ИНТЕГРАЛЬНАЯ ОЦЕНКА ОКСИДАТИВНОГО СТАТУСА ПРИ ОСТРОМ ТОКСИЧЕСКОМ ГЕПАТИТЕ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ АЛКОГОЛЬНОЙ БОЛЕЗНЬЮ ПЕЧЕНИ

BACKGROUND Acute toxic hepatitis associated with acute poisoning with alcohol-containing disinfectants remains a medical and social problem.MATERIAL AND METHODS With an aid of chemiluminescence, we performed the integrated assessment of the oxidative status in the blood serum and homogenized liver biopsy tissue of 62 patients with the diagnosis «severe acute toxic hepatitis associated with the use of alcohol-containing disinfectants».RESULTS The research showed that at the onset of a disease, patients with acute toxic hepatitis had an expressed activation of free radical oxidation of the blood serum and biopsy tissue. This was indicated by almost double increase in the intensity of free radicals generation (Ssp). This signifi cantly increased production of peroxide (Sind-1) and hydroxyl radicals (Slum) — 2.5 and 1.86 times, respectively; also, it increased concentration of lipid hydroperoxides (h) almost three times, evidencing activation of the initial stage of lipid peroxidation There was no statistically signifi cant fall of figures indicating the liver parenchymal oxidative status 30 days after the admission. The same situation was observed 6 months after the beginning of the study.CONCLUSION Analyzing chemiluminescence scans of blood serums up to 30 days from admission, it is possible to conclude indirectly on a condition of the oxidative status in a liver parenchyma of patients.АКТУАЛЬНОСТЬ Развитие острого токсического гепатита как результата острого отравления спиртосодержащими дезинфектантами остается медицинской и социальной проблемой.МАТЕРИАЛ И МЕТОДЫ С помощью метода хемилюминесценции (ХМЛ) проведена интегральная оценка оксидативного статуса с использованием сыворотки крови и гомогенизированных гепатобиоптатов у 62 пациентов с диагнозом «острый токсический гепатит тяжелого течения вследствие употребления спиртсодержащих дезинфектантов».РЕЗУЛЬТАТЫ Исследование показало, что в начале заболевания у больных острым токсическим гепатитом происходила выраженная активация процессов свободнорадикального окисления сыворотки крови и гепатобиоптатов. На это указывало практически двукратное усиление интенсивности генерации свободных радикалов (Ssp). При этом существенно усилилась продукция перекисных (Sind-1) и гидроксильных радикалов (Slum) — в 2,5 и 1,86 раза соответственно; а также почти в 3 раза повысилась концентрация гидроперекисей липидов (h), что свидетельствовало об активации начального этапа процессов пероксидации липидов. Через 30 сут после поступления пациентов в стационар статистически значимого снижения значений показателей оксидативного статуса в паренхиме печени по отношению к таковым при поступлении не происходило. Такая же картина наблюдалась и через 6 мес после начала наблюдения.ЗАКЛЮЧЕНИЕ Анализируя ХМЛ-граммы сывороток крови больных в сроки до 30 сут от момента поступления, можно косвенно судить о состоянии оксидативного статуса в паренхиме печени пациентов

Complex estimation of mitochondrial changes of immunocompetent blood cells in pregnant women with urgent and premature birth

Inflammation is among the factors promoting development of premature rupture of the membranes (PPROM). Upon the conditions of physiological immune imbalance in pregnancy, inflammation modifies its course and can even change the immune response. Appropriate indexes may be quantitative and functional. We used a marker of mitochondrial membrane potential (MPM, Ay) as an integral index of the functional state of immunocompetent blood cells (IBC) in 159 women who were examined at 8-14 weeks of gestation; they were observed up to 34-36 weeks. Of these cohort, 121 women were referred to a comparison group. The main group (n = 46) consisted of pregnant women with PPROM at the term of 28-33 weeks. The examination was carried out according to current medical standards, with informed consent, being approved by the Ethics committee at the Khabarovsk branch of Far Eastern Scientific Centre of Physiology and Pathology of Respiration — Research Institute of Maternity and Childhood Protection. Additionally, MPM and lymphocyte populations were determined by flow cytometry. The degree of disturbed energy supply in the IBC was based on the data of simultaneous determination of lymphocyte, granulocyte and monocyte numbers with reduced MPM values (application for invention No. 2020115963), thus revealing 3 degrees of energy deficiency: 1st degree, monovariant IBC composition with reduced MPM; 2nd degree, bivariant composition, 3rd degree, total changes. A relative and absolute decrease in CD3 (72% vs 78% and 1624 vs 1980), CD8 (28% vs 33% and 651 vs 851), an increase in CD19 (14% vs 9% and 304 vs 219) were revealed in pregnant women with PPROM. When assessing MPM values in the IBC populations, a decreased proportion of women without energy deficiency from the 1st to the 2nd trimester (from 41% to 30%), due to the 3rd degree of energy deficiency (from 17% to 26%) was detected. A shift of affected pools at the 2nd degree of energy deficiency in favor of lymphocytic-granulocytic association (from 7% to 25%) from lymphocytic-monocytic compartment (from 73% to 50%) was found. From the 2nd to 3rd trimester, we have detected redistribution of granulocyte pools at the 1st degree (0 to 8%) and from the lymphocytic-granulocytic association (25% and 5%) to monocytic-granulocytic (25% and 40%). In the group with PPROM, there was a decreased proportion of pregnant women without energy deficiency (13% and 27%), as well as with the 1st and 2nd degrees (17% vs 31% and 9% vs 17%), due to the 3rd degree of energy deficiency (61% and 26 %), relative to the comparison group. The IBC pools of in the main group were redistributed at the 1st degree in favor of granulocytes (25% and 8%), at the 2nd, in favor of the lymphocytic-monocytic association (100% and 55%) from the granulocytic-monocytic (0% and 40%). Such imbalance of bioenergetic processes in the IBC can be an important factor of pathologically ongoing inflammation. These changes could be caused by both higher incidence of infections in such patients and by alloimmune interactions between mother and fetus. However, they may also determine the pathological course of inflammation. Preterm birth, which is usually caused by PPROM, is a multifactorial pathological condition. However, independent on specific triggers, the changes in energy supply of IBC, at least, may serve as a significant biomarker of probability for this disorder

Features of mitochondrial membrane potential of immunocompetent blood cells in children with chronic nonspecific lung diseases accompanied by pneumofibrosis

Pneumofibrosis is a pathological outcome of pulmonary tissue inflammation. It can complicate any lung and bronchial disorder. The mitochondrial membrane potential reflects functional state of immunocompetent blood cells that influence progression of a chronic inflammatory process. The aim of this work was to study the features of mitochondrial membrane potential (MMP) of immunocompetent blood cells in children with chronic nonspecific lung diseases (CNPD), accompanied by pneumofibrosis. We have examined 79 children with CNPD manifesting with symptoms of focal pneumofibrosis. The group of patients included children with congenital lung malformations (43%), consequences of bronchopulmonary dysplasia (41%), chronic bronchitis (10%), post-pneumonic pulmonary fibrosis (6%). The average age of children was 6.5±1.2 years, including 43 boys (54%) and 36 girls (46%). The comparison group included 46 children with COPD without signs of pulmonary fibrosis, the control group consisted of 30 apparently healthy children. The contents of cells with reduced MMP among lymphocytes, monocytes, and granulocytes in peripheral blood was determined with JC-1 dye, using the BD FACSCalibur instrument and Cell Quest Pro software (Becton Dickinson, USA). The proportion of lymphocytes with reduced MMP in patients with COPD was similar in the children of the main and comparison group, exceeding the indexes of the control group by 1.7 times (p < 0.001). Decreased MMP of granulocytes in children with pneumofibrosis was detected 1.9 times more often than in children with fibrosis-free CNPD cases (p < 0.05), and 3.4 times more common than in children from the control group (p < 0.001). Monocytes with reduced MMM in children with pulmonary fibrosis were detected 2 times more often than in children with COPD without fibrosis (p < 0.05), and 7.3 times more frequent than in the control group (p < 0.001). The changes were more expressed in children during exacerbation of the disease. The revealed features suggest a decreased level of metabolic activity of blood cells, thus, probably, presenting an immunopathogenetic basis for development of pneumofibrosis

Непосредственные результаты резекций прямой кишки по поводу рака в зависимости от восстановления целостности тазовой брюшины: ретроспективное исследование

Background. Colorectal anastomotic leakage remains on of the most significant challenges in rectal surgery.Objective: to assess the impact of pelvic peritoneal floor reconstruction on the incidence of postoperative complications associated with colorectal anastomosis.Materials and methods. In this retrospective cohort study, we analyzed medical records of rectal cancer patients who had undergone rectal resection with anastomosis formation between 2013 and 2020. we compared patients who had no pelvic peritoneal floor reconstruction (from 2013 to 2017) and those who had it (2018–2020). Only patients with favorable prognosis (tumor located at least 5 cm above the transitional anal fold and no history of chemoradiotherapy) were included. The primary outcome measure was the incidence of peritonitis and colorectal anastomosis leakage. Secondary outcome measures included overall incidence of complications (Clavien–Dindo), mortality rate, blood loss, and duration of surgery.Results. A total of 120 patients were included into the experimental group, while the control group was composed of 125 patients. Ten patients from the control group developed peritonitis (8.0 %), whereas in the experimental group, there were no cases of peritonitis (p = 0.002). Anastomotic leakage was registered in 12 individuals from the experimental group (12.5 %) and 14 controls (11.2 %) (p = 0.753). The overall incidence of postoperative complications was 23.3 % (n = 28) among patients who had pelvic peritoneal floor reconstruction and 18.4 % (n = 23) among those who did not have it (p = 0.342). Colostomy was required in 92 patients from the experimental group (76.7 %) and 78 patients from the control group (62.4 %) (p = 0.018). The postoperative mortality was 0.8 % in the control group (n = 1) and 0 % in the experimental group (p = 1).Conclusion. Pelvic peritoneal floor reconstruction reduces the risk of peritonitis, but does not affect the overall risk of anastomotic leakage. This method is effective for the prevention of severe postoperative complications.Введение. Несостоятельность колоректального анастомоза остается одной из основных проблем хирургии рака прямой кишки.Цель исследования – оценить влияние восстановления тазовой брюшины на снижение частоты послеоперационных осложнений, связанных с колоректальным анастомозом.Материалы и методы. В ретроспективном когортном исследовании проанализированы данные историй болезни пациентов, которым выполнялась резекция прямой кишки по поводу рака прямой кишки с формированием анастомоза в период 2013–2020 гг. сравнивали пациентов, которым не проводили восстановление тазовой брюшины (с 2013 по 2017 г.), и пациентов, которым тазовая брюшина была восстановлена (2018–2020 гг.). Включали пациентов с благоприятными прогностическими факторами (локализация опухоли выше 5 см от переходной анальной складки, отсутствие предшествующей химиолучевой терапии). Основным оцениваемым параметром была частота перитонитов при развитии несостоятельности колоректального анастомоза, дополнительными оцениваемыми параметрами – общая частота осложнений (по Clavien–Dindo), летальность, кровопотеря, длительность операции.Результаты. В основную группу было включено 120 пациентов, в контрольную – 125. В исследуемой группе перитонитов не было, в контрольной группе – 10 (8,0 %) случаев (p = 0,002). Общая частота развития несостоятельности анастомоза в исследуемой группе – 15 (12,5 %) случаев, в контрольной – 14 (11,2 %) случаев (p = 0,753); общая частота осложнений в исследуемой группе – 28 (23,3 %) случаев, в контрольной – 23 (18,4 %) случая (p = 0,342); частота формирования кишечных стом в исследуемой группе – 92 (76,7 %) случая, в контрольной – 78 (62,4 %) случаев (p = 0,018). Послеоперационная летальность составила 1 (0,8 %) случай в контрольной группе, в то время как в исследуемой группе послеоперационной летальности не зафиксировано (p = 1).Выводы. Восстановление тазовой брюшины достоверно снижает риск развития перитонита, но не общий риск развития несостоятельности анастомоза. данный метод эффективен в профилактике тяжелых послеоперационных осложнений

INTEGRAL ESTIMATION OF OXIDATIVE STATUS IN PATIENTS WITH ACUTE TOXIC HEPATITIS AND CHRONIC ALCOHOLIC LIVER DISEASE

BACKGROUND Acute toxic hepatitis associated with acute poisoning with alcohol-containing disinfectants remains a medical and social problem.MATERIAL AND METHODS With an aid of chemiluminescence, we performed the integrated assessment of the oxidative status in the blood serum and homogenized liver biopsy tissue of 62 patients with the diagnosis «severe acute toxic hepatitis associated with the use of alcohol-containing disinfectants».RESULTS The research showed that at the onset of a disease, patients with acute toxic hepatitis had an expressed activation of free radical oxidation of the blood serum and biopsy tissue. This was indicated by almost double increase in the intensity of free radicals generation (Ssp). This signifi cantly increased production of peroxide (Sind-1) and hydroxyl radicals (Slum) — 2.5 and 1.86 times, respectively; also, it increased concentration of lipid hydroperoxides (h) almost three times, evidencing activation of the initial stage of lipid peroxidation There was no statistically signifi cant fall of figures indicating the liver parenchymal oxidative status 30 days after the admission. The same situation was observed 6 months after the beginning of the study.CONCLUSION Analyzing chemiluminescence scans of blood serums up to 30 days from admission, it is possible to conclude indirectly on a condition of the oxidative status in a liver parenchyma of patients

FEATURES OF THE OUTBREAK OF THE COMMUNITY-ACQUIRED PNEUMONIA CAUSED BY MYCOPLASMA PNEUMOINIAE AT CHILDREN IN KHABAROVSK REGION

Aim. To study the features of outbreak of community-acquired pneumonia caused by M. pneumoniae in children in the Khabarovsk region during the autumn-winter period 2016 - 2017. Materials and methods. A study was conducted of 30 clinical samples - smears from the posterior pharyngeal wall and sputum samples obtained from patients with community-acquired pneumonia due to M. pneumoniae. Samples were examined for the presence of mutations in the 23S rRNA gene of M. pneumoniae. Results. The age ofthe patients was from 2 to 16 years. In two cases, family foci of the incidence of community-acquired pneumonia occurred. In 19 samples, a mutation was detected in 23S rRNA of M. pneumoniae. Conclusion. The data obtained indicate that in the development of the outbreak of community-acquired pneumonia caused by M. pneumoniae in children in the Khabarovsk region in the autumn-winter period 2016 - 2017, macrolide-resistant strains of the pathogen were involved