Late debut undifferentiated forms of spinal amyotrophy (clinical observation)

The clinical observation of a patient with undifferentiated form of spinal amiotrofii awards as monomelic form of spinal degeneration.В клиническом наблюдении представлен пациент с недифференцированной формой спинальной амиотрофии, дебютировавшей как мономелическая форма спинальной дегенераци

Непереносимость раннего энтерального питания у пациентов с острым панкреатитом средней тяжести при применении назогастрального и назоеюнального доступа

RELEVANCE Early enteral nutrition is an essential element of intensive care for acute pancreatitis. Its intolerance is manifested by high gastric residual volumes, pain syndrome, bloating, diarrhea, nausea and vomiting. The relevance of our study is determined by the lack of information on how the routes of nutrient delivery affect its tolerability considering the gradual «as­per­protocol» increase in nutrition volumes for patients with moderately severe acute pancreatitis.THE AIM OF THE STUDY Was to identify the key factors that determine intolerance to early nasogastric and nasojejunal enteral feeding in ICU patients with the early phase of moderately severe acute pancreatitis.MATERIAL AND METHODS We conducted an open randomized controlled trial. Out of 64 patients with predicted severe course of acute pancreatitis, we identified a cohort with moderately severe acute pancreatitis, in which 17 (51.5%) patients received early enteral nutrition through a nasogastric tube, and 16 (48.5%) via an endoscopically placed nasojejunal tube. The criteria for nutrition intolerance were as follows: nasogastric tube discharge of more than 500±100 ml at a time or more than 500 ml/day in comparison with the enterally administered during this period, increased pain, bloating, diarrhea, nausea and vomiting. Using the method of logistic regression, indicators with prognostic significance were determined. The null hypothesis was rejected at p<0.05.RESULTS Regardless of the nutrition route, the progression of multiple organ failure increases the incidence of high gastric residual volumes (SOFA — OR (odds ratio) — 1.337, 95% CI (confidence interval) 1.001–1.787; p = 0.049). Pain syndrome is less common on the day of surgery (OR 0.258, 95% CI 0.110–0.606; p=0.002). Nasojejunal feeding was associated with a lower incidence of nausea and vomiting (OR 0.168, 95% CI 0.06–0.473; p=0.001), but with more diarrhea (OR 6.411, 95% CI 1.274–32.262; p=0.024).CONCLUSION The progression of multiple organ failure increases the incidence of high gastric residual volumes. The pain syndrome is less pronounced on the day of surgery and more intense in case of nasogastric nutrition. Postpyloric nutrition reduces the incidence of nausea and vomiting, but increases diarrhea.АКТУАЛЬНОСТЬ Раннее энтеральное питание (РЭП) является обязательным элементом интенсивной терапии острого панкреатита ОП). Непереносимость его проявляется: высокими остаточными объемами в желудке (ООЖ), болевым синдромом, вздутием живота, диареей, тошнотой и рвотой. Отсутствие информации о влиянии способа доставки питания на его переносимость при протокольном увеличении объема у пациентов со среднетяжелой формой ОП определяет актуальность нашего исследования.ЦЕЛЬ ИССЛЕДОВАНИЯ Выявить ключевые факторы, определяющие непереносимость РЭП через назогастральный (НГ) и назоеюнальный (НЕ) зонды у пациентов отделения реанимации и интенсивной терапии в раннюю фазу ОП средней степени тяжести.МАТЕРИАЛ И МЕТОДЫ Проведено открытое рандомизированное контролируемое исследование. Из 64 пациентов с ОП, имеющих предикторы тяжелого течения, была выделена когорта со среднетяжелой формой, в которой 17 пациентов (51,5%) получали РЭП в НГ зонд, а 16 (48,5%) — в НЕ, установленный эндоскопически. Критериями непереносимости питания были: сброс по НГ зонду более 500±100 мл одномоментно или более 500 мл/сут в сравнении с введенным за этот период энтерально, усиление болевого синдрома, вздутие живота, диарея, тошнота и рвота. С помощью метода логистической регрессии определены показатели, обладающие прогностической значимостью. Нулевую гипотезу отвергали при p<0,05.РЕЗУЛЬТАТЫ Вне зависимости от метода введения питания прогрессирование полиорганной недостаточности увеличивает частоту высоких ООЖ (SOFA — ОШ (отношение шансов) — 1,337, 95% ДИ (доверительный интервал) 1,001–1,787; р=0,049). Болевой синдром встречается реже в день операции (ОШ — 0,258, 95% ДИ 0,110–0,606; р=0,002). Питание в НЕ зонд сопряжено с меньшей частотой развития тошноты и рвоты (ОШ — 0,168, 95% ДИ 0,06–0,473; р=0,001), но с большей диареей (ОШ — 6,411, 95% ДИ 1,274–32,262; р=0,024).ЗАКЛЮЧЕНИЕ Прогрессирование полиорганной недостаточности повышает частоту высоких остаточных объемов в желудке. Болевой синдром менее выражен в день операции и более интенсивен при назогастральном питании. Постпилорическое питание снижает частоту тошноты и рвоты, но увеличивает диарею

Модифицированный дельфийский анализ положений и критериев качества методических рекомендаций «Седация пациентов в отделениях анестезиологии, реанимации и интенсивной терапии»

АКТУАЛЬНОСТЬ: Подходы к седации в отделениях анестезиологии, реанимации и интенсивной терапии за последние 20 лет изменились. В 2020 г. в рубрикаторе клинических рекомендаций были размещены методические рекомендации «Седация пациентов в отделениях анестезиологии, реанимации и интенсивной терапии». ЦЕЛЬ ИССЛЕДОВАНИЯ: Способствовать повышению качества планового обновления рекомендаций с помощью модифицированного дельфийского анализа положений и критериев качества текущей версии документа, размещенного в рубрикаторе клинических рекомендаций Минздрава России. МАТЕРИАЛЫ И МЕТОДЫ: Мы использовали модифицированный метод Дельфи с двумя раундами анкетирования для выработки единого мнения. Достижение согласия специалистов было проведено в три этапа: подготовительный этап, этап обсуждений и этап выработки консенсусного заключения. Для проведения оценки был создан опросник, состоящий из 3 блоков: оценка положений методических рекомендаций; оценка критериев качества методических рекомендаций; общая оценка методических рекомендаций. Оценку производили на основании шкалы Лайкерта. Рассчитывали медиану, моду и средневзвешенную оценку. Если при оценке положений и критериев качества методических рекомендаций значение медианы или моды любого положения было менее 7, средневзвешенной оценки — менее 70 %; значение медианы или моды критериев качества менее 7,5, средневзвешенной оценки — менее 75 %, то это положение (критерий качества) должно быть рекомендовано для переработки. РЕЗУЛЬТАТЫ: Оценка положений и критериев была проведена в первом круге обсуждения. На втором круге обсуждения были окончательно выработаны предложения и рекомендации для разработчиков методических рекомендаций. Консенсус был достигнут в ходе двух раундов модифицированного анализа Дельфи. В результате проведенного анализа 16 из 21 положения и 5 из 6 критериев качества были согласованы, остальным требовалась редакция формулировки текста положения и комментария. ВЫВОДЫ: В результате независимой оценки независимыми специалистами 5 положений и 1 критерий качества были рекомендованы для редакции. Также были согласованы комментарии к этим положениям и критерию качества методических рекомендаций «Седация пациентов в отделениях анестезиологии, реанимации и интенсивной терапии»

Clinical Recommendations of the Northwest Society for Enteral and Parenteral Nutrition, Interregional Association for Emergency Surgery, Russian Gastroenterological Association, Union of Rehabilitation Therapists of Russia and Russian Transplantation Society on Diagnosis and Treatment of Short Bowel Syndrome-Associated Intestinal Failure in Adults

Aim. Current clinical recommendations address the epidemiology, causes, clinical manifestations and pathogenesis of possible immediate and long-term complications, as well as the problematic issues related to treatment and rehabilitation of adult short bowel syndrome patients.Key points. Short bowel syndrome (SBS) is a symptom complex of impaired digestion caused by the reduction of small intestine absorptive surface and manifested by intestinal failure (IF) of various severity (maldigestion and malabsorption) developing into malnutrition and systemic somatogenic disorders. The vital strategic aspects of its treatment are the personalisation of liquid, macro- and micronutrients consumption as well as avoidance of intestinal failure- and parenteral nutrition-associated complications. Various nutritional support regimes and the indications for infusion therapy and maintenance parenteral nutrition are considered in this patient category, also in outpatient settings. To mitigate the dependence on intravenous fluid- and nutrient administration and attain enteral autonomy in SBS-IF patients, the use of recombinant glucagon-like peptide-2 (GLP-2) is justified as exerting a pronounced trophic effect on the epithelial regenerative potential as well as structural and functional adaptation of intestinal mucosa. The SBS-IF patients prescribed with home parenteral nutrition and/or their caregivers should be trained in a special programme that covers the catheter care, preparation of infusion solutions and nutrient mixture container, infusion pump operation as well as the prevention, recognition and management of complications. The main referral indications for small bowel transplantation (SBT) are: fast-progressing cholestatic liver disease-complicated irreversible intestinal failure; thrombosis of two or more central venous conduits used for parenteral nutrition; recurrent catheter-associated bloodstream infection.Conclusion. Current recommendations on diagnosis and treatment as well as the developed criteria of medical aid quality assessment are applicable at different levels of healthcare

Regulation of early steps of GPVI signal transduction by phosphatases: a systems biology approach

We present a data-driven mathematical model of a key initiating step in platelet activation, a central process in the prevention of bleeding following Injury. In vascular disease, this process is activated inappropriately and causes thrombosis, heart attacks and stroke. The collagen receptor GPVI is the primary trigger for platelet activation at sites of injury. Understanding the complex molecular mechanisms initiated by this receptor is important for development of more effective antithrombotic medicines. In this work we developed a series of nonlinear ordinary differential equation models that are direct representations of biological hypotheses surrounding the initial steps in GPVI-stimulated signal transduction. At each stage model simulations were compared to our own quantitative, high-temporal experimental data that guides further experimental design, data collection and model refinement. Much is known about the linear forward reactions within platelet signalling pathways but knowledge of the roles of putative reverse reactions are poorly understood. An initial model, that includes a simple constitutively active phosphatase, was unable to explain experimental data. Model revisions, incorporating a complex pathway of interactions (and specifically the phosphatase TULA-2), provided a good description of the experimental data both based on observations of phosphorylation in samples from one donor and in those of a wider population. Our model was used to investigate the levels of proteins involved in regulating the pathway and the effect of low GPVI levels that have been associated with disease. Results indicate a clear separation in healthy and GPVI deficient states in respect of the signalling cascade dynamics associated with Syk tyrosine phosphorylation and activation. Our approach reveals the central importance of this negative feedback pathway that results in the temporal regulation of a specific class of protein tyrosine phosphatases in controlling the rate, and therefore extent, of GPVI-stimulated platelet activation

At the intersection of globalization and "civilizational originality' : cultural production in Putin's Russia

This special issue originates from a transnational collaboration of scholars in philology, comparative literature, social theory, sociology, anthropology, ethnography, and media studies. The collection strives to advance a research agenda built on the nexus of three intellectual and academic domains: post-Soviet Russian cultural studies', the research paradigm put forward by Cultural Studies, as well as empirical methods developed in sociology. The collection illustrates the importance of expanding the experience of Cultural Studies beyond its established spheres of national investigation, while it also speaks to the necessity to re-evaluate the hegemony of the English-language academic and cultural production on the global scale. The collection offers insights into the gamut of cultural practices and institutional environments in which Russian cultural production happens today. It shows how cultural industries and institutions in Russia are integrated into the global marketplace and transnational communities, while they also draw on and contribute to local lives and experiences by trying to create an autonomous space for symbolic production at personal and collective levels. Through diverse topics, the issue sheds light on the agency, i.e. practitioners and participants, creators and consumers, of Russian cultural production and the neoliberal practices implemented on creative work and cultural administration in Russia today. The Introduction outlines the development of academic studies on Russian cultural practices since 1991; describes main political developments shaping the cultural field in Putin's Russia; and, finally, identifies the Cultural Studies debates the editors of the collection find most productive for investigations of Russia, i.e. the instrumentalization of culture and culture as resource. Relocated in an analysis of a post-socialist society, these conceptualisations seem increasingly problematic in a situation where local and federal policies governing cultural and creative work focus simultaneously on marketization and on nationalism as the main tools of legitimizing the federal government.Peer reviewe

Systems biology of platelet-vessel wall interactions

Platelets are small, anucleated cells that participate in primary hemostasis by forming a hemostatic plug at the site of a blood vessel's breach, preventing blood loss. However, hemostatic events can lead to excessive thrombosis, resulting in life-threatening strokes, emboli, or infarction. Development of multi-scale models coupling processes at several scales and running predictive model simulations on powerful computer clusters can help interdisciplinary groups of researchers to suggest and test new patient-specific treatment strategies

Nutritional therapies for mental disorders

According to the Diagnostic and Statistical Manual of Mental Disorders, 4 out of the 10 leading causes of disability in the US and other developed countries are mental disorders. Major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder (OCD) are among the most common mental disorders that currently plague numerous countries and have varying incidence rates from 26 percent in America to 4 percent in China. Though some of this difference may be attributable to the manner in which individual healthcare providers diagnose mental disorders, this noticeable distribution can be also explained by studies which show that a lack of certain dietary nutrients contribute to the development of mental disorders. Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries; and are exceptionally deficient in patients suffering from mental disorders. Studies have shown that daily supplements of vital nutrients often effectively reduce patients' symptoms. Supplements that contain amino acids also reduce symptoms, because they are converted to neurotransmitters that alleviate depression and other mental disorders. Based on emerging scientific evidence, this form of nutritional supplement treatment may be appropriate for controlling major depression, bipolar disorder, schizophrenia and anxiety disorders, eating disorders, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), addiction, and autism. The aim of this manuscript is to emphasize which dietary supplements can aid the treatment of the four most common mental disorders currently affecting America and other developed countries: major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder (OCD)