Dysfunction of the meibomian glands in patients with diabetes mellitus

The prevalence of diabetes mellitus has increased in recent decades. The most common ophthalmic manifestations of diabetes mellitus are retinopathy, epitheliopathies, corneal erosion and dry eye syndrome, the symptoms of which are more pronounced than in people without diabetes. The meibomian glands, which are the producer of various lipids, participate in the formation of the lipid layer of the tear film, which prevents the evaporation of the water-mucin phase and ensures the preservation of homeostasis of the ocular surface. Meibum is a lipid-rich secret produced by fully differentiated meibocytes. Impaired insulin secretion, insulin resistance, absolute insulin deficiency, as well as hyperglycemia, potentiate the development of oxidative stress and a cascade of metabolic changes, leading to a change in the anatomical and functional state of the meibomian glands, which affects the qualitative and quantitative secretion. Cytological abnormalities, as well as the structure of the excretory ducts of the meibomian glands in patients with long-term diabetes mellitus, were established using the method of laser scanning microscopy. Using the method of mass spectrometry, it is possible to determine the patterns of changes in the chemical composition of meibum in patients with diabetes mellitus. The data obtained can become one of the criteria for predicting the course, reflect the degree of compensation and / or progression of diabetes mellitus

The effect of a new coronavirus infection caused by the SARS-CoV-2 virus on microcirculation in the conjunctiva

Introduction. The availability of an objective assessment of the microcirculatory bed is possible when examining the vessels of the conjunctiva. This is especially true in individuals who have had COVID-19 and have diseases associated with endothelial dysfunction.Aim. To study the microcirculation in the conjunctiva after a new coronavirus infection caused by the SARS-CoV-2 virus.Materials and methods. 83 patients with a history of coronavirus infection were examined. Patients were divided into 2 groups depending on the presence or absence of comorbidities. Group 1 patients (n = 42) with post-COVID changes in the conjunctiva (severe  injection of  the eyeball, chemosis, microhemorrhagia, folliculosis of  the tarsal and bulbar conjunctiva, the  presence of  a  nodular formation  (conflicts), slight edema of  the corneal epithelium) and a  history of  concomitant diseases: arterial hypertension, diabetes, coronary heart disease, atherosclerosis. Group 2 patients (n = 41) with no history of concomitant diseases and similar post-COVID changes in  the conjunctiva. The control group consisted of  healthy volunteers without a  history of coronavirus infection (n = 30). All subjects underwent laser Doppler flowmetry of the bulbar conjunctiva 3, 6, 12 months after the coronavirus infection.Results and discussion. In comparison with the control group of persons after 3 months, microcirculatory disorders were detected in both groups (group 1 – subcompensated, group 2 – decompensated). In group 1, after 6 months and 12 months, violations persisted in  the subcompensation stage, which were accompanied by an increase in  the intensity of  the functioning of  the regulatory systems of the microcirculation: the M index corresponded to normal values, and the values of σ and Kv were above the norm. After 6 months in group 2, compensation of microcirculatory disorders was noted (indicators M, σ, Kv were normal), which persisted even by 12 months of observation.Conclusion. The data obtained indicate that in patients with concomitant endothelial dysfunction, the processes of restoration of the microvasculature are slowed down

Formation, accumulation and development of human capital in the modern conditions

Purpose: The aim of the study is to identify trends in the formation of human capital. Design/Methodology/Approach: The theoretical and methodological basis of the research is the scientific works of domestic and foreign scientists in the field of labor economics, human capital and management. Historical, statistical, economic and social sources of information were used to approach the subject under modern conditions. Findings: It was revealed that in the rural and urban areas the reproduction of human resources is carried out at various rates. The demographic factors influencing the reproduction of labor resources in the Russian Federation were analyzed. Practical implications: The authors substantiated the conclusions that the existence of problems in the development of rural territories is the result of the insufficient effectiveness of the measures taken by state authorities in the agrarian sphere. Originality/Value: Recommendations were made to improve the efficiency of social and economic policy in rural areas, including an increase in government subsidies to social infrastructure facilities, including feldsher-obstetric items, objects of pre-school and school education and culture.peer-reviewe

The efficiency of tear substitute therapy at dysfunction tear basic secretion

Purpose: to evaluate the efficiency and tolerance of drops replacing tear with hyaluronic acid 0.15% (Hylabak, thea, France) for the treatment of tear film diseases, in particular blepharoconjunctival form of dry eye syndrome.Methods: 32 patients (range 38 to 72 years) with blepharoconjunctival form of dry eye syndrome were treated lubricant Hylabak 2-4 times a day during 7-30 days.Results: After treatment was detected the elimination of complaints in 30 of 32 people, increasing the stability of the tear film (increasing values of the samples Norn test from 7.3 ±0.5 to 10.1±0.6 seconds), as well as normalization of Schirmer test (from 8.8±0.4 to 15.2±0.5 mm).Conclusion: the study was showed high efficacy of lubricant Hylabak and subjective tolerability at blepharoconjunctival form of dry eye syndrome

Morris-Thorne wormholes with a cosmological constant

First, the ideas introduced in the wormhole research field since the work of Morris and Thorne are briefly reviewed, namely, the issues of energy conditions, wormhole construction, stability, time machines and astrophysical signatures. Then, spherically symmetric and static traversable Morris-Thorne wormholes in the presence of a generic cosmological constant are analyzed. A matching of an interior solution to the unique exterior vacuum solution is done using directly the Einstein equations. The structure as well as several physical properties and characteristics of traversable wormholes due to the effects of the cosmological term are studied. Interesting equations appear in the process of matching. For instance, one finds that for asymptotically flat and anti-de Sitter spacetimes the surface tangential pressure of the thin-shell, at the boundary of the interior and exterior solutions, is always strictly positive, whereas for de Sitter spacetime it can take either sign as one could expect, being negative (tension) for relatively high cosmological constant and high wormhole radius, positive for relatively high mass and small wormhole radius, and zero in-between. Finally, some specific solutions with generic cosmological constant, based on the Morris-Thorne solutions, are provided.Comment: latex, 49 pages, 8 figures. Expanded version of the paper published in Physical Review

Nomenclatural standards, voucher specimens and genetic passports of potato cultivars created in the Siberian and Ural breeding centers

The present paper discusses methodological approaches to the creation of nomenclatural standards and genetic passports for Russian cultivars, currently being developed at the N.I. Vavilov Institute of Plant Genetic Resources (VIR) in collaboration with different breeding research centers. Plant material of potato cultivars bred in the Siberian Research Institute of Plant Cultivation and Breeding was collected by the cultivar creator A.D. Safonova in the experimental field of this institute and transferred to the VIR herbarium for preparation of their nomenclatural standards. Plant shoots and tubers of potato cultivars bred in other Siberian research centers in collaboration with the A.G. Lorkh All-Russian Research Institute of Potato Farming (VNIIKH) was collected by the representative of this institute in the experimental field of VNIIKH. As a result of joint research, nomenclatural standards were accomplished for 11 cultivars, namely ‘Аntonina’, ‘Zlatka’, ‘Lina’, ‘Lûbava’, ‘Nakra’, ‘Pamâti Rogačeva’, ‘Sarovskij’, ‘Safo’, ‘Solnečnyj’, ‘Tuleevskij’, ‘Ûna’** bred in five different Siberian breeding institutes including cultivars developed in collaboration with VNIIKH. Nomenclatural standards were prepared according to the ‘International Code of Nomenclature for Cultivated Plants’. DNA samples isolated from nomenclatural standards were used for preparation of genetic passports of these 11 cultivars. These genetic passports include information of the polymorphism of eight chromosome-specific microsatellites, data on the markers of 11 R-genes conferring resistance to various harmful organisms, as well as the information about cytoplasm types. Voucher specimens of additional three Siberian cultivars ‘Kemerovčanin’, ‘Kuznečanka’, ‘Tanaj’ and five Ural cultivars ‘Аlâska’, ‘Bravo’, ‘Irbitskij’, ‘Lûks’, ‘Terra’ from the Ural Research Institute for Agriculture were also registered in the VIR herbarium collection. For these eight cultivars, the genetic passports were not issued, but the results of SSR genotyping and molecular screening of voucher specimens performed with the same set of the DNA markers are presented in this report. A similar set of DNA markers was used for genotyping cultivar accessions from the in vitro and field collections of various institutes as well as cultivar specimens from eco-geographical tests performed within the framework of the Comprehensive Research Plan of the subprogram “Development of potato breeding and seed production in the Russian Federation”. The comparison of cultivar genetic passport data with genotyping results of specimens having the same name, but obtained from different sources made it possible to verify this plant material

IgG4-RELATED DISEASE. CLINICAL NOTES

IgG4-related diseases are a new nosological entity that encompasses a few previously known diseases. IgG4-related systemic disease is diagnosed if two or more affected organs are detected. This group of diseases has two similar signs: serological (elevated serum IgG4 subclass concentrations) and histological (organ and tissue infiltration from plasmo-cytes secreting IgG4, and eosinophils, and the development of fibrosclerosis and phlebitis obliterans). The paper describes two cases. In one case, a multisystemic disease was observed virtually at its onset whereas in the other this lesion was diagnosed several years after the natural course of the disease

Современные подходы к использованию глюкокортикоидных и цитотоксических препаратов при болезни Шегрена

Tsel' issledovaniya. Otsenit' effektivnost' dlitel'noy terapii bolezni Shegrena (BSh) malymi dozami glyukokortikoidnykh (GK) i alkiliruyushchikh tsitotoksicheskikh (ATs) preparatov Materialy i metody. V issledovanie vklyucheno 412 patsientov (406 zhenshchin i 6 muzhchin) s BSh, nablyudavshikhsya v Institute revmatologii v 1975 - 2007 gg. Mediana nablyudeniya - 9 (5-15) let. Sredniy vozrast bol'nykh na nachalo nablyudeniya - 44,8 goda. Mediana dlitel'nosti BSh do pervogo postupleniya - 9 let, mediana vozrasta debyuta BSh - 33 goda. Effektivnost' dlitel'noy terapii malymi dozami GKu 151 bol'nogo (mediana - 10 let), malymi dozami ATsu 147 bol'nykh (mediana - 5 let) otsenena v sravnenii s rezul'tatami lecheniya 94 bol'nykh, poluchavshikh tol'ko «oftal'mologicheskie» i «stomatologicheskie» metody terapii. Rezul'taty issledovaniya. Pokazano, chto terapiya malymi dozami GK i ATs polozhitel'no vliyala na nekotorye zhelezistye i vnezhelezistye proyavleniya zabolevaniya, odnako k snizheniyu veroyatnosti razvitiya limfoproliferativnykh zabolevaniy (r=0,036) i povysheniyu vyzhivaemosti bol'nykh s BSh privodila tol'ko terapiya ATs (r=0,037). Razrabotany i predstavleny metodiki lokal'nogo ispol'zovaniya GK pri tyazhelykh oftal'mologicheskikh i stomatologicheskikh proyavleniyakh BSh. U 150 bol'nykh s BSh s tyazhelymi sistemnymi proyavleniyami predstavleny pokazaniya i protivopokazaniya dlya provedeniya pul's-terapii (PT), kombinirovannoy PT, plazmafereza, krioafereza i dvoynoy fil'tratsii plazmy v sochetanii s kombinirovannoy PT. Pokazano, chto naznachenie malykh doz GK i PT u zhenshchin s BSh s sokhranennym menstrual'nym tsiklom privodit k bolee rannemu nastupleniyu menopauzy i sposobstvuet razvitiyu glyukokortikoidnogo i postmenopauzal'nogo osteoporoza v otdalennye sroki. Otseneny naibolee znachimye pobochnye proyavleniya terapii GK i ATs pri razlichnykh variantakh terapii BSh.Цель исследования. Оценить эффективность длительной терапии болезни Шегрена (БШ) малыми дозами глюкокортикоидных (ГК) и алкилирующих цитотоксических (АЦ) препаратов Материалы и методы. В исследование включено 412 пациентов (406 женщин и 6 мужчин) с БШ, наблюдавшихся в Институте ревматологии в 1975 - 2007 гг. Медиана наблюдения - 9 (5-15) лет. Средний возраст больных на начало наблюдения - 44,8 года. Медиана длительности БШ до первого поступления - 9 лет, медиана возраста дебюта БШ - 33 года. Эффективность длительной терапии малыми дозами ГКу 151 больного (медиана - 10 лет), малыми дозами АЦу 147 больных (медиана - 5 лет) оценена в сравнении с результатами лечения 94 больных, получавших только «офтальмологические» и «стоматологические» методы терапии. Результаты исследования. Показано, что терапия малыми дозами ГК и АЦ положительно влияла на некоторые железистые и внежелезистые проявления заболевания, однако к снижению вероятности развития лимфопролиферативных заболеваний (р=0,036) и повышению выживаемости больных с БШ приводила только терапия АЦ (р=0,037). Разработаны и представлены методики локального использования ГК при тяжелых офтальмологических и стоматологических проявлениях БШ. У 150 больных с БШ с тяжелыми системными проявлениями представлены показания и противопоказания для проведения пульс-терапии (ПТ), комбинированной ПТ, плазмафереза, криоафереза и двойной фильтрации плазмы в сочетании с комбинированной ПТ. Показано, что назначение малых доз ГК и ПТ у женщин с БШ с сохраненным менструальным циклом приводит к более раннему наступлению менопаузы и способствует развитию глюкокортикоидного и постменопаузального остеопороза в отдаленные сроки. Оценены наиболее значимые побочные проявления терапии ГК и АЦ при различных вариантах терапии БШ

Лечение синдрома «сухого глаза» при первичной глаукоме

PURPOSE: To develop the methods of treatment and prevention of secondary «dry eye» in patients with primary open-angle glaucoma. METHODS: The study involved 50 patients (100 eyes): 20 men, 30 women aged 46 to 85 years (mean age 65.5±9.6 years) with primary glaucoma. Glaucoma duration varied from 1.5 to 17 years. The patients administered the following hypotensive drops: Betoptik, Azopt, Arutimol, Xalatan, Travotan, Alfagan, Taflotan, Dorzopt as monotherapy or a combination of two or three of them. All patients underwent a clinical examination, Schirmer test, Norn test, vital staining with lissamine green and fluorescein, impression cytology, osmolarimetry (Tearlab Corp, USA) tearscopy, confocal microscopy («Confoscan-4», Nidek (Japan). The functional state of the meibomian glands and passability of its canaliculi were determined by the presence of lipids in the imprints of the palpebral intermarginal space on Millipore® filter after its OsO4-vapor staining (RF patent number 2.373.832). The digital image of the interference pattern of the lipid layer was analyzed by computer software «Lacrima». Follow-up period was 3 years. RESULTS: The signs of the «dry eye» syndrome were detected in 70.6% (76 eyes). Of these, 23.6% of patients (18 eyes) had meibomian gland dysfunction confirmed by Norn tests - 9.7±0.1. The most common complaint was the ocular pain sensation. The result of Schirmer test (20.7±0.8 mm) allows us to conclude the presence of hypersecretion as the initial manifestation of «dry eye». No increased tear osmolarity (average was 290.2±13.1 mOsm/l) was shown. The main changes pertained to the condition of the lipid layer of the tear film: an irregular thickness with normal thickness limited only to some small areas. Conjunctiva impression cytology showed a significant (from single to total absence of the field of view) reduction in the number of goblet cells and revealed pronounced degenerative changes in the epithelium. Confocal microscopy revealed a cytotoxic effect on the cornea (the front of desquamated epithelial corneal edema, stroke and intermittent crimp in subbasal neural plexus. When prescribing treatment for the «dry eye» associated with primary glaucoma, it is important to correct the defects of the lipid layer of the tear film using Systanebalance instillations. Adjuvant reparative agents may be presented by Korneregel, Sisteyn gel or Vit A Pos administered overnight. According to our data, these drugs should be used for a long time, depending on results of confocal microscopy of the cornea. For inflammatory process management we used the spectacle frame «Blephasteam» in combination with the drug Restasis. CONCLUSION: We have developed an algorithm of dry eye treatment in glaucoma patients, which allowed to optimize the state of the ocular surface and ensure the stability of the functional parameters for the entire period of observation.ЦЕЛЬ. Разработка лечения и профилактики развития вторичного синдрома «сухого глаза» у пациентов с первичной открытоугольной глаукомой. МЕТОДЫ. Обследовано 50 пациентов (100 глаз) - 20 мужчин, 30 женщин в возрасте от 46 до 85 лет (средний возраст 65,5±9,6 года) с первичной глаукомой. Продолжительность заболевания глаукомой от 1,5 до 17 лет. Алгоритм обследования включал: клинический осмотр, тест Ширмера, пробу Норна, тесты с витальными красителями: лиссаминовым зеленым и флюоресцеином, импрессионно-цитологическое исследование, осмолярометрию, тиаскопию, конфокальную микроскопию, определение функционального состояния мейбомиевых желез. Срок наблюдения составил 3 года. РЕЗУЛЬТАТЫ. Признаки синдрома «сухого глаза» (ССГ) были выявлены в 70,6% (76 глаз). В 23,6% случаев (18 глаз) имела место дисфункция мейбомиевых желез. Спектр жалоб был представлен: чувством жжения (89%), резью (71%), ощущением инородного тела (56%), болезненными ощущениями при инстилляциях (43%). Средние значения общего объема слезопродукции по данным теста Ширмера составили 20,7±0,8 мм, показатели пробы Норна - 9,7±0,1, осмолярности - 290,2±13,1 мОсм/л. Интерференционная картина слезной пленки выявила изменения ее липидного слоя в виде неравномерного истончения с сохранением нормальной толщины лишь на незначительных по площади участках, отсутствие цветов высокого порядка. С помощью конфокальной микроскопии показали наличие десквамированного переднего эпителия роговицы, отечность, извитость и прерывистость хода нервов суббазального сплетения. Результаты импрессионно-цитологического исследования продемонстрировали наличие дистрофических изменений эпителия конъюнктивы и снижение числа бокаловидных клеток. Степень этих изменений коррелировала с длительностью заболевания и количеством используемых антиглаукомных средств. При изменении гипотензивного режима в 5 (6,5%) случаях зафиксировано увеличение показателей осмолярности - в среднем до 330,0±11,2 мОсм/л, сопровождавшееся снижением показателей пробы Норна до 7,3±0,2 с и истончением липидного слоя. Нормализацию показателей осмолярности достигали назначением оптива в течение 3 недель, коррекцию липидного слоя - с помощью препарата систейн-баланс, восстановление эпителия роговицы - репаративными средствами (корнерегель, систейн-гель или витА-Пос). Для купирования воспалительного процесса применяли физиотерапевтический метод - очковую оправу «Блефастим» в комбинации с рестасисом. ЗАКЛЮЧЕНИЕ. Предложенная схема медикаментозного сопровождения пациентов с первичной глаукомой позволила снизить количество и степень проявления субъективных жалоб, сохранить стабильность объема слезопродукции в течение всего периода наблюдения, восстановить функциональное состояние мейбомиевых желез, эпителия роговицы и конъюнктивы, повысить стабильность слезной пленки за счет увеличения толщины липидного слоя