Vol 71, No 5 (2016)

ANAESTHESIOLOGY AND CRITICAL CARE MEDICINE: CURRENT ISSUES

Methods of Molecular Transfusion in Intensive Care of Critical States in Pediatric Postoperative Cardiac Surgery Patients

Yaroustovsky M.B., Abramyan M.V., Komardina E.V.

Abstract

Molecular techniques in transfusion medicine have become popular in the clinical practice of pediatric intensive care units when the patient needs blood purification, more recently, in children in critical condition. Considering the anatomical and physiological characteristics of the child’s body, pronounced severity, and rapid progression of multiple organ disorders, the key problems defining the treatment results are instrument reading, choice and timely initiation of extracorporeal therapy. Today, along with the methods of renal replacement therapy in children albumin dialysis therapy and high-volume plasmapheresis are successfully applied in the treatment of acute liver dysfunction; extracorporeal membrane oxygenation — in the treatment of biventricular cardiac and/or respiratory failure. Selective endotoxin sorption methods (LPS-adsorption) are implemented in the treatment of severe gram-negative sepsis.
Annals of the Russian academy of medical sciences. 2016;71(5):341-349
pages 341-349 views

INFECTIOUS DISEASES: CURRENT ISSUES

Aptamers in the Treatment of Bacterial Infections: Problems and Prospects

Zeninskaya N.A., Kolesnikov A.V., Ryabko A.K., Shemyakin I.G., Dyatlov I.A., Kozyr A.V.

Abstract

Aptamers are short single-stranded oligonucleotides which are selected via targeted chemical evolution in vitro to bind a molecular target of interest. The aptamer selection technology is designated as SELEX (Systematic evolution of ligands by exponential enrichment). SELEX enables isolation of oligonucleotide aptamers binding a wide range of targets of interest with little respect for their nature and molecular weight. A number of applications of aptamer selection were developed ranging from biosensor technologies to antitumor drug discovery. First aptamer-based pharmaceutical (Macugen) was approved by FDA for clinical use in 2004, and since then more than ten aptamer-based drugs undergo various phases of clinical trials. From the medicinal chemist’s point of view, aptamers represent a new class of molecules suitable for the development of new therapeutics. Due to the stability, relative synthesis simplicity, and development of advanced strategies of target specific molecular selection, aptamers attract increased attention of drug discovery community. Difficulties of the development of next-generation antibiotics basing on the conventional basis of combinatorial chemistry and high-throughput screening have also amplified the interest to aptamer-based therapeutic candidates. The present article reviews the investigations focused on the development of antibacterial aptamers and discusses the potential and current limitations of the use of this type of therapeutic molecules.
Annals of the Russian academy of medical sciences. 2016;71(5):350-358
pages 350-358 views

MICROBIOLOGY: CURRENT ISSUES

Comparative Genotyping of Staphylococcus aureus Strains Isolated from Skin Lesions, Nasal Cavities, and Feces of Children with Atopic Dermatitis

Pikina A.P., Shkoporov A.N., Kulagina E.V., Khokhlova E.V., Chaplin A.V., Volodin N.N., Kafarskaya L.I., Korotkiy N.G., Efimov B.A.

Abstract

Background: The lesion of skin of the majority atopic dermatitis patients is chronically colonized by bacteria belonging to the species Staphylococcus aureus. Topical antibacterial and anti-inflammatory therapy treatment are often ineffective due to fast recolonization by S. aureus and exacerbation of allergic process.

Aims: Our aim was to determine a frequency of S. aureus colonization in skin lesions, mucous membranes of the nasal cavity and intestine of children with atopic dermatitis, to compare the genotypes of Staphylococcus aureus strains isolated from different biotopes of atopic dermatitis patients, and to clarify whether the intestinal and nasal cavities microbiota may act as a source of S. aureus recolonization of skin lesions.

Materials and methods: Bacteriological examination of fecal samples, skin, and nasal swabs was conducted in 38 atopic dermatitis patients. The pure bacterial cultures of S. aureus were identified using API Staph (Biomerieux, France) and Vitek 2 MS (Biomerieux, France). Isolates of S. aureus were subjected to genotyping by analysis of rRNA internal 16S-23S rRNA spacer regions and high resolution melting analysis (HMR) of polymorphic spa X-regions.

Results: 99% S. aureus strains were successfully identified using MALDI-TOF mass-spectrometry. S. aureus cultures were isolated from all biotopes in 31,6% of children, from skin and nasal cavities — in 42% of cases, from skin and feces — in 2,6% of cases, only from skin — in 10,5%, from nasal cavities and feces — in 2,6%, and only from nasal cavities — in 2,6% of cases. In 8% of children, S. aureus was not detected in any of the biotopes. Genotyping of the isolates enabled the detection of 17 different genotypes. A match between the genotypes of skin and nasal strains, and skin and fecal strains was observed in 88% and 61% of the cases respectively.

Conclusions: The observed a high-frequency matching genotypes suggests the possibility of migration of S. aureus strains inside biotopes in humans and the absence of specialization to colonization of any of the niches.

Annals of the Russian academy of medical sciences. 2016;71(5):367-374
pages 367-374 views

CELL TRANSPLANTOLOGY AND TISSUE ENGINEERING: CURRENT ISSUES

The Use of Stem Cells in the Treatment of Intervertebral Disc Degeneration

Byvaltsev V.A., Stepanov I.A., Bardonova L.A., Belykh E.G.

Abstract

The paper presents a review of current data on the use of stem cells in the treatment of intervertebral disc degeneration. Acute spinal pain is often a consequence of the pathology affecting the intervertebral disc. Many applied therapeutic techniques do not provide effective results as expected because most of them address symptoms, but do not treat the underlying disease. We have outlined current findings on the molecular mechanisms of intervertebral disc degeneration, analyzed international experimental studies demonstrating the feasibility of a stem cell therapy for intervertebral disc degeneration. The conducted studies reported on the clinical application of mesenchymal stem cells or stem cells derived from adipose, synovium, and bone marrow tissue. The most pressing and undetermined issues that require further experimental and clinical studies are indicated and defined in the article.
Annals of the Russian academy of medical sciences. 2016;71(5):359-366
pages 359-366 views

NEUROLOGY AND NEUROSURGERY: CURRENT ISSUES

Facet Fixation Combined with Lumbar Interbody Fusion: Comparative Analysis of Clinical Experience and A New Method of Surgical Treatment of Patients with Lumbar Degenerative Diseases

Byvaltsev V.A., Kalinin A.A., Okoneshnikova A.K., Kerimbaev T.T., Belykh E.G.

Abstract

Background: For the treatment of patients with degenerative diseases of the lumbar spine the technique of pedicle fixation is widespread, when after open decompression channel structure locking screws are introduced into the vertebral body through the back vertebra legs. We first used a fundamentally new way of fixing the rear using the facet-boards Cage «Facet Wedge», when posterior fixation is done by closing the facet joints with minimally invasive, percutaneous method. We have not found data on the clinical efficacy of facet fixation in scientific literature.

Aims: To compare the clinical efficacy of facet fixation combined with interbody fusion in the treatment of patients with degenerative lumbar spine disease.

Materials and methods: The study included 145 patients who were divided into 2 groups. The study group with long-term observation included patients (n=100) who underwent a new method for lumbar fixation; the method comprises unilateral or bilateral implantation of titanium Cage «facet Wedge» in the joint space facet joint in combination with the anterior, lateral, and transforaminal interbody fusion. Clinical comparison group (n=45) included retrospectively recruited patients who were performed titanium pedicle screw installation after open decompression and interbody fusion posterior lumbar fixation. Dynamic observation and comprehensive evaluation of the treatment clinical results was carried out for 18 months after surgery.

Results: Cage facet installation technology is quite simple, universal for the stabilization of the rear of the complex after interbody fusion from the front, side, and rear access; and does not require the intraoperative application of expensive high-tech equipment. Comparative analysis of the main group showed significantly better results in terms of the duration of the operation [CG 125 (90; 140) min, the CCG 205 (160; 220) min; p=0.01], the volume of blood loss [CG 80 (70; 120) ml, CCG 350 (300; 550) ml; p=0.008], activation time [CG 2 (1; 2) days, 4 CCG (3; 5) days; p=0.02], length of hospitalization [CG 9 (10; 11) days, the CCG 13 (12; 15) days; p=0.03], the level of pain on a visual analog scale [CG 3 (2; 4) mm, CCG 15 (12; 18) mm; p=0.001], quality of life (by index Oswestry) [CG 8 (6; 8) points, the CCG 23 (20; 28) points, p=0.003], and labor rehabilitation [CG 3 (2; 6) months, CCG 9 (6; 12) months; p=0.0001]. The number of postoperative complications in group 1 was 13%, in the 2nd ― 31,1% (p=0,0012). The new method involves fixing the back with considerably less surgical trauma of paravertebral soft tissue that results in early activation of patients, reduction of stay in hospital period, and better functional recovery of patients.

Conclusions: The application of facet fixation combined with interbody fusion in the treatment of patients with degenerative diseases of the lumbar spine allows achieving the best clinical outcomes and fewer postoperative complications during the short and long-term follow-up if compared with the traditional method of transpedicular stabilization. The combination of low-impact and reliability facet fixation techniques for posterior stabilization of the operated segment creates favorable conditions for the restoration of a functional condition of patients, full social and physical rehabilitation.

Annals of the Russian academy of medical sciences. 2016;71(5):375-384
pages 375-384 views

PSYCHOLOGY AND PSYCHIATRY: CURRENT ISSUES

Autoantibodies to Neuropeptides in the Different States of Opium Addiction

Sharkova V.A., Kovalev I.A., Shivanova A.Y.

Abstract

Background: During the last years the addiction rate remains stable high. While the neurochemical drug effect remains unclear.

Aims: To analyze the changes of the idiotypic (аАТ1) and anti-idiotypic (аАТ2) autoantibodies to the neuroproteins S100, MBP, GFAP, NGF on the different stages of opium addiction and to indicate prognosis criteria of their effect.

Materials and methods: 70 patients (only men, aged 22−38) with diagnosis opium addiction underwent examination. According to the results of testing, we detected the intoxication in 24 patients, withdrawal ― in 24, and 22 patients were at remission stage of 21−28 days. The control group included only healthy people (n=18). The survey was focused on the rate detection of the idiotypic and anti-idiotypic IgG class antibodies in relation to the rate of neural proteins (S100, MBP, GFAP, NGF) in the serum with the IEA.

Results: in patients with opium intoxication, we revealed statistical assurance in the rate of autoantibodies amount and their counterweights to the neural proteins rate between control and experimental groups. Only the rate of the аАТ2 protein significantly decreased relatively to the MBP. In patients with abstinence, the rate of аАТ1 to the MBP, GFAP (р≤0,05) increased. The rate of аАТ2 in relation to the GFAP and MBP also increased (р≤0,05), at the same time it decreased in relation to the S100 and NGF (р≤0,05). The autoantibodies amount at the remission stage corresponded to the amount at the intoxication stage. The comparative analysis of the patient groups with the different stages of opium addiction detected the identity criteria both in the intoxication and remission. We revealed statistical assurance in the rates of аАТ1 to MBP and аАТ2 to NGF in patients with intoxication and abstinence, and in the rates of аАТ1 to GFAP, MBP, and аАТ2 to GFAP (decreased in the remission) and to S100, MBP (increased in the remission) in patients with abstinence and at remission.

Conclusion: Levels of idiotypic and anti-idiotypic antibodies to the neural proteins S100, MBP, GFAP, NGF (especially аАТ2 to MPB) could be used as diagnostic factor and for accessing different states of opium addiction.

Annals of the Russian academy of medical sciences. 2016;71(5):385-391
pages 385-391 views

ONCOLOGY: CURRENT ISSUES

Role of MUC1 Expression in Tumor Progression

Karaulov A.V., Gurina N.N., Novikov D.V., Fomina S.G., Novikov V.V.

Abstract

Mucin 1 (MUC1) is a multistructural and multifunctional protein that is involved in regulating diverse cellular activities. This strongly glycosylated transmembrane protein forms a mucous gel on the surface of epithelial cells that protects the cells from injury. MUC1 acts as a signaling molecule and transcription factor modulating metabolism and resistance to bacterial-induced inflammation. This article presents a review of the relationship between structural and functional changes of the MUC1 and the characteristics of cancer cells. The alteration in MUC1 expression level, a number of structural forms, protein glycosylation and localization occurs in cancer cells. These alterations lead to metabolic reprogramming associated with proliferation, resistance to hypoxia and angiogenesis which affects the survival of cancer cells. Furthermore, cancer cells can take advantage of MUC1 interaction with adhesion molecules for invasion and metastasis. Thus, MUC1 plays a key role both in the homeostasis of epithelial cells and in cancer progression. Understanding the role of MUC1 expression in tumor cells survival is important for the development of new monitoring and therapeutic approaches for the treatment MUC1 positive maligancies.
Annals of the Russian academy of medical sciences. 2016;71(5):392-396
pages 392-396 views

STATE OF MEDICAL SCIENCES

Stimulation of Research in Biomedicine. Role of Effective Contract

Aleksandrova N.V., Shkolnikova M.A., Dlin V.V., Yugay M.T.

Abstract

Background: Analysis of publication activity in the field of biomedicine shows insignificant input of Russia in the world scientific product. This is largely due to the lack of incentives for researchers. Article describes stimulation of researchers in Russia, compares it with foreign models, formulates main shortcomings of support and stimulation of research in Russia and introduces the concept of effective contract.

Aims: Development of personnel motivation and stimulation of employees of scientific and research organizations in the field of health.

Materials and methods: As a successful experience the article describes the implementation of effective contract in Veltishev Research and Clinical Institute for Pediatrics where for years remuneration of researchers depended upon their positions without consideration of research results. Effective contract brought significant changes in the traditional system setting new performance and efficiency criteria. New evaluation system took into account publication activity, presentation activity, implementation of research results, raising scientific personnel, thesis work and income-generating activities.

Results: Introduction of effective contract already in the second year led to a rise in the number of foreign publications, publications in journals with impact factor of more than 2, the general increase in the number of articles in peer-reviewed journals with impact factor more than 0.3, the growth of the number of articles by 1 researcher, Hirsch index improving both by individual employees and the entire Institute, increase of grant activity and presentation activity at top-rated professional congresses. The growth of publication and presentation activities has been achieved at the reduction of research staff by 23%. From financial viewpoint effective contract resulted in the redistribution of resources in favour of more efficient researchers.

Conclusions: The introduction of effective contract and increase of requirements for scientific output did not cause resistance of staff, although demanded certain time for joint development of criteria by scientific community, as well as the development and implementation of soft for continuous assessment of research activity.

Annals of the Russian academy of medical sciences. 2016;71(5):397-405
pages 397-405 views

ANNIVERSARIES, CONGRATULATIONS

Nikolay Vasilevich Medunitsyn

Editorial A.

Abstract

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Annals of the Russian academy of medical sciences. 2016;71(5):406
pages 406 views

Yuriy Petrovich Pivovarov

Editorial A.

Abstract

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Annals of the Russian academy of medical sciences. 2016;71(5):407
pages 407 views

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