A New Combined European Permanent Network Station Coordinates Solution

The EUREF (International Association of Geodesy (IAG) Reference Frame Sub-Commission for Europe) network of continuously operating GPS stations (EPN) was primarily established for reference frame maintenance, and also plays an important role for geodynamical research in Europe. The main goal of this paper is to obtain an independent homogeneous time-series of the EPN station coordinates, which is also available in SINEX format. A new combined solution of the EPN station coordinates was computed. The combination was performed independently for every week, in three steps: 1. the stated constraints on the coordinates were removed from the individual solutions of the Analysis Centers; 2. the de-constrained solutions were aligned to ITRF2000; 3. the resulting solutions were combined using the Helmert block-ing technique. All the data from GPS week 900 to week 1302 (April 1997 - December 2004) were used. We investigated in detail the behavior of the transformation parameters aligning the new combined solution to ITRF2000. In general, the time-series of the transformation parameters show a good stability in time although small systematic effects can be seen, most likely caused by station instabilities. A comparison of the new combined solution to the official EUREF weekly combined solution is also presented

Клиническое значение лептина при системной красной волчанке

Objective: to study the frequency of hyperleptinemia in patients with systemic lupus erythematosus (SLE), its relationship with clinical and laboratory manifestations of the disease, drug therapy, and other metabolic disorders.Patients and methods. The cross-sectional study included 46 women with a definite diagnosis of SLE (median age 40 [31; 48] years) and disease duration 3.0 [0.9; 9.0] years. Glucocorticoids (GC) were received by 38 (83%) patients, hydroxychloroquine – by 35 (76%), immunosuppressants – by 10 (22%), biologic disease-modifying antirheumatic drugs – by 5 (11%). In all patients, fasting levels of glucose, leptin, apoliproprotein B (ApoB) and immunoreactive insulin were determined, and homeostatic model assessment for insulin resistance (HOMA-IR) was calculated. Concentration of leptin ≥11.1 ng/ml, ApoB – >1.6 mg/ml were considered an elevated level. HOMA-IR index ≥2.77 corresponded to the presence of insulin resistance (IR).Results and discussion. Hyperleptinemia was found in 34 (74%) patients with SLE, an increased level of ApoB – in 19 (41%), IR – in 10 (22%). In patients with hyperleptinemia, serositis, positivity for anti-double-stranded DNA (aDNA) and hypocomplementemia were less common, overweight and obesity were more frequent, the SLEDAI-2K index was lower, the aDNA level was lower, and the concentration of the C3 component of complement, insulin, HOMA-IR index, body mass index (BMI) and disease duration were higher (p<0.05 for all cases). BMI <25 kg / m2 had 26 (57%) women, 14 (54%) of whom had hyperleptinemia. In patients with BMI <25 kg / m2, we found a relationship between leptin concentration and disease duration (r=0.4, p=0.04), SLE activity according to SLEDAI-2K (r=-0.6, p=0.003), levels of aDNA (r=-0.6, p<0.001), C3 component of complement (r=0.5, p=0.01), maximum (r=0.7, p<0.001) and supporting (r=0,5, p=0.023) GC doses.In patients with BMI ≥25 kg/m2 (n=20), no such relationship was observed.Conclusion. Hyperleptinemia was found in the majority of women with SLE; elevated levels of ApoB and IR were much less common. Patients with hyperleptinemia are characterized by a longer duration and less activity of the disease, as well as the presence of overweight and obesity and an increase in the HOMA-IR index. In SLE patients with normal body weight, the concentration of leptin increased along with GC dose elevation.Цель исследования – изучение частоты гиперлептинемии у пациентов с системной красной волчанкой (СКВ), ее взаимосвязи с клинико-лабораторными проявлениями заболевания, лекарственной терапией, а также другими метаболическими нарушениями.Пациенты и методы. В поперечное исследование включено 46 женщин с достоверным диагнозом СКВ (медиана возраста 40 [31; 48] лет) и длительностью заболевания 3,0 [0,9; 9,0] года. Глюкокортикоиды (ГК) получали 38 (83%) больных, гидроксихлорохин – 35 (76%), иммуносупрессанты – 10 (22%), генно-инженерные биологические препараты – 5 (11%). У всех больных определены натощак уровни глюкозы, лептина, аполипропротеина В (АпоВ) и иммунореактивного инсулина, рассчитан индекс оценки гомеостатической модели резистентности к инсулину (HOMA-IR). Повышенной считали концентрацию лептина ≥11,1 нг/мл, АпоВ – >1,6 мг/мл.Индекс HOMA-IR ≥2,77 соответствовал наличию инсулинорезистентности (ИР).Результаты и обсуждение. Гиперлептинемия обнаружена у 34 (74%) больных СКВ, повышенный уровень АпоВ – у 19 (41%), ИР – у 10 (22%). При гиперлептинемии реже встречались серозит, позитивность по антителам к двуспиральной ДНК (аДНК) и гипокомплементемия, чаще – избыточная масса тела и ожирение, были ниже индекс SLEDAI-2K, уровень аДНК, выше – концентрация С3-компонента комплемента, инсулина, индекс HOMA-IR, индекс массы тела (ИМТ) и длительность заболевания (р<0,05 для всех случаев). ИМТ<25 кг/м2 имели 26 (57%) женщин, у 14 (54%) из которых обнаружена гиперлептинемия. У пациенток с ИМТ <25 кг/м2 выявлена взаимосвязь концентрации лептина с длительностью заболевания (r=0,4, p=0,04), активностью СКВ по SLEDAI-2K (r=-0,6, p=0,003), уровнем аДНК (r=-0,6, p<0,001), С3-компонента комплемента (r=0,5, p=0,01), максимальной (r=0,7, p<0,001) и поддерживающей (r=0,5, p=0,023) дозами ГК. У больных с ИМТ ≥25 кг/м2 (n=20) подобной взаимосвязи не отмечено.Заключение. Гиперлептинемия выявлена у большинства женщин с СКВ, повышенный уровень АпоВ и ИР встречались гораздо реже.Для пациенток с гиперлептинемией характерны большая длительность и меньшая активность заболевания, а также наличие избыточной массы тела и ожирения, увеличение индекса HOMA-IR. У больных СКВ с нормальной массой тела концентрация лептина нарастала по мере увеличения дозы ГК

ROLE OF INFLAMMATION MARKERS IN DEVELOPMENT OF ATHEROSCLEROSIS AND ITS COMPICATIONS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Cardiovascular events caused by early development and rapid progression of atherosclerotic vascular disease are the main reason behind early lethality among patients with systemic lupus erythematosus (SLE). The rapid development of atherosclerosis in patients with this disease is related to the inflammatory nature of SLE and associated with different inflammatory mediators.Objective. To specify the role of markers and inflammatory mediators (soluble CD40L (sCD40L), soluble tumor necrosis factor α receptors (sTNFα), and neopterin) in the development of atherosclerosis in SLE patients. Materials and Methods. 227 patients (156 females and 71 males) with SLE were examined; median age was 35.6±0.7 years; mean duration of disease was 132.9±7.7 months. The presence of the conventional risk factors (RF) of cardiovascular diseases was determined in SLE patients and control group individuals. Thickening of the intima-media complex and presence of atherosclerotic plaques are signs of atherosclerotic lesion of vessels. The control group consisted of 116 individuals having no rheumatic diseases. Serum concentrations of sCD40L, sTNFα, and neopterin were determined in 187, 193, and 155 SLE patients, respectively, and in 20 control group individuals.Results. sCD40L, sTNFα, and neopterin levels in SLE patients were higher than those in the control group (p<0.05). sCD40L concentration was associated with age, presence of conventional RFs, cholesterol (CS) level, low-density lipoprotein CS, SLE-related factors (SLEDAI-2K score, duration of disease, subclinical manifestations of atherosclerosis, and presence of ischemic heart disease (p>0.05 in all cases)). A relationship was found between sTNFα concentration and arterial hypertension, systolic and diastolic arterial blood pressure levels, concentrations of triglycerides (TG), high-density lipoprotein CS (HDL CS), apolipoprotein A1, factors associated with SLE (duration of disease, chronic kidney disease, SLEDAI-2K score, and lesion index (p<0.05 in all cases)). No reliable association was detected between the sTNFα and manifestations (clinical and subclinical) of atherosclerosis. A reliable difference was revealed between the sTNFα levels depending on gender: the average sTNFα level in males and females was 5.2±1.1 and 4.2±0.3 ng/ml, respectively (p=0.027). The neopterin level correlated with concentrations of TG, LDL CS, atherogenity index, clinical manifestations of atherosclerosis, and SLE-related factors: SLEDAI-2K score and presence of chronic kidney disease (p<0.05 in all cases).Conclusions: sCD40L is the key biological marker of atherosclerotic lesions in blood vessels; the increase in its concentration can be used to predict the risk of cardiovascular complications in SLE patients. The results allow one to consider neopterin both as an immunological indicator of autoimmune pathology and as a predictor of atherosclerotic lesions in blood vessels and related cardiovascular catastrophes. The increase in sTNFα can be used as a laboratory marker of the activity of SLE and atherosclerotic vascular disease

Сахарный диабет и гипергликемия у больных ревматоидным артритом

Proinflammatory cytokines involved in the pathogenesis of rheumatoid arthritis (RA) are able to inhibit the production of insulin and to cause insulin resistance in peripheral tissues. Conceivably RA increases the risk of developing carbohydrate metabolic disturbances (CMDs), such as diabetes mellitus (DM), fasting hyperglycemia (FH), and impaired glucose tolerance. Patients with a concurrence of RA and DM belong to a category of the most critically ill patients with a poor prognosis of macro- and microvascular complications.Objective: to estimate the rate of CMDs (DM and FH) in a cohort of patients with RA and their possible impact on the course of arthritis.Subjects and methods. The investigation enrolled 165 patients (28 men and 137 women) aged 55 [47; 61] years who were diagnosed with RA and followed up at the V.A. Nasonova Research Institute of Rheumatology. The patients who were seropositive for rheumatoid factor and anti-cyclic citrullinated peptide antibodies were 86.3 and 78.8%, respectively. RA activity was low in 29.1% of the patients, moderate in 48.5%, and high in 22.4%. Glucocorticoids (GC) were taken at a mean dose of 5 [5; 7.5] mg/day by 40.6% of the patients; methotrexate, leflunomide, and genetically engineered biological agents were used by 72.7, 8.5, and 23.7%, respectively. A survey was conducted among the patients to find out their awareness of the presence of CMDs and fasting venous plasma glucose levels were determined to screen for hyperglycemia. Height and weight were measured and body mass index (BMI) was calculated.Results. CMDs were present in 21 (12.7%) of the 165 patients with RA. Only 11 (6.7%) of the 165 patients were aware of having DM (2 cases with type 1 DM and 9 with type 2 DM); laboratory tests revealed CMDs in the remaining 10 patients (8 cases with FH and 2 with type 2 DM). The patients with DM and FH had a large number of tender joints (TJN) and high scores of general health survey (GHS) and DAS28 than those with normal blood glycose levels, but did not differ in RA duration, acute-phase indicators (erythrocyte sedimentation rate, C-reactive protein), and the number of swollen joints. Fifty-seven (34.5%) patients were overweight and 39 (23.6%) were obese. In the patients who took GC, glucose levels were lower (5.1 [4.7; 5.5]) than in those who did not (5.4 [5.0; 5.9] mmol/l; p = 0.001) and correlated with BMI ((r = 0.3; p = 0.01).Conclusion. The investigation demonstrated the high rate of DM and FH in RA, but low patient awareness of these conditions, as well as the relationship of CMDs to arthritis activity mainly due to the changes of subjective indices (GHS and TJN). The intake of GC and BMI may affect blood glucose levels in RA.Провоспалительные цитокины, участвующие в патогенезе ревматоидного артрита (РА), способны тормозить продукцию инсулина и вызывать инсулинорезистентность периферических тканей. Возможно, при РА увеличивается риск развития нарушений углеводного обмена (НУО): сахарного диабета (СД), гипергликемии натощак (ГН), нарушения толерантности к глюкозе. Больные с сочетанием РА и СД относятся к категории наиболее тяжелых пациентов с неблагоприятным прогнозом макро- и микрососудистых осложнений.Цель исследования – оценить частоту НУО (СД и ГН) в когорте пациентов с РА и их возможное влияние на течение артрита.Материал и методы. В исследование было включено 165 пациентов (28 мужчин, 137 женщин), средний возраст – 55 [47; 61] лет, наблюдающихся в ФГБНУ НИИР им. В.А.Насоновой с диагнозом РА. Серопозитивными по ревматоидному фактору были 86,3% больных, по антителам к циклическому цитруллинированному пептиду – 78,8%. Активность РА была низкой у 29,1% пациентов, умеренной – у 48,5%, высокой – у 22,4%. Глюкокортикоиды (ГК) получали 40,6% больных (в средней дозе 5 [5; 7,5] мг/сут), метотрексат – 72,7%, лефлуномид 8,5%, генно-инженерные биологические препараты – 23,7%. Проводили опрос пациентов для выявления осведомленности о наличии НУО и исследование уровня глюкозы натощак в венозной плазме для скрининга гипергликемии. Измеряли рост и массу тела пациентов, рассчитывали индекс массы тела (ИМТ).Результаты исследования. НУО имелись у 21 (12,7%) из 165 пациентов с РА. Только 11 (6,7%) из 165 пациентов с РА знали о наличии у них СД (2 случая СД 1-го типа, 9 случаев СД 2-го типа), у оставшихся 10 больных НУО (у 8 больных – ГН, у 2 – СД 2-го типа) обнаружены при лабораторном обследовании. Пациенты с СД и ГН имели большое число болезненных суставов (ЧБС), более высокие оценку общего состояния здоровья пациента (ООЗП) и DAS28, чем больные с нормогликемией, но не отличались по длительности РА, уровню острофазовых показателей (СОЭ, СРБ), числу припухших суставов. Избыточная масса тела отмечена у 57 (34,5%), ожирение – у 39 (23,6%) пациентов. На фоне приема ГК уровень глюкозы был ниже (5,1 [4,7; 5,5]), чем у больных без ГК-терапии (5,4 [5,0; 5,9] ммоль/л, p=0,001), и коррелировал с ИМТ (r=0,3, p=0,01).Заключение. Продемонстрированы большая частота СД и ГН при РА, низкая осведомленность о них больных, а также взаимосвязь НУО с активностью артрита, преимущественно за счет изменения субъективных показателей (ООЗП, ЧБС). На уровень глюкозы в крови при РА могут оказывать влияние прием ГК и ИМТ

Обновленные рекомендации EULAR/ERA–EDTA 2019 г. по терапии волчаночного нефрита. Комментарии экспертов. Часть I

The paper presents the main provisions of the 2019 updated European League Against Rheumatism (EULAR)/European Renal Association (ERA) – European Dialysis and Transplant Association (EDTA) guidelines for the management of lupus nephritis. It discusses the technology of preparing recommendations by an international group of rheumatologists, nephrologists, morphologists, and pediatricians. The main part contains recommendations on the use of induction and maintenance therapy with immunosuppressants, glucocorticoids, and biological agents. The issues relating to the management of pregnant patients with end-stage renal failure are considered.Представлены основные положения обновленных рекомендаций EULAR/ ERA–EDTA 2019 г. по терапии волчаночного нефрита. Обсуждается технология подготовки рекомендаций международной группой ревматологов, нефрологов, морфологов и педиатров. В основной части содержатся рекомендации по применению индукционной и поддерживающей терапии с использованием иммуносупрессоров, глюкокортикоидов и генно-инженерных биологических препаратов. Рассмотрены вопросы ведения пациенток с беременностью и терминальной почечной недостаточностью

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Climatic signals observed by VLBI

VLBI observations at various stations all over the globe have been carried out since the beginning of the eighties. As VLBI allows to determine tropospheric parameters such as hydrostatic and wet zenith path delays stable and long time series of these parameters exist that can be used for climatological studies. From the wet zenith delays information about trends and periodic variations of the amount of water vapour in the troposphere can be obtained. For example a trend of ~+0.7 mm/year in the wet zenith delay will correspond to a trend of ~ +0.1 mm/year in precipitable water. For assessing the reliability of the linear trends and the amplitudes of annual and semiannual components, data from VLBI, GPS, and the ECMWF (European Centre for Medium-Range Weather Forecasts) were compared. Good agreement was found for the seasonal variations, though the linear trends showed some disagreement. Possible reasons for this disagreement are discussed. Finally, the effect of El Niño events on tropospheric mapping functions and on length-of-day time series is shown

INFECTION COMPLICATIONS AFTER COLON-PROCTOLOGIC SURGERIES: EPIDEMIOLOGY, PATHOGENESIS AND PREVENTION

The review presents some data that reflect the incidence frequency, pathogenesis and approaches to the prevention of infectious complications after coloproctological surgery. They show no uniform recommendations for prevention thereof using the techniques and technologies available with the emergency care specialists. The effectiveness of various pro- and prebiotics, fecal microbiota transplantation are most extensively studied. Also the role of changes in intestinal canal biocenosis and endoluminal translocation in the pathogenesis of systemic infection and other infectious complications is demonstrated