ОСОБЛИВОСТІ ПСИХОЛОГІЧНОЇ ДЕЗАДАПТАЦІЇ ПАЦІЄНТІВ ІЗ ГАСТРОЕЗОФАГЕАЛЬНОЮ РЕФЛЮКСНОЮ ХВОРОБОЮ

The article presents up-to-date data concerning psychosomatic problem in medicine, in particular world experience of studying disorders of psychological of adaptation in patients with gastroesophageal reflux disease (GERD), as well as own researches data. When using psychological tests, detection rate of anxiety and depression in patients with GERD was 100 and 91.2 % respectively. The research studies revealed that presence of psychological dysadaptation in patients with GERD makes it impossible to achieve a stable remission of the underlying disease and necessitates appropriate correction.     The aim of the study – to determine the specificity of psychological dysaptation of the patients with gastroesophageal reflux disease. Materials and Methods. 45 patients with GERD were under our supervision. To verify the diagnosis we used an endoscopic examination of the upper gastrointestinal tract that was performed using flexible Olympus-type fibrogastrostocks according to the generally accepted technique. Results and Discussion. Among 45 patients there were 31 women and 14 men, the age of patients varied from 19 to 70 years, the mean age was (45.67±2.32) years. The anamnesis showed that the duration of the disease varied from 7 months to 20 years. At the same time a history of 1 to 5 years showed more often: in 51.1 % of the patients. The average duration of illnesses of the examined patients was (7.77±1.35) years. Conclusions. According to MRI, changes in the psychological status of the examined patients with GERD were detected in 76.7 %. The most significant of them were: depression (63.3 %), hypochondria (43.3 %) and psychasthenia (20.0 %).Функционирование системы органов пищеварения взаимосвязано с состоянием психической сферы человека, соответственно, большинство заболеваний желудочно-кишечного тракта относится к психосоматической патологии. В современном понимании психосоматическая медицина рассматривается в качестве науки о взаимосвязи психических и соматических процессов. Значительный интерес к данной проблеме вполне закономерный, поскольку на практике все чаще приходится сталкиваться с ситуациями, когда отклонение от оптимальной жизнедеятельности организма, характеризующиеся как заболевание, состояние, реакция или дезадаптация, не могут быть объяснены исключительно в контексте морфологического строения человека. Цель исследования – изучить нарушения психологической адаптации у пациентов с гастроэзофагеальной рефлюксной болезнью (ГЭРХ). Материалы и методы. Мы оценивали наличие, выражение, распространение и локализацию воспалительной реакции слизистой оболочки нижней трети пищевода, а также наличие эрозивно-язвенных изменений и их осложнений. Психологическое обследование больных включало индивидуальную беседу и психодиагностическое тестирование с помощью опросников, допускающих количественную оценку исследуемых признаков. Статистическая обработка результатов исследований была осуществлена ​​с помощью методов вариационной статистики, которые реализовались стандартным пакетом прикладных программ Statistica for Windows 6.0. Сравнивали два средних показатели с помощью t-критерия Стьюдента и непараметрических критериев. В то же время различия между средними показателями считали достоверными при достигнутом уровне значимости (р) ниже 0,05. Результаты исследований и их обсуждение. Под нашим наблюдением находилось 45 пациентов с ГЭРБ. Для верификации диагноза мы использовали эндоскопическое исследование верхних отделов желудочно-кишечного тракта, которое осуществляли с помощью фиброгастроскопов типа Olympus по общепринятой методике. Среди 45 обследованных больных были 31 женщина и 14 мужчин возрастом 19–70 лет, средний возраст составил (45,67±2,32) года. Изучение анамнеза показало, что продолжительность заболевания колебалась от 7 месяцев до 20 лет. При этом в 51,1 % больных оказывался анамнез от 1 до 5 лет. Средняя продолжительность заболеваний обследованных больных была (7,77±1,35) года. Выводы. По данным Миннесотского многоаспектного личностного опросника (ММРИ), изменения психологического статуса обследованных больных ГЭРБ были обнаружены в 76,7 %. Наиболее значимыми среди них были: депрессия (50 %), ипохондрия (30 %) и психастения (20 %).Функціонування системи органів травлення, загалом, взаємодіє зі станом психічної сфери людини, тому більшість захворювань шлунково-кишкового тракту відносять до психосоматичної патології. У сучасному розумінні психосоматична медицина є наукою, що вивчає взаємозв’язки між психічними і соматичними процесами. Підвищений інтерес до цієї проблеми можна вважати повністю закономірним, оскільки на практиці доволі часто відхилення від оптимальної життєдіяльності організму, що класифікуються в якості захворювання, стану, реакції або дезадаптації, не можуть пояснюватись виключно у контексті морфологічної будови людини. Мета дослідження – вивчити порушення психологічної адаптації у пацієнтів із гастроезофагеальною рефлюксною хворобою (ГЕРХ). Матеріали і методи. Ми оцінювали наявність, вираження, поширення та локалізацію запальної реакції слизової оболонки нижньої третини стравоходу, а також наявність ерозивно-виразкових змін та їх ускладнень. Психологічне обстеження хворих включало індивідуальну бесіду та психодіагностичне тестування за допомогою опитувальників, що допускають кількісну оцінку досліджуваних ознак. Статистичне опрацювання результатів досліджень було здійснено за допомогою методів варіаційної статистики, які реалізувались стандартним пакетом прикладних програм Statistica for Windows 6.0. Порівнювали два середні показники за допомогою t-критерію Стьюдента і непараметричних критеріїв. Водночас розбіжності між середніми показниками вважали вірогідними при досягнутому рівні значимості (р) нижче 0,05. Результати досліджень та їх обговорення. Під нашим спостереженням перебувало 45 пацієнтів із ГЕРХ. Для верифікації діагнозу ми використовували ендоскопічне дослідження верхніх відділів шлунково-кишкового тракту, яке здійснювали за допомогою гнучких фіброгастроскопів типу Olympus за загальноприйнятою методикою. Серед обстежених були 31 жінка та 14 чоловіків віком 19–70 років, середній вік становив (45,67±2,32) року. Вивчаючи анамнез, ми побачили, що тривалість захворювання коливалась у середньому від 7 місяців до 20 років. Водночас, найчастіше був анамнез від 1 до 5 років (51,1% пацієнтів), а середня тривалість захворювань становила (7,77±1,35) року. Висновки. За даними Мінесотського багатофакторного особистісного опитувальника (ММРІ), зміни психологічного статусу обстежених хворих на ГЕРХ було виявлено у 76,7 %. Найзначущими з-поміж були: депресія (63,3 %), іпохондрія (43,3 %) та психастенія (20,0 %)

High Triglycerides Are Associated with Low Thrombocyte Counts and High VEGF in Nephropathia Epidemica

© 2016 Ekaterina V. Martynova et al.Nephropathia epidemica (NE) is a mild form of hemorrhagic fever with renal syndrome. Several reports have demonstrated a severe alteration in lipoprotein metabolism. However, little is known about changes in circulating lipids in NE. The objectives of this study were to evaluate changes in serum total cholesterol, high density cholesterol (HDCL), and triglycerides. In addition to evaluation of serum cytokine activation associations, changes in lipid profile and cytokine activation were determined for gender, thrombocyte counts, and VEGF. Elevated levels of triglycerides and decreased HDCL were observed in NE, while total cholesterol did not differ from controls. High triglycerides were associated with both the lowest thrombocyte counts and high serum VEGF, as well as a high severity score. Additionally, there were higher levels of triglycerides in male than female NE patients. Low triglycerides were associated with upregulation of IFN-γ and IL-12, suggesting activation of Th1 helper cells. Furthermore, levels of IFN-γ and IL-12 were increased in patients with lower severity scores, suggesting that a Th1 type immune response is playing protective role in NE. These combined data advance the understanding of NE pathogenesis and indicate a role for high triglycerides in disease severity

FROM PERSONALIZED TO PRECISION MEDICINE

The need to maintain a high quality of life against a backdrop of its inevitably increasing duration is one of the main problems of modern health care. The concept of "right drug to the right patient at the right time", which at first was bearing the name "personalized", is currently unanimously approved by international scientific community as "precision medicine". Precision medicine takes all the individual characteristics into account: genes diversity, environment, lifestyles, and even bacterial microflora and also involves the use of the latest technological developments, which serves to ensure that each patient gets assistance fitting his state best. In the United States, Canada and France national precision medicine programs have already been submitted and implemented. The aim of this review is to describe the dynamic integration of precision medicine methods into routine medical practice and life of modern society. The new paradigm prospects description are complemented by figures, proving the already achieved success in the application of precise methods for example, the targeted therapy of cancer. All in all, the presence of real-life examples, proving the regularity of transition to a new paradigm, and a wide range  of technical and diagnostic capabilities available and constantly evolving make the all-round transition to precision medicine almost inevitable

Serum cytokine signature that discriminates Helicobacter pylori positive and negative juvenile gastroduodenitis

© 2016 Khaiboullina, Abdulkhakov, Khalikova, Safina, Martynova, Davidyuk, Khuzin, Faizullina, Lombardi, Cherepnev and Rizvanov.Gastroduodenitis caused by H. pylori, often acquired in early childhood, is found in about 50% of the adult population. Although H. pylori infections can remain asymptomatic, its virulence factors usually trigger epithelial vacuolization and degeneration, loss of microvilli, disintegration of cytoplasm, and leukocyte accumulation. It is believed that leukocyte infiltration is driven by cytokines produced locally in infected tissue. However, so far little is known about changes in serum cytokines in juvenile patients infected with H. pylori. Serum cytokine profiles were analyzed in 62 juvenile patients diagnosed with gastroduodenitis using the Bio-Plex multiplex assay. H. pylori infection was confirmed in 32 patients, while 30 patients were H. pylori-free. Cytokines CXCL5 and CXCL6, potent neutrophil chemoattractants, were upregulated in all patients diagnosed with gastroduodenitis. Serum levels of IL8, a prototype neutrophil attractant, remained unchanged in subjects with gastroduodenitis relative to controls. Therefore, our data suggest that CXCL5 and CXCL6 play a role in directing neutrophil trafficking into inflamed gastroduodenal tissue. In addition, the CCL25/GM-CSF ratio differed significantly between H. pylori-positive and -negative juveniles. Further, study is needed to evaluate the role of CCL25 and GM-CSF in the pathogenesis of the different etiologies of gastroduodenitis

Divergent immunomodulation capacity of individual myelin peptides-components of liposomal therapeutic against multiple sclerosis

© 2017 Ivanova, Khaiboullina, Gomzikova, Martynova, Ferreira, Garanina, Sakhapov, Lomakin, Khaibullin, Granatov, Khabirov, Rizvanov, Gabibov and Belogurov. Multiple sclerosis (MS) is an autoimmune disease characterized by demyelination and consequent neuron injury. Although the pathogenesis of MS is largely unknown, a breach in immune self-tolerance to myelin followed by development of autoreactive encephalitogenic T cells is suggested to play the central role. The myelin basic protein (MBP) is believed to be one of the main targets for autoreactive lymphocytes. Recently, immunodominant MBP peptides encapsulated into the mannosylated liposomes, referred as Xemys, were shown to suppress development of experimental autoimmune encephalomyelitis, a rodent model of MS, and furthermore passed the initial stage of clinical trials. Here, we investigated the role of individual polypeptide components [MBP peptides 46-62 (GH17), 124-139 (GK16), and 147-170 (QR24)] of this liposomal peptide therapeutic in cytokine release and activation of immune cells from MS patients and healthy donors. The overall effects were assessed using peripheral blood mononuclear cells (PBMCs), whereas alterations in antigen-presenting capacities were studied utilizing plasmacytoid dendritic cells (pDCs). Among three MBP-immunodominant peptides, QR24 and GK16 activated leukocytes, while GH17 was characterized by an immunosuppressive effect. Peptides QR24 and GK16 upregulated CD4 over CD8 T cells and induced proliferation of CD25 + cells, whereas GH17 decreased the CD4/CD8 T cell ratio and had limited effects on CD25 + T cells. Accordingly, components of liposomal peptide therapeutic differed in upregulation of cytokines upon addition to PBMCs and pDCs. Peptide QR24 was evidently more effective in upregulation of pro-inflammatory cytokines, whereas GH17 significantly increased production of IL-10 through treated cells. Altogether, these data suggest a complexity of action of the liposomal peptide therapeutic that does not seem to involve simple helper T cells (Th)-shift but rather the rebalancing of the immune system

Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 9th edition

Dear Colleagues! We are glad to present the 9th Edition (revised) of Standards of Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation. The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), American Diabetes Association (ADA, 2018, 2019), American Association of Clinical Endocrinologists (AACE, 2019), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014, 2018) and Russian Association of Endocrinologists (RAE, 2011, 2012, 2015). Current edition of the “Standards” also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals. Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 463 million patients by the end of 2019. According to the current estimation by the International Diabetes Federation, 578 million patients will be suffering from diabetes mellitus by by 2030 and 700 million by 2045. Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 584 575 patients with DM in this country by the end of 2018 (3,1% of population) with 92% (4 238 503) – Type 2 DM, 6% (256 202) – Type 1 DM and 2% (89 870) – other types of DM, including 8 006 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) con- firmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 9 million patients (about 6% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they don’t receive any treatment ant have high risk of vascular complications. Severe consequences of the global pandemics of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral, coronary and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death. In сurrent edition of the “Standards”: New goals of glycemic control for the elderly, based on the presence of functional dependence, as well as for pregnant women, children and adolescents, are given. Added a snippet that describes the continuous glucose monitoring. Only low-density lipoprotein cholesterol level is used as a target for lipid metabolism. Proposes more stringent target levels of blood pressure. It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes: the excess of the initial level of HbA1c over the target level was used as a criterion. In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages. Recommendations for psychosocial support are added. The position of metabolic surgery as a method of treatment of DM with morbid obesity is updated. Recommendations for diagnostic and treatment of hypogonadism syndrome in men with DM are added. For the first time, evidence levels of confidence and credibility levels of recommendations for diagnostic, therapeutic, rehabilitative and preventive interventions based on a systematic review of the literature are given in accordance with the recommendations of the Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation. This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discus- sions held at national meetings and forums. These guidelines are intended for endocrinologists, primary care physicians and other medical professionals involved in the treatment of DM. On behalf of the Working Grou

Experience of development and implementation of electronic diary of student in work practice on the pediatric faculty

The article discusses the experience of the organization of the educational process during the practical training of students. The description of work with electronic documentation for the purpose of operative communication between the teacher and the student is given. Convenience in work and prospects of further development of this educational technology are shownВ статье рассматривается опыт организации образовательного процесса в ходе производственной практики студентов. Приводится описание работы с электронной документацией с целью оперативной связи между преподавателем и студентом. Показаны удобство в работе и перспективность дальнейшей разработки данной образовательной технологии

Diabetes mellitus type 1 in adults

Public organization “Russian Association of Endocrinologists”. Clinical guidlines

ПРОГНОСТИЧЕСКИЕ ФАКТОРЫ ПРИ ЛЕЧЕНИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ

It was shown that the butyrylcholinesterase activity in the blood of women with non-malignant breast cancer was lower as compared to patients with malignant breast cancer (P < 0,001). Using two dimensional gel-electrophoresis method it was found that blood plasma proteomic maps are different for patients with various molecular subtypes of breast cancer. Identified differences consist in the appearance of additional new proteins and changes in the expression of proteins present in norm. Current data provide an advance to develop supplemental methods of breast cancer diagnosis and prognosis of the therapy outcomes.Установлено, что активность бутирилхолинэстеразы в цельной крови пациенток с доброкачественными опухолями молочной железы ниже по сравнению с этим показателем при злокачественных образованиях (Р < 0,001). На гель-электрофореграммах плазмы крови пациенток с раком молочной железы обнаружено изменение белковой экспрессии и появление новых белковых онкомаркеров, которые зависят от молекулярно-генетического подтипа опухоли. Выявленные различия позволят разработать дополнительные методы диагностики и прогнозирования результатов терапии

Diabetes mellitus type 2 in adults

Public organization “Russian Association of Endocrinologists”. Clinical guidelines.&nbsp