Колебания ледников Томич и Водопадный (Алтай) во второй половине XX – начале XXI в.

Estimates of dynamics of two Altai glaciers Tomich (Katun Ridge) and Vodopadny (North Chuisky Ridge) for the whole period of instrumental observations are shown in the paper. Data on changes of the glaciers’ areas and volumes were obtained from the topographic maps, satellite images and author’s field researches performed in 2009–2011. During the period of observations (1952–2012), the glacier areas decreased by 19–25%, and the volumes by 34–45%, and the maximum loss of ice took place since the mid-1990s up to present time. The annual rate of the ice loss has been linked to the average summer air temperature over the glacier area of Altai.Дана оценка динамики двух ледников Алтая – Томич (Катунский хребет) и Водопадный (Северо-Чуйский хребет) за период инструментальных наблюдений. Данные об изменении площади и объёма ледников с 1960–70‑х годов до настоящего времени получены на основе архивных материалов: топографических карт, космических и радиолокационных съёмок, а также полевых исследований, выполненных авторами на этих ледниках в 2009–2011 гг. За исследуемый период площадь ледников сократилась на 19–25%, а объём – на 30–45%. Максимальная потеря льда произошла с середины 1990‑х годов до настоящего времени. Установлена связь между интенсивностью ежегодной потери льда и средней летней температурой в ледниковой зоне Алтая

ИССЛЕДОВАНИЕ ГОЛОВНОГО МОЗГА У ПАЦИЕНТА С САХАРНЫМ ДИАБЕТОМ 1-го ТИПА С ИСПОЛЬЗОВАНИЕМ МЕТОДИК МАГНИТНО-РЕЗОНАНСНОЙ ТОМОГРАФИИ

Type 1 diabetes mellitus (T1DM) is now widely distributed worldwide and in theRussian Federation, it is an important medical and social problem in connection with the development of serious, disabling complications. Some of these complications could make changes in the brain which are accompanied by cognitive impairments that decrease quality of life and worsening disease compensation. The diagnosis of these disorders to date, possible by using modern methods of magnetic resonance imaging, which describe not only the morphological changes of the brain, but also the metabolism of nervous tissue. The study of the brain, namely structural and metabolic manifestations of diabetes, is one of the priority problem of modern medical science.The aim of the study was to evaluate dynamics in the different techniques of magnetic resonance imaging in the diagnosis of brain changes in patients with T1DM.Research methods included physical examination, in accordance with the diagnostic algorithm of patients with T1DM, a neurologist consultation, an assessment of cognitive function, analysis of brain changes using standard magnetic resonance imaging and spectroscopy. Statistical processing was performed using software package R-system. This publication presents a clinical case of a patient with T1DM and severe cognitive impairments are associated with changes in the brain, diagnosed using standard magnetic resonance imaging and spectroscopy. The study shows the positive role of correction of carbohydrate metabolism in improving cognitive function in a patient with T1DM.In addition, the process analysis revealed the absence of dynamic changes in the brain of a patient with T1DM according to standard magnetic resonance imaging. This required the use of additional techniques – magnetic resonance spectroscopy, which revealed changes of metabolism in the thalamus N-acetyl aspartate, choline and creatinine.Сахарный диабет (СД) 1-го типа (СД-1) в настоящее время широко распространен как во всем мире, так и в Российской Федерации, и является важной медико-социальной проблемой в связи с развитием серьезных инвалидизирующих осложнений. К таким осложнениям относятся изменения головного мозга, которые сопровождаются когнитивными нарушениями, значительно снижающими качество жизни и ухудшающими компенсацию заболевания. Диагностика и выявление этих нарушений на сегодняшний день возможны с помощью современных методик магнитно-резонансной томографии (МРТ), которые описывают не только морфологические изменения головного мозга, но и метаболизм нервной ткани. Исследование структурных и метаболических изменений головного мозга на фоне СД является одной из приоритетных задач современной медицинской науки.Цель исследования – оценить изменения головного мозга с помощью различных методик магнитно-резонансной томографии у пациента с СД-1 и когнитивной дисфункцией.Материал и методы. Проведены общеклиническое обследование в соответствии с алгоритмом диагностики больных СД-1, консультация невролога, оценка когнитивной функции, анализ изменений головного мозга с помощью стандартной МРТ и спектроскопии.В данной публикации представлен клинический случай пациента с СД-1 и выраженными когнитивными нарушениями, а также с изменениями головного мозга, диагностированными с помощью стандартной МРТ и спектроскопии.Результаты. Выявлены нарушение углеводного обмена и наличие когнитивной дисфункции у пациента с СД-1. Кроме того, в процессе анализа обнаружены неспецифические изменения головного мозга у пациента с СД-1 по данным стандартной МРТ. Это потребовало использования дополнительной методики – магнитно-резонансной спектроскопии, с помощью которой удалось выявить изменения метаболизма в таламусе N-ацетиласпартата, холина и креатина

Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

ROLE OF MAGNETIC RESONANCE IMAGING IN THE EARLY DIAGNOSIS OF COGNITIVE IMPAIRMENTS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS

Objective: to assess the role of brain magnetic resonance imaging (MRI) in patients with type 1 diabetes mellitus (DM1) in relation to clinical, metabolic, and psychoneurological disorders.Material and methods. Fifty-eight patients aged 16 to 30 years with DM1 were examined; a control group consisted of 29 healthy young people matched by gender and age. Their examination involved clinical, metabolic, and psychological testing. The quality of life was assessed using the general Medical Outcomes Study Short Form (MOS SF-36) and the specific Audit-Dependent Quality of Life (AdDQoL). The Montreal Cognitive Assessment (MoСа test) was employed to screen for cognitive impairments. All the patients were advised by a neurologist. Brain MRI using a 1.0 T Siemens Magnetom scanner was carried out to evaluate structural changes in the central nervous system.Results. The examination of the patients with DM1 revealed the signs of grey matter atrophy, enlarged Virchow–Robin spaces, white matter injury, which correlated with the presence of chronic hyperglycemia, cognitive impairments, and microvascular complications.Conclusions. Routine brain MRI is best carried out in patients with DM1 and poor disease control to timely implement therapeuticand-prophylactic measures for preventing cognitive impairments and improving the quality of life

AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE IN THE STRUCTURE OF CYSTIC DYSPLASIA IN CHILDREN

Cystic dysplasia is a heterogeneous group of diseases, with 12–15% share in the structure of congenital kidney anomalies and 8–10% share in the structure of the causes of chronic renal failure in children. The article presents the results of observation of patients with polycystic kidney disease. To study the clinical features of the course of various forms of cystic dysplasia in children we analyzed the histories of children with autosomal recessive and autosomal dominant polycystic kidney disease. We revealed clinical, laboratory and instrumental features of the course of various types of cystic renal dysplasia

Characteristic of Сells' Reaction of APUD-System of Guinea Pigs as Marker of Adaptive-Compensatory Processes under Aerogenic Immunization against Plague

Carried out was morphometric analysis of cells' reaction of APUD system (neuroendocrinal cells) of guinea pigs immunized with live plague vaccine by aerogenic method. The results of investigations were compared with characteristics of the state of biomodel's internal organs. Elucidated was that the changes of morphofunctional state of neuroendocrinal cells in lungs and organs of immunity were of phase character suggesting the involvement of APUD system elements in the inhalant method of antigenic material intake. Assessment of APUD-system cell's reaction enables to estimate indirectly the nature of adaptive and compensatory processes in biomodel in the course of anti-plague vaccination

Dynamics of glaciers Tomich and Vodopadny (Altai) for the second half of XX – beginning of XXI centuries

Estimates of dynamics of two Altai glaciers Tomich (Katun Ridge) and Vodopadny (North Chuisky Ridge) for the whole period of instrumental observations are shown in the paper. Data on changes of the glaciers’ areas and volumes were obtained from the topographic maps, satellite images and author’s field researches performed in 2009–2011. During the period of observations (1952–2012), the glacier areas decreased by 19–25%, and the volumes by 34–45%, and the maximum loss of ice took place since the mid-1990s up to present time. The annual rate of the ice loss has been linked to the average summer air temperature over the glacier area of Altai

INFECTIOUS DISEASES IN HEMATOLOGIST’S PRACTICE: VISCERAL LEYSHMANIASIS IN HIV-INFECTED PATIENT

The clinical case of visceral leishmaniasis and HIV coinfection, associated with bone marrow involvement, which is uncommon in Siberia, was demonstrated. The detailed literature review on the issue was given. The data analysis of leishmaniasis prevalence dynamics in northern latitudes was conducted and the features of disease epidemiology were highlighted. The clinical forms of this parasite invasion and the contemporary ideas about mechanism of lieshmania escape from phagocytosis were described on the basis of recent data. The algorithm of differential diagnosis, diagnosis criterions and treatment standards were developed. The comprehensive approach to diagnosis and management of the zoonosis and HIV coinfection were described. The disease hematological features such as pancytopenia, lymphadenopathy, hepatosplenomegaly and fever were revealed. The significant of bone marrow hematopoiesis examination in leishmaniasis was specified. The analysis of the literature on the transformation of modern visceral leishmaniasis was carried out: an increase in the number of erased clinical debut forms, an increase in the duration of the latent period of the disease up to 130–160 days after transfection, an increase in the role of immunodepression factors in the clinical manifestation of the disease. The data on the epidemiological sources of zoonosis - insect vectors, conditions of infection, methods of prevention have been performed