Динамика энергоструктурной активности при ингаляционной анестезии

Цель. Улучшение результатов лечения больных путем придания периоперационному обеспечению ингаляционной анестезии севофлураном энергопротективной направленности. Материалы и методы. У пациентов с острой патологией органов брюшной полости проведен аудит энергоструктурной активности во время ингаляционной анестезии севофлураном. В группе сравнения использовали общепринятый протокол, в основной – с применением органопротективных технологий. Определяли клинические индексы опасности (КИО), безопасности (КИБ), кардиальный резерв (КР), микроциркуляторно–митохондриальную недостаточность (ММН), концентрацию в крови нейроглиального белка (S100) и нейронспецифической энолазы (NSE). Результаты. Ингаляционная анестезия севофлураном нарушает энергоструктурные взаимодействия (ЭСВ) в массе клеток тела (МКТ). Энергопротективные технологии снижают степень повреждения, о чем свидетельствовала концентрация в крови S100 и NSE. Выводы. Применение энергопротективных технологий в соответствии с категориями энергоструктурной активности в МКТ позволяет улучшить результаты лечения пациентов с острой патологией брюшной полости и персонифицировать анестезиологическое обеспечение. Выявлена и доказана тесная корреляционная связь между ранними проявлениями структурных микроповреждений клеток головного мозга с энергоструктурными изменениями в МКТ пациентов

Homeostatic MyD88-dependent signals cause lethal inflamMation in the absence of A20

Toll-like receptors (TLRs) on host cells are chronically engaged by microbial ligands during homeostatic conditions. These signals do not cause inflammatory immune responses in unperturbed mice, even though they drive innate and adaptive immune responses when combating microbial infections. A20 is a ubiquitin-modifying enzyme that restricts exogenous TLR-induced signals. We show that MyD88-dependent TLR signals drive the spontaneous T cell and myeloid cell activation, cachexia, and premature lethality seen in A20-deficient mice. We have used broad spectrum antibiotics to demonstrate that these constitutive TLR signals are driven by commensal intestinal flora. A20 restricts TLR signals by restricting ubiquitylation of the E3 ligase tumor necrosis factor receptor–associated factor 6. These results reveal both the severe proinflammatory pathophysiology that can arise from homeostatic TLR signals as well as the critical role of A20 in restricting these signals in vivo. In addition, A20 restricts MyD88-independent TLR signals by inhibiting Toll/interleukin 1 receptor domain–containing adaptor inducing interferon (IFN) β–dependent nuclear factor κB signals but not IFN response factor 3 signaling. These findings provide novel insights into how physiological TLR signals are regulated

Unusual presentation of metastatic adenocarcinoma

<p>Abstract</p> <p>Background</p> <p>The most common tumours of the adrenal gland are adenoma, pheochromocytoma, adrenocortical carcinoma, and metastases. Although the imaging features of these tumours are established, the imaging characteristics of uncommon adrenal masses are less well known. In patients with extradrenal tumour, incidental discovery of an adrenal mass necessitates excluding the possibility of metastatic malignancy.</p> <p>Case presentation</p> <p>A 52 year-old female was diagnosed with oesophageal adenocarcinoma and treated with oesophagectomy and adjuvant chemotherapy. Sixteen months later on staging CT scan a 2 × 2 cm adrenal mass was detected, which increased in size over a period of time to 3 × 3 cm in size. Adrenalectomy was performed and histological examination revealed metastatic adenocarcinoma within an adrenal adenoma.</p> <p>Conclusion</p> <p>The present case highlights the unusual behaviour of an oesophageal adenocarcinoma causing metastasis to an adrenocortical adenoma.</p

Placing your faith on the betting floor: Religiosity predicts disordered gambling via gambling fallacies

Background and aims: We examined the potential role religious beliefs may play in disordered gambling. Specifically, we tested the idea that religiosity primes people to place their faith in good fortune or a higher power. In the context of gambling, however, this may lead to gambling fallacies (e.g., erroneous beliefs that one has control over a random outcome). People who are high in religiosity may be more at risk of developing gambling fallacies, as they may believe that a higher power can influence a game of chance. Thus, this research investigated the relationship between religiosity and gambling problems and whether gambling fallacies mediated this relationship. Methods: In Study 1, we recruited an online sample from Amazon's Mechanical Turk to complete measures that assessed the central constructs (religiosity, disordered gambling, and gambling fallacies). In Study 2, we conducted a secondary analysis of a large data set of representative adults (N = 4,121) from a Canadian province, which contained measures that assessed the constructs of interest. Results: In Study 1, religiosity significantly predicted gambling problem. Conversely, there was no direct relationship between religiosity and gambling in Study 2. Importantly, a significant indirect effect of religiosity on disordered gambling severity through gambling fallacies was found in both studies, thus establishing mediation. The results remained the same when controlling for age, gender, ethnicity, and socioeconomic status for both studies. Discussion and conclusion: These findings suggest religiosity and its propensity to be associated wit

Severe Diverticulitis Associated to <i>Clostridioides difficile</i> Infection in a 91 Year Old Patient (Clinical Case)

Aim. To present a clinical case of a 91-year-old patient with a severe course of diverticulitis combined with the development of Clostridioides difficile-associated disease.Key points. On admission the patient complained of pain in the left iliac region, increased body temperature, constipation and bloating. The medical history showed that constipation increased on the background of prolonged bed rest and discontinuation of psyllium. According to the laboratory and instrumental examinations, the patient had signs of acute diverticulitis, antibacterial therapy was corrected twice, positive dynamics of the condition was noted. However, a few days later, the patient developed a clinic of C. difficile-associated disease, which required the prescription of anticlostridial therapy (vancomycin), until the laboratory confirmation of the accession of this infection was obtained. Combined therapy of exacerbation of diverticular disease and C. difficile-associated disease made it possible to achieve a steady improvement of the condition.Conclusion. The exclusion of possible development of C. difficile-associated disease on the background or prior antibiotic therapy is an important condition for correct and adequate management of a patient with exacerbation of diverticular disease. If the patient develops a clinical picture of C. difficile-associated disease, treatment may be initiated before laboratory confirmation

Integral geometry of complex space forms

We show how Alesker's theory of valuations on manifolds gives rise to an algebraic picture of the integral geometry of any Riemannian isotropic space. We then apply this method to give a thorough account of the integral geometry of the complex space forms, i.e. complex projective space, complex hyperbolic space and complex euclidean space. In particular, we compute the family of kinematic formulas for invariant valuations and invariant curvature measures in these spaces. In addition to new and more efficient framings of the tube formulas of Gray and the kinematic formulas of Shifrin, this approach yields a new formula expressing the volumes of the tubes about a totally real submanifold in terms of its intrinsic Riemannian structure. We also show by direct calculation that the Lipschitz-Killing valuations stabilize the subspace of invariant angular curvature measures, suggesting the possibility that a similar phenomenon holds for all Riemannian manifolds. We conclude with a number of open questions and conjectures.Comment: 68 pages; minor change

Rapid intraoperative insulin assay: a novel method to differentiate insulinoma from nesidioblastosis in the pediatric patient

Introduction: Hyperinsulinism is the most common cause of recurrent and persistent hypoglycemia in infancy and childhood. Causes can include nesidioblastosis, pancreatic islet cell tumors such as insulinoma, and associations with multiple endocrine neoplasia syndromes. Although new, improved imaging techniques have allowed for more precise preoperative localization of insulinomas, the differentiation of nesidioblastosis and insulinoma, particularly in children, can be challenging. To improve intraoperative localization and confirmation of successful resection of insulinoma, a novel hormonal assay, the rapid intraoperative insulin assay, is reported for the first time in a pediatric patient. This intraoperative radioimmunoassay for insulin yields results within several minutes and confirms complete resection of insulinoma. Case description: We present a case of pancreatic insulinoma in a child with symptoms of severe hypoglycemia, causing seizures. The insulinoma was enucleated laparoscopically, and rapid intra-operative insulin assay used to determine the success of the procedure. Discussion and evaluation: This rapid intra-operative test provides a valuable adjunct for determining complete excision in complicated cases of recurrent or questionable insulinoma. Although not a common problem, for pediatric patients in whom the diagnosis is not clear, this test may provide a novel approach to confirming disease. Conclusion: We propose the use of this assay in facilitating intra-operative resection and confirmation of complete excision in pediatric patients. This population may especially benefit from this novel assay to confirm complete resection and to differentiate multiple etiologies of hyperinsulinism

Colorectal Cancer in Patient with Functional Gastrointestinal Symptoms

Aim. A clinical observation to highlight the importance of detailed examination in patients with functional gastrointestinal symptoms.Key points. A 28-yo female patient was admitted with complains of left ileal pain, abdominal distention and up to 4-day stool delay. The complaints had long been interpreted as clinical manifestations of irritable bowel syndrome. No significant abnormalities were revealed in outpatient check-up (general and biochemical blood panels, stool test, abdominal ultrasound, oesophagogastroduodenoscopy). Colonoscopy was performed on admission, with diagnosis of rectal adenocarcinoma. The patient had a prompt surgical intervention, repeated courses of polychemotherapy and is currently followed by an oncologist and coloproctologist. No relapse signs have been reported.Conclusion. Patients with the complaints satisfying the Rome Criteria Revision IV for functional gastrointestinal diseases should have a thorough examination as per recommendations of the Russian Gastroenterological Association and Russian Association of Coloproctologists

The Effectiveness of Add-on Treatment with Nutraceutical

Aim: evaluation of the effectiveness of the nutraceutical “Standard Zdorovia: Gastro” (“SZ Gastro”) in the treatment of patients with irritable bowel syndrome (IBS).Materials and methods. 52 patients (62 % women) diagnosed with IBS and IBS in combination with functional dyspepsia (FD) were included in the study and divided into two groups. Both groups received basic therapy according to the guidelines. The experimental group received as add-on the nutraceutical “SZ Gastro” (containing a standardized amount of menthol, gingerol and D-limonene); patients in the control group — placebo. The duration of the study was 30 days. The severity of somatic symptoms was assessed with the 7×7 questionnaire. Emotional state was assessed with the Four Dimensional Distress, Depression, Anxiety, and Somatization Questionnaire (4DSQ).Results. Patients of the experimental and control groups did not differ from each other either in terms of demographics, basic treatment, or in the severity of symptoms at the beginning of the study.The effectiveness of the treatment in the patients, who received add-on “SZ Gastro” was significantly higher than in the patients of the control group: in the control group the percentage of improvement of somatic symptoms was 22.35 %, in the experimental group it amounted to 49.18 % (χ2 = 15.9; p = 0.0001). The percentage of patients with significant decrease of emotional disturbances was also higher in the experimental group: distress (χ2 = 18.7; p = 0.0000), anxiety (χ2 = 6.9; p = 0.0097) and somatization (χ2 = 14.99; p = 0.0001). No significant side effects were registered in any of the groups.Conclusions. Add-on of nutraceutical “SZ Gastro” to basic treatment is safe and significantly increases effectiveness of the therapy in the patients with IBS and IBS in combination with PD