Gaze following ability in children 5, 10 and 15 months old

Joint attention is attention to an external object shared between two persons. The joint attention mechanism plays an important role in early cognitive, social and emotional development. Therefore, impairments of joint attention development can trigger different psychic disorders. The simplest form of joint attentional behavior is gaze following. The literature on the development of gaze following in children indicates that there is a great deal of variance regarding the age of emergence and development of this skill. This study aims to examine the age dynamics of the gaze following skill in infants and to establish more precisely the age at which this skill emerges. This comparative study of gaze following ability of infants at the age of 5, 10 and 15 months was conducted in Yekaterinburg at the Laboratory of the Brain and Neurocognitive Development, Ural Federal University. Gaze following ability was measured by the eye tracker task “Gaze following”. Significant differences were found between the proportion of tasks with first gaze to a congruent object performed by 5 and 10 month old children and between 10 and 15 month old children. Furthermore, there was a significant difference of fixation duration on a congruent object between 10 and 15 month old children. The results reveal that the gaze following ability emerges in children already by the age of 5 months, develops significantly by 10 months, and develops almost completely by 15 months. © E. R. VALIEVA, A. I. KOTYUSOVRussian Science Foundation, RSF: 16-18-10371Acknowledgements. This work was supported by a grant from the Russian Science Foundation no. 16-18-10371. We thank the staff of the Laboratory of Brain and Neurocognitive Development for the opportunity to conduct this study and for their help in carrying it out

Травматологический аспект лечения политравмы у пациентов пожилого и старческого возраста

 The conducted analysis of Russian and foreign literature sources showed that the problem of diagnostics and treatment of polytrauma in elderly and senile patients is still relevant. The main discussion point is the high  mortality rate in this group of patients. Although at this level of the  medicine’s evolution, an active approach to the treatment offered to such patients is applicable, the mortality rate in this group of patients remains much higher than in the group of patients under 65. The priority here is to study the difficulties of diagnosing injuries in elderly and senile patients with  polytrauma. Also, a fundamental issue is the development of an effective algorithm for the surgical treatment of injuries, taking into  consideration age­related changes, the presence of concomitant pathology and an increased risk of complications in patients of this age group.  Проведенный анализ отечественных и зарубежных источников литературы показал, что проблема диагностики и лечения политравмы у пациентов пожилого и старческого возраста сохраняет свою актуальность в настоящее время. Основным предметом обсуждения остается высокая смертность в данной группе пациентов. На данном этапе развития медицины актуален активный подход к их лечению, смертность в этой группе больных остается в несколько раз выше, чем в группе пациентов младше 65 лет. Приоритетным направлением является изучение проблем диагностики повреждений у лиц пожилого и старческого возраста с политравмой. Также основополагающим вопросом является разработка эффективного алгоритма хирургического лечения повреждений, учитывающего возрастные изменения, наличие сопутствующей патологии и повышенный риск развития осложнений у пациентов данной возрастной группы

Прогностическая ценность Geriatric Index of Comorbidity для прогнозирования исходов у пациентов старше 60 лет с политравмой. Ретро­спективное когортное исследование

Background Nowadays, since the older people are keeping and increasing their professional and social activity, the risk of injury in these patients is escalating. However, the results of polytrauma treatment among patients over 60 years old are worse than in the group of younger patients. This may be associated with the presence of concomitant somatic pathology, which worsens the prognosis of for survival among elderly and senile patients. In the modern literature, there is no description of effective tools for assessing the comorbid status in elderly and senile patients with polytrauma. Nevertheless, there are scales and indices of comorbidity developed for non-surgical patients. To increase the effectiveness of treatment of patients over 60 years of age with polytrauma and a several concomitant diseases, it is necessary to develop new or adapt one of the already created tools for assessing comorbid status.Purpose of the study To assess the dependence of the mortality rate in a group of patients with polytrauma over 60 years of age on the presence of concomitant somatic pathology and its severity, calculated by the geriatric index of comorbidity.Materia l and methods During the period from 2005 to 2020, 116 patients with polytrauma and chronic somatic pathology were treated at the Sklifosovsky Institute. The inclusion criteria for the study were the following: patients aged over 60 years old; или patients’ age over 60 years old; the Injury Severity Score over 17, the presence of concomitant somatic pathology in patients. The exclusion criteria were the lack of complete necessary information in the medical history, patients’ age being less than 60 years old. The Geriatric Index of Comorbidity was calculated for each patient. A retrospective analysis was conducted.Results A Geriatric Index of Comorbidity of 3 or more in the elderly patients with polytrauma was found prognostically unfavorable for survival (p=0.005). When implementing the Geriatric Index of Comorbidity rating system, the presence of concomitant somatic pathology was found to have the greatest impact on elderly and senile patients with polytrauma and Injury Severity Score 18–24 (p=0.001).Conclusion The system of calculating the Geriatric Index of Comorbidity is advisable to use for assessing the risk of mortality from concomitant somatic pathology and its severity in patients with polytrauma over 60 years of age.АКТУАЛЬНОСТЬ На данный момент, учитывая сохранение и увеличение профессиональной и социальной активности пожилых людей, растет риск получения травм у данного контингента больных. Результаты лечения пациентов старше 60 лет с политравмой значительно хуже, чем в группе более молодого возраста. Это может быть связано с наличием сопутствующей соматической патологии, ухудшающей прогноз выживаемости среди пациентов пожилого и старческого возраста. В современной литературе нет описания эффективных инструментов оценки коморбидного статуса у исследуемой группы пациентов. В настоящее время применяют шкалы и индексы коморбидности для пациентов терапевтического профиля. Чтобы увеличить эффективность лечения пациентов старше 60 лет с политравмой и наличием нескольких сопутствующих заболеваний, необходимо разработать или адаптировать один из уже созданных инструментов оценки коморбидного статуса.ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить зависимость летальности в группе пациентов с политравмой старше 60 лет от наличия сопутствующей соматической патологии и тяжести ее, рассчитанной по Geriatric Index of Comorbidity (GIC).МАТЕРИАЛ И МЕТОДЫ В период с 2005 по 2020 год в институте имени Склифосовского пролечены 116 пациентов с политравмой и хронической соматической патологией. Критерии включения в исследование: возраст пациентов более 60 лет, балл Injury Severity Score (ISS) более 17, а также наличие у пациентов сопутствующей соматической патологии. Критерии исключения — отсутствие полной необходимой информации в истории болезни, а также возраст менее 60 лет. У каждого пациента рассчитан GIC. Проведен ретроспективный анализ.РЕЗУЛЬТАТЫ Значение GIC 3 и более баллов у пациентов старших возрастных групп с политравмой прогностически неблагоприятно для жизни (p=0,005). При использовании системы оценки GIC сопутствующая соматическая патологии оказывает наибольшее влияние на исход лечения пациентов пожилого и старческого возраста с политравмой и баллами ISS 18–24 (p=0,001)

Features of antifungal therapy during long-lasting infectious process: a clinical case of fungal keratitis and profile of antifungal sensitivity based on assessing biofilm formation

Among infectious diseases, opportunistic mycoses hold a special place. There has been accumulating a lot of evidence regarding the clinical and epidemiological aspects of infection caused by Fusarium spp., which global incidence rate among microbial keratitis ranges from 2 to 40% depending on the geographical location of the country. Colonizing mucous membranes, fungi can exist not only in the form of plankton, but form biofilms after surface attachment, which leads to elevated resistance to multiple antifungal agents. Here we describe a clinical case of fungal keratitis due to Fusarium solani by determining profile of the antifungal sensitivity for isolated fungal strains, by taking into account their potential for biofilm formation. We used an F. solani culture isolated from the patient as well as F. solani test culture obtained from the Russian National Collection of Microorganisms. While determining the sensitivity of fungal planktonic cultures to antifungal agents from the azole group (fluconazole, voriconazole), amphotericin B and terbinafine, it was revealed that antimycotics amphotericin B and voriconazole exerted a marked antifungal activity against clinical isolate, whereas the plankton F. solani test culture was more sensitive to all groups of antifungal agents. Due to a long-lasting progressive course of the infectious process and the high biofilm-forming ability of the clinical strain F. solani, the activity of antifungal agents on biofilm cells was modeled and examined in vitro. It was shown that regarding to the fungal biofilms, value of the minimally inhibitory concentration exceeded those for planktonic cultures by 100-fold. The mechanisms of action for antifungal agents on vital parameters of fungal cell structures were analyzed by using confocal laser scanning microscopy after staining samples with propidium iodide and acridine orange for 15 min to detect changes between intact and damaged cell surface. It was found that within the biofilm fungal cells preserved viability even after exposure to high concentrations of antifungals. In addition, despite the fungicidal drug activity at substantial concentrations acting on the biofilm cell membrane, the cell nuclei remained viable. Owing to the presence ot the mechanism of resistance in mycelial fungi shown in the study, it is necessary to take into account and investigate characteristics of biofilms in terms of drug sensitivity that will allow to optimize a choice of antimicrobial therapy

Improved method for the obtaining DTTA-appended 2,2’-bipyridine ligands for lanthanide cations

The composition of the reaction mixture after DTTA tert-butyl ester alkylation with 6'-halomethyl-5-phenyl-2,2'-bipyridines was studied. In addition to the target product, DTTA-appended 2,2’-bipyridine, the corresponding 6'-hydroxymethyl-substituted 2,2’-bipyridine and (5'-phenyl-[2,2'-bipyridin]-6-yl)methyl formate were isolated as by-products in some cases. Finally, an improved procedure for the DTTA tert-butyl ester alkylation with 6'-halomethyl-5-phenyl-2,2'-bipyridines by using Finkelstein reaction was developed

Synthesis of New Phosphorylated 1,2,4-Triazole-3-thiones. N,S-Functionalization Methods

© 2018, Pleiades Publishing, Ltd. New phosphorylated 1,2,4-triazole-3-thiones have been synthesized, and the possibility of their N,Sfunctionalization has been demonstrated. The direction of alkylation of 1,2,4-triazole-3-thiones with ethyl acrylate has been shown to depend on the substituent on the N4 atom

High Efficiency of Kanakinumabum for a Patient with a Late Diagnosed Chronic Infantile Neurological Cutaneous Articular Syndrome (CINCA)

The article presents the monitoring of a severe course of CINCA/NOMID syndrome diagnosed at late stages. The use of monoclonal antibodies to IL 1 — kanakinumabum — in a patient with chronic neurological cutaneous and articular syndrome was successful: fever, cutaneous and pain syndromes were completely stopped, joint contractures decreased after one week of therapy. Laboratory parameters of the child’s disease activity (ESR and CRP) became normal after 8 weeks of treatment. Movements in the affected joints recovered completely after 24 weeks; the audiologist noted an improvement in hearing. The above clinical example demonstrates the high efficiency of kanakinumabum for a patient with chronic neurological cutaneous and articular syndrome, and shows the perspective of therapeutic application of IL 1 blocker for patients with CINCA syndrome including advanced stages of the disease. No adverse effects were noted during kanakinumabum therapy

Experience of the successful treatment with canakinumab of a patient with NLPC4-associated autoinflammatory syndrome with enterocolitis

The article shows the observation of rare NLPC4-associated autoinflammatory syndrome with enterocolitis and familial cold urticaria. Diagnosis is confirmed molecularly-genetically: previously not described mutation c.928C>T in the heterozygous state in NLRC4 gene is discovered by a method of the new generation sequencing. The use of a monoclonal antibody to the interleukin 1 canakinumab provided complete relief of fever and skin and intestinal symptoms in just 1 week of treatment. Later the signs of inflammation have disappeared completely; the patient’s quality of life improved and life-threatening complications were prevented. The above example demonstrates the high clinical efficacy of canakinumab in the patient with NLRC4-associated autoinflammatory syndrome and suggests promising therapeutic use of interleukin 1 blockers in such patients. There were no adverse events during canakinumab therapy

Современный взгляд на проблему лечения травматической отслойки тканей

The treatment of traumatic soft tissue detachments is an urgent problem for a first-level trauma hospital. This paper provides an analysis of the literature sources of the PubMed database, which are devoted to the classification, diagnosis and treatment of traumatic skin detachments. It was revealed that most of the works are publications of 1–2 clinical cases, only a few works are retrospective studies of patient groups. Currently, there is no generally accepted classification of traumatic detachment of soft tissues, due to the complexity and mosaic nature of pathoanatomical signs. According to the tactics of treatment, there is a difference in approaches for low-energy trauma (sports injury) and high-energy impact (traffic accidents, falls from a height). In the first case, the treatment methods are compression therapy, physiotherapy, and in rare cases, puncture. In the second case, puncture and drainage are the main method of treatment, and in persistent recurrent cases, chemical ablation or open surgery to excise the capsule in combination with vacuum drainage are the methods of treatment. Methods of endoscopic treatment of the walls of the detachment, ligation of the lymphatic vessels around the detachment, and the use of blockable sutures for obliteration of the detachment cavity are currently new methods of treatment, which effectiveness requires further study.Лечение  травматических  отслоек  мягких тканей  является  актуальной проблемой  для травматологического стационара  первого  уровня. В данной  работе  приводится  анализ  литературных источников базы PubMed, которые посвящены классификации, диагностике и лечению травматических отслоек покровов. Выявлено, что большинство работ — это публикации 1–2  клинических наблюдений, лишь несколько работ — это ретроспективные исследования  групп пациентов. В настоящее время отсутствует общепринятая классификация травматических отслоек мягких тканей ввиду сложности и мозаичности патоанатомических  признаков. По тактике лечения отмечается разница в подходах при травме низкой энергии (спортивная травма) и при высокой энергии воздействия (дорожно-транспортные  происшествия, падения с высоты). В первом случае методами лечения являются компрессионная  терапия, физиотерапия, в редких случаях — пункция. Во втором случае — пункция и дренирование являются основным способом лечения, а в упорных рецидивирующих случаях способами лечения выступают химическая абляция либо открытая операция по иссечению капсулы в сочетании с вакуумным дренированием. Методы эндоскопической обработки  стенок отслойки, перевязки  лимфатических сосудов вокруг отслойки и применение блокируемых  нитей для облитерации  полости отслойки в настоящее  время  являются новыми методами лечения, эффективность которых требует дальнейшего изучения

Клинический случай применения тоцилизумаба у пациента с системным ювенильным идиопатическим артритом

This article describes a case of successfully used tocilizumab (interleukin 6 receptors monoclonal antibodies) in a two-year patient with severe systemic juvenile idiopathic arthritis resistant to oral and parenteral glucocorticoids, nonsteroidal anti-inflammatory drugs, and methotrexate. Just after the first injection of tocilizumab, fever and pain ceased, morning stiffness decreased significantly; laboratory disease activity indices normalized by the 4th week of drug use; by the 16th week inflammatory changes in the joints regressed completely, the disease entered its inactive phase. After using tocilizumab, remission duration was 20 months for articular syndrome and systemic manifestations. No adverse reactions have been registered.В статье описан случай успешного применения моноклональных антител к рецепторам интерлейкина 6 тоцилизумаба у двухлетнего пациента с тяжелым течением системного ювенильного идиопатического артрита, резистентного к пероральным и парентеральным глюкокортикостероидам, нестероидным противовоспалительным препаратам, метотрексату. Уже после первого введения тоцилизумаба купировались лихорадка и болевой синдром, значительно уменьшилась утренняя скованность, к 4-й нед введения препарата нормализовались лабораторные показатели активности болезни, к 16-й нед полностью регрессировали воспалительные изменения в суставах, была констатирована фаза неактивной болезни. Длительность ремиссии суставного синдрома и системных проявлений после применения тоцилизумаба составила 20 мес. Нежелательных реакций на фоне проводимой терапии не зарегистрировано