Impact of Emphysema Subtypes and Volume on Lung Ventilation and Gas Exchange Functions as Evidenced by Computed Tomography

Objective: to characterize the relationship between the subtype and volume of pulmonary emphysema on the indicators of lung ventilation and gas exchange functions. Material and methods. The data of radiation and functional studies were analyzed in 50 patients. The inclusion criteria were chronic obstructive pulmonary disease and emphysema, which had been diagnosed by computed tomography (CT) and confirmed by two radiologists; comprehensive pulmonary function studies, including spirometry and body plethysmography, were performed; diffusion capacity was measured using a single-breath method, involving inhalation of carbon monoxide, and a breath hold. Patients with primary pulmonary emphysema, any history of pulmonary surgery, and emphysema concurrent with other lung X-ray syndromes (consolidation, cavity) were excluded. CT was performed with a 1-mm thick slice and standard scanning parameters on Toshiba tomographs (Japan). Pulmonary function was tested using a MasterScreen Body Diffusion expert diagnostic unit (VIASYS Healthcare, Germany) in accordance with the criteria for correct pulmonary functional tests proposed by a joint group of experts from the American Thoracic Society and the European Respiratory Society. Volumetric analysis of emphysema was performed using the Lung Volume Analysis software package (Toshiba, Japan). In the study, there was a predominance of male patients (n = 42 (84%)), mainly in the 61-70 age group. Results. The isolated type of emphysema was rare: centrilobular and paraseptal emphysemas were seen in 3 (6%) and 2 (4%) patients, respectively. The mixed type of emphysema was detected in 90% of cases; 33 (66%) patients having a predominant centrilobular component constituted a large proportion. It was determined that as the volume of emphysema increased, the patency of the airways worsened, the static pulmonary volumes increased, the lungs were hyperinflated, pulmonary gas exchange worsened, the bronchial resistance slightly increased during calm breathing. No statistically significant results were found from the point of view of correlations between the volume of emphysema and other parameters of pulmonary function. Conclusion. An increase in the volume of emphysema deteriorates pulmonary function; the greatest contribution to the overall picture is made by the patients with a mixed type of emphysema with a predominance of the centrilobular component

Взаимосвязь функциональных нарушений респираторной системы со структурными изменениями в легких по данным компьютерной томографии у больных туберкулезом легких в сочетании с хронической обструктивной болезнью легких

The aim of the study was to evaluate structural changes in the lung tissue in patients with pulmonary tuberculosis (TB) and coexisting obstructive pulmonary disease (COPD) using highresolution computed tomography (HRCT) and to analyze an influence of CT lesions on the lung function.Materials and methods. One hundred and sixteen TB patients were involved. HRCT with Nodule Analysis and Lung Volume Analysis additional soft ware, spirometry, body plethysmography and measurement of diffusing capacity of the lungs for carbon monoxide were performed in all patients. We used descriptive statistics and Spearman’s correlation analysis.Results. Patients with TB + COPD (n = 23) had extensive (> 3 lung segments) specific changes in the lungs more likely than patients without COPD (n = 93): 83% and 44%, respectively; p < 0.05. Patients with TB + COPD also had higher total volume of TB lesions (p < 0.05) and emphysema (61 and 30%, respectively; p < 0.05) on CT scans. Patients with TB + COPD had panlobular emphysema (17%) more often than other variants of emphysema. Patients without COPD had predominantly centrilobular emphysema (13%); panlobular emphysema was seen in a few cases (2%). Ventilation and gas exchange parameters were related to the volume of TB lesions on CT scans. An increase in emphysema volume on CT scans negatively affected the airflow limitation in all patients and deteriorated lung hyperinflation and lung diffusing capacity in patients with TB + COPD.Conclusions. TBspecific pulmonary lesions were significantly more prominent inpatients with TB + COPD. TBspecific pulmonary lesions could worsen ventilation and gas exchange. More extended emphysema on CT scans could worsen bronchial obstruction in all patients, deteriorate lung hyperinflation and diffusing capacity in patients with TB + COPD.Заболеваемость хронической обструктивной болезнью легких (ХОБЛ) неуклонно растет, а т. к. курят или курили большинство пациентов с туберкулезом легких (ТЛ), специфический процесс все чаще развивается на фоне ХОБЛ. Хотя компьютерная томография (КТ) является ведущим методом визуализации ТЛ, структурные изменения легких, вызванные сопутствующей ХОБЛ, недооцениваются.Целью явилось выявление особенностей специфических и эмфизематозных изменений легких у больных ТЛ в сочетании с ХОБЛ по данным КТ и их влияния на функциональные возможности системы дыхания.Материалы и методы. В исследование включены пациенты с ТЛ (n = 116), которым было выполнено функциональное исследование внешнего дыхания (спирометрия, бодиплетизмография, исследование диффузионной способности легких) и КТ грудной клетки с дополнительным анализом изменений легких с помощью программ Nodule Analysis и Lung Volume Analysis. Использовались описательная статистика и корреляционный анализ Спирмена.Результаты. У пациентов с ТЛ и ХОБЛ (n = 23) чаще встречались распространенные специфические изменения (> 3 сегментов), чем у пациентов без ХОБЛ (n = 93) (83 и 44 %; p < 0,05), больше суммарные объемы фокусов и распада (p < 0,05), чаще выявлялись эмфизематозные изменения (61 и 30 %; p < 0,05). У пациентов с ТЛ и ХОБЛ преобладал смешанный (26 %) и наиболее тяжелый панлобулярный (17 %) тип эмфиземы. У пациентов без ХОБЛ чаще встречался центрилобулярный вариант (13 %), панлобулярный визуализирован в единичных случаях (2 %). Выявлена зависимость параметров вентиляции и легочного газообмена от объемных характеристик специфических из менений. Увеличение объема эмфизематозных изменений оказывало негативное влияние на проходимость дыхательных путей у всех групп пациентов, а у больных с ХОБЛ вызывало увеличение гиперинфляции легких и ухудшение легочного газообмена.Заключение. При сочетании ТЛ с ХОБЛ встречается достоверно больший объем специфического поражения и деструкции. Специфические изменения у больных ТЛ и ХОБЛ ухудшают состояние легочного газообмена. Увеличение объема эмфизематозных изменений приводит к ухудшению проходимости дыхательных путей как у пациентов с ТЛ в сочетании с ХОБЛ, так и без, а также к увеличению гиперинфляции легких и ухудшению легочного газообмена у больных с ТЛ и ХОБЛ

Очень ранний клинический ответ при лечении ингибитором янус-киназ тофацитинибом у больных активным ревматоидным артритом: динамика боли и элементов центральной сенситизации

Janus kinase (JK) inhibitors block the intracellular signaling pathways that are responsible for the synthesis of proinflammatory cytokines and mediators, which in turn cause the activation of pain receptors and central sensitization (CS). It is suggested that JK inhibitors can rapidly eliminate pain and reduce the severity of CS.Objective: to evaluate the effect of the JK inhibitor tofacitinib (TOFA) on the intensity of pain and the signs of CS in patients with active rheumatoid arthritis (RA) at 7 and 28 days after therapy initiation.Patients and methods. A study group consisted of 39 patients (79.5% female) (mean age 50.9±11.1 years) with RA (DAS28 5.8±0.6). Of these, 89.7% were seropositive for rheumatoid factor; 82.0% took methotrexate and 18.0% received leflunomide. All the patients were prescribed TOFA 5 mg twice daily due to the inefficacy or intolerance of biological agents. The investigators estimated pain intensity using a Brief Pain Inventory (BPI), rated the presence of a neuropathic pain component (NPC) with the PainDETECT questionnaire, and assessed the signs of CS with the Central Sensitization Inventory (CSI) during the first 4 weeks after TOFA administration.Results and discussion. The patients initially experienced moderate or severe pain (the mean scores of 5.33±2.51 on the numerical rating scale (NRS) included in BPI); 53.8% had signs of CS (CSI scores of ≥40); 17.9% had signs of a NPC (PainDETECT scores of >18). Already on day 7 after the start of TOFA administration, there was a statistically significant decrease in the mean NRS pain intensity scores to 4.06±2.2 (p=0.01) and by 29.4±17.9%, as shown by the patient's assessment of the analgesic effect of therapy (BPI), as well as the severity of CS, namely a decrease in the mean NRS pain score to 35.9±11.2 (p=0.01). On 28 days, the effect became better: there was a reduction in the level of NRS pain to 2.32±1.57 (p<0.001), in pain according to the patient's assessment of the analgesic effect of therapy to 43.6±29.6%; in the median PainDETECT score to 2.5 [0; 8.7] (p<0.001); and in CSI scores to an average of 26.4±13.9 (p <0.001). No serious adverse reactions were noted.TOFA has a rapid analgesic effect, which allows it to be considered as a chooser for pathogenetic therapy in patients with active RA and severe pain, especially in the presence of CS signs and secondary fibromyalgia. Undoubtedly, large-scale, long-term controlled studies with a wider range of estimated parameters are required to clarify the therapeutic potential of TOFA in this patient category. The limitation of this investigation was its open observer design pattern.Conclusion. The use of the JK inhibitor TOFA can achieve a rapid analgesic effect, inter alia due to its effect on CS and NPC.Ингибиторы янус-киназ (ЯК) блокируют внутриклеточные сигнальные пути, отвечающие за синтез провоспалительных цитокинов и медиаторов, которые, в свою очередь, вызывают активацию болевых рецепторов и развитие центральной сенситизации (ЦС). Предполагается, что ингибиторы ЯК могут быстро устранять боль и уменьшать выраженность ЦС.Цель исследования – оценить влияние ингибитора ЯК тофацитиниба (ТОФА) на выраженность боли и признаки ЦС у больных активным ревматоидным артритом (РА) через 7 и 28 дней после начала терапии.Пациенты и методы. Исследуемую группу составили 39 больных РА (средний возраст 50,9±11,1 года, 79,5% женщин), DAS28 – 5,8±0,6. Из них 89,7% были серопозитивными по ревматоидному фактору, 82,0% получали метотрексат и 18,0% – лефлуномид. Всем пациентам был назначен ТОФА 5 мг 2 раза в день в связи с неэффективностью или непереносимостью генно-инженерных биологических препаратов. Оценивались выраженность боли с помощью опросника BPI (Brief Pain Inventory), наличие невропатического компонента боли (НКБ) с помощью опросника PainDETECT и признаков ЦС с помощью опросника CSI (Central Sensitization Inventory) в первые 4 нед после назначения ТОФА.Результаты и обсуждение. Пациенты исходно испытывали умеренную или выраженную боль (в среднем 5,33±2,51 по числовой рейтинговой шкале – ЧРШ, включенной в BPI), 53,8% имели признаки ЦС (CSI ≥40), 17,9% – признаки НКБ (PainDETECT >18). Уже через 7 дней после начала приема ТОФА отмечалось статистически значимое снижение интенсивности боли в среднем до 4,06±2,2 по ЧРШ (р=0,01) и на 29,4±17,9% по оценке анальгетического эффекта терапии пациентом (BPI), а также выраженности ЦС – уменьшение значения CSI в среднем до 35,9±11,2 (р=0,01). Через 28 дней эффект усилился: наблюдалось снижение уровня боли по ЧРШ до 2,32±1,57 (р<0,001), боли по оценке анальгетического эффекта терапии пациентом до 43,6±29,6%, медианы значения PainDETECT до 2,5 [0; 8,7] (р<0,001), показателя CSI в среднем до 26,4±13,9 (р<0,001). Серьезных неблагоприятных реакций не отмечено. ТОФА обладает быстрым анальгетическим эффектом, что позволяет рассматривать его как средство выбора при проведении патогенетической терапии у больных активным РА с выраженной болью, особенно при наличии признаков ЦС и вторичной фибромиалгии. Несомненно, требуются большие по масштабу длительные контролируемые исследования с более широким кругом оцениваемых параметров для уточнения лечебного потенциала ТОФА у этой категории пациентов. Ограничением настоящего исследования явился его открытый наблюдательный характер.Заключение. Использование ингибитора ЯК ТОФА позволяет достичь быстрого анальгетического эффекта, в том числе за счет влияния на ЦС и НКБ

A NEW DESIGN OF THE GRAIN SEEDER SEEDING DEVICE EQUIPPED WITH A SECTIONAL TYPE COIL WITH GROOVES ARRANGED ALONG THE HELICAL LINE

When sowing with grain seeders to obtain the highest and stable yields of cultivated crops, seeding devices, as well as coulters, remain one of the most important working parts of sowing machines , since the quality of sowing depends on their work. They provide a guaranteed constant flow of sown seeds, the maximum possible stability of a given seeding rate, minimal damage to the sown seeds, as well as the possibility to sow seeds that differ in their dimensional characteristics, and to quickly adjust to a given seeding rate. Improving the quality indicators of sowing grain crops by further improving the technological process and the device of a coil seeding machine having a sectional type coil with helical grooves is relevant for the agroindustrial complex of the Russian Federation. The article describes the design and the schematic diagram of the new seeding device of a grain seeder equipped with a sectional type coil with helical grooves, which allows a greater distribution of seeds along the length of the groove formed by the seeder coulter increases, and there is also a decrease in the crushing of seeds, which will further increase the yield of the cultivated crop

Comparative efficacy of infliximab and adalimumab in patients with ankylosing spondylitis

Objective: to study the comparative efficacy of the genetically engineered biological agents infliximab (INF) and adalimumab (ADA) in patients with ankylosing spondylitis (AS). Subjects and methods. The study included 86 patients with active AS who had failed to achieve remission with the maximal tolerated doses of nonsteroidal anti-inflammatory drugs, sulfasalazine, methotrexate, and glucocorticoids. The patients were divided into 2 groups: 1) 53 patients (mean age 35±9 years, disease duration 13.9±7.5 years) took INF; 2) 33 patients (mean age 35±12 years; disease duration 9.1±6.7 years) received ADA. Therapeutic effectiveness was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) scores, ASsessments in Ankylosing Spondylitis (ASAS) remission criteria, vertebral index changes, laboratory parameters, and HLA-B27 typing. INF was administered at a dose of 3—5 mg/kg body weight (300—400 mg) at 0, 2, and 6 weeks and then every 8 weeks, ADA was given in a dose of 40 mg once every 2 weeks. Therapeutic effectiveness was evaluated every 12 weeks. Results. At 48 weeks of therapy, there was a 50% decrease in BASDAI scores in 64 and 60% of the patients in the INF and ADA groups, respectively. ASDAS dropped in 69% and reached its minimal value in 51% in the INF group; those in the ADA group were 54 and 66%, respectively. The mean BASFI score was almost halved in both INF and ADA groups; its low score was recorded in 67 and 60%, respectively. Both groups showed a significant increase in the spine range of motion after 12 weeks of therapy. By the end of the study, there was a significant improvement of locomotion (BASMI) as compared to the baseline values: from 19.4±8.1 to 13.6±4.8 and from 17.3±6.2 to 15.9±7.3, respectively. According to the ASAS criteria, partial remission was achieved in 69% of the patients receiving INF and in 75% of those taking ADA. There were marked positive laboratory changes. The INF and ADA groups displayed decreases in erythrocyte sedimentation rate (ESR) from 37.7±18.9 to 19.0±16.8 and from 38.3±16.5 to 17.8±18.5, respectively (p<0.001 in both groups) and C-reactive protein (CRP) from 39.8+37.2 to 7.8±24.0 (p < 0.001) and from 23.2±21.2 to 1.0±2.5 (p > 0.13), respectively; and an increase in hemoglobin from 125.9±18.8 to 137.5±20.4 (p < 0.001) and from 129.7±16.2 to 146.3±11.5 (p > 0.10), respectively. Adverse reactions (AR) were found in 37 and 33% in the IFN and ADA groups, respectively. The most common AR (elevated hepatic enzymes) was seen in 11 and 9% in Groups 1 and 2, respectively. Serious ARs that caused to discontinue the use of a drug were observed in only 1 patient receiving INF. In Group 1, 3% of the patients were found to have a lower therapeutic effectiveness requiring that the biological drug be changed for ADA. Conclusion. BASDAI and BASMI scores indicated a more marked clinical response to INF therapy. Both groups showed a rapid decrease in acute-phase inflammatory markers, such as ESR and CRP, and elevated hemoglobin just in the early periods of therapy. Functional improvement in locomotion (in spondylitis, peripheral arthritis) was achieved in both groups. The genetically engineered biological agents were well tolerated

Impulse oscillometry in the diagnosis of obstructive ventilation disorders in pulmonary tuberculosis patients

Impulse oscillometry (IO) possesses certain advantages (being non-invasive and requiring no special breathing maneuvers) but fundamental differences from the well-known methods of external respiration function assessment make it difficult to introduce it into clinical practice. The objective: to evaluate specific changes in the parameters of IO in pulmonary tuberculosis patients and those with obstructive ventilation disorders. External respiration function was extensively assessed in pulmonary tuberculosis patients using IO, spirometry and body plethysmography. The classical interpretation algorithm was used and 2 groups were distinguished: 218 patients with obstructive disorders, and 90 patients without ventilation disorders. In patients with obstructive disorders, deviations of the total respiratory impedance, resistance at a frequency of 5 Hz, reactance area, and resonant frequency were the most significant. IO made it possible to identify additional disorders of mechanical properties in 11% of patients in the group without ventilation disorders according to the results of spirometry and body plethysmography. Correlation analysis in the group of patients with obstruction showed correlations of various strength between the changes in resistance and reactance with characteristics of airway obstruction assessed by traditional methods of ventilation capacity examination, and changes in static pulmonary volumes, which reflected obstructive reconstruction of the total lung capacity. OI can be used as a part of the assessment of ventilation disorders in pulmonary tuberculosis patients

Destruction of bonds between soil particles in the process of water erosion

It is known that tensile strength of soil samples is by three orders of magnitude greater than the shear stresses on the bottom of slope streams responsible for the detachment and transport of soil particles by water current. C.E. Mirtskhulava believed that detachment of soil particles by water current occurs due to the fatigue destruction of bonds between soil particles.Taking this fact into account, tensile strength is lower by two orders of magnitude. M.A. Nearing had an opinion that detachment of soil particles occurs in the points of separation of vortices from the bottom of the stream, where the shear stress is by two orders of magnitude higher than the average. These approaches did not explain overcoming by slope streams of the cohesion forces between soil particles. Studies of the influence of water temperature on the washout rate of model samples have shown that the soil erosion is highly dependent on the water temperature, which is close to the Van’t Hoff’s rule. This means that destruction of bonds between soil particles is probably the result of interaction between the soil solid phase and water molecules. Experiments have also shown that destruction of bonds between soil particles in the sample of chernozem monoaggregate soil occurs under a layer of still water. Upon the start of the water flow, particles that lost bond with the rest of the soil body immediately break away. The number of particles with disrupted bonds grows with the duration of the sample exposure to still water, although with some flattening. Experiments confirm the validity of the hypothesis of non-hydraulic nature of forces that disrupt inter-aggregate bonds during water erosion