НОЗОКОМИАЛЬНЫЙ РЕСПИРАТОРНО-СИНЦИТИАЛЬНЫЙ ВИРУСНЫЙ БРОНХИОЛИТ У НЕДОНОШЕННЫХ ДЕТЕЙ: ОСОБЕННОСТИ ТЕЧЕНИЯ, ЛЕЧЕНИЕ И ПРОФИЛАКТИКА В РЕАЛЬНОЙ КЛИНИЧЕСКОЙ ПРАКТИКЕ

Objective: to study the clinical, laboratory and radiological features of the course of nosocomial bronchiolitis respiratory syncytial viral (RSV ) etiology and effectiveness of the therapy in preterm infants in the neonatal hospital conditions. Patients and Methods: We analyzed case histories of 10 hospitalized patients who had RSV etiology bronchiolitis established by RIF / PCR in neonatal Moscow hospitals in  2011-2013. Results: RSV infection in hospitalized preterm infants with and without bronchopulmonary dysplasia runs hardly, requiring treatment in the intensive care unit, oxygen therapy and  lungs mechanical ventilation. The respiratory failure is the symptom of the of RSV bronchiolitis severity. X-ray picture of the disease is characterized by peribronchial changes, emphysematous swelling , segmental infiltration and bronchial obstruction (atelectasis, hypoventilation ). The frequency of bacterial complications of RSV bronchiolitis is low. In clinical practice newborns with severe RSV bronchiolitis are treated with antibiotics, bronchodilators, steroids. The timely isolation of patients can prevent the extention of the infection in the hospital. Conclusions: The preventive measures are needed to prevent the extention of RSV in neonatal hospitals, including specific immune prophylaxisof RSV infection in children at risk .Цель исследования: изучить клинические, лабораторные и рентгенологические особенности течения нозокомиального бронхиолита респираторно-синцитиально-вирусной (РСВ) этиологии и эффективность проводимой терапии у недоношенных детей в условиях неонатологического стационара. Пациенты и методы: произведен анализ историй болезней 10 госпитализированных пациентов, перенесших бронхиолит РСВ-этиологии, установленной методом РИФ/ПЦР в неонатологических стационарах г. Москвы в 2011–2013 гг. Результаты: РСВ-инфекция у госпитализированных недоношенных детей с и без бронхолегочной дисплазии протекает тяжело, требуя лечения в условиях отделения реанимации и интенсивной терапии, назначения оксигенотерапии и проведения искусственной вентиляции легких. Тяжесть течения РСВ-бронхиолита определяется дыхательной недостаточностью. Рентгенологическая картина заболевания характеризуется перибронхиальным изменениями, эмфизематозным вздутием, сегментарной инфильтрацией и нарушением бронхиальной проходимости (ателектаз, гиповентиляция). Частота бактериальных осложнений при РСВ-бронхиолите невелика. В реальной клинической практике новорожденным с тяжелым течением РСВ-бронхиолита назначаются антибиотики, бронхолитики, стероиды. Предотвращению распространения инфекции в стационаре может способствовать своевременная изоляция больных.  Выводы: необходимы профилактические мероприятия для предотвращения распространения РСВ в неонатологических стационарах, в т.ч. специфическая иммунопрофилактика РСВ-инфекции у детей групп риска.

Nosocomial respiratory syncytial virus bronchiolitis in preterm infants: Characteristics of the course, treatment and prevention in clinical practice

Objective: to study the clinical, laboratory and radiological features of the course of nosocomial bronchiolitis respiratory syncytial viral (RSV) etiology and effectiveness of the therapy in preterm infants in the neonatal hospital conditions. Patients and Methods: We analyzed case histories of 10 hospitalized patients who had RSV etiology bronchiolitis established by RIF/PCR in neonatal Moscow hospitals in 2011-2013. Results: RSV infection in hospitalized preterm infants with and without bronchopulmonary dysplasia runs hardly, requiring treatment in the intensive care unit, oxygen therapy and lungs mechanical ventilation. The respiratory failure is the symptom of the of RSV bronchiolitis severity. X-ray picture of the disease is characterized by peribronchial changes, emphysematous swelling, segmental infdtration and bronchial obstruction (atelectasis, hypoventilation). The frequency of bacterial complications of RSV bronchiolitis is low. In clinical practice newborns with severe RSV bronchiolitis are treated with antibiotics, bronchodilators, steroids. The timely isolation of patients can prevent the extention of the infection in the hospital. Conclusions: The preventive measures are needed to prevent the extention of RSV in neonatal hospitals, including specific immune prophylaxis of RSV infection in children at risk

Nosocomial respiratory syncytial virus bronchiolitis in preterm infants: Characteristics of the course, treatment and prevention in clinical practice

Objective: to study the clinical, laboratory and radiological features of the course of nosocomial bronchiolitis respiratory syncytial viral (RSV) etiology and effectiveness of the therapy in preterm infants in the neonatal hospital conditions. Patients and Methods: We analyzed case histories of 10 hospitalized patients who had RSV etiology bronchiolitis established by RIF/PCR in neonatal Moscow hospitals in 2011-2013. Results: RSV infection in hospitalized preterm infants with and without bronchopulmonary dysplasia runs hardly, requiring treatment in the intensive care unit, oxygen therapy and lungs mechanical ventilation. The respiratory failure is the symptom of the of RSV bronchiolitis severity. X-ray picture of the disease is characterized by peribronchial changes, emphysematous swelling, segmental infdtration and bronchial obstruction (atelectasis, hypoventilation). The frequency of bacterial complications of RSV bronchiolitis is low. In clinical practice newborns with severe RSV bronchiolitis are treated with antibiotics, bronchodilators, steroids. The timely isolation of patients can prevent the extention of the infection in the hospital. Conclusions: The preventive measures are needed to prevent the extention of RSV in neonatal hospitals, including specific immune prophylaxis of RSV infection in children at risk

Clinical and epidemiological features and prevention of nosocomial bronchiolitis with RSV etiology in children of severe course risk groups

Preterm infants and children with bronchopulmonary dysplasia, hemodynamically significant congenital heart diseases and number of other diseases are a group of severe risk of RSV bronchiolitis requiring hospitalization and intensive, including respiratory, therapy. RSV bronchiolitis can develop as at stationary phase due to nosocomial infection, and outpatient. The article presents current information about clinical and epidemiological features of nosocomial RSV bronchiolitis in children of severe course risk groups based on infection outbreaks analysis from literature and own data. It presents data on non-specific prevention of nosocomial RSV infection and experience of prevention with nosocomial spread of monoclonal antibody to virus F protein palivizumab. © 2016, Pediatria Ltd. All rights reserved

Clinical and epidemiological features and prevention of nosocomial bronchiolitis with RSV etiology in children of severe course risk groups

Preterm infants and children with bronchopulmonary dysplasia, hemodynamically significant congenital heart diseases and number of other diseases are a group of severe risk of RSV bronchiolitis requiring hospitalization and intensive, including respiratory, therapy. RSV bronchiolitis can develop as at stationary phase due to nosocomial infection, and outpatient. The article presents current information about clinical and epidemiological features of nosocomial RSV bronchiolitis in children of severe course risk groups based on infection outbreaks analysis from literature and own data. It presents data on non-specific prevention of nosocomial RSV infection and experience of prevention with nosocomial spread of monoclonal antibody to virus F protein palivizumab. © 2016, Pediatria Ltd. All rights reserved

Contemporary strategy of pulmonary hypertension management in pediatrics

Pulmonary hypertension (PH) in pediatrics is a polygenic multifactorial condition with extremely adverse prognosis. Selection of optimal management is a severe task. In absence of treatment the mean life duration in children is not higher one year. Last two decades, revolution in approaches to treatment improved the survival of this patients group. Recently, pediatricians and pediatric cardiologists have three drugs groups that act on the main pathogenetic chains of PH: endothelin pathway, nitric oxide pathway and prostacyclin pathway. At the moment, approaches to pediatric PH are based on the data obtained in the trials on adult patients. However, not long ago there were first randomized trials on children performed. The group of authors of current article presents a modern view on the problem of PH in children, and expert recommendations on children management. Class of recommendations and evidence level were set by the data obtained in pediatric population or on adult population with at least 10%of children included. To the strategy, developed by the Russian clinicians, laid the analysis of experience of the pathology treatment in Russian Federation, as the current practics and clinical guidelines on pediatric PH in Europe, and the recent trials published. © 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved

Contemporary strategy of pulmonary hypertension management in pediatrics

Pulmonary hypertension (PH) in pediatrics is a polygenic multifactorial condition with extremely adverse prognosis. Selection of optimal management is a severe task. In absence of treatment the mean life duration in children is not higher one year. Last two decades, revolution in approaches to treatment improved the survival of this patients group. Recently, pediatricians and pediatric cardiologists have three drugs groups that act on the main pathogenetic chains of PH: endothelin pathway, nitric oxide pathway and prostacyclin pathway. At the moment, approaches to pediatric PH are based on the data obtained in the trials on adult patients. However, not long ago there were first randomized trials on children performed. The group of authors of current article presents a modern view on the problem of PH in children, and expert recommendations on children management. Class of recommendations and evidence level were set by the data obtained in pediatric population or on adult population with at least 10%of children included. To the strategy, developed by the Russian clinicians, laid the analysis of experience of the pathology treatment in Russian Federation, as the current practics and clinical guidelines on pediatric PH in Europe, and the recent trials published. © 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved

Nonwoven polycaprolactone scaffolds for tissue engineering: The choice of the structure and the method of cell seeding

Nonwoven polycaprolactone materials produced by electrospinning are perspective internal prosthetic implants. Seeding these implants with multipotent mesenchymal stromal cells stimulates the replacement of the prosthesis with recipient's own connective tissue. Electrospinning method was used for producing polycaprolactone matrices differing in thickness, pore diameter, fiber size, and biomechanical properties. Labeled cells were seeded on scaffolds in three ways: (1) static, (2) dynamic, and (3) directed flow of the cell suspension generated by capillary action. Cell distribution on the surface and the interior of the scaffolds was studied; the metabolic activity of cells was measured by MTT assay. Static seeding method yielded fully confluence of cells covered the entire scaffold surface, but the cells were located primarily in the upper third of the matrix. Dynamic method proved to be effective only for scaffolds of thickness greater than 500 microns, irrespective of the pore diameter. The third method was effective only for scaffolds with the pore diameter of 20-30 microns, regardless of the material thickness. Resorbable nonwoven polycaprolactone electrospun materials have appropriate biomechanical properties and similar to native tissue matrix structures for internal prosthesis. The choice of the most effective cell seeding method depends on the spatial characteristics - the material thickness, pore diameter, and fibers size, which are determined by the electrospinning conditions

Нетканые материалы на основе поликапролактона для тканевой инженерии: выбор структуры и способа заселения

Nonwoven polycaprolactone materials produced by electrospinning are perspective internal prosthetic implants. Seeding these implants with multipotent mesenchymal stromal cells stimulates the replacement of the prosthesis with recipient's own connective tissue. Electrospinning method was used for producing polycaprolactone matrices differing in thickness, pore diameter, fiber size, and biomechanical properties. Labeled cells were seeded on scaffolds in three ways: (1) static, (2) dynamic, and (3) directed flow of the cell suspension generated by capillary action. Cell distribution on the surface and the interior of the scaffolds was studied; the metabolic activity of cells was measured by MTT assay. Static seeding method yielded fully confluence of cells covered the entire scaffold surface, but the cells were located primarily in the upper third of the matrix. Dynamic method proved to be effective only for scaffolds of thickness greater than 500 microns, irrespective of the pore diameter. The third method was effective only for scaffolds with the pore diameter of 20-30 microns, regardless of the material thickness. Resorbable nonwoven polycaprolactone electrospun materials have appropriate biomechanical properties and similar to native tissue matrix structures for internal prosthesis. The choice of the most effective cell seeding method depends on the spatial characteristics - the material thickness, pore diameter, and fibers size, which are determined by the electrospinning conditions.Нетканые материалы на основе поликапролактона, полученные методом электроформования, являются перспективными имплантатами для эндопротезирования. Заселение таких имплантатов мультипотентными мезенхимальными стромальными клетками способствует замещению протеза собственной соединительной тканью реципиента. Целью настоящего исследования являлось сравнение эффективности трех методов заселения клетками нетканых носителей на основе поликапролактона, обладающих различными пространственными характеристиками. Методом электроформования были получены три образца поликапролактоновых матриц, отличающихся толщиной, диаметром пор и волокон, биомеханическими свойствами. Заселение носителей мечеными мультипотентными мезенхимальными стромальными клетками пупочного канатика проводили тремя способами: статичным, динамическим и методом с использованием капиллярного эффекта. Оценивали распределение клеток по поверхности и толщине образцов, метаболическую активность клеток измеряли с помощью МТТ-теста. Статичный метод позволил получить носители с равномерным покрытием поверхности, однако клетки в основном располагались в верхней трети матрикса. Динамический метод оказался эффективен только для носителей толщиной более 500 мкм, независимо от диаметра пор. Метод заселения с использованием капиллярного эффекта был эффективен только для носителей с диаметром пор 20-30 мкм, независимо от толщины материала. Биорезорбируемые нетканые материалы на основе по-ликапролактона, полученные методом электроформования, обладают подходящими биомеханическими свойствами для выполнения пластики дефектов стенок брюшной полости, имеют сходное с матриксом нативной ткани строение. Выбор наиболее эффективного метода заселения носителей клетками зависит от его пространственных характеристик - толщины материала, диаметра пор и волокон, которые, в свою очередь, определяются условиями электроформования материала