72 research outputs found
To the Mechanism of Adrenaline Damage to the Heart Tissue and the Mechanism of Cardioprotection by Neonatal, Xenogenic, Cardiac Cells. Dynamics of Creatine Phosphate, Lactate and Malondialdehyde
The development of disturbances in energy processes and damaging free radical reactions in various pathological processes, including cardiovascular diseases, are interrelated and lead to a significant deterioration in the course of diseases.Aim of the study. Research of the dynamics of malondialdehyde, creatine phosphate and lactate in the cardiac tissue of rats under experimental adrenaline stress and during its correction with neonatal, xenogenic, cardiac cells.Methods. The experiment was carried out on outbred male rats. Adrenaline damage to the heart was simulated by a single subcutaneous injection of 0.1% adrenaline solution at a dose of 0.5 mg per 100 g of body weight. The first group (37 rats) was injected subcutaneously with adrenaline, the second group (41 rats) – adrenaline and isolated heart cells of a newborn rabbit at a dose of 500 000. The third group included 6 healthy rats.Results. It was found that a spike in the level of malondialdehyde and, accordingly, the activation of free radical processes in adrenaline damage to the heart, occurred during the restructuring of the energy of the heart cell from intense glycolysis to the restoration of active mitochondrial ATP synthesis (which corresponded to the end of the depletion of lactate and creatine phosphate, and the beginning of the restoration of their content in heart cells). The dynamics of MDA sensitively reflected both the activity and the inhibition of oxidative processes in mitochondria, which manifested itself, respectively, both in the form of peaks and in a low level of MDA and corresponded to the interpretation of the dynamics of lactate and creatine phosphate.In the cardiac tissue of rats with transplantation of neonatal, xenogenic cardiac cells, the accumulation of lactate in the early stages of the experiment decreased, the subsequent depletion of the cellular reserves of creatine phosphate and lactate was inhibited, the period of inhibition (non-increase) in MDA was shorter, the subsequent increase in MDA was more moderate than in control animals.Conclusion. The data obtained indicate that neonatal cardiac cells are able to limit the disturbance of aerobic and of anaerobic processes in the heart tissue and promote the restoration of mitochondrial energy processes. Moreover, they contribute to a more efficient restoration of mitochondrial ATP synthesis, accompanied by a smaller burst of damaging free radical processes
The biochemistry laboratory of the Scientific Center of Reconstructive and Restorative Surgery SB RAMS
The article briefly describes the history of the biochemistry laboratory of the Federal State Organization "Scientific Center of Reconstructive and Restorative Surgery" SB RAMS - from organizing VI. Astafev Siberian Branch of the All-Union Scientific Center of Surgery RAMS, and create groups: 1) biochemistry (head A.L. Tarabrin) and 2) express diagnosis and drug therapy (head E.E.Kuznetsova). The main areas of research have been associated with the study of mechanisms, assessment of severity of the correction and effectiveness in the clinic and in the experiment with coronary heart disease, acute myocardial infarction, toxic hepatitis, hypercholesterolemia, hypertension, inflammatory bowel diseases, injuries. We investigated the efficacy and mechanisms: the thrombolysis in AMI, actions imozimaza in purulent processes, new antibiotics, anti-cytokine therapy in IBD, stem cell therapy in various pathologies. Results of some studies
Сравнительная характеристика иммунологических тестов для выявления туберкулезной инфекции. Возможность массового скрининга
Goal: to evaluate efficiency of various immunological tests (tuberculin tests, IGRA tests, skin tests containing proteins specific for M. tuberculosis – ESAT-6, CFP10) in the detection of tuberculous infection, their sensitivity, specificity and opportunities to be used for mass screening in children and adolescents.Materials. 122 Russian and foreign publications have been analyzed including reviews and meta-analyses.Results. The specificity of tuberculin testing is fairly low due mass BCG vaccination among children and adolescents, IGRA tests possess high specificity but can not be used for mass screening due to high costs, intravenous manipulations and need for the well-equipped laboratory. Skin tests with agents containing the same proteins as IGRA tests are highly specific, sensible and effective for mass screening. Detection rate of tuberculosis and post-tuberculous changes in children with positive reaction to these tests is significantly higher compared to those with positive reactions to Mantoux testing with 2 TU PPD-L. Цель: оценка эффективности различных иммунологических тестов (туберкулиновые пробы, тесты IGRA и кожные пробы с препаратами, содержащими специфичные для M. tuberculosis белки - ESAT-6, CFP10) для выявления туберкулезной инфекции, их чувствительности, специфичности и возможности использования для массового скрининга у детей и подростков.Материалы. Проанализированы 122 источника российской и иностранной литературы, включая обзоры и метаанализы.Результаты. Туберкулинодиагностика в условиях массовой вакцинации БЦЖ детей и подростков обладает низкой специфичностью, тесты IGRA обладают высокой специфичностью, но не применимы при массовом скрининге из-за высокой стоимости, внутривенных манипуляций и необходимости оснащенной лаборатории. Кожные пробы с препаратами, содержащими те же белки, что и тесты IGRA, обладают высокой специфичностью, чувствительностью, а также эффективностью при массовом скрининге. Выявляемость туберкулеза и посттуберкулезных изменений у детей с положительными реакциями на эти пробы значительно выше, чем у лиц с положительными реакциями на пробу Манту с 2 ТЕ PPD-L
Molecular Genetic Studies of Intraoperative Ligamentum Flavum Bioptates of Patients with Spinal Canal Stenosis
Background. Ligamentum flavum is involved in the development of stenosis of the spinal canal and dural sac, but the mechanisms underlying degenerative-dystrophic changes have not yet been sufficiently studied. Aim. To study the expression of candidate genes potentially involved in connective tissue metabolism in intraoperative samples of Ligamentum flavum of patients with stenosis processes of spinal canal and duralsac on the lumbar spine.Materials and methods. During the surgical treatment, Ligamentum flavum biopsies were collected from 33 people with stenosis processes of spinal canal and dural sac on the lumbar spine (16 men, 17 women). RNA was isolated, then reverse transcription was performed. After that, real time PCR was performed (CFX96, Biorad) with the specific primers (RealTimePrimers.com).Results. The characteristics of the expression of candidate genes that are active in the Ligamentum flavum of the examined patient population are given: NAT1 and NAT2 acetyltransferase genes; genes that determine the intensity of local metabolism (Dio1, Dio2 and Dio3); estradiol receptor genes ESR1 and ESR2; genes encoding receptors for growth factors and parathyroid hormone. All Ligamentum flavum samples showed activity of the NAT, ESR 2, FGFR1, FGFR3, NA20, PTH1R, and PTH2R genes. In the vast majority of samples (93.9–97.0 %), the following genes were active: PDGFA, ESR1, CALCR, and PDGFB. In 21.2–39.4 % of samples, “silence” of the Dio1, Dio2, Dio3, NAT2 and GDF5 genes was detected, and only 39.4 % of samples revealed NAT1 transcripts. The highest heterogeneity of transcript content was observed for Dio1, NAT2, and Dio2. The most stable expression in Ligamentum flavum tissue and a narrow range of fluctuations were characterized by genes with a high level of activity AANAT, ESR2, NAA20 and genes with an average level of activity FGFR1, FGFR3, PTH1R and PTH2R.Conclusions. Ligamentum flavum is a promising little-studied substrate for molecular genetic research. The revealed features of gene expression provide new information about pathogenesis, and the new fundamental knowledge obtained can provide a basis for developing methods for preventing the development of epidural fibrosis
Fecal calprotectin and microbiota of the gut
Analysis of the literature and our research showed that an imbalance of the intestinal microbiota is associated with many diseases. We present some of the mechanisms of disease. Using non-invasive, simple, affordable method of determination of fecal calprotectin reveals the presence and progression of chronic non-specific inflammatory bowel disease, and can be widely used in clinical practic
Surgical treatment of urethral tuberculosis in men – history and present (literature review)
The literature review provides data on tuberculosis of the urethra in men. This disease is rarely recorded, as a rule, at the stage of formation of the urethral stricture, which can develop many years after the onset of the disease. Urethral tuberculosis is usually secondary to other localizations of extrapulmonary tuberculosis, such as tuberculosis of the prostate, penis, kidney, and bladder, but there are also isolated forms of this disease. The most common symptoms of urethral tuberculosis are the presence of strictures, skin-urethral and recto-prostatic fistulas, and purulent urethritis. Almost always, with this disease, conservative specific therapy was carried out, which in some cases made it possible to completely eliminate the symptoms and ensure the patient’s clinical recovery. Tuberculous urethral strictures are operated on according to generally accepted rules, but there is no single algorithm for the surgical treatment of strictures of this etiology, often limiting itself only to urine diversion or urethral dilation. Of the urethroplasty, the most commonly used end-to-end urethral anastomosis. In our opinion, a promising direction is the use of various grafts for the surgical treatment of this disease
Six-month therapy of CGRP monoclonal antibodies in real-world clinical practice: an interim analysis of efficacy and safety data
Introduction. Migraine is one of the most common disabling neurological disorders. Recently developed monoclonal antibodies to calcitonin gene-related peptide (CGRP) or its receptor are the first targeted medication for preventive therapy of both episodic and chronic migraine. They have been thoroughly investigated in clinical trials; however, there is little data from real-world clinical practice available to date. The aim of this study is to assess the efficacy and safety of 6 months of treatment with erenumab in real-world clinical practice and investigate the effect of the drug on the patients’ sensitivity to medicines for migraine headaches relief and patient satisfaction after treatment.Materials and methods. Our observational cohort prospective study included patients in our Headache Clinic prescribed monoclonal antibodies blocking the CGRP-receptor – erenumab. During the investigation, we evaluated the previous preventive therapy and its efficacy, the number of days with migraine per month, adverse events occurring during the erenumab treatment, depression and anxiety (HADS), migraine disability (MIDAS), the presence of allodynia (ACS-12) and improved response to acute therapy after treatment. A total of 42 patients participated in the study: 6 men, 36 women, the average age was 43.9 ± 12.2. Of them, 38 patients (90%) had chronic migraine. Thirty-two patients (76%) had previously been prescribed preventive therapy, which proved ineffective, and 10 patients (24%) had not once received any type of migraine prevention.Results. Among our patients, we identified 11 patients with resistant migraine and one patient with refractory migraine. During the study, two patients dropped out due to adverse events (constipation). Thirty patients continued the administration of erenumab 70 mg for at least six months. The average number of migraine days per month before treatment was 22.8, and after six months of treatment, it dropped to 7.3. Twenty-nine patients (72.5%) also noted that the response to acute headache treatment improved after the therapy.Conclusion. The results of our study are consistent with the international experience of using erenumab and confirm its effectiveness for migraine preventive therapy, including difficult-to-treat migraine cases. However, further studies with more participants and evaluation of predictors of successful monoclonal antibody therapy are still needed
Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease
The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.The aim: to consider the clinical and diagnostic features of intestinal tuberculosis and Crohn’s disease, to show the role of various methods of their diagnosis (CT of the abdominal cavity, CT-enterography, colonoscopy with biopsy).A clinical example shows a case illustrating the difficulties of diagnosing intestinal tuberculosis, initially diagnosed as Crohn’s disease. The features of the course, complex diagnosis and treatment of intestinal tuberculosis and its complications during immunosuppression are demonstrated. At the first stage of treatment, the patient’s data related to CT of the chest organs, colonoscopy and histological examination of biopsy samples were incorrectly interpreted. As a result, a wrong diagnosis of Crohn’s disease was made, and immunosuppressive therapy was prescribed that provoked a generalization of the existing tuberculosis process. Subsequently, repeated surgical interventions were performed for complications of intestinal tuberculosis – perforation of tuberculous ulcers, peritonitis. Based on the analysis of the literature data and our own observation, it is shown that granulomatous inflammation in the study of intestinal biopsies doesn’t always allow us to make a clear diagnosis, first of all, there are intestinal tuberculosis and Crohn’s disease in the differential diagnostic series. The use of histobacterioscopy according to Ziehl – Neelsen, the study of fecal matter by luminescent microscopy, as well as molecular genetic methods for detecting DNA MTB allow us to verify the diagnosis. If Crohn’s disease is misdiagnosed as intestinal tuberculosis, then the prescribed anti-tuberculosis therapy can cause harm and lead to a delay in the underlying disease treatment. The reverse misdiagnosis is potentially more dangerous: if tuberculosis is misdiagnosed as Crohn’s disease, then the appointment of immunosuppressive therapy can lead to the generalization of tuberculosis and the development of fatal complications
Single-stage combined urethroplasty for extended strictures of the anterior urethra of tuberculous origin
Background. Urethral strictures are currently one of the most complex pathologies in reconstructive urology. The most promising direction in this area is the development of single-stage surgical interventions that meets modern requirements for the quality of life of patients.The aim of the study. To evaluate the possibility and the effectiveness of surgical treatment of extended recurrent tuberculous urethral strictures in men using a combination of a skin flap and a buccal graft. In the literature, there is no description of the use of this technique in patients with urethral tuberculosis.Materials and methods. We observed 44 patients with urethral tuberculosis. Three men from this group of patients were diagnosed with tuberculous (post-tuberculous) extended recurrent stricture of the anterior urethra and they underwent combined single-stage urethroplasty with a ventral fasciocutaneous flap and a buccal graft using the inlay method in the penile region and with a buccal graft using the ventral onlay method in the bulbous urethra. Ultrasound of the urethra served as a method that determines the possibility of performing this surgery in case of maintaining a sufficient width of the urethral plate with a moderate degree of spongiofibrosis.Results. Patients were under observation for 34, 50 and 54 months and have good long-term functional results – all patients have unassisted urination and no residual urine. Post-micturition dribbling persists in 1 patient. The overall effectiveness of the treatment of these strictures, taking into account the treatment of repeated cases of the disease recurrence, is high.Conclusion. This technique demonstrates the possibility of performing a single-stage reconstruction of the anterior urethra in patients with extended recurrent tuberculous (post-tuberculous) urethral strictures and is also applicable for the surgical treatment of urethral strictures of other origins
Оценка эффективности массового скрининга для выявления туберкулезной инфекции у детей в возрасте от 1 до 7 лет в Москве
The objective: to evaluate effectiveness of mass screening for tuberculosis infection in children aged 1 to 7 years in different periods – before and after the use of tuberculosis recombinant allergen skin test (TRA) in primary health care as an additional diagnostic method.Subjects and Methods. The study was designed as continuous observational prospective-retrospective study. Two different periods were assessed: the first one was 2014-2016 when screening for tuberculosis infection was performed in all children from 1 to 17 years (inclusive) using Mantoux test with 2 TU PPD-L in pediatric primary health care, and then children suspected to have a positive reaction were referred to TB dispensary where they were examined with a skin test with TRA if necessary. The second period was from 2018 to 2020 when children of 1-7 years old were given Mantoux test and if tuberculosis infection was suspected, a skin test with TRA was done both in primary health care network and TB units. In the first 3 years, 1,864,137 children were examined and in the second 3 years, 2,078,800 children from 1 to 7 years old were examined.Results. Among children of 1-7 years old who were screened by two stages (initial Mantoux test, and then in those who had a positive reaction, the TRA test was used), only 10-12% of those referred to a phthisiologist were subject to dispensary follow-up. Thus, with the implementation of the new edict on screening for tuberculosis infection in children with two tests, this proportion has not changed compared to previous years, when screening was carried out only with one Mantoux test. The reason why almost 90% of the children who were referred to TB Dispensary were not subject to dispensary follow-up is the following: children who have had previous conversion of tuberculin tests, along with everyone else are again screened with Mantoux test despite being previously followed up by TB dispensary due to the primary infection.Recommendations:Currently, there is no division of Group VI into Subgroups A, B, C in the dispensary follow up grouping. Why should conversion of Mantoux test reaction from negative into positive not be considered an infection, and the increase in the reaction must be at least 6 mm.Since Order No. 124n of the Russian Ministry of Health allows testing with TRA in the primary health care in case of suspected infection, it is advisable to refer those who have already had this test to a phthisiologist.A child with conversion of Mantoux test should not be re-screened with Mantoux test but the TRA test should be used. If a positive reaction to the TRA test occurs for the first time, it should be considered as conversion of this test, and in this case the child should be examined by computed tomography (CT), and preventive therapy should be prescribed. If in subsequent years the TRA reaction increases by at least 6 mm after previous preventive therapy, the child should be re-referred for CT to rule out the development of active tuberculosis.Цель: оценка эффективности массового скрининга для выявления туберкулезной инфекции у детей в возрасте от 1 до 7 лет в разные периоды ‒ до и после начала использования кожной пробы с аллергеном туберкулезным рекомбинантным (АТР) в учреждениях первичной медико-санитарной помощи в качестве дополнительного метода диагностики.Материалы и методы. Дизайн работы – сплошное наблюдательное проспективно-ретроспективное исследование. Взяты 2 разных периода: первый – 2014-2016 гг., когда скрининг туберкулезной инфекции проводили у всех детей от 1 до 17 лет (включительно) при помощи пробы Манту с 2 ТЕ ППД-Л в учреждениях первичной медико-санитарной помощи детскому населению, а затем детей с увеличением реакции направляли в противотуберкулезный диспансер, где при необходимости их обследовали при помощи кожной пробы с АТР; второй период ‒ 2018-2020 гг., когда детям 1-7 лет проводили пробу Манту и при подозрении на развитие туберкулезной инфекции ‒ кожную пробу с АТР как в учреждениях общей лечебной сети, так и в условиях противотуберкулезного учреждения. В первые 3 года обследовано 1 864 137, а во вторые 3 года – 2 078 800 детей в возрасте 1-7 лет.Результаты. Среди детей 1-7 лет, которым проводится двухэтапный скрининг (сначала пробой Манту, затем у лиц с положительной реакцией ‒ пробой с АТР), из направленных к фтизиатру только 10-12% подлежали диспансерному наблюдению. Таким образом, с внедрением нового приказа по скринингу туберкулезной инфекции у детей двумя пробами эта доля не изменилась по сравнению с предыдущими годами, когда скрининг проводился только одной пробой Манту. Причина, по которой почти 90% детей из тех, кто был направлен в ПТД, не подлежали диспансерному наблюдению, состоит в следующем: дети, у которых ранее уже был зафиксирован «вираж» туберкулиновых проб, наряду со всеми, опять проходят скрининг пробой Манту, несмотря на то что наблюдаются или наблюдались ранее в противотуберкулезном диспансере по поводу первичного инфицирования.Рекомендации:В настоящее время в диспансерной группировке отсутствует деление VI группы на подгруппы А, Б, В. Почему не считать инфицированием переход отрицательной реакции на пробу Манту в положительную, и при этом увеличение реакции должно составить не менее 6 мм.Поскольку приказ МЗ РФ № 124н позволяет проводить постановку пробы с АТР при подозрении на инфицирование уже в первичном звене здравоохранения, целесообразно направлять к фтизиатру уже прошедших предварительно эту пробу.Ребенок с «виражом» реакций на пробу Манту не должен проходить повторно скрининг с помощью этой пробы, ограничившись пробой с АТР. При появлении впервые положительной реакции на пробу с АТР это следует считать «виражом» данной пробы, ребенку в этом случае следует проводить компьютерную томографию (КТ) и превентивную терапию. Если в последующие годы реакция на АТР увеличится не менее чем на 6 мм после проведенной ранее превентивной терапии, ребенка повторно следует направить на КТ для исключения развития туберкулеза
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