Comparative Analysis of Clinical, Hormonal and Morphological Studies in Patients with Neuroendocrine ACTH-Producing Tumours

This paper highlights the problem of neuroendocrine tumours (NETs) with clinical symptoms of hypercorticism caused by hypersecretion of adrenocorticotropic hormone (ACTH) by tumour cells. In most cases (85%), the tumours were localized in the pituitary gland (Cushing's disease); 15% of the patients had an extrapituitary tumour that manifest as an ectopic ACTH secretion (EAS). Comparative analysis of clinical, hormonal, histological, and immunohistochemical characteristics of pituitary and extrapituitary ACTH-secreting NET was performed. It included 46 patients with CD and 38 ones exhibiting ectopic ACTH secretion (EAS). Results of the study suggest differences between CD and EAS in terms of the severity of clinical manifestations and duration of the disease. Hormonal studies showed that EAS unlike CD was associated with high plasma ACTH and cortisol levels, late-evening salivary cortisol and daily urinary free cortisol, the absence of a 60% or greater reduction of cortisol in the HDDST test, and the presence of a low (less than 2) ACTH gradient in response to desmopressin administration with catheterization of cavernous sinuses. The study of morphofunctional characteristics of the removed NET demonstrated the ability of both pituitary and extrapituitary NETs to express ACTH as well as GH, PRL, LH, and FSH. The angiogenic markers (CD31 and VEGF) were detected with equal frequency regardless of the NET localization. The histological structure of all corticotropinomas suggested their benign origin, but extrapituitary NETs were represented by different morphological types with varying malignancy, invasiveness, and metastatic properties. A higher cell proliferation potential (Ki-67) was documented for NET in patients presenting with an ectopic ACTH secretion compared to those having corticotropinomas

Certain features of using modified collagen-containing raw materials with prolonged shelf life in food technology

In the current circumstances, trends in nutrition of a person striving to lead a healthy life-style require intake of meat products with the reduced energy value, minimal amounts of fat, increased protein mass fraction, presence of substances improving homeostasis of the body. The synergism of the modern nutrition science and meat industry enables creating food products that satisfy consumers’ demand. Today, in the Russian Federation, a theoretical and practical base of the technology development has been collected to the full extent in the field of rational processing of secondary raw materials in the food industry, optimal use of animal secondary raw materials, study of the protein ingredients of animal and plant origin and their deep scientifically substantiated processing, improvement of technological processes and equipment, and correspondently, product range extension. The paper broadens the information about the modified collagen-containing raw materials (cattle rumen), examines physico-chemical characteristics of the collagen-containing raw material and its changes in the process of freeze-drying with a special attention paid to the study of changes in the histological structure. The presence of the relatively uniform fibrillar structure was determined, which facilitated discovering the functional potential of proteinoids that form the fibrillar matrix in the composition of products from different groups. Analysis of IR-spectra revealed several significant absorption bands linked with the state of peptide bonds. The character of bands is linked with the complex of valence and deformation vibrations of the N- and С- types. It is believed that IR-spectra reflect conformations in the protein secondary structure, which suggests preserving properties of the tropocollagen particle or collagen molecule. Freeze-dried modified collagen-containing cattle rumen was tested by the example of jellies. The obtained databank broadens information about physico-chemical properties of modified collagen-containing raw materials (cattle rumen).In the current circumstances, trends in nutrition of a person striving to lead a healthy life-style require intake of meat products with the reduced energy value, minimal amounts of fat, increased protein mass fraction, presence of substances improving homeostasis of the body. The synergism of the modern nutrition science and meat industry enables creating food products that satisfy consumers’ demand. Today, in the Russian Federation, a theoretical and practical base of the technology development has been collected to the full extent in the field of rational processing of secondary raw materials in the food industry, optimal use of animal secondary raw materials, study of the protein ingredients of animal and plant origin and their deep scientifically substantiated processing, improvement of technological processes and equipment, and correspondently, product range extension. The paper broadens the information about the modified collagen-containing raw materials (cattle rumen), examines physico-chemical characteristics of the collagen-containing raw material and its changes in the process of freeze-drying with a special attention paid to the study of changes in the histological structure. The presence of the relatively uniform fibrillar structure was determined, which facilitated discovering the functional potential of proteinoids that form the fibrillar matrix in the composition of products from different groups. Analysis of IR-spectra revealed several significant absorption bands linked with the state of peptide bonds. The character of bands is linked with the complex of valence and deformation vibrations of the N- and С- types. It is believed that IR-spectra reflect conformations in the protein secondary structure, which suggests preserving properties of the tropocollagen particle or collagen molecule. Freeze-dried modified collagen-containing cattle rumen was tested by the example of jellies. The obtained databank broadens information about physico-chemical properties of modified collagen-containing raw materials (cattle rumen)

EFFECTIVENESS OF EDUCATIONAL PROGRAMS ON EARLY DIAGNOSIS OF ANKYLOSING SPONDYLITIS FOR PRIMARY CARE PHYSICIANS IN KAZAN

The diagnosis of ankylosing spondylitis (AS) in the real-life practice is delayed for 7–8 years on average. Educational programs for primary care physicians may promote the disease diagnosis. Objective. To analyze the effectiveness of the educational programs for the early diagnosis of AS for primary contact physicians in the real-life clinical practice in Kazan. Material and methods. The development of the educational programs and determination of their effectiveness com- prised three stages: 1) determination of the level of knowledge and problems in the diagnosis and treatment of AS among primary care physicians and neurologists; 2) development of educational programs suitable to be used in the real-life clinical practice; 3) analysis of the effectiveness of implementing the programs according to the reports on work of the City Rheumatology Center in 2009–2011. Results. After running the courses, the number of patients with AS at the Kazan City Rheumatology Center increased almost twofold, from 378 in 2009 to 683 in 2011; the period from the onset of the disease to diagnosis was simultane- ously reduced from 8.4 to 3.5 years. Conclusion. The educational programs for primary care physicians and neurologists in Kazan have promoted shorten- ing of the AS diagnosis time

Туберкулезные менингиты у ВИЧ-позитивных и ВИЧ-негативных пациентов

The objective: to study the epidemiological rates of tuberculous meningitis (TM) in Smolensk and Kaluga Oblasts in 2015-2020.Subjects and Methods. 51 medical fles (Form no. 003-u) of patients with TM were analyzed, those patients were treated in in-patient settings in Smolensk and Kaluga Oblasts over a 6-year period (2015-2020).Results. The proportion of TM signifcantly correlates with the prevalence of HIV in 2 Oblasts (r = 0.953, p = 0.140 and r = 0.978, p = 0.095, respectively), which allows stating that HIV is the main risk factor for the development of TM. Tuberculous meningitis is more common in men (70.6%) of working age (94.1%), unemployed (60.8%), in combination with pulmonary tuberculosis (64.7%). Late diagnosis of TM is registered in ⅔ of cases; patients fail to undergo the mandatory minimum diagnostic examination. Among patients with HIV infection, TM more often develops in men (90%) of working age (100%), who do not have a regular job (80%), against the background of risk factors (drug addiction, hepatitis C, experience of incarceration), duration of HIV infection up to 10 years and recurrence of tuberculosis. Among HIV positive patients, a severe state, generalized forms of tuberculosis, including lung lesions with scanty bacterial discharge in sputum are registered in 100% of cases.Цель: изучить эпидемиологические показатели по туберкулезному менингиту (ТМ) в Смоленской и Калужской областях в 2015-2020 гг.Материалы и методы. Проведен анализ 51 медицинской карты стационарного больного (форма № 003-у) пациентов с ТМ,лечившихся в Смоленской и Калужской областях, за 6-летний период (2015-2020 гг.).Результаты. Доля ТМ достоверно коррелирует с распространенностью ВИЧ-инфекции в обоих регионах (r = 0,953, p = 0,140 и r = 0,978, p = 0,095 соответственно), это дает основание говорить, что ВИЧ-инфекция является основным фактором риска развития ТМ. ТМ чаще болеют мужчины (70,6%) работоспособного возраста (94,1%), неработающие (60,8%), в сочетании с туберкулезом легких (64,7%). Поздняя диагностика ТМ регистрируется в ⅔ случаев, пациентам не выполняется обязательный диагностический минимум обследования. Среди пациентов с ВИЧ-инфекцией ТМ чаще развивается у мужчин (90%) трудоспособного возраста (100%), не имеющих постоянной работы (80%), на фоне факторов риска (наркомания, гепатит С, пребывание в местах лишения свободы), при длительности ВИЧ-инфекции до 10 лет и рецидиве туберкулеза. Среди ВИЧ-позитивных пациентов в 100% случаев регистрируются тяжелое состояние, генерализованные формы туберкулеза, включающие поражение легких со скудным бактериовыделением в мокроте

Forecasting the development of mechanical engineering using the system dynamics method

At modern conditions of world economy tendencies, the connections between subjects of economy are becoming more difficult and closer. In particular, if in the past were spread hard forms of private ownership of enterprises at present-day world is going conversion to more flexible and mobile composition of subjects' activities. Computer simulation modeling is giving the best results at the areas were the participants of social and economic activities are spending significant efforts and sufficiently much time for visuality playing and analysis of possible variants of the development of the events. The more difficult is the situation the more objects, factors, and possible variants of events' progress is necessary to play in different combinations between together and bigger effect possible to expect from application of simulation model for analyzing of the situation and for searching and making optimized decisions. The application of system dynamics method allows executing forecasting of economic agents including the sectors of economy. © 2020 American Institute of Physics Inc.. All rights reserved

Ferutinin Induces Membrane Depolarization, Permeability Transition Pore Formation, and Respiration Uncoupling in Isolated Rat Liver Mitochondria by Stimulation of Ca 2+ -Permeability

It is well known that the terpenoid ferutinin (4-oxy-6-(4-oxybenzoyloxy) dauc-8,9-en), isolated from the plant Ferula tenuisecta, considerably increases the permeability of artificial and cellular membranes to Ca2+-ions and produces apoptotic cell death in different cell lines in a mitochondria-dependent manner. The present study was designed for further evaluation of the mechanism(s) of mitochondrial effects of ferutinin using isolated rat liver mitochondria. Our findings provide evidence for ferutinin at concentrations of 5–27 µM to decrease state 3 respiration and the acceptor control ratio in the case of glutamate/malate as substrates. Ferutinin alone (10–60 µM) also dose-dependently dissipated membrane potential. In the presence of Ca2+-ions, ferutinin (10–60 µM) induced considerable depolarization of the inner mitochondrial membrane, which was partially inhibited by EGTA, and permeability transition pore formation, which was diminished partly by cyclosporin A, and did not influence markedly the effect of Ca2+ on mitochondrial respiration. Ruthenium Red, a specific inhibitor of mitochondrial calcium uniporter, completely inhibited Ca2+ -induced mitochondria swelling and membrane depolarization, but did not affect markedly the stimulation of these Ca2+-dependent processes by ferutinin. We concluded that the mitochondrial effects of ferutinin might be primarily induced by stimulation of mitochondrial membrane Ca2+-permeability, but other mechanisms, such as driving of univalent cations, might be involved

Оценка эффективности и безопасности совместного применения нестероидных противовоспалительных препаратов и толперизона пролонгированного высвобождения у пациентов с травмой голеностопного сустава

   Ankle capsular ligamentous apparatus damage is one of the most common problems. Ankle injuries account for one-fifth of all lower extremity sports injuries. More than 81 % of acute ankle injuries are treated conservatively, with the rate of unsatisfactory results after this treatment ranging from 2 to 36.9 %.   Objective: to evaluate the efficacy and safety of the combined use of aceclofenac (Airtal) and tolperisone (Mydocalm Long) in patients with acute ankle ligament injuries.   Material and methods. Sixty patients aged 18 to 65 years with acute ankle ligament injury of grade II according to Kannus and Renstrom, with pain intensity in the joint on a visual analogue scale (VAS) ≥ 50 mm, who had no contraindications for the use of these drugs, participated in the study. Patients in the main group (n = 30) received aceclofenac 100 mg in powder form 2 times daily and tolperisone 450 mg in tablets once daily for 14 days. Patients in the comparison group (n = 30) received only aceclofenac 100 mg in powder form 2 times daily for 14 days. The efficacy of therapy was assessed by pain dynamics according to VAS and functional abilities according to the Foot and Ankle Ability Measure (FAAM) questionnaire, which included the Activities of Daily Living (ADL) subscale and the Sports subscale. To assess safety, laboratory tests were performed at visits 1 and 4, and adverse events (AEs) were assessed at visits 2, 3, and 4.   Results and discussion. Combined use of aceclofenac and tolperisone in patients with acute ankle ligament injuries resulted in more clinically significant pain reduction and improvement in functional indicators than aceclofenac monotherapy. In the combination therapy group, after completion of treatment on day 15, the severity of pain decreased by 94.8%, the increase in the score on the ADL scale was 62.9 % and on the Sports scale – 70.4 %. In the monotherapy group, pain intensity decreased by 85.1 %, the increase in the score on the ADL scale reached 40.7% and onthe Sports scale – 43.4 %. Throughout the study period, the medications were well tolerated, and no AEs were recorded.   Conclusion. The combined use of aceclofenac and tolperisone in patients with acute ankle ligament damage leads to a reduction in pain intensity in a short time, significantly improves indicators of functional activity, promotes a faster return to sports activities, and at the same time has a favourable safety profile.   Повреждение капсульно-связочного аппарата голеностопного сустава – одна из распространенных проблем. Травмы голеностопного сустава составляют пятую часть всех спортивных повреждений нижних конечностей. Консервативное лечение используется более чем в 81 % случаев острых повреждений голеностопного сустава, при этом частота неудовлетворительных результатов варьируется от 2 до 36,9 %.   Цель исследования – оценить эффективность и безопасность совместного применения ацеклофенака (Аэртал) и толперизона (Мидокалм Лонг) у пациентов с острым повреждением связок голеностопного сустава.   Материал и методы. В исследовании участвовали 60 пациентов в возрасте от 18 до 65 лет c острым повреждением связок голеностопного сустава II степени тяжести по Kannus и Renstrom, с интенсивностью боли в суставе по визуальной аналоговой шкале (ВАШ) ≥ 50 мм, не имеющих противопоказаний для назначения указанных препаратов. Пациенты основной группы (n = 30) получали ацеклофенак 100 мг в порошках 2 раза в день и толперизон 450 мг в таблетках 1 раз в день на протяжении 14 дней. Пациенты группы сравнения (n = 30) использовали только ацеклофенак 100 мг в порошках 2 раза в день на протяжении 14 дней. Эффективность терапии оценивалась по динамике боли по ВАШ и функциональных возможностей по опроснику FAAM, который включал подшкалу повседневной деятельности (ADL) и подшкалу спорта (Sports). Для оценки безопасности во время визитов 1 и 4 проводились лабораторные исследования, а на момент визитов 2, 3 и 4 оценивались нежелательные реакции (НР).   Результаты и обсуждение. При совместном применении ацеклофенака и толперизона у пациентов с острым повреждением связок голеностопного сустава выявлены клинически более значимые уменьшение боли и улучшение функциональных показателей, чем при монотерапии ацеклофенаком. В группе комбинированной терапии после окончания курса лечения на 15-й день выраженность боли снизилась на 94,8 %, прирост счета по шкале повседневной деятельности составил 62,9 %, а по шкале спорта – 70,4 %. В группе монотерапии выраженность боли уменьшилась на 85,1 %, прирост счета по шкале повседневной деятельности достиг 40,7 %, а по шкале спорта – 43,4 %. На протяжении всего периода исследования переносимость препаратов была хорошей, НР не зарегистрировано.   Заключение. Совместное применение ацеклофенака и толперизона у пациентов с острым повреждением связок голеностопного сустава в короткие сроки приводит к снижению выраженности боли, значительно улучшает показатели функциональной активности, способствует более быстрому возвращению к спортивным нагрузкам и при этом имеет благоприятный профиль безопасности

Long-term follow-up of a female patient with Weber–Christian panniculitis

Weber–Christian disease is a rare form of lobular panniculitis characterized by painful subcutaneous nodules on the trunk and limbs commonly concurrent with systemic manifestations and a tendency to relapse. Known are only sporadic cases of a long-term (more than 5-year) followup of patients with Weber–Christian disease. For this reason, there are neither prognostic criteria for the disease no proven conventional treatment option now. The paper describes a clinical case of a female patient with a verified diagnosis of Weber–Christian disease who has a sustained subclinical remission due to low-dose prednisone use and basic antirecurrent therapy

A case report of surgical treatment of amiodarone-induced thyrotoxicosis in a patient with multiple organ failure

Amiodarone is a drug used in the treatment of life-threatening arrhythmias, which can lead to the development of amiodarone-induced thyrotoxicosis. In most cases this pathology can be treated by conservative methods; surgical treatment is resorted to in cases of thyrotoxicosis refractory to medical treatment. This case report describes surgical treatment of a patient with amiodarone-induced thyrotoxicosis, progressive heart failure, neurological pathology, bilateral pneumonia, functioning tracheostomy, systemic infectious process, multiple organ dysfunction syndrome, who was treated in the intensive care unit. Due to the lack of response to therapy with antithyroid drugs (thiamazole, lithium preparations and pulse therapy with prednisolone) and a progressive deterioration of the condition in a short period of time, according to vital indicators, the patient underwent thyroidectomy. In the postoperative period, there was a decrease in the occurrence of chronic heart failure symptoms. Medical control of cardiac arrhythmias was achieved. Surgical stage proceeded without complications in the period of 30-days. The patient was discharged for outpatient rehabilitation treatment