The influence of bronchial asthma control level on the quality of life indices

Objective: to study the indices of general and specific quality of life in schoolchildren, depending on the level of bronchial asthma control. Materials and methods: Quality of life parameters of 189 in-patients with BA, aged 6–17 years and 95 controls were studied. Parallel questioning with subsequent analysis of quality of life indices in 189 parents of BA children and 95 parents of the control group children was performed. General QL was evaluated using РedsQL (Pediatric Quality of Life Inventory 4.0). Specific quality of life was evaluated using specific quality of life questionnaire for the children ill with bronchial asthma – PAQLQ (Pediatric Asthma Quality of Life Questionnaire). Statistical analysis of the data obtained was done by variance statistical methods using the standard program package of multivariate statistical analysis Statistica 6.0 Results. The study found the index of physical functioning to be 43.6 [31.3–62.5] points in the children with UC BA, 53.1 [37.5–68.2] points in those with PC BA, being significantly lower as compared to the control group children – 79.6 [56.0–100.0] points (P 0.05). The cumulative index of QL was dependent on the level of BA control. It was 2.5 [1.4–3.6] points in the children with UC BA, being significantly lower as compared to those with PC BA – 3.9 [2.8–4.9] points, and C BA – 6.2 [5.6–6.8] points (р<0.001); and in the children with PC BA this index was significantly lower as compared to those with C BA (P < 0.01). Conclusions. Along with traditional methods of assessment of respiratory function and laboratory indices of inflammatory process activity in bronchial asthma, study of physical and mental health, social activity, general well-being and many other parameters of quality of life, as well as the influence of treatment on these parameters should be carried out

Assessment of morphological criteria for the efficiency of radiofrequency circumferential denervation of the pulmonary artery in the experiment (animals, pigs)

The aim of the study. To assess the influence of radiofrequency circumferential exposure modes on the morphological parameters of the pulmonary artery tissues in animal experiment (pigs).Material and methods. In the experiments, we used outbred pigs divided into 3 groups (4 animals in each). The first experimental group included 188 histological samples of the pulmonary arteries (PA) after radiofrequency circumferential exposure on the PA using an ablator clamp. Two lines of exposure on the PA and two lines of exposure on each PA mouth were performed. Ablation was performed until the target level of tissue impedance between the ablator branches corresponding to the values at transmural damage was reached. The second experimental group included 162 histological samples of the PA after circumferential denervation of pulmonary trunk and both PA mouths. Ablation was completed upon reaching 50 % impedance level relative to the impedance values at transmural damage. The third group (control) included 55 histological samples of PA without radiofrequency exposure. The material obtained was studied using light microscopy, hematoxylin and eosin and van Gieson’s staining, and also by impregnation with silver salts according to S. Ramón y Cajal.Conclusions. Morphological criteria for irreversible destruction of nerve fibers and ganglia of the pulmonary trunk adventitial layer and for PA bifurcation were obtained when using two studied ablation modes. Circumferential PA denervation using subthreshold power of radiofrequency exposure made it possible to avoid irreversible damage to the nerve endings and ganglia of the PA intimal layer and thus to preserve physiological neuroreflectory regulation of the PA and the entire pulmonary circulation. Turning off the cascade of pathological reflexes eliminates the factor of the progression of pulmonary hypertension associated with an increase in peripheral resistance of the pulmonary arterioles precapillary link

Features of morphological and ultrastructural organization of the cornea (literature review)

The human cornea – the anterior fibrous membrane of the eye, is a unique ordered optical-biological system that is avascular, saturated with nerve endings, includes tissue-specific cells, consists mainly of various types of collagen. An exceptional feature of the collagen layers of the cornea, including the collagen plates of the stroma, is transparency, which provides physiological refraction and light transmission due to the stable supporting properties of the cornea. The data on the morphological structure of the cornea, which is an important element of the optical system of the eye, are of considerable interest not only from theoretical, but also from practical positions. This is due to the fact that the identification of the first signs of deviation from normal physiological morphological and ultrastructural criteria in the cornea allows us to establish the nature of its pathological changes, which can be caused by both hereditary predisposition and local and general disorders. It has been shown that the thinning of the layers of the cornea, a decrease in the density of endotheliocytes or keratocytes signal the development of dystrophic processes in it. In addition to evaluating quantitative morphometric data, changes in qualitative ultrastructural indicators play an important role. In particular it was found that a decrease in the density of endothelial cells is accompanied by an increase in their size and a decrease in the cell nucleus. In addition, a number of degenerative pathological conditions are characterized by a decrease in the diameter of collagen fibrils and a change in the density of fibrillary packaging.This literature review presents basic information, features of morphology, ultrastructural organization and functional purpose of layers and cells of the human cornea

Результаты оценки гемостаза методом тромбоэластографии у пациентов с COVID-19

All currently existing studies of the hemostasis system  in COVID-19 using thromboelastography (TEG) were performed on the delta strain of SARS-CoV-2, while there is no information in the literature on conducting such studies in patients infected with the current omicron strain.Research objective. To determine the state of the hemostasis system in hospitalized patients with COVID-19 (omicron strain) using TEG. To assess the relevance of existing guidelines on anticoagulant therapy.Materials and methods. TEG was performed in 93 hospitalized patients with COVID-19 aged 1 to 88 years, of which 66 patients (group 1) on the first day and 27 patients (group 2) – on the second day. For comparison with the parameters of healthy volunteers, a sample of 30 people was formed. Data analysis was performed using the Statistica, version  12 (StatSoft, USA). To compare the independent variable in more than two samples, a multivariate ANOVA analysis of variance was performed with the calculation of the Kruskal-Wallis test. To assess the relationships between continuous variables, the Spearman direct linear correlation coefficient (r) was determined.Results. 53% of patients had hypocoagulation, 31% had normocoagulation, and 16% had hypercoagulation. Elderly patients (61 [26–72]) more often have developed hypocoagulation. Young patients (24.5 [7–37]) more often have developed hypercoagulation. Routine methods for assessing hemostasis did not reflect its true state. Higher levels of fibrinogen (4.5 [5.8–4] g/l) and D-dimer (1.28 [0.5–2.77] µg/ ml) were observed in patients from the group with normocoagulation. Was revealed a statistical tendency towards an increase in the level of amylase when there was an increase in the coagulation properties of the blood.Conclusion. With the current course of COVID-19 and early admission of non-severe patients to the hospital, normocoagulation and hypocoagulation predominate. Elderly and senile patients are not recommended to prescribe anticoagulants without TEG. It is necessary to specify the recommendations for prescribing anticoagulants to hospitalized patients. For the diagnosis of hemostasis disorders expand application of TEG.Все существующие в настоящее время исследования системы гемостаза при COVID-19 с помощью тромбоэластографии проведены на дельта-штамме SARS-CoV-2, при этом в литературе отсутствует информация о проведении подобных исследований у больных, инфицированных актуальным на сегодня штаммом омикрон.Цель:  определить  состояние   системы   гемостаза у госпитализированных больных COVID-19 (штамм омикрон) с помощью тромбоэластографии и оценить актуальность существующих рекомендаций по антикоагулянтной терапии.Материалы и методы: тромбоэластография проведена 93 госпитализированным пациентам с COVID-19 в возрасте от 1 года до 88 лет, из них 66 больным (группа 1) – в 1-й день, 27 (группа 2) – на 2-й день. Группа контроля – 30 человек. Статистическая обработка результатов исследования проводилась с помощью программы Statistica 12.0 (Stat Soft, USA). Для сравнения независимой переменной более чем в 2 выборках выполнен многофакторный дисперсионный анализ ANOVA с расчетом критерия Краскела – Уоллиса. Для оценки взаимосвязей между непрерывными переменными определен коэффициент прямой линейной корреляции Спирмена (r).Результаты: у 53% пациентов отмечалась гипокоагуляция, у 31% – нормокоагуляция, у 16% – гиперкоагуляция. Гипокоагуляция чаще развивалась у пациентов пожилого возраста (61 [26–72] лет), гиперкоагуляция – у молодых пациентов (24,5 [7–37] лет). Рутинные методы оценки гемостаза не отражали его истинное состояние. Более высокие уровни фибриногена (4,5 [5,8–4] г/л) и D-димера (1,28 [0,5–2,77] мкг/мл) отмечались у пациентов из группы нормокоагуляции. Выявлена статистическая тенденция к росту уровня амилазы при повышении коагуляционных свойств крови.Заключение: при раннем поступлении нетяжелых больных с COVID-19 в стационар преобладают нормо- и гипокоагуляция. Пациентам пожилого и старческого возраста не рекомендуется назначать антикоагулянты без выполнения тромбоэластографии. Необходимо уточнить рекомендации по назначению антикоагулянтов госпитализированным больным и шире использовать тромбоэластографию в диагностике нарушений гемостаза

Диагностические критерии тяжести обструктивного синдрома и способы его коррекции у больных бронхиальной астмой и хроническим бронхитом

The combination of bronchial asthma and chronic bronchitis is inevitable in old astmatic patients. The tolerance for sympatomimetic bronchodilatators and small reversebility are the grounds for elaboration of optimal schemes of bronchodilatation therapy. The including of antycholinergic agents into medical programs allow to obtain improvement of bronchial conduction and decrease the use of sympatomimetics.Сочетание бронхиальной астмы и хронического бронхита неизбежно у пожилых астматиков. Толерантность к симпатомиметикам, малая обратимость бронхиальной обструкции являются предпосылкой для разработки оптимальных схем бронхолитической терапии. Включение в лечебную программу антихолинергических препаратов позволяет добиться улучшения бронхиальной проходимости на фоне снижения потребности в симпатомиметиках

Комплексная оценка речевого развития детей, зачатых с помощью экстракорпорального оплодотворения

Introduction. The high frequency of the use of assisted reproductive technologies and the inconsistency of information about the parameters of the cognitive development of IVF children determined the formulation of the research problem.The purpose of the work is to assess the originality of the speech development of children and adolescents conceived using the IVF procedure. The age of the children at the time of the survey was from 5 to 15 years.Methods and materials. A sample of 51 children (29 boys), mean age (7.9±2.8) years, 14 children had psychiatric diagnoses (ASD, mental retardation, etc.). Research methods: speech therapy assessment of speech development, neuropsychological diagnostics according to L.S. Tsvetkova, WICS, descriptive statistics, correlation analysis.Results. 41% of children had mild variants of speech development delay under 3 years old, 59 % of children had normal speech development. With age, the frequency of detected deviations in speech development decreases, so that in older age group (from 11 to 15 years old), 85 % have normotypical development of speech. Correlation analysis showed the originality of the correlations of the parameters of speech development, neuropsychological assessment, and scores on Wechsler subtests.Conclusions. An unambiguous conclusion about the violation of speech development in children conceived by IVF cannot be drawn, however, in the presence of mental pathology and taking into account the age of the mother and the number of ART procedures, attention should be paid to the provision of speech therapy and neuropsychological correction from an early age.Введение. Высокая частота использования вспомогательных репродуктивных технологий (ВРТ) и противоречивость информации о параметрах когнитивного развития детей, зачатых с помощью экстракорпорального оплодотворения (ЭКО) определила постановку проблемы исследования.Цель работы — оценка своеобразия речевого развития детей и подростков, зачатых с помощью процедуры ЭКО и находящихся в возрастном интервале от 5 до 15 лет.Методы и материалы. Выборка из 51 ребенка (29 мальчиков), средний возраст — (7,9±2,8) года, 14 детей имели психиатрические диагнозы (расстройства аутистического спектра(РАС), шизотипическое расстройство (ШТР) и др.). Применяли логопедическую оценку развития речи, нейропсихологическую диагностику по Л.С. Цветковой, диагностику IQ по Векслеру, описательную статистику, корреляционный анализ.Результаты. У 41 % детей имелись легкие варианты задержки речевого развития в возрасте до 3 лет, нормативно развивалась речь у 59 % детей. С возрастом частота выявляемых отклонений в речевом развитии падает, в старшей возрастной группе (от 11 до 15 лет) норма развития речи встречалась у 85 % испытуемых. Корреляционный анализ показал своеобразие корреляционных плеяд у детей, зачатых с помощью ЭКО, при сопоставлении параметров речевого развития, нейропсихологической оценки, баллов по субтестам Векслера.Заключение. Однозначного вывода о нарушении речевого развития у детей, рожденных с помощью ЭКО, сделать нельзя, однако при наличии психической патологии и с учетом возраста матери и числа применения процедур ВРТ следует обратить внимание на оказание логопедической и нейропсихологической коррекции с раннего возраста

The first and only combination of basal and prandial insulin analogs degludec and aspart: the position of Russian endocrinologists

Insulin therapy for diabetes mellitus is the most effective way to control glycemia with the progression of the disease and the ineffectiveness of other sugar-lowering drugs. At the same time, the existing limitations of traditional insulin preparations, along with increasing attention to the individualized treatment of this disease, are pushing developers to create drugs that most closely reproduce the effect of natural human insulin. In this regard, the appearance of a combination of insulin analogs, the action profile of which practically imitates insulin secretion by a healthy pancreas, presents new possibilities in the treatment of diabetes mellitus. Insulin degludec / insulin aspart (IDegAsp, Ryzodeg®, Novo Nordisk, Denmark) is the first and only soluble combination preparation containing 70% of the ultra-long-acting insulin analogue degludec and 30% of the ultra-short-acting insulin analogue aspart in one injection, which meets the need for both basal and prandial insulin. The combined drug has nothing in common with traditional mixed insulin preparations (both human and analog) and provides doctors and patients with significant advantages over the latter. The article presents the position of Russian experts-diabetologists with extensive experience in the use of IDegAsp regarding the role and place of the drug in real clinical practice. Data from real clinical practice confirm that IDegAsp is a reasonable choice for starting and intensifying insulin therapy for type 2 diabetes mellitus when basal and prandial glycemic control is required. The use of the drug is most appropriate in patients who are on basal, biphasic, basal-plus/basal-bolus regimens and who do not achieve the goals of glycemic control during prior therapy. One of the leading reasons for choosing IDegAsp may also be a lower risk of developing hypoglycemia compared to insulin analogues of previous generations — biphasic insulin aspart and basal insulin glargine 100 U/ml. In addition, IDegAsp is a simple, flexible and safe insulin therapy for patients on premix therapy and basal-plus/basis-bolus regimens who require basal and prandial glycemic control. IDegAsp is a simple, flexible and safe insulin therapy. The greatest benefit of this drug use can be obtained by patients for whom adherence to a complex therapy regimen is difficult (the elderly, with cognitive impairment, after a stroke, with dementia), as well as patients who have an active lifestyle, accompanied by irregular food intake. It is important to note that since January 1, 2021, there is no need for a decision by a special medical commission to prescribe (IDegAsp) Ryzodeg®. This fact, as well as a significant price reduction at the end of 2020, opens up broader prospects for using the drug in the routine practice of a Russian endocrinologist

Показатели гомеостаза у больных саркоидозом органов дыхания

In 69 patients with pulmonary sarcoidosis the following homeostatic indices were studied before and after treatment: parameters of immunological tests, peroxide lipid oxidation, enzyme antioxidant defence, hormonal profile. The considerable disorders of all chains in systemic immunity were revealed: attenuation of T-lymphocytes with their subpopulation discrepancy, decreasing levels of IgA, M, G and increasing level of fibronectin. Significant changes in bronchopulmonary lavage fluid were found: decrease of alveolar macrophages, increase in lymphocytes, neutrophils, fibronectin and secretory IgA. The intensification of peroxide lipid oxidation was accompained by reduced antioxidant defense and pronounced hormonal disbalans was also marked. The criteria for differential diagnosis of pulmonary sarcoidosis and tuberculosis were elaborated.Исследованы особенности гомеостаза у 69 больных саркоидозом органов дыхания: динамика показателей системного иммунитета и местной защиты легких, антиоксидантной обеспеченности организма и гормонального гомеостаза до и после лечения. Установлено, что у больных саркоидозом значительно нарушены все звенья системного иммунитета (снижение колличества Т -лимфоцитов с нарушениями на уровне отдельных субпопуляций, снижение уровней IgA, M, G и увеличение фибронектина (ФН). Обнаружено уменьшение содержания альвеолярных макрофагов, повышение колличества лимфоцитов и нейтрофилов, а также ФН и секреторного IgA в бронхоальвеолярной жидкости. Со стороны процессов свободно-радикального окисления липидов отмечается повышение интенсивности перекисных процессов на фоне снижения антиоксидантной обеспеченности организма. Выявлен выраженный дисбаланс гормонального гомеостаза. Разработаны критерии дифференциальной диагностики саркоидоза и туберкулеза органов дыхания

Canalization of Gene Expression and Domain Shifts in the Drosophila Blastoderm by Dynamical Attractors

The variation in the expression patterns of the gap genes in the blastoderm of the fruit fly Drosophila melanogaster reduces over time as a result of cross regulation between these genes, a fact that we have demonstrated in an accompanying article in PLoS Biology (see Manu et al., doi:10.1371/journal.pbio.1000049). This biologically essential process is an example of the phenomenon known as canalization. It has been suggested that the developmental trajectory of a wild-type organism is inherently stable, and that canalization is a manifestation of this property. Although the role of gap genes in the canalization process was established by correctly predicting the response of the system to particular perturbations, the stability of the developmental trajectory remains to be investigated. For many years, it has been speculated that stability against perturbations during development can be described by dynamical systems having attracting sets that drive reductions of volume in phase space. In this paper, we show that both the reduction in variability of gap gene expression as well as shifts in the position of posterior gap gene domains are the result of the actions of attractors in the gap gene dynamical system. Two biologically distinct dynamical regions exist in the early embryo, separated by a bifurcation at 53% egg length. In the anterior region, reduction in variation occurs because of stability induced by point attractors, while in the posterior, the stability of the developmental trajectory arises from a one-dimensional attracting manifold. This manifold also controls a previously characterized anterior shift of posterior region gap domains. Our analysis shows that the complex phenomena of canalization and pattern formation in the Drosophila blastoderm can be understood in terms of the qualitative features of the dynamical system. The result confirms the idea that attractors are important for developmental stability and shows a richer variety of dynamical attractors in developmental systems than has been previously recognized

Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 9th edition

Dear Colleagues! We are glad to present the 9th Edition (revised) of Standards of Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation. The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), American Diabetes Association (ADA, 2018, 2019), American Association of Clinical Endocrinologists (AACE, 2019), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014, 2018) and Russian Association of Endocrinologists (RAE, 2011, 2012, 2015). Current edition of the &ldquo;Standards&rdquo; also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals. Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 463 million patients by the end of 2019. According to the current estimation by the International Diabetes Federation, 578 million patients will be suffering from diabetes mellitus by by 2030 and 700 million by 2045. Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 584 575 patients with DM in this country by the end of 2018 (3,1% of population) with 92% (4 238 503) &ndash; Type 2 DM, 6% (256 202) &ndash; Type 1 DM and 2% (89 870) &ndash; other types of DM, including 8 006 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) con- firmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 9 million patients (about 6% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they don&rsquo;t receive any treatment ant have high risk of vascular complications. Severe consequences of the global pandemics of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral, coronary and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death. In сurrent edition of the &ldquo;Standards&rdquo;: New goals of glycemic control for the elderly, based on the presence of functional dependence, as well as for pregnant women, children and adolescents, are given. Added a snippet that describes the continuous glucose monitoring. Only low-density lipoprotein cholesterol level is used as a target for lipid metabolism. Proposes more stringent target levels of blood pressure. It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes: the excess of the initial level of HbA1c over the target level was used as a criterion. In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages. Recommendations for psychosocial support are added. The position of metabolic surgery as a method of treatment of DM with morbid obesity is updated. Recommendations for diagnostic and treatment of hypogonadism syndrome in men with DM are added. For the first time, evidence levels of confidence and credibility levels of recommendations for diagnostic, therapeutic, rehabilitative and preventive interventions based on a systematic review of the literature are given in accordance with the recommendations of the Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation. This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discus- sions held at national meetings and forums. These guidelines are intended for endocrinologists, primary care physicians and other medical professionals involved in the treatment of DM. On behalf of the Working Grou