МЕТОДИЧЕСКИЕ ОСНОВЫ СОВЕРШЕНСТВОВАНИЯ ОРГАНИЗАЦИОННОЭКОНОМИЧЕСКОГО МЕХАНИЗМА РАЗМЕЩЕНИЯ И СПЕЦИАЛИЗАЦИИ ПРОДУКТОВЫХ ПОДКОМПЛЕКСОВ СИБИРСКОГО РЕГИОНА

The paper explores the methodological grounds of economic mechanism development. The mechanism is used for distribution and specification of food subcomplexes in Siberian region. The paper finds out that distribution and specification cannot be substituted by other technological factors and measures as distribution and specification are more efficient. Distribution and specification of food subcomplexes are characterized by structural shifts in agricultural production due to necessary efficient structure of food supply, the number, structure and distribution of population and resources availability. The authors make a case that due to climate differences in the country and regions it is important to apply the mechanism of regulation on the basis of regional economic target programmes. These programmes are aimed at technological reequipment and economic favourable conditions for sustainable development of prior branches. When regional authorities defend the regional target programmes, they get subsidies from the federal budget. The development of economic mechanism used for distribution and specification of food subcomplexes contributes to revealing of the problems in agricultural development and their state regulation level and requires further consideration of theoretical and methodological provisions. This strengthens the significance of complex research on fulfilling the population needs in food products by means of own resources.Рассмотрены методические основы совершенствования организационно-экономического механизма размещения и специализации продуктовых подкомплексов сибирского региона. Воздействие рационального размещения и специализации на темпы роста производства и производительности труда по своей эффективности не может быть заменено никакими другими организационно-техническими и технологическими факторами и мероприятиями. Размещение и специализация продуктовых подкомплексов определяются структурными сдвигами сельскохозяйственного производства, обусловленными в первую очередь необходимостью рационализации структуры потребления пищевых продуктов, численностью, структурой и размещением населения, а также наличием ресурсов. В условиях выраженной природно-климатической разнородности территории страны, ее регионов очень важным является применение механизма регулирования на основе региональных экономически значимых целевых программ. Такие программы направлены на техническое и технологическое переоснащение, создание экономических условий устойчивого развития приоритетных отраслей. При прохождении защиты на федеральном уровне представленных экономически значимых программ регионы получают возможность софинансирования их из федерального бюджета. Совершенствование организационно-экономического механизма размещения и специализации продуктовых подкомплексов сибирского региона позволяет выявить проблемы в развитии агропромышленного производства, определить уровень их государственного регулирования, требует дальнейшего осмысления ряда теоретических и методических положений, что усиливает актуальность комплексных исследований данной проблемы для более полного обеспечения потребностей населения в основных продуктах питания за счет собственных ресурсов

Risk Factors for Obesity Development in Different Periods of Childhood

Obesity is an important health problem in many countries. Obesity among the child population is growing steadily, including the Russian Federation. Development of this disease often occurs in childhood and sometimes the origin of obesity goes back to prenatal period. There are a number of endogenous and exogenous factors than play an important role in development of obesity. These are heredity, socioeconomic status of the family, factors which are revealed during pregnancy and child delivery — weight gain, administration of antibacterial drugs and hyperglycemia in mother during her pregnancy, mode of delivery, feeding type and time of complementary food introduction, excessive consumption of calories with food, improper daily routine and lack of sleep, skipping meals, use of gadgets and associated physical inactivity and excessive food intake, marketing of high-calorie foods and others. Prevailing risk factors can be identified for each age period. Study and early identification of risk factors taking into account age of a child is necessary to take timely prevention measures and inform parents and their children about possible reasons and consequences of obesity

Subsets of cerebrospinal fluid lymphocytes in acute pediatric respiratory viral infection with meningeal syndrome

Current urgency of studying the intrathecal cellular immune response to infections of central nervous system is determined by limited knowledge on existing data about mechanisms of the brain immune protection in normal and diseased state. Implication of multi-colour flow cytometry in clinical laboratory diagnostics allowed to perform detailed studies of biological liquors, including cerebrospinal fluid (CSF). Currently, however, there are only scarce data on the lymphocyte subpopulations in CSF. Appropriate reference values remain a challenging issue. A study of CSF lymphocyte pool in absence of definite results at previous examination may be a potential way to resolve this problem. These clinical conditions include acute respiratory viral infections (ARVI), presenting with pseudomeningitidis (meningism) syndrome. The aim of this work was to characterize the subsets of lymphocytes from CSF of the children with ARVI with the meningism symptoms in order to get basic (control) values for diagnostics of inflammatory brain diseases. We have studied subpopulation composition of the CSF lymphocytes form in 27 children with ARVI complicated by the meningism (pseudomeningitidis) by means of flow cytometry using FACSCalibur analyzer with BD MultiTEST IMK Kit reagents. The data evaluation was performed with FlowJo software. We have studied relative contents of the main subsets, i.e., total Т cells (CD3+); Т helpers (CD3+CD4+Th); cytotoxic T cells (CD3+CD8+CTL); natural killers (СD3-CD16+CD56+NK); В cells (CD3-CD19+), and minor lymphocyte subpopulations: double-positive (DP) (CD3+CD4+CD8+); double-negative (DN) (CD3+CD4-CD8-) T cells; NKT (СD3+CD16+CD56+); CD3+CD8bright, CD3+CD8dim, CD3-CD8+NK. Statistical evaluation was carried out with standard GraphPad Prism 5 software. Among the main lymphocyte populations in CSF, T cell were predominant (96.2%), as well as their subpopulations, i.e., CD4Th (53.4%), and CD8+CTL (28.2%), with low amounts of NK (2.2%) and B cells (0.7%). The mean relative content of minor subpopulations (DN or DP T cells, and NKT cells) was, respectively, 5.3, 4.0, and 9%. Age dependence was revealed for the contents of major and minor lymphocyte subsets. With advancing age of the children, the relative numbers of CD3+ and CD4+Тh cells in CSF increase, as well as CD4/CD8 ratio, associated with decreased share of NK cells, like as DN and CD3+CD8dimТ cells. The results obtained are reflect some features of lymphocyte pool in CSF of the children without inflammatory process in CNS. Thus, they may be referred as control values (inflammation-free brain disorders) when studying immune pathogenesis of neuroinfections and other inflammatory diseases of CNS in the children from different age groups

ДИАГНОСТИЧЕСКОЕ ЗНАЧЕНИЕ БЕЛКОВ ОСТРОЙ ФАЗЫ В ЦЕРЕБРОСПИНАЛЬНОЙ ЖИДКОСТИ ДЕТЕЙ С НЕЙРОИНФЕКЦИОННЫМИ ЗАБОЛЕВАНИЯМИ

In the article presented results of the examination of acute phase proteins in cerebrospinal liquid in 237 children with meningitis and encephalitis viral and bacterial etiology. The dependence between the level of acute phase proteins in cerebrospinal liquid and etiology of neuroinfectional process, the severity of brain damage and the process stage was determined. Diagnostic and prognostic efficiency of the acute phase proteins (C-reactive protein, albumin, alpha-1-antitripsin, alpha-2-macroglobulin, gaptoglobin) examination in children with neuroinfections was specified. Developed method of express diagnostics of the severity of inflammatory damage of the brain in bacterial meningitis in children by determination in cerebrospinal liquid alpha-2-macroglobulin is described.В статье представлены результаты исследования белков острой фазы в цереброспинальной жидкости у 237 детей с менингитами и энцефалитами вирусной и бактериальной природы. Определена зависимость уровня острофазных белков в цереброспинальной жидкости от этиологии нейроинфекционного процесса, тяжести поражения мозговой ткани, стадии заболевания. Уточнена диагностическая и прогностическая эффективность исследования острофазных белков, таких как С-реактивного белка, альбумина, альфа1- антитрипсина, альфа2-макроглобулина, гаптоглобина, при нейроинфекциях у детей. Описан разработанный метод экспресс-диагностики тяжести воспалительного поражения мозга при бактериальных менингитах у детей путем определения концентрации в ликворе альфа2-макроглобулина

Major and minor lymphocytes subpopulations in peripheral blood and cerebrospinal fluid of children with meningitis

Introduction. The analysis of current publications indicates at our insufficient understanding of subpopulation composition of lymphocytes in peripheral blood and cerebrospinal fluid (CSF) during pediatric neuroinfectious diseases. It has been found that the main lymphocyte populations are divided into many small (minor) subpopulations.The purpose of this research was to assess percentage of major and minor blood and CSF lymphocyte subsets in children with aseptic viral meningitis (AM) or bacterial purulent meningitis (BM).Materials and methods. Phenotyping of blood and CSF lymphocytes of children aged from 4 months to 17 years diagnosed with AM (n = 86) and BM (n = 39) was carried out by using flow cytometry. As a comparison group, we analyzed peripheral blood and CSF samples collected from children with acute respiratory viral infections (ARVIs) associated with syndrome of meningism (n = 27). There was evaluated percentage of the major cell subpopulations (CD3+ T-lymphocytes, T-helpers — CD3+CD4+ Th, cytotoxic T-lymphocytes — CD3+CD8+ CTL, natural killer cells — CD3-CD16+CD56+ NK, B-cells — CD3-CD19+), as well as minor lymphocyte subsets (double positive (DP) (CD3+CD4+CD8+), double negative (DN) (CD3+CD4-CD8-) T-cells, NKT (CD3+CD16+CD56+), CD3-CD8+ NK, CD3+CD8dim and CD3+CD8 8bright).Results. It was found that the acute period of BM and AM vs. the comparison group (ARVI) was characterized by significant differences in the blood and CSF composition of major and minor lymphocyte subsets. In particular, blood T-cells, Th, CTL, NK, NKT, DN, CD3-CD8+ NK, CD3+CD8bright and CD3+CD8dim dominated in parallel with significantly lowered B-cell frequency in AM vs. BM. In the CSF of children with AM, T-cells and Th prevailed, whereas count of B-cells and CD3-CD8+ NK was lower compared to those in BM. In addition, further differences were revealed in CSF and blood cell subset composition depending on nosological entity, while maintaining differences in some major and minor lymphocyte subpopulations lacked in the comparison group. Calculating the CSF/blood ratio for the major and minor lymphocyte subsets uncovered the prevalence for the majority of cell subpopulations (the coefficients ranged from 1.2 to 16.4) in the CSF of the comparison group (ARVI), except B-cells, NK and CD3-CD8+ NK (coefficients ranged from 0.07 to 0.31). AM and BM were featured with various changes in the CSF/blood ratio found for most of the studied subpopulations in the acute period as well as the recovery phase highlighted with characteristic traits for each nosological form.Conclusion. The data obtained indicate about finding specific features in the activation of systemic and intrathecal immune response during viral and bacterial meningitis in children, which may be used as an additional differential diagnostic criterion

Characteristics of blood pressure level in children with different body weight

BACKGROUND: Essential arterial hypertension (AH) develops more often in children with accompanying risk factors — obesity, overweight, positive heredity and genetic predisposition.AIM: Study of peculiarities of arterial hypertension clinical course in adolescents with normal body weight, overweight and obesity.MATERIALS AND METHODS: The study was conducted on children with arterial hypertension who received treatment in two hospitals in Voronezh in 2016–2020. A retrospective analysis of the children’s case histories was carried out taking into account the anamnesis, clinical laboratory and instrumental examination data and the pharmacotherapy. Some children underwent polymerase chain reaction genetic testing to determine pathological alleles of genes regulating blood pressure (BP).RESULTS: 96 patients aged 9 to 17 took part in the study. The group with normal body weight included 38 children (39.6%), median age 16.4 (aged 10.7; 17.9), with overweight — 33 people (34.4%), median age 15.2 (aged 12.0; 17.9), with obesity — 25 children (26.0%), median age 14.5 (aged 9.2; 17.9). Obese children developed arterial hypertension at earlier age (p = 0.023). According to blood pressure daily monitoring (BPDM), pathological values of systolic blood pressure (SBP) during the day (above the 95th percentile) among children with normal body weight were observed in 17 patients (44.7%), with excess body weight — in 14 people (42.4%), with obesity — in 16 people (64%), p = 0.031. Accurate difference values between the groups were obtained in terms of time index (TI) of SBP at night (p = 0.006). Time index of diastolic BP during the day > 50% was observed only in the obese children group — 4 people (16%) (p = 0.042). Pathological alleles of the angiotensinogen gene (AGT: 704 T>C), aldosterone synthase gene (CYP11B2: -344 C>T) and endothelial nitrogen synthase type 3 (NOS3: -786 T> C) were identified most frequently during genetic testing in some patients.CONCLUSION: Children with obesity developed earlier arterial hypertension compared to the same-age children with normal body weight and more often had unfavorable type of arterial hypertension according to BPDM. These results can be used to choose individual therapy and to develop special attention as regards certain target organs damage

КЛИНИКО-ЛАБОРАТОРНАЯ ОЦЕНКА СИНДРОМА ИНТОКСИКАЦИИ ПРИ ОСТРЫХ РЕСПИРАТОРНЫХ ВИРУСНЫХ ИНФЕКЦИЯХ У ДЕТЕЙ

There was performed a comparative analysis of clinical and laboratory indicators of intoxication syndrome in 70 children aged from 1 month to 16 years with acute respiratory viral infection (АRVI) of different etiology. To make an objective appraisal of the intoxication syndrome intensity the spectral characteristics of low and median molecular weight substances (LMMWS) in plasma and red blood cells with the calculation of their balance was studied, the level of exogenous pathogens was defined. The intensity of clinical symptoms was evaluated in points (from 0 to 3). It was established that total clinical manifestation of intoxication syndrome was from 3,4 ± 0,6 points in the case of respiratory syncytial viral infection to 6,2 ± 0,8 points in the case of influenza depending on the etiology. The increased level of LMMWS in red blood cells and exogenous pathogens was noticed to compare with the control values in all the groups regardless of the etiology. In the case of influenza the increase of LMMWS in plasma to 11,5 ± 0,5 c.u., and of the level of exogenous pathogens to 0,25 ± 0,04 c.u. was noted. The most expressed changes of indicators were revealed in the case of mixed viral infection when LMMWS in plasma was increased to 14,0 ± 1,6 c.u., LMMWS in red blood cells — to 27,0 ± 1,2 c.u., and exogenous pathogens amount — to 0,4 ± 0,09 c.u. A direct correlation of the average force between clinical and laboratory criteria of intoxication was revealed (r = 0,3; p < 0,05). Проведен сравнительный анализ клинико-лабораторных показателей синдрома интоксикации у 70 детей в возрасте от 1 месяца до 16 лет с острой респираторной вирусной инфекцией (ОРВИ) разной этиологии. Для объективной оценки выраженности интоксикации исследовали спектральную характеристику веществ низкой и средней молекулярной массы (ВНСММ) плазмы и эритроцитов с расчетом их соотношения, определяли уровень экзогенных патогенов. Выраженность клинических симптомов оценивалась в баллах (от 0 до 3). Установлено, что суммарная клиническая выраженность синдрома интоксикации в зависимости от этиологии составляла от 3,4 ± 0,6 баллов при респираторно-синцитиальной вирусной инфекции до 6,2 ± 0,8 баллов при гриппе (p < 0,05). Отмечено повышение уровня ВНСММ эритроцитов и экзогенных патогенов в сравнении с контрольными значениями во всех группах вне зависимости от этиологии. При гриппе отмечалось увеличение концентрации веществ низкой и средней молекулярной массы плазмы до 11,5 ± 0,5 у.е., уровня экзогенных патогенов до 0,25 ± 0,04 у.е. Наиболее выраженные изменения показателей отмечены при смешанной вирусной инфекции, при которой уровень ВНСММ плазмы повышался до 14,0 ± 1,6 у.е., ВНСММ эритроцитов до 27,0 ± 1,2 у.е., экзогенных патогенов до 0,4 ± 0,09 у.е. Выявлена прямая корреляционная связь средней силы между клиническими и лабораторными критериями интоксикации (r = 0,3; p < 0,05).

КЛИНИКО-ЛИКВОРОЛОГИЧЕСКИЕ РАЗЛИЧИЯ ПРИ СЕРОЗНЫХ И ГНОЙНЫХ МЕНИНГИТАХ У ДЕТЕЙ РАЗНОГО ВОЗРАСТА

The article presents features of clinical course and composition of cerebrospinal liquid in cases of purulent and serous meningitis depending on the age of the patients and the disease etiology. 40 children with bacterial purulent meningitis of meningococcal, hemophilic and unknown aetiology and 40 children with serous meningitis predominantly of enteroviral etiology were examined. The differences in duration and intensity of clinical symptoms, total protein concentration, and liquor cytosis were detected. The highest liquor indicators were revealed in the case of hemophilic meningitis in children of early age and in the case of meningococcal meningitis in children over seven years old. This fact can be explained by various pathogenic features of the causative agent and different compensatory reactions in children of different age. Охарактеризованы особенности клинического течения и состава цереброспинальной жидкости при гнойных и серозных менингитах в зависимости от возраста и этиологии заболевания. Обследованы 40 детей с бактериальными гнойными менингитами менингококковой, гемофильной и неустановленной этиологии и 40 детей с серозными менингитами, преимущественно энтеровирусной этиологии. Обнаружены различия в длительности и выраженности клинических симптомов, концентрации общего белка и цитоза ликвора. Наиболее высокие ликворологические показатели выявлены при гемофильном менингите у детей раннего возраста и при менингококковом менингите у детей старше 7 лет, что вероятно обусловлено различием патогенных свойств возбудителя и компенсаторных реакций у детей разного возраста.

ЗНАЧЕНИЕ ГЕМАТОЛОГИЧЕСКИХ ПОКАЗАТЕЛЕЙ ПРИ ОСТРЫХ РЕСПИРАТОРНЫХ ВИРУСНЫХ ИНФЕКЦИЯХ У ДЕТЕЙ

Hematological studies are basic and mandatory in diagnostics and laboratory monitoring of infectious diseases, which led to their inclusion in the modern standards of laboratory examinations of children. Assessment of hematological parameters used for the provisional differential diagnosis of viral or bacterial nature of the disease. For research currently being used increasingly Hematology analyzers, which allows to facilitate and standardize the results. In this paper a comparison and differences hematological parameters practically healthy children and children with respiratory infections. Identified some changes in indicators of haemogram depending on the etiology and character of the clinical course of the disease. On the basis of the leukocyte formula defined leukocyte indices of intoxication and illustrates their importance in assessing the severity of the infection process.Гематологические исследования являются основными и обязательными в диагностике и лабораторном мониторинге инфекционных заболеваний, что обусловило их включение в современные стандарты лабораторного обследования детей. Оценку гематологических показателей используют для предварительной дифференциальной диагностики вирусной или бактериальной природы заболевания. Для проведения исследований в настоящее время все чаще применяют гематологические анализаторы, что позволяет ускорить и стандартизировать получение результатов. В настоящей работе проведено сопоставление и показаны отличия гематологических показателей практически здоровых детей и детей с респираторными инфекциями. Выявлены изменения показателей гемограммы в зависимости от этиологии и характера течения заболевания. На основании лейкоцитарной формулы определены лейкоцитарные индексы интоксикации и показана их значимость в оценке тяжести инфекционного процесса

ЦИТОКИНЫ В ЦЕРЕБРОСПИНАЛЬНОЙ ЖИДКОСТИ ПРИ МЕНИНГИТАХ У ДЕТЕЙ

The aim: is to investigate pro- and anti-inflammatory cytokines in the cerebrospinal fluid of children with meningitis of different aetiology in the dynamics of the disease.Materials and methods: there were examined 93 children: 29 of them had bacterial purulent meningitis, 42 ones – serous meningitis, and 22 – an acute respiratory viral infection of meningeal symptomatology (control group). The design of the investigation is an open comparative research. The concentration of proinflammatory (IL-1β, IL-6, IL-8) and anti-inflammatory (IL-4, IL-10) cytokines was defined by the solid-phase immune-enzyme assay. The results were processed statistically by computer standard programs Excel and Statistica 7.Results and discussion: different levels of the cytokine concentration increase were detected in the acute period of the disease, the maximal one – in the case of bacterial purulent meningitis, IL-6 and IL-10 in particular. The concentration of IL-1β, IL-6, IL-4, IL-10 was significantly increased to compare with serous meningitis. The decrease of cytokine level was detected in the period of reconvalescence.Conclusion: the cytokine concentration increase in the cerebrospinal fluid in the acute stage of bacterial purulent and serous meningitis indicates both the presence of common patterns of neuroinfectious process and the features caused by the agent, and their increase in the stage of reconvalescense demonstrates the remaining intrathecal inflammation.Цель: исследование про- и противовоспалительных цитокинов в цереброспинальной жидкости детей с менингитами различной этиологии в динамике заболевания.Материалы и методы: обследовано 93 ребенка: у 29 диагностирован бактериальный гнойный менингит, у 42 – серозный менингит, у 22 – острая респираторная вирусная инфекция с менингеальной симптоматикой (контрольная группа). Дизайн – открытое сравнительное исследование. Концентрацию провоспалительных (ИЛ-1β, ИЛ-6, ИЛ-8) и противовоспалительных (ИЛ-4, ИЛ-10) цитокинов определяли методом твердофазного иммуноферментного анализа. Результаты обработаны статистически на компьютере с помощью стандартных программ Excel и Statistica 7.Результаты и обсуждение: в остром периоде заболевания выявлена различная степень увеличения концентрации цитокинов, максимальная при бактериальных гнойных менингитах, особенно ИЛ-6 и ИЛ-10. Достоверно по сравнению с серозными менингитами увеличены концентрации ИЛ-1β, ИЛ-6, ИЛ-4, ИЛ-10. В стадии реконвалесценции установлено снижение уровня цитокинов.Заключение: увеличение концентрации цитокинов цереброспинальной жидкости в острой стадии бактериальных гнойных и серозных менингитов свидетельствует как о наличии общих закономерностей нейроинфекционного процесса, так и об особенностях, обусловленных возбудителем, а их увеличение в стадии реконвалесценции – о сохраняющемся интратекальном воспалении