95 ЛЕТ САНКТ-ПЕТЕРБУРГСКОМУ ИНСТИТУТУ ФТИЗИОПУЛЬМОНОЛОГИИ: ОСНОВНЫЕ НАПРАВЛЕНИЯ ИССЛЕДОВАНИЙ ЗА ПОСЛЕДНЕЕ ДЕСЯТИЛЕТИЕ ПО ПРОФИЛАКТИКЕ, ДИАГНОСТИКЕ И ЛЕЧЕНИЮ ТУБЕРКУЛЕЗА

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Forty years of temporal analysis of products

A detailed understanding of reaction mechanisms and kinetics is required in order to develop and optimize catalysts and catalytic processes. While steady-state investigations are known to give a global view of the catalytic system, transient studies are invaluable since they can provide more comprehensive insight into elementary steps. For almost forty years temporal analysis of products (TAP) has been successfully utilized for transient studies of gas phase heterogeneous reactions, and there have been a number of advances in instrumentation and numerical modeling methods in that time. Since TAP is a complex methodology it is often viewed as a niche specialty. With the purpose to make TAP more relevant and approachable to a wider segment of the catalytic research community, part of the intention of this work is to highlight the significant contributions TAP has made to elucidating mechanistic and kinetic aspects of complex, multi-step heterogeneous reactions. With this in mind, an outlook is also disclosed for the technique in terms of what is needed to revitalize the field and make it more applicable to the recent advances in catalyst characterization (e.g. operando modes)

POSITIVE RESULTS OF TRANSPLANTATION OF MULTI-COMPONENT COMPOSITE MATERIAL CONTAINING ALLOGENEIC MESENCHYMAL STEM CELLS AFTER CYSTECTOMY IN A RABBIT

Of late much attention has been paid to tissue engineering by urologists. After successful testing on animals, artificial urinary bladders with self-specific cells were transplanted to humans. Our research is aimed at investigating the opportunity of using cellular technologies  if no healthy  self-specific material is available.The goal of this experiment  is to investigate the opportunity of using a multi-component composite material containing  allogeneic cells to replace the defect of urinary wall under experimental conditions.The standard technique was used for isolation and culturing of mesenchymal stromal stem cells from the rabbit's  bone marrow. Multi-component composite material based on the polylactide  matrix was inoculated by allogeneic cells and transplanted in vivo to the model of partial cystectomy. In 2.5 months the presence of labeled cells in the implantation site was confirmed by objective methods

Возможности оптимизации медицинской помощи больным пульмонологического профиля в условиях мегаполиса

The experience of the Sankt-Petersburg scientific and clinical Center of intensive pulmonology and thoracic surgery in 1995-1998 is presented in the article. The Center’s structure merges the outpatient department, the pulmonology department, the thoracic surgery department and the cardiorespiratory intensive care unit in a single technological chain. Results of examination and treatment of 17 845 patients demonstrate advantages of such a form of specialized medical care.The interaction between the outpatient and inpatient departments contributed to a reduction in the mean bed-day for therapeutic patients and a preoperative bed-day for thoracic surgery patients. The outpatient department allowed solving diagnostic and therapeutic problems in 92% of the patients without their hospitaization. While using this technique we managed to reduce a preoperative bed-day in the thoracic surgery department up to 2.3 days and to increase the operative activity up to 89%. The method offered is based on the idea of a closed cycle of the diagnostics and treatment starting from the primary consultation via the inpatient stage, if necessary, up to the outpatient rehabilitation period. The advantages and reserve of this method are discussed in the article.В статье представлен опыт работы Санкт-Петербургского научно-практического центра интенсивной пульмонологии и торакальной хирургии за 1995-1998 гг., структура которого увязывала в единую технологическую цепочку амбулаторно-поликлиническое звено, пульмонологическое отделение, отделение торакальной хирургии и отделение кардиореспираторной реанимации. На материале обследования и лечения 17 845 пациентов показаны преимущества подобной формы оказания медицинской помощи профильным больным.Взаимодействие амбулаторных и стационарных подразделений способствовало сокращению среднего койко-дня у терапевтических больных, предоперационного койко-дня у торакальных больных. Возможности амбулаторной службы позволили у 92% больных решить диагностические и лечебные вопросы, не прибегая к госпитализации. Предоперационный койко-день в отделении торакальной хирургии удалось сократить до 2,3 дня, а оперативная активность при использовании предложенной технологии достигла 89%. Обсуждаются преимущества апробированной формы работы и резервы предлагаемой технологии оказания пульмонологической помощи населению, в основе которой лежит идея замкнутого цикла комплексной диагностики и лечения от первичного обращения, при необходимости через стационарный этап, до восстановительного лечения в условиях поликлиники

ДИНАМИКА РАСПРОСТРАНЕННОСТИ ТУБЕРКУЛЕЗА С МНОЖЕСТВЕННОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ

The tendency of tuberculosis prevalence reduction observed in the Russian Federation is mostly related to the cases without multiple drug resistance (MDR). In general the number of MDR TB cases still tends to be increasing in the Russian Federation. Confident long-term reduction is registered only in the Central and North-Western Districts with relatively low level of MDR TB prevalence. From 2017 MDR TB patients are expected to prevail in the structure of the sputum positive cases which surely provides negative impact on the treatment efficiency and epidemic trends. The system of dispensary follow-up allows evaluating the annual number of MDT TB cases and following the ways of its increase and reduction. Taking MDR TB sources on and off the register is less intensive compared to the same flows of non-MDR infectious cases. The number of MDR TB sources is increasing mostly due new tuberculosis cases however acquired MDR TB makes significant contribution to the growth of MDR TB sources number. The increase in the ratio of respiratory MDR TB patients with sputum conversion to those died reflects the success in the improvement of the treatment strategy of MDR TB patients.Наблюдающаяся в Российской Федерации тенденция снижения распространенности туберкулеза относится в основном к случаям заболевания без множественной лекарственной устойчивости (МЛУ) возбудителя. Число больных с МЛУ микобактерий туберкулеза (МБТ) в целом по РФ сохраняет тенденцию к росту. Многолетнее достоверное снижение показателя отмечается только в Центральном и Северо-Западном федеральных округах с относительно низким уровнем распространенности МЛУ МБТ. С 2017 г. в РФ ожидается доминирование больных с МЛУ МБТ в структуре состоящих на учете бактериовыделителей, что не может не оказать негативного влияния на эффективность лечения и направленность дальнейших эпидемических тенденций. Система диспансерного учета больных туберкулезом позволяет оценить годовое число источников МЛУ МБТ и проследить пути его увеличения и уменьшения. Взятие и снятие с учета источников МЛУ МБТ происходит менее интенсивно, чем аналогичное движение числа бактериовыделителей без МЛУ МБТ. Пополнение числа источников МЛУ МБТ происходит преимущественно за счет впервые выявленных случаев туберкулеза, однако отмечается существенный рост пополнения числа источников МЛУ МБТ за счет вторичной МЛУ МБТ. Рост отношения числа больных туберкулезом органов дыхания с МЛУ МБТ, у которых прекратилось бактериовыделение, к умершим отражает успехи в совершенствовании стратегии лечения больных туберкулезом с МЛУ МБТ

Influence of silicone mammoplasty on the immunoendocrine status of female recipients

The article concerns a study of early influence of silicone breast implants on the development of autoimmune reactions and dynamics of prolactin and thyroid hormone levels in women after mammoplasty. At the present time, this issue remains relevant for several reasons: more than 20 million pairs of implants have been installed in the world and the number of their implantations is constantly growing. Despite relative safety of the silicone implants, some of them are periodically banned by regulatory bodies in various countries. At the same time, there is a growing number of controversial publications in the scientific literature, about potential adverse consequences of their use. Some authors suggest an association between the silicone implants and risk of developing autoimmune conditions, connective tissue disorders, and occasional malignancies. On the other hand, the journals are full of publications about the overall safe tolerance of such medical devices by the patients. These considerations served as a pre-requisite to our research. As part of this project, we have assayed serum levels of autoantibodies to ten antigens, as well as contents of prolactin and thyroid hormones by means of ELISA technique in 27 patients before, 3 and 6 months after aesthetic and reconstructive mammoplastics performed within a period of September 2018 to November 2019. As a result, it was found that 5 out of 27 patients exhibited changes in the autoimmunity spectrum and intensity after mammoplasty. In particular, the concentrations of autoantibodies to modified citrullinated vimentin and IgM autoantibodies to cardiolipin exceeded the normal level at 3 and 6 months. In addition, the initially high prolactin concentration in mammoplasty recipients dropped to normal ranges by 3 months after breast surgery, even after several-fold increased initial levels. As for thyroid hormones, there were no statistically significant changes in their dynamics. The increase of autoantibodies to various target antigens after mammoplasty was statistically significant and positively correlated with each other. This can be explained, for example, by dependence on the adjuvant effect of silicone, which is not associated with antigen specificity. However, it may generally stimulate the immune responses

Возможности прогнозирования продолжительности жизни больных XOБЛ с целью уточнения показаний к трансплантации легких

The results of 58 COPD patients’ dynamic observation (56 males and 2 females) were analysed. The patients had been treated in the State Scientific Pulmonology Centre of Health Ministry of Russian Federation and the municipal pulmonology hospital N 2 of Sankt-Peterburg city in the years 1996-1998. The patients were examined using standard clinical techniques, lung function and diffusing capacity tests, blood gas analysis, echography of pulmonary circulation. Prognostic criteria were evaluated which enable to determine the optimal date for lung grafting.Initially all the patients were divided into two groups: 9 patients whose lifetime had not exceeded 18 months after their first examination and 49 patients who had lived more than 18 months after their first examination. The first group patients demonstrated the signs of right heart hypertrophy and overload significantly more often.Their pulmonary artery blood pressure was increased to 38 mm Hg and the capillary blood oxygen contents was greatly diminished. Lung function and diffusing capacity parameters, pCO2 did not differ in the groups.Next, the certain indices’ influence on the life-expectancy as well as the prognostic value of chronic cor pulmonale existence and severity were assessed.The correlation analysis displayed a strong tie between the COPD patients’ life-expectancy and the pulmonary artery blood pressure level, dyspnoe, heart beat rate, hypoxaemia level and also between the pulmonary artery blood pressure level and the capillary blood oxygen contents. The correlation between the severity of corpulmonale failure and the patients’ life-expectancy was faint.The pulmonary artery blood pressure proved to be the most important parameter for the patients’ prognosis: ones having it normal lived more than 2 years meanwhile the patients with the pulmonary artery blood pressure higher 50 mm Hg lived not more 18 months. The lung functional parametbrs were not found to be the independent prognostic factors.So, based on the result obtained the indications for lung grafting in COPD patients are thought to be the pulmonary artery blood pressure higher than 50 mm Hg, the pO2 level less than 60 mm Hg and the conservative therapy failure.Проанализированы материалы динамического наблюдения 58 больных ХОБЛ (56 мужчин и 2 женщины), пролеченных в ГНЦ пульмонологии М3 РФ и ГМПБ № 2 г. Санкт-Петербурга в 1986-1998 гг. Больным проведено стандартное общеклиническое обследование, исследование функции внешнего дыхания и диффузионной способности легких, газового состава крови, эхографическое исследование гемодинамики малого круга кровообращения. Оценивали прогностические критерии, позволяющие определить оптимальные сроки выполнения трансплантации легких. В начале исследования больные были разделены на 2 группы: прожившие не более 18 месяцев после первого обследования (9 человек) и прожившие более 18 месяцев (49 человек). В первой группе значительно чаще выявлялись признаки гипертрофии правых отделов сердца и их перегрузки, было повышено давление в легочной артерии в среднем до 38 мм рт.ст., напряжение кислорода в капиллярной крови было значительно ниже. Показатели функции внешнего дыхания, диффузионная способность легких, рСО2 в сравниваемых группах не различались. Далее оценивалось влияние ряда показателей на продолжительность жизни, а также прогностическое значение наличия и выраженности хронического легочного сердца.Корреляционный анализ показал сильную взаимосвязь между продолжительностью жизни больных ХОБЛ и уровнем давления в легочной артерии, одышкой и частотой пульса, выраженностью гипоксемии, а также - между давлением в легочной артерии и напряжением кислорода в капиллярной крови. Корреляция между степенью декомпенсации легочного сердца и продолжительностью жизни больных была слабой.Наиболее прогностически значимым показателем оказался уровень давления в легочной артерии: при нормальном давлении в легочной артерии все больные жили более 2 лет, а при давлении выше 50 мм рт. ст. - не более 18 месяцев. Функциональные показатели не имели самостоятельного прогностического значения.Таким образом, на основании полученных результатов показаниями для трансплантации легких при ХОБЛ можно считать давление в легочной артерии более 50 мм рт. ст., уровень рО2 менее 60 мм рт. ст., отсутствие эффекта от проводимой консервативной терапии

БАКТЕРИЦИДНАЯ АКТИВНОСТЬ ЛЕЙКОЦИТОВ У БОЛЬНЫХ ТУБЕРКУЛЕЗОМ ЛЕГКИХ

Bactericidal activity of leukocytes was investigated in 63 patients with new infiltrate pulmonary tuberculosis and 28 patients with fibrous cavernous pulmonary tuberculosis. The diverse oxygen-dependent bactericidal activity of phagocytes is typical of the patients suffering from both clinical forms of tuberculosis: reduction of nitrosative stress rates, which is more frequent in those suffering from fibrous cavernous tuberculosis, and increase of oxidative stress rates, which is more intensive in case of fibrous cavernous tuberculosis. The associated functions were detected among immune-competent cells, involved in the bactericidal function: in case of fibrous cavernous tuberculosis – between oxidative stress rates, and in case of infiltrate pulmonary tuberculosis – between nitrosative stress rates; the synergistic effect of respiratory burst was observed. In case of chronic pulmonary tuberculosis, both types of cells were equally responsible for bactericidal functions, while neutrophils were dominating in new infiltrate pulmonary tuberculosis, without prior treatment, being the cells of the first line of defense. The obtained results allowed concluding that in case of new pulmonary tuberculosis without prior treatment, nitrosative stress played the important role in the killing of tuberculous mycobacteria, while in case of chronic tuberculosis – it was oxidative stress.Бактерицидная активность лейкоцитов изучена у 63 больных впервые выявленным инфильтративным туберкулезом легких (ИТЛ) и 28 ‒ фиброзно-кавернозным туберкулезом легких (ФКТ). Для больных с обеими клиническими формами туберкулеза характерна разнонаправленная кислородзависимая бактерицидная активность фагоцитирующих клеток: снижение показателей нитрозилирующего стресса, в большей степени характерное для больных ФКТ, и рост показателей оксидативного стресса, больше выраженного при ФКТ. Выявлена сопряженность функционирования иммунокомпетентных клеток, участвующих в бактерицидной функции: при ФКТ ‒ между показателями оксидативного стресса, при ИТЛ – нитрозилирующего; отмечен синергический эффект респираторного взрыва. Если при хронической форме туберкулеза легких за бактерицидную функцию одинаково «отвечают» оба типа клеток, то при впервые выявленном нелеченном ИТЛ доминирующая роль отводится нейтрофилам как клеткам первой линии защиты. Полученные результаты дают основание полагать, что при впервые выявленном нелеченном туберкулезе легких важная роль в подавлении микобактерий туберкулеза отводится нитрозилирующему стрессу, а при хронической форме туберкулеза – оксидативному

CHARACTERISTICS OF AUTOIMMUNE INFLAMMATION IN THE PATIENTS WITH LUNG TUBERCULOSIS

Tuberculosis is a granulomatous disease caused by Mycobacterium tuberculosis, being characterized by the development of caseous granulomas in various organs, mainly in lungs. M. tuberculosis is known to be a trigger for autoimmune inflammation, due to the possible mimicry of bacterial proteins as autoantigens. Recently, a significance of mesenchymal vimentin as an autoantigen in mycobacterial infections has been actively discussed. The aim of the present study was to determine autoantibodies for various vimentin modifications in the patients with tuberculosis.The study was performed in 2014-2017 and included 28 patients with pulmonary tuberculosis (group I), 30 patients with nonspecific lung diseases (group II): 15 with granulomatous polyangiitis, and 15 with different alveolites. Control group consisted of healthy subjects (n = 40). Concentration of antibodies to mutated citrullinated vimentin (anti-MCV) was measured using ELISA (ORGENTEC, Germany). The patients with elevated anti-MCV levels were tested for antibodies to cyclic citrullinated peptide (anti-CCP) using ELISA technique (EUROIMMUN, Germany). Statistical analysis was carried out using GraphPad Prism 6 (GraphPad Software, USA), Statistica 10 (Statsoft, USA) using nonparametric analysis of samples with Mann-Whitney and Chi-square criteria, and Spearman method for correlation analysis. The differences were considered statistically significant at p < 0.05.The anti-MCV concentrations were significantly higher in patients with tuberculosis (group I, 60.7% of cases, 17/28) than in group II, and control group (23.6 and 25.0% of cases, respectively). No statistically significant differences were revealed between the results of anti-MVC and anti-CCP levels in comparison group with the control group (p = 0.18).High levels of anti-MCV antibodies in the patients with pulmonary tuberculosis reflect an opportunity of developing autoimmune process in the disease pathogenesis. Measurement of plasma anti-MCV antibody concentrations may be important for correction of the therapy, especially upon administration of immunosuppressive and hormonal corticosteroid drugs. It has been shown that anti-CCP are not characteristic to the lung diseases