On a snow cover composition in the vicinity of the Verkhnekamsky Salt Deposit

The snow cover chemical composition was investigated on the territory of the Verkhnekamskiy potash-magnesium salt deposit in the zone of influence of atmospheric emissions of Berezniki Potash Mining Complex (Perm Region). The object of researches was the snow in this area. Features of specific pollutants contained in the emissions of these mine groups and their relationship with the air intake and following atmospheric deposition were examined. With regard for specific character of pollutants in the emissions, studies of melt water included determination of the following chemical components – SO42-, Cl-, NO3-, NO2-, НCO3-, Ca2+, Mg2+, Na+, K+, of the pH value as well as suspended solid substances, and total mineralization. An analysis of snow composition was performed on two sites from which one was the surrounding background territory, while another area was the urban territory of city Berezniki, i.e. area of operating mine group. To assess the results the indicator of specific stock macro component was used. Increased specific stock relative to the background snowpack is clearly indicative of components directly related to the extraction and processing of salts Cl-, Na+, K+. The revealed anomalies have a local character and, as a rule, do not extend beyond boundaries of sanitary protection zones of the enterprises. Maps of distribution of values of the specific reserves for the analyzed list of components in the melt water were constructed. Our results obtained for the Verkhnekamskiy Deposit area were compared with similar published data on the territories of cities in the zone influenced by motor roads, reserves, and coastal zones of the Russian Arctic seas

Experience in the use of docosahexaenoic acid (BrudiPlus) in patients with increased sperm DNA fragmentation index in Acad. V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology

Male factor is the reason of infertility in almost half of marriages. Infertile men have the percentage of sperm with violations of DNA integrity of over 30 %; with that, healthy fertile men have that indicator of less than 15 %. Understanding of importance of damages of sperm DNA is growing with distribution ofauxiliary reproductive technologies. As of today, these consequences have not been studies yet, and the therapeutic effect of intake of antioxidants has not direct correlation with the sperm DNA fragmentation level. Docosahexaenoic acid is one of the most valuable omega-3 polyunsaturated fatty acids for human health. Docosahexaenoic acid is the main component of the brain gray matter, retina, testes, and sperm cell membranes. In connection with that, a study was held the purpose of which was to assess the effect of the nutraceutical enzymatic docosahexaenoic acid triglyceride (BrudiPlus) in high concentrations on damaged sperm DNA of patients with idiopathic pathozoospermia. 40 patients with idiopathic pathozoospermia and the level of DNA fragmentation over the statutory value took part in this study. The following positive results were received: intake of BrudiPlus allowed decreasing sperm DNA damages and improving of antioxidant system of sperm

Гемосорбция с использованием колонки на основе сверхсшитого стирол-дивинибензольного сополимера с иммобилизированным ЛПС-селективным лигандом в комплексе интенсивного лечения острого повреждения легких при хирургическом лечении рака легкого (клиническое наблюдение)

Acute respiratory distress syndrome (ARDS) is a serious challenge in the contemporary reanimatology due to its prevalence, versatility of pathogenesis mechanisms, and continuously high mortality. The development of an uncontrolled cascade of systemic inflammation reactions, ‘cytokine storm’, followed by multiple organ failure (MOF) is an essential pathophysiological trigger of acute lung injury. Besides, critically ill patients are characterized by a relative intestinal ischemia, wherein, according to the ‘intestine-lung axis’ concept that treats intestinal and pulmonary epithelium as a continuous surface, translocation of bacteria and/or endotoxin directly into blood flow might occur. Extracorporeal removal of excessively produced inflammatory response mediators and endotoxin (bacterial lipopolysaccharide, LPS) from systemic circulation by selective hemosorption might represent a life-saving approach in sepsis.Purpose: to evaluate the efficacy of selective sorption in a combined therapy for acute lung injury related to postoperative injury after lung cancer surgery.Results. A single 4-hour selective sorption procedure in the combined therapy of a critically ill postoperative patient produced fast (within 24 hrs.) effects: decreased leukocytosis (the leukocyte count fell down from 32X109 to 13X109, L-1) and endotoxin activity (EAA — from 0.67 to 0.32, units), reduced blood plasma anti-inflammatory cytokine (IL-6 — from 1860 to 62, pg/ml) and procalcitonin (PCT — from 46 to 0.32, ng/ml), recovery of gas exchange, discontinuation of hemodynamic support with pressor amines as no longer needed (as early as 2 hours after sorption).Conclusion. The clinical case of a successful therapy including selective sorption based on hyper-crosslinked styrene-divinylbenzene copolymer with immobilized LPS-selective ligand warrants further clinical studies on the efficiency of a novel selective hemosorption column use to correct post-radical respiratory complications in oncological patients.Острый респираторный дистресс-синдром (ОРДС) является серьезной проблемой современной реаниматологии, что связано с частотой его развития, многогранностью механизмов патогенеза, неизменно высокой летальностью. Важным патофизиологическим триггером острого повреждения легких является развитие неконтролируемого каскада реакций системного воспаления, «цитокинового шторма» с последующим формированием полиорганной дисфункции (ПОН). Кроме того, у больных, находящихся в критических состояниях, существует относительная ишемия кишечника, при которой согласно концепции «ось кишечник-легкое», когда эпителий кишки и легкого рассматриваются как непрерывная поверхность, может произойти транслокация бактерий и/или эндотоксина непосредственно в кровоток. Одним из возможных подходов лечения этой категории больных может быть экстракорпоральное удаление из системного кровотока избыточно продуцируемых медиаторов воспалительного ответа и эндотоксина методом гемосорбции с использованием селективных сорбентов.Цель исследования. Оценить эффективность селективной сорбции в комплексном лечении острого повреждения легких, связанного с хирургической травмой, после оперативного вмешательства по поводу рака легкого.Результаты. проведение однократной 4-часовой процедуры селективной сорбции в составе комплексного лечения пациента с тяжелым пост-операционным состоянием привело к быстрым (в течение суток) эффектам: снижению лейкоцитоза (числа лейкоцитов с 32X109 до 13X109, л-1) и активности эндотоксина (EAA с 0,67 до 0,32, у. е.), уменьшению содержания провоспалительного цитокина (IL-6 с 1860 до 62, пг/мл) и прокальцитонина (РСТ с 46 до 0,32, нг/мл) в плазме крови, восстановлению показателей газообмена, отмене необходимости в гемодинамической поддержке прессорными аминами (уже через 2 часа после сорбции).Заключение. Клинический пример успешной терапии с включением селективной сорбции, основанной на использовании сверхсшитого стирол-дивинибензольного сополимера с иммобилизированным ЛПС-селективным лигандом, обосновывает необходимость дальнейшего изучения ее при менения как средства быстрой коррекции респираторных послеоперационных осложнений, в том числе — у онкологических больных после радикальных торакопластических операций

Attempt to assess direct interactions between tumor burden, myeloid-derived suppressor cells and PD-1- and TIM-3-expressing T cells in multiple myeloma patients

The avoidance of immune surveillance by malignant plasma cells (PCs) in multiple myeloma (MM) is mediated by different mechanisms, among which an induction of T cell exhaustion and expansion of myeloid-derived suppressor cells (MDSCs) appear to play substantial roles, but it is still a lack of data on possible MDSC-mediated induction of T cell exhaustion. The aim of the present work was to evaluate possible relationship between frequencies of MM PCs, MDSCs and phenotypically exhausted PD-1+ and TIM-3+ T cells in bone marrow (BM) samples and peripheral blood (PB) of MM patients at various disease stages. Peripheral blood (n = 88) and BM samples (n = 56) were obtained from MM patients (newly diagnosed (n = 6), patients in remission (n = 71) and with progressive disease (n = 11)). Frequencies of T cells expressing checkpoint receptors PD-1 and TIM-3, polymorphonuclear MDSCs (PMN-MDSCs, Lin-CD14-HLA-DR- CD33+CD15+/CD66b+), monocyte MDSCs (M-MDSCs, CD14+HLA-DRlow/-), early MDSCs (E-MDSCs, Lin-HLA-DR-CD33+CD15-/CD66b-), and MM PCs (CD45dimCD38+CD138+CD56+CD19-CD117+CD27- CD81-) were assessed with flow cytometry. Circulating and BM-resident PD-1+/TIM-3+T cell subsets, BM E-MDSCs, as soon as MM PCs and serum beta2-microglobulin (B2-M) levels were gradually increased in patients at different stages. Despite that, there were no associations between the markers of tumor load and the studied cell subsets. In patients in remission, BM PMN-MDSCs negatively correlated with CD4+T cells, CD4+PD-1+ and CD8+TIM-3+T cell subsets; there were positive correlations between BM E-MDSCs and CD4+PD-1+TIM-3+ cells and PB M-MDSCs and CD8+PD-1+ and (as a trend) CD8+TIM-3+T cells. We found no associations for the samples of patients at diagnosis and with progression. We can conclude that a possible mutual influence of malignant PCs, MDSCs and PD-1+/TIM-3+T cells is nonlinear, especially during a manifest tumor growth at diagnosis and progression. The detected negative correlations between resident PMN- MDSCs and T cell subsets might be associated with MDSC suppressive function, affecting both predominantly activated PD-1+ cells and exhausted TIM-3+ subsets. The positive correlations between BM E-MDSCs and CD4+PD-1+TIM-3+ cell subset and circulating M-MDSCs and PD-1+ and TIM-3+ CD8+T cells might confirm an ability of MDSCs to induce T cell exhaustion

ИСПОЛЬЗОВАНИЕ ГЕПАТОПРОТЕКТОРОВ У БОЛЬНЫХ РАКОМ ЯИЧНИКОВ

Objective: to evaluate the efficiency of pharmacological correction of endogenous intoxication in patients with Stages III—IV ovarian cancer (OC) in the perioperative period. Subjects and methods. Thirty-to-70-year old seventy patients with Stages III-IV OC who had been surgically treated under general anesthesia were examined. The bio chemical parameters of intoxication, such as middleweight molecules, the total, effective concentration and binding capacity of albumin, integral hematological indices of intoxication, and C-reactive protein, were studied in the perioperative period. Results. Analysis of the performed tests showed that the premorbid background in all the examinees was characterized by varying degrees of endogenous intoxication (EI), increased leukocytic index of intoxication, hematological index of intoxication, and modified hematological index of intoxication, an imbalance between the accumulation and binding of overproduced toxic ligands, the intensified production of acutephase inflammatory proteins by the activation of a systemic inflammatory response, and decreased systemic responsiveness. These changes occur with suppressed systemic responsiveness, inadequate intoxication compensation by physiological detoxification systems and hemostatic instability. Conclusion. The use of heptral and Remaxol as part of the metabolic pharmacological correction infusion program nonequivalently caused reductions in the activity of an inflammatory response and the efficiency of EI correction in patients with OC in the perioperative period. The administration of Remaxol for systemic hyporesponsiveness and pronounced intoxication in OC patients promoted the optimization of systemic responsiveness, by producing a reduced toxic effect of tumorassociated EI. Цель — оценить эффективность фармакологической коррекции эндогенной интоксикации у больных раком яичников III—IV стадии в периоперационном периоде. Материал и методы. Обследованы 70 больных раком яичников III—IV стадии, в возрасте от 30 до 70 лет, перенесших хирургический этап лечения в условиях общей анестезии. В периоперационном периоде изучены биохимические показатели интоксикации — молекулы средней массы, общая, эффективная концентрация и связывающая способность альбумина, гематологические интегральные индексы интоксикации, С-реактивный белок. Результаты. Анализ проведенных исследований показал, что у всех исследуемых больных преморбидный фон характеризовался разной степени выраженности эндогенной интоксикацией (ЭИ), ростом лейкоцитарного индекса интоксикации, гематологического показателя интоксикации, модифицированного гематологического показателя интоксикации, нарушением баланса накопления и связывания избыточно продуцируемых токсических лигандов, интенсификацией продукции белков острой фазы воспаления активизацией системного воспалительного ответа, снижением общей реактивности организма. Эти изменения происходят на фоне угнетения общей реактивности организма, неадекватной компенсации интоксикации физиологическими системами детоксикации и нестабильностью гомеостаза. Заключение. Использование в составе инфузионной программы метаболической фармакологической коррекции гептрала и Ремаксола неравнозначно способствовало уменьшению активности воспалительной реакции и эффективности коррекции ЭИ у больных РЯ в периоперационном периоде. Использование Ремаксола в условиях снижения общей реактивности организма и выраженной интоксикации у больных раком яичников способствует оптимизации общей реактивности организма, обеспечивая снижение токсического воздействия опухолевой ЭИ.

Risk factors of adverse outcome of COVID-19 and experience of Tocilizumab administration in patients on maintenance hemodialysis due to diabetic kidney disease

BACKGROUND: Patients with Type 2 Diabetes (T2DM) and patients on maintenance hemodialysis (MHD) are at a high risk of adverse clinical course of COVID-19. To date, the causes of high mortality in these groups are not fully understood. Data about peculiarity of clinical course and Tocilizumab (TCZ) administration in patients with T2DM receiving MHD due to outcome of diabetic kidney disease (DKD) are not yet highlighted in current publications.AIMS: Identification of risk factors (RF) of adverse COVID-19 outcome and evaluation of TCZ administration in patients with T2DM receiving MHD due to DKD.MATERIALS AND METHODS: The patients treated in Moscow City Hospital No52 were included in retrospective observational study. The observation period was from 04.15 to 07.30 2020. The study endpoints were the outcomes of hospitalization — discharge or lethal outcome. Data were collected from electronic medical database. The following independent variables were analysed: gender, age, body mass index, time from the onset of symptoms to hospital admission, cardiovascular and general comorbidity (Charlson Index, CCI), cardiovascular event (CVE) during hospitalization, treatment in ICU, mechanical ventilation (MV), degree of lung damage according to CT data, level of prandial glycemia at admission, MHDassociated parameters (vintage, type of vascular access, frequency of complications). The autopsy reports were evaluated for the purpose of lethal structure investigation. In a subgroup treated TCZ the time from symptoms onset to TCZ administration and number of laboratory indicators were evaluated.RESULTS: 53 patients were included, mean age 68 ±9 y, males — 49%. General mortality in observation cohort was 45%, mortality in ICU — 81%, mortality on MV — 95%. High cardiovascular and general comorbidity was revealed (mean CCI — 8,3 ±1,5 points). The causes of outcomes according to autopsy reports data: CVE 37,5% (among them — acute myocardial infarction during hospitalization), severe respiratory failure — 62,5%. The independent predictors of lethal outcome were: MV (OR 106; 95% CI 11,5–984; р <0,001), 3-4 degree of lung damage according to CT data (ОR 6,2; 95% CI 1,803–21,449; р = 0,005), CVE during hospitalization (ОR 18,9; 95% CI 3,631–98,383; р <0,001); CCI ≥10 points (ОR 4,33; 95% CI 1,001–18,767; р = 0,043), level of prandial glycemia at admission ≥10 mmol/l (ОR 10,4; 95% CI 2,726–39,802; р <0,001). For risk identification of upcoming lethal outcome a predictive model was created with the use of discovered RF as variables. The predictive value of this model is 92,45% (positive prognostic value — 96,5%, negative prognostic value — 87,5%).In TCZ treated subgroup the laboratory markers of adverse outcome were detected with application of correlation analysis. Among them: increasing level of CPR 24-48 hours before lethal outcome (r = 0,82), the reduction of lymphocytes count after TCZ administration (r = -0,49), increasing of leukocytes and further reduction of lymphocytes count 24-48 hours before lethal outcome (r = 0,55 и r = -0,52, resp.)).CONCLUSIONS: The number of RF of adverse COVID-19 outcome in patients with T2DM receiving MHD due to DKD are identified. CVE is one of the leading causes of mortality in study cohort. According to our experience the preventive (instead of rescue) strategy of TCZ administration should be used

Lag Time between Onset of First Symptom and Treatment of Retinoblastoma: An International Collaborative Study of 692 Patients from 10 Countries

BACKGROUND: The relationship between lag time and outcomes in retinoblastoma (RB) is unclear. In this study, we aimed to study the effect of lag time between onset of symptoms and diagnosis of retinoblastoma (RB) in countries based on their national-income and analyse its effect on the outcomes. METHODS: We performed a prospective study of 692 patients from 11 RB centres in 10 countries from 1 January 2019 to 31 December 2019. RESULTS: The following factors were significantly different among different countries based on national-income level: age at diagnosis of RB (p = 0.001), distance from home to nearest primary healthcare centre (p = 0.03) and mean lag time between detection of first symptom to visit to RB treatment centre (p = 0.0007). After adjusting for country income, increased lag time between onset of symptoms and diagnosis of RB was associated with higher chances of an advanced tumour at presentation (p < 0.001), higher chances of high-risk histopathology features (p = 0.003), regional lymph node metastasis (p < 0.001), systemic metastasis (p < 0.001) and death (p < 0.001). CONCLUSIONS: There is a significant difference in the lag time between onset of signs and symptoms and referral to an RB treatment centre among countries based on national income resulting in significant differences in the presenting features and clinical outcomes

RGPPU Experience in the Implementation of the Educational Process Using Remote Educational Technologies

В статье рассмотрен опыт РГППУ реализации образовательного процесса с применением дистанционных образовательных технологий, а также функционирование электронной информационно-образовательной среды университета.The article considers the experience of the Russian State University of Higher Education in the implementation of the educational process with the use of distance learning technologies, as well as the functioning of the electronic information and educational environment of the university

Реперфузионное повреждение почек у больных с постренальной обструкцией

Objective: to define a role of renal reperfusion lesion in the development of renal failure in cancer patients after elimination of longstanding urinary tract occlusion.Subjects and methods. The study covered 26 patients in whom cancer disease was complicated by the development of urinary tract obstruction with evolving renal failure. All the patients received surgical treatment aimed at eliminating urinary tract occlusion. In the early postoperative period, progression of renal dysfunction was seen in all cases. The time course of changes in microcirculation, gas exchange, oxidative-antioxidative balance, and renal function were investigated to study the mechanisms responsible for the development of renal failure after surgery. Clinical and laboratory indices were analyzed before and 1 and 2 days after surgery.Results. The study has revealed that renal reperfusion lesion plays a prominent role in the development of renal failure in cancer patients after elimination of longstanding urinary tract obstruction, which should be borne in mind when preparing patients for surgery and managing them in the postoperative period, namely, to include membrane-stabilizers, antioxidants, and detoxicant therapy. Цель исследования — определить роль реперфузионного поражения почек в развитии почечной недостаточности у онкологических больных после устранения длительно формирующейся окклюзии мочевых путей.Материалы и методы. Основу исследования составили 26 больных, течение онкологического заболевания у которых осложнилось формированием обструкции мочевых путей с развитием почечной недостаточности. Всем больным выполняли хирургическое лечение, направленное на устранении окклюзии мочевых путей. Во всех случаях в раннем послеоперационном периоде наблюдали прогрессирование нарушений функционального состояния почек. В целях изучения механизмов развития почечной недостаточности после проведения хирургического вмешательства изучали динамику показателей микроциркуляции, газообмена, показателей оксидантно-антиоксидантного баланса, функционального состояния почек. Анализ показателей клинико-лабораторного обследования проводили до операции, на 2-е и 3-и сутки послеоперационного периода.Результаты. Проведенные исследования выявили важную роль ре-перфузионного поражения почек в развитии почечной недостаточности у онкологических больных после устранения длительно формирующейся обструкции мочевых путей, что необходимо учитывать при подготовке больных к операции и ведению их в послеоперационном периоде — включение в терапию мембранстабилизирующих, антиоксидантных препаратов и дезинтоксикационного лечения.

The effects of breastfeeding on retinoblastoma development: Results from an international multicenter retinoblastoma survey

The protective effects of breastfeeding on various childhood malignancies have been established but an association has not yet been determined for retinoblastoma (RB). We aimed to further investigate the role of breastfeeding in the severity of nonhereditary RB development, assessing relationship to (1) age at diagnosis, (2) ocular prognosis, measured by International Intraocular RB Classification (IIRC) or Intraocular Classification of RB (ICRB) group and success of eye salvage, and (3) extraocular involvement. Analyses were performed on a global dataset subgroup of 344 RB patients whose legal guardian(s) consented to answer a neonatal questionnaire. Patients with undetermined or mixed feeding history, family history of RB, or sporadic bilateral RB were excluded. There was no statistically significant difference between breastfed and formula-fed groups in (1) age at diagnosis (p = 0.20), (2) ocular prognosis measures of IIRC/ICRB group (p = 0.62) and success of eye salvage (p = 0.16), or (3) extraocular involvement shown by International Retinoblastoma Staging System (IRSS) at presentation (p = 0.74), lymph node involvement (p = 0.20), and distant metastases (p = 0.37). This study suggests that breastfeeding neither impacts the sporadic development nor is associated with a decrease in the severity of nonhereditary RB as measured by age at diagnosis, stage of disease, ocular prognosis, and extraocular spread. A further exploration into the impact of diet on children who develop RB is warranted