Диагностические критерии гепаторенального синдрома и современные методы терапии (обзор литературы)

Hepatorenal syndrome (HRS) is a variant of functional renal failure in acute or chronic liver pathology. Type 1 HRS entails a rapidly progressive decline in kidney function within few days and without liver transplantation, 95,0 % of patients die within the next few weeks. With type 2 HRS, kidney function remains stable or gradually declining over several months. HRS diagnosis is based on the exclusion of other causes of renal failure. Pathophysiological changes in renal failure in the case of HRS are quite complex – they include an increase in the synthesis of vasoactive substances, which lead to a decrease in renal perfusion, a decrease in resistance in peripheral arteriovenous anastomosis, the development of portal hypertension, ascites, a decrease in colloidal osmotic pressure and a consistently increasing delay of sodium and water in the kidneys. HRS therapy is based on acid-base balance and anemia correction, intravenous administration of albumin, paracentesis, the removal of nephrotoxic agents and the renal replacement therapy is only symptomatic.areast-font-family:"Times New Roman";mso-bidi-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA'>, 420012Гепаторенальный синдром (HRS) является вариантом функциональной почечной недостаточности при острой или хронической патологии печени. При HRS 1 типа почечная функция ухудшается за несколько дней и без трансплантации печени 95,0 % пациентов умирают в течение ближайших недель. При HRS 2 типа функция почек остается на стабильном уровне либо наблюдается постепенное ее снижение на протяжении нескольких месяцев. Диагноз HRS основан на исключении других причин почечной недостаточности. Патофизиологические изменения при почечной недостаточности в случае HRS достаточно сложны – они включают в себя увеличение синтеза вазоактивных веществ, которые приводят к уменьшению почечной перфузии, снижению сопротивления в периферическом артериовенозном соустье, развитию портальной гипертензии, асциту, снижению коллоидно-осмотического давления и последовательно возрастающей задержке почками натрия и воды. Терапия HRS основана на коррекции кислотно-щелочного баланса и анемии, внутривенном введении альбумина, парацентезе, удалении нефротоксических агентов, а заместительная почечная терапия – это только симптоматическая мера

РЕЗУЛЬТАТЫ СОЧЕТАННОЙ ЛУЧЕВОЙ ТЕРАПИИ РАКА ПИЩЕВОДА С ПРИМЕНЕНИЕМ БРАХИТЕРАПИИ ВЫСОКОЙ МОЩНОСТИ

Between 2008 and 2015, 82 patients with inoperable esophageal cancer were treated with radiation therapy. The patients were divided into 3 groups. Group I consisted of 30 patients, who received external beam radiation therapy (EBRT) in combination with brachytherapy. Group II and group III patients (30 and 22 patients, respectively) received EBRT alone. Patients of group II received EBRT at a total dose of 60–70 Gy and patients of group III received EBRT at a total dose of 40–50 Gy. Treatment outcomes were better in patients treated with combination of EBRT and brachytherapy than in patients treated with EBRT alone. There was no significant difference between groups 2 and 3 with regard to their survival rates. Two-year overall survival rates in group I, II and III were 36 %, 12 % and 12 % and the median overall survival time was 15.7; 9.7 and 6.6 months, respectively.Проведено сравнительное исследование с включением 82 пациентов, страдающих раком пищевода, получивших самостоятельный курс лучевой терапии. В первую группу вошли 30 пациентов, получивших сочетанную лучевую терапию с брахитерапией, во 2-ю группу – 30 пациентов, получивших дистанционную лучевую терапию (ДЛТ) до суммарной дозы 60–70 Гр, у 22 пациентов 3-й группы суммарная доза ДЛТ была ограничена 40–50 Гр. Результаты лечения оказались лучше в группе сочетанной лучевой терапии, в то время как значение суммарной дозы ДЛТ не повлияло на показатели выживаемости. Двухлетняя общая выживаемость в сравниваемых группах составила 36, 12 и 12 %, медиана общей выживаемости – 15,7; 9,7 и 6,6 мес соответственно.

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Impact of elevated nitrate on sulfate-reducing bacteria: A comparative study of Desulfovibrio vulgaris

Sulfate-reducing bacteria have been extensively studied for their potential in heavy-metal bioremediation. However, the occurrence of elevated nitrate in contaminated environments has been shown to inhibit sulfate reduction activity. Although the inhibition has been suggested to result from the competition with nitrate-reducing bacteria, the possibility of direct inhibition of sulfate reducers by elevated nitrate needs to be explored. Using Desulfovibrio vulgaris as a model sulfate-reducing bacterium, functional genomics analysis reveals that osmotic stress contributed to growth inhibition by nitrate as shown by the upregulation of the glycine/betaine transporter genes and the relief of nitrate inhibition by osmoprotectants. The observation that significant growth inhibition was effected by 70 mM NaNO{sub 3} but not by 70 mM NaCl suggests the presence of inhibitory mechanisms in addition to osmotic stress. The differential expression of genes characteristic of nitrite stress responses, such as the hybrid cluster protein gene, under nitrate stress condition further indicates that nitrate stress response by D. vulgaris was linked to components of both osmotic and nitrite stress responses. The involvement of the oxidative stress response pathway, however, might be the result of a more general stress response. Given the low similarities between the response profiles to nitrate and other stresses, less-defined stress response pathways could also be important in nitrate stress, which might involve the shift in energy metabolism. The involvement of nitrite stress response upon exposure to nitrate may provide detoxification mechanisms for nitrite, which is inhibitory to sulfate-reducing bacteria, produced by microbial nitrate reduction as a metabolic intermediate and may enhance the survival of sulfate-reducing bacteria in environments with elevated nitrate level