variability of the virus. The current review summarizes the results of phylodynamic and phylogeographic studies of different HCV populations that allowed to characterize epidemic processes, to analyze the divergence of HCV into genotypes and subtypes, and to determine the geographic origin of the current HCV epidemic variants.

Annals of the Russian academy of medical sciences. 2015;70(5):573-578
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Causes and Factors of Male Infertility
Kolesnikova L.I., Kolesnikov S.I., Kurashova N.A., Bairova T.A.

Abstract

The preservation of reproductive health of the population is an important factor of demographic policy of the state. According to some authors from 14 to 30% of couples of reproductive age suffer from infertility, male factor in such marriages is detected in more than half of the cases. As you know, in recent years there has been a significant deterioration in the main indicators of reproductive function of men. Increased the number of andrological diseases, morphological disorders of the male reproductive system, almost halved the production of sperm in men of reproductive age. The reason probably lies behind a whole range of stress factors, such as medical ignorance, uncontrolled and inappropriate use of medication, metabolic disturbances, lack of vitamins and minerals, the impact of industrial pollutants, as well as the growth of addictive disorders (alcoholism, smoking and drug addiction). The forms of infertility differ according to its etiology and severity from minor changes to complete spermatogenesis dysfunction of the gonads, and can also occur due to genetic disorders. The lack of analysis of the relationship between clinical and genetic-biochemical components in men with infertility makes it impossible to understand the pathogenesis of infertility and to assess the risks of male infertility. High level of current medicine does not always guarantee an identification of the cause of male infertility. The article analyzes data from the review of specialized literature on the diagnosis and etiopathogenesis of male infertility. Frequency and clinical signs of pathology of the male reproductive system depend on the combinatorial effects of environmental influences, manifested most often in mutually reinforcing effect. A combination of several, seemed to be imperceptible factors makes the risk of development of male reproductive pathology very high. This situation compels specialists to conduct comprehensive studies on the men reproductive potential.

Annals of the Russian academy of medical sciences. 2015;70(5):579-584
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Gender Differences of Behavioral Risk Factors in Saint-Petersburg Inhabitants
Orlov A.V., Rotar' O.P., Boyarinova M.A., Alieva A.S., Dudorova E.A., Kolesova E.P., Moguchaya E.V., Paskar' N.A., Solntsev V.N., Baranova E.A., Konradi A.O.

Abstract

Background: In developed countries there are significant gender differences in lifetime expectancy that can be explained by behavioral risk factors (RF).

Objective: The aim of our study was to estimate gender features of behavioral RF in general population of Saint-Petersburg, Russia.

Methods: As a part of all-Russian epidemiology survey ESSE-RF a random sampling of 1600 Saint-Petersburg inhabitants (25-64 y.o.) stratified by age and sex was performed. All participants filled in the questionnaire. Anthropometry (weight, height, body-mass index (BMI), waist circumference (WC)) and fasting blood-tests (lipids, glucose by Abbott Architect 8000 (USA)) were performed.

Results: There were examined 573 (36%) men and 1027 (64%) women. No gender differences in obesity were found according to BMI criteria — in 178 (31.2%) women and 352 (35.1%) men. Obesity was more often detected in females according to WC criteria: АТРIII — 44.1 vs 30.3%; IDF 51.2 vs 66.4% (p <0.001 for both). Linear regression analysis was performed and age was associated with BMI — 1.6 kg/m2/decade, WC in women — 5,2 cm/decade and WC in men — 2.8 cm/decade, р <0.001 for all anthropometric parameters. Optimal level of physical activity was equally documented in both genders — 540 (61.2%) women and 286 (58.9%) men. Daily intake of sweets was lower in men — 228 (39.8%) vs 539 (52.5%) in women (p <0.001). 810 (50,6%) of trial subjects were non-smokers, 395 (24,7%) were former smokers, and 395 (24,7%) were smokers at the moment of trial. The higher number of female smokers was observed — 194 (19.1%).

Conclusion: A high prevalence of obesity is observed in sample of Saint-Petersburg inhabitants — it is higher among women according to WC criteria regardless of menopause, possibly due to bigger sweets consumption. Males smoke more often and consume less fresh fruits and vegetables which is accompanied by a higher prevalence of hyperglycemia and hypertriglyceridemia.

Annals of the Russian academy of medical sciences. 2015;70(5):585-591
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Morphofunctional Changes of Spleen After Hemostasis by Nonequilibrium Plasma
Semichev E.V., Baikov A.N., Shevtsova N.M., Bushlanov B.S., Gereng E.A., Aleinik A.N.

Abstract

Background: Heavy bleeding is developed in case of spleen injury. It often leads to death. At present the search and development of new methods for hemostasis of spleen bleeding continues. An innovative method is coagulation of nonequilibrium plasma.

Objective: Our aim was to study the effect of nonequilibrium plasma on the morphofunctional state of the spleen.

Methods: The non-randomized study by type of «case-control» was conducted. The experiment was carried out on 45 male rabbits weighing 3000–3200 g. 1st group (control; n =5) — intact animals without surgery; 2nd group (experimental, n =40) — animals after atypical resection of the spleen and hemostasis by nonequilibrium plasma. The volume of blood loss, FBC, histological data, splenogram analysis data were assessed at defined periods (60 min, 3rd, 5th, 7th, 14th, 30th, 90th, 180th days) after surgery. They were compared with data of the control group.

Results: The volume of blood loss during the resection of the spleen with hemostasis by nonequilibrium plasma was 16.6 [15.98;17.22] ml. Increase of neutrophil to 38 [24; 39] (control group 17 [13, 18], p =0.009), monocytes to 15 [14, 18] (control group 8 [6, 11], p =0.036) is revealed in the FBC in the early period after hemostasis with nonequilibrium plasma. It is reduced to the norm on 30 day. Histological examination revealed leukocyte infiltration, edema, microvascular stasis, dilatation of vessels in the early period. At long-term period structure of the organ is normalized. Splenogramm analysis revealed a statistically significant (p =0.023) decrease in the relative number of small lymphocytes by 28% in animals after hemostasis with nonequilibrium plasma as compared to control (23.3 [17.9; 26.7] versus 30.8 [29.25; 34.3]
respectively).

Conclusion: treatment of bleeding surface by plasma flow for 1.5–2 min is required order to achieve effective hemostasis during surgery
of spleen injuries in the experiment. After coagulation there is minimal damage of the spleen parenchyma, which manifests itself as activation reaction. At long-term period parenchyma of the spleen completely regenerates with the formation of cicatrical tissue that does not affect the functioning of organ.

Annals of the Russian academy of medical sciences. 2015;70(5):592-598
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Pathogenetic Relationship between Endothelial Dysfunction and Disorders of Blood Coagulation Potential in Pregnancy Complicated by Pre-Eclampsia
Sergeeva O.N., Chesnokova N.P., Ponukalina E.V., Rogozhina I.E., Glukhova T.N.

Abstract

Until now, there is no systematic information on the role of endothelial dysfunction in the mechanisms of disorders of blood coagulation potential and microcirculation in different organs and tissues in preeclampsia.

Objective: Our aim was to extend the existing principles of diagnosis of pre-eclampsia by establishing the role of endothelial dysfunction in the mechanisms of blood coagulation potential violations.

Methods: A prospective comparative study was performed. Condition of coagulation processes studied by conventional techniques, parameters of a functional endothelium (nitric oxide metabolites, endothelin 1, thrombospondin, thrombomodulin and intercellular adhesion molecules in blood plasma) — by ELISA.

Results: The study group included 55 patients with moderate preeclampsia and 49 pregnant women with severe pre-eclampsia, in the control group — 40 women with physiological pregnancy. In patients with pre-eclampsia moderate observed increase in plasma endothelin-1 (p <0.001), thrombospondin (p <0.001), intercellular adhesion molecules (p <0.001) while reducing the level of nitrogen oxide (p <0.001), increase in time of fibrinolysis (p <0.050) and decreased international normalized ratio (p <0.050) compared with the control group. With increasing severity of preeclampsia the researchers detected in blood plasma of patients a progressive increase in endothelin 1 (p1 <0.020), thrombospondin (p1 <0.001), intercellular adhesion molecules (p1 <0.001) and decrease of nitric oxide metabolites (p1 <0.001) and thrombomodulin (p1 <0.001); the last combined with the activation of procoagulant hemostasis.

Conclusion: There is a pathogenetic relationship between the development of endothelial dysfunction, impaired blood coagulation potential and the severity of clinical signs of preeclampsia. To widen the number of existing techniques to diagnose the severity of pre-eclampsia we recommende to mesure endothelin 1, thrombomodulin, thrombospondin, intercellular adhesion molecules and nitric oxide metabolites in the blood plasma, and use traditional indicators to assess the hemostatic system.

Annals of the Russian academy of medical sciences. 2015;70(5):599-603
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Condition of State and Trait Anxiety in Pregnant Women with Fetal Malformations
Khudaverdyan A.D.

Abstract

Objective: Our aim was to assess the level of state and trait anxiety, and the level of tolerated stress in pregnant women with fetus malformations.


Methods: A controllled non-randomized clinical study with sequential inclusion of participants was carried out. Psychoemotional status of pregnant women was assessed by Spielberger anxiety scale, with identification of state and trait anxiety, as well as on the basis of medical history data. Pregnant women were divided into 2 groups. Control group — 20 women with physiological gestation course without any fetus malformations and absence of stress situations in medical history. Main group — 40 women with fetus malformations, presence of long stressful situations in medical history, starting from early gestation period.

Results: 60 women aged 20–37 years old, at the pregnancy age of 20–38 weeks were examined by ultrasound with assessment anatomy of the fetus. Comparative analysis of the psychological and emotional status of pregnant women from both groups indicated significant increase of the state and trait anxiety level in the main group of women compared to the control in the average grew from 30.80±1.47 to 48.13±3.84 (p <0.001) and from 32.35±1.45 to 50.25±3.40 (p <0.001) respectively.

Conclusion: The identified high level of state and trait anxiety in pregnant women with fetus malformations allows concluding that maternal stress is a potential risk factor for generation of intrauterine malformations of the fetus. This serves as a basis to recommend corresponding prophylactic, anti-stress measures should be taken during such pregnancy, especially at early stages, when fetus tissues formation process is taking place.

Annals of the Russian academy of medical sciences. 2015;70(5):604-607
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Interneurons Brainstem of the Human
Chertok V.M., Kotsyuba A.E., Startseva M.S.

Abstract

Objective: To conduct a comparative study of the structural organization of internuclear interneurons involved in the metabolism of nitrogen monoxide, hydrogen sulphide and carbon monoxide in the caudal brain stem humans.

Methods: The cross-sectional study was performed. We used histochemical and immunohistochemical methods to study the internuclear interneurons expressing neuronal nitric oxide synthase, cystathionine β-synthase and heme oxygenase-2 which are located between the giant and small cell reticular nuclei (cell group 1), small cell reticular nucleus and the nucleus of the solitary tract (cell group 2) or is surrounded by reticular lateral nucleus (cell group 3).

Results: The work was carried out on the corpses of 6 men 18–44 years old who died from causes unrelated to the damage of the central nervous system. We revealed the differences between internuclear organization and intranuclear interneurons and local structural features of internuclear interneurons that are more clearly 
visible between the cell group 1 including a relatively large number of large neurons and cell groups 2 and 3 (р <0,001). In the latter two groups small cells with high concentrations of the neuronal nitric oxide synthase and heme oxygenase-2 dominated.

Conclusion: Despite the fact that the number of internuclear interneurons significantly is less than the number of intranuclear cells, they have structural prerequisites to control integration processes in the brain. Internuclear interneurons produce gasotransmitters and classical mediators of nerve impulse, form a local chain of interneurons between vasomotor nuclei, share many links with the above and the lower parts of the brain.

Annals of the Russian academy of medical sciences. 2015;70(5):608-613
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ANNIVERSARIES, CONGRATULATIONS
Gennadii Grigor'evich Onishchenko
 

Abstract

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Annals of the Russian academy of medical sciences. 2015;70(5):614
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