СТАН КІСТКОВОЇ ТКАНИНИ ТА ВІТАМІН D-СТАТУС У ДІТЕЙ В ПЕРІОД ДРУГОГО РОСТОВОГО СПУРТУ

The aim of the study – to determine the structural and functional condition of the bone tissue and the vitamin D status in schoolchildren during the second growth spurt. Materials and Methods. 205 nominally healthy children aged from 9 to 17 were examined after their categorization depending on the presence/absence of the growth spurt (GS) and its intensity. Group 1 consists of 50 children who have grown up by 8–12 cm for the current year; Group 2 is represented by 46 children who have grown up by over 12 cm, Group 3 covers 109 children who have had no growth spurt. The examination included analysis of the medical history, evaluation of physical and sexual development, ultrasound and X-Ray densitometry, determination of the 25-(ОН)-D3 level. Results. The ultrasound densitometry (UD) revealed a reduced mineral density of the bone tissue (MDBT) in children as follows: Group 1 – 24 children (48.0 %), the average Z-score reached (1.8±0.56); Group 2 – 28 children (60.87 %), the average Z-score amounted to (1.96±0.27); Group 3 – 43 children (39.45 %), the average Z-score reached (1.68±0.72). DXA allowed for examining 32 children with a reduced MDBT as shown by the ultrasound; 18 (56.25 %) of them were diagnosed with a reduced MDBT. Percentage of the children with a reduced MDBT during the growth spurt (Group 1) and the intensive growth spurt (Group 2)  reached 38.9 % and 50.0 %, respectively. The average 25-(ОН)-D3 level in children with a reduced MDBT belonging to Group 1 was (39.04±11.84) nmol/L; in children with a normal MDBT, it was (42.43±6.3) nmol/L; in children with a reduced MDBT belonging to Group 2, its average level reached (45.68±5.48) nmol/L, the average 25-(ОН)-D3 level in case of a normal MDBT was (45.47±4.69) nmol/L; in children with a reduced MDBT falling under Group 3 the average value was (36.73±8.94) nmol/L which is evidently different from the corresponding vitamin level in children with a normal MDBT, namely (42.91±9.1) nmol/L, (р˂0.05). Conclusions. A reduced mineral density of the bone tissue in schoolchildren during the growth spurt occurs due to the lack or deficit of vitamin D3. However, the most significant factor in the MDBT reduction is the fact that the processes of the bone mass accumulation cannot keep pace with an intensive linear growth of the skeleton.Цель исследования – определение структурно-функционального состояния костной ткани и витамин D-статуса у детей в период второго ростового спурта. Материалы и методы. Обследовано 205 условно здоровых детей возрастом 9–17 лет. Дети были разделены на группы в зависимости от наличия ростового спурта (РС) и его интенсивности. I группа – 50 детей, которые за текущий год выросли на 8–12 см; II группа – 46 детей, которые за текущий год выросли более чем на 12 см, III группа – 109 детей, у которых не было РС. Обследование включало анализ данных анамнеза, оценку физического и полового развития, ультразвуковую и рентгеновскую денситометрию, определение 25-(ОН)- D3. Результаты исследования и их обсуждение. При проведении ультразвуковой денситометрии (УД) детям снижение минеральной плотности костной ткани (МПКТ) было диагностировано: I группа – 24 ребенка (48,0 %), средний показатель Z-score составил 1,8±0,56; II группа – 28 детей (60,87 %), средний показатель Z-score – 1,96±0,27; III группа – 43 ребенка (39,45 %), средний показатель Z-score – 1,68±0,72. При помощи DXA было обследовано 32 ребенка, у которых при проведении УД выявлено снижение МПКТ; у 18 из них (56,25 %) было диагностировано снижение МПКТ. Количество детей со снижением МПКТ в период ростового спурта  (І группа) и интенсивного ростового спурта (ІІ группа) составило, соответственно, 38,9 и 50,0 %. Средний уровень витамина 25-(ОН)- D3 у детей I группы со снижением МПКТ составил (39,04±11,84) нмоль/л; у детей с нормальной МПКТ – (42,43± 6,3) нмоль/л; у детей II группы со снижением МПКТ его средний уровень составил (45,68±5,48) нмоль/л, с нормальной МПКТ – (45,47±4,69) нмоль/л; у детей III группы со снижением МПКТ его средний уровень (36,73±8,94) нмоль/л, что достоверно отличается от его значений у детей с нормальной МПКТ – (42,91±9,1) нмоль/л (р˂0,05). Выводы. Снижение минеральной плотности костной ткани у детей школьного возраста в период ростового спурта происходит на фоне недостаточности или дефицита витамина D3, но, в то же время, наибольшее значение в снижении МПКТ играет несоответствие скорости накопления костной ткани линейному росту скелета.Мета дослідження – визначення структурно-функціонального стану кісткової тканини та статусу вітаміну D3 у школярів у період другого ростового спурту. Матеріали та методи. Обстежено 205 умовно здорових дітей віком 9–17 років, які були розподілені на групи залежно від наявності ростового спурту (РС) та його інтенсивності. I група – 50 дітей, які за поточний рік прибавили у рості 8–12 см;  II група – 46 дітей, які за поточний рік прибавили у рості більше 12 см, III група – 109 дітей, які не мали РС. Обстеження включало аналіз даних анамнезу, оцінку рівня фізичного та статевого розвитку, ультразвукову та рентгенівську денситометрію, визначення рівня 25-(ОН)-D3. Результати дослідження та їх обговорення. При проведенні ультразвукової денситометрії (УД) дітям зниження мінеральної щільності кісткової тканини (МЩКТ) діагностовано: I група – 24 дитини (48,0 %), середній показник Z-score складав 1,8±0,56; II група – 28 дітей (60,87 %), середній показник Z-score – 1,96±0,27; III група – 43 дитини (39,45 %), середній показник Z-score – 1,68±0,72. За допомогою DXA було обстежено 32 дитини, у яких при проведенні УД виявлено зниження МЩКТ; у 18 з них (56,25 %) було діагностовано зниження МЩКТ. Відсоток дітей зі зниженням МЩКТ у період ростового спурту (І група) та інтенсивного ростового спурту (ІІ група) складав, відповідно, 38,9 та 50,0 %. Середній рівень вітаміну 25-(ОН)-D3 у дітей I групи зі зниженою МЩКТ становив (39,04±11,84) нмоль/л; у дітей із нормальною МЩКТ – (42,43±6,3) нмоль/л; у дітей II групи зі зниженою МЩКТ його середній рівень становив (45,68±5,48) нмоль/л, при нормальній МЩКТ – (45,47±4,69) нмоль/л; у дітей III групи зі зниженою МЩКТ його середній рівень склав (36,73±8,94) нмоль/л, що вірогідно відрізняється від його значень у дітей з нормальною МЩКТ – (42,91±9,1) нмоль/л (р˂0,05). Висновки. Зниження мінеральної щільності кісткової тканини у дітей шкільного віку в період ростового спурту відбувається на тлі недостатності або дефіциту вітаміну D3, проте найбільш суттєвим чинником зниження МЩКТ є саме відставання процесів накопичення кісткової маси на тлі інтенсивного лінійного росту скелета

THE ONSET OF ANCA-ASSOCIATED SYSTEMIC VASCULITIS MASKING RHEUMATOID ARTHRITIS

The paper describes a case of microscopic polyangiitis (MPA), the first clinical manifestation of which has been joint damage characterized chiefly by arthralgias. The overproduction of rheumatoid factor and anticyclic citrullinated peptide antibodies served as the basis for assuming rheumatoid arthritis (RA). Two years after disease onset, there were the first signs of glomerulonephritis (GN) that further progressed to severe kidney failure. MPA was diagnosed by a renal biopsy that revealed the morphological pattern of immunonegative GN with glomerular crescents. The diagnosis was verified by the presence of serum antineutrophil cytoplasmic antibodies (ANCA). There were no X-ray bone changes typical for RA at a 10-year follow-up. The paper discusses whether it is important to incorporate ANCA-associated systemic vasculitis into a diagnostic search in patients with early arthritis, particularly when the latter is concurrent with involvement of the kidney or other organs

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

Influence of Oxygen Ion Migration from Substrates on Photochemical Degradation of CH3NH3PbI3 Hybrid Perovskite

Measurements of XPS survey, core levels (N 1s, O 1s, Pb 4f, I 3d), and valence band (VB) spectra of CH3NH3PbI3 (MAPbI3) hybrid perovskite prepared on different substrates (glass, indium tin oxide (ITO), and TiO2) aged under different light-soaking conditions at room temperature are presented. The results reveal that the photochemical stability of MAPbI3 depends on the type of substrate and gradually decreases when glass is replaced by ITO and TiO2. Also, the degradation upon exposure to visible light is accompanied by the formation of MAI, PbI2, and Pb0 products as shown by XPS core levels spectra. According to XPS O 1s and VB spectra measurements, this degradation process is superimposed on the partial oxidation of lead atoms in ITO/MAPbI3 and TiO2/MAPbI3, for which Pb–O bonds are formed due to the diffusion of the oxygen ions from the substrates. This unexpected interaction leads to additional photochemical degradation. © 2021 by the author. Licensee MDPI, Basel, Switzerland.Funding: The sample preparation, aging experiments, UV‐vis, XRD, and SEM characterization were supported by Russian Science Foundation (project No. 19‐73‐30020). The XPS measurements were supported by the Ministry of Education and Science of the Russian Federation (project FEUZ‐2020‐0060), Theme ‘Electron’, no. AAAA‐A18‐118020190098‐5 and Russian Foundation for Basic Research (projects No. 21‐52‐52002/21 and 20‐42‐660003). C.‐C.C. acknowledges the financial support from the Ministry of Science and Technology in Taiwan (MOST 110‐2923‐E‐002‐007‐MY3) and the Top University Project from National Taiwan University (110L7836 and 110L7726)

Артрит как манифестное проявление системного васкулита, ассоциированного с антинейтрофильными цитоплазматическими антителами: трудности диагностики

The clinical picture of the symptomatic phase of antineutrophil cytoplasmic antibody-associated systemic vasculitis (ANCA-SV) can vary widely and be accompanied by joint damage, which complicates the early diagnosis of the disease. The paper presents a case of ANCA-SV with acute kidney injury, the manifestations of the symptomatic phase of which were confined to joint damage, myalgia, and Raynaud's syndrome, which led to delayed diagnosis at the stage of renal failure requiring hemodialysis (HD). Urgent adequate induction therapy could preserve kidney function, despite 10-day anuria and 5-week HD.The paper discusses the need for a systematic detailed examination of patients with the onset of a joint inflammatory lesion, especially in those with its systemic manifestations, and the inclusion of serum ANCA tests in the standards of diagnosis in early arthritis. Клиническая картина манифестной фазы системных васкулитов, ассоциированных с антинейтрофильными цитоплазматическими антителами (АНЦА-СВ), может широко варьировать и сопровождаться поражением суставов, что затрудняет раннюю диагностику заболевания. Представлено описание случая АНЦА-СВ с тяжелым поражением почек, проявления манифестной фазы которого ограничивались поражением суставов, миалгиями и синдромом Рейно, что привело к запоздалой диагностике на стадии почечной недостаточности с потребностью в гемодиализе (ГД). Неотложное назначение адекватной индукционной терапии позволило сохранить функцию почек, несмотря на 10 дней анурии и 5 нед ГД.Обсуждаются необходимость планомерного подробного обследования пациентов с дебютом воспалительного поражения суставов, особенно с системными проявлениями, и включение исследования АНЦА в сыворотке крови в стандарты диагностики при раннем артрите.

MEDICAL AND SOCIAL CHARACTERISTICS OF WOMEN OF YOUNG REPRODUCTIVE AGE AFTER HYSTERECTOMY

Background. In many countries, hysterectomy is one of the most frequently performed surgical procedures.The objective of our analysis was to assess the social and medical characteristics of young reproductive-age patients who underwent hysterectomy.Materials and methods. A retrospective study involved 140 women aged 18–35 years (median age 29.4 ± 4.7 years) who underwent emergency or elective hysterectomy in the hospitals of Zabaykalsky Krai for a period of 5 years (January 1, 2013, to December 31, 2017).Results. 51.4 % of patients were housewives; 52.9 % were single; 55.7 % had bad habits (smoking, alcohol consumption). These women had a high incidence of socially significant infections: HIV – 3.6 %, active forms of tuberculosis – 1.5 %. 89.3 % of hysterectomies were emergent and 10.7 % were elective (p = 0.0001; OR = 69.4; 95% CI 32.6–148.1). The indications for the emergency hysterectomy were uterine myoma (80 %) and cervical or ovarian cancer (20 %). The obstetrical complications were the main indications for the emergency surgery: placenta abruption – 24.0 %; placenta previa – 20.8 % (placenta increta and/or percreta – 16.8 %; massive antenatal bleeding – 4.0 %); postpartum hemorrhage after vaginal delivery and caesarean section 19.2 %; septic and/or hemorrhagic shock in early miscarriages (from 8 to 19 weeks of gestation) 15.2 %. Mortality was registered in case of emergency hysterectomy only (4.3 %). Half of the deaths (50 %) occurred in cases of complicated miscarriages.Conclusion. To preserve the reproductive potential of young women of reproductive age, it is necessary to increase their social and cultural level, and responsibility for their own health and gender behavior

Laser capture microdissection (LCM) and whole genome amplification (WGA) of DNA from normal breast tissue --- optimization for genome wide array analyses

<p>Abstract</p> <p>Background</p> <p>Laser capture microdissection (LCM) can be applied to tissues where cells of interest are distinguishable from surrounding cell populations. Here, we have optimized LCM for fresh frozen normal breast tissue where large amounts of fat can cause problems during microdissection. Since the amount of DNA needed for genome wide analyses, such as single nucleotide polymorphism (SNP) arrays, is often greater than what can be obtained from the dissected tissue, we have compared three different whole genome amplification (WGA) kits for amplification of DNA from LCM material. In addition, the genome wide profiling methods commonly used today require extremely high DNA quality compared to PCR based techniques and DNA quality is thus critical for successful downstream analyses.</p> <p>Findings</p> <p>We found that by using FrameSlides without glass backing for LCM and treating the slides with acetone after staining, the problems caused by excessive fat could be significantly decreased. The amount of DNA obtained after extraction from LCM tissue was not sufficient for direct SNP array analysis in our material. However, the two WGA kits based on Phi29 polymerase technology (Repli-g^®(Qiagen) and GenomiPhi (GE Healthcare)) gave relatively long amplification products, and amplified DNA from Repli-g^®gave call rates in the subsequent SNP analysis close to those from non-amplified DNA. Furthermore, the quality of the input DNA for WGA was found to be essential for successful SNP array results and initial DNA fragmentation problems could be reduced by switching from a regular halogen lamp to a VIS-LED lamp during LCM.</p> <p>Conclusions</p> <p>LCM must be optimized to work satisfactorily in difficult tissues. We describe a work flow for fresh frozen normal breast tissue where fat is inclined to cause problems if sample treatment is not adapted to this tissue. We also show that the Phi29-based Repli-g^®WGA kit (Qiagen) is a feasible approach to amplify DNA of high quality prior to genome wide analyses such as SNP profiling.</p