Международный опыт вакцинации беременных против коклюша (обзор литературы)

Whooping cough is still an urgent health problem in Russia, despite the vaccination that has been carried out for many decades. The group at high risk of severe whooping cough and death from it is children under 1 year old who have not received routine vaccination or are not vaccinated by age (the first months of life). The world health organization recognizes vaccination of pregnant women as the most effective method of preventing whooping cough in children before they receive three routine vaccinations. World experience in immunization programs for pregnant women against pertussis shows that up to 91% of children under 3 months of life are protected from pertussis as a result of transplacental transmission of antibodies formed in the mother after her vaccination (which corresponds to the timing of vaccination of children against pertussis in Russia: the first vaccination at the age of 3 months). The maximum preventive effect for a child was observed when a pregnant woman was immunized at 28–32 weeks of gestation. The safety of vaccination for both mother and child is shown. No serious adverse events related to vaccination have been reported. Coverage of pregnant women with vaccination in different countries reaches 51-70%. In order to increase adherence to vaccination of pregnant women, medical personnel should be regularly trained in the basics of vaccination, as well as conduct active health education among the population.Коклюш в России по-прежнему остается актуальной проблемой здравоохранения, несмотря на проводимую в течение многих десятилетий вакцинацию. Группой высокого риска тяжелого течения коклюша и смерти от него являются дети до 1 года, не получившие плановой вакцинации или не привитые по возрасту (первых месяцев жизни). Всемирная организация здравоохранения признает наиболее эффективным методом профилактики коклюша у детей до того, как они получат три плановые прививки, вакцинацию беременных. Мировой опыт по программам иммунизации беременных женщин против коклюша показывает, что до 91% детей до 3 месяцев жизни защищены от коклюша в результате трансплацентарной передачи антител, сформированных у матери после ее вакцинации (что соотносится со сроками вакцинации детей против коклюша в России: первая прививка в возрасте 3 месяцев). Максимальный профилактический эффект для ребенка отмечен при иммунизации беременной женщины на 28–32-й неделе гестации. Показана безопасность вакцинации, как для матери, так и для ребенка. Серьезные нежелательные явления, связанные с вакцинацией, зарегистрированы не были. Охват беременных вакцинацией в разных странах достигает 51–70%. С целью повышения приверженности к вакцинации беременных следует регулярно обучать медицинский персонал основам вакцинопрофилактики, а также проводить активную санитарно-просветительскую работу среди населения

НОВЫЕ ПЕРСПЕКТИВЫ АНТИТРОМБОТИЧЕСКОЙ ТЕРАПИИ У ПАЦИЕНТОВ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ, ПЕРЕНЕСШИХ СТЕНТИРОВАНИЕ КОРОНАРНЫХ АРТЕРИЙ: ВОЗМОЖНОСТИ ДАБИГАТРАНА

After percutaneous coronary intervention, patients receive double antiplatelet therapy for several months, which includes acetylsalicylic acid and a P2Y12 receptor inhibitor. In most cases, managing the patients with the atrial fibrillation requires adding an anticoagulant drug to the antiplatelet therapy — triple antithrombotic therapy. The rejection of triple therapy in favour of the administration of an anticoagulant and only one antiaggregant is a prospective line of reducing the risk of bleeding in these patients. The number of studies evaluating the effectiveness and safety of such therapy remains limited, and the guidelines for anticoagulant therapy are largely based on the studies of only "stable" patients with atrial fibrillation and on the results of registers, i.e. data of “real-life” clinical practice. The RE-DUAL PCI study showed that the administration of dabigatran in combination with the P2Y12 receptor inhibitor in patients with atrial fibrillation after percutaneous coronary intervention is much safer and no less effective than the classical triple therapy. A special feature of the study was the evaluation of the effectiveness and safety of two doses of dabigatran, each of which was approved for stroke prevention. This provides clinicians with additional options for treating patients with atrial fibrillation after percutaneous coronary intervention.После проведения чрескожного коронарного вмешательства пациентам в течение нескольких месяцев проводится двойная антиагрегантная терапия, в состав которой входит ацетилсалициловая кислота и блокатор P2Y12-рецепторов. Наличие фибрилляции предсердий у этих пациентов в большинстве случаев обуславливает необходимость назначения в дополнение к антиагрегантной терапии еще и антикоагулянтного препарата, то есть проведение тройной антитромботической терапии. Перспективным направлением снижения риска развития кровотечений у таких пациентов является отказ от тройной терапии в пользу назначения антикоагулянта и только одного антиагреганта. Количество исследований, оценивающих эффективность и безопасность такой терапии, остается ограниченным, и рекомендации относительно использования антикоагулянтной терапии во многом основаны на исследованиях только «стабильных» больных с фибрилляцией предсердий и на результатах регистров — данных «реальной практики». Результаты исследования RE-DUAL PCI показали, что назначение дабигатрана в сочетании с блокатором P2Y12-рецепторов пациентам с фибрилляцией предсердий после чрескожного коронарного вмешательства, в сравнении с традиционной тройной терапией, значительно безопаснее и не менее эффективно.Особенностью исследования стала оценка эффективности и безопасности двух доз дабигатрана, каждая из которых утверждена для профилактики инсульта, что предоставляет клиницистам дополнительные возможности лечения пациентов с фибрилляцией предсердий после чрескожного коронарного вмешательства

No-reflow phenomenon and reperfusion injury. Mechanisms and treatment

Currently, one of the key methods of treating a patient with ST-elevation myocardial infarction is to restore blood flow to the infarct-related artery as quickly, completely and steadily as possible. However, in some cases, it is not possible to achieve adequate myocardial reperfusion, despite the restoration of coronary blood flow. This phenomenon was named no-reflow. Due to the lack of a unified approach to the diagnosis of no-reflow, its occurrence varies widely – from 2 to 44 %. Failure to achieve adequate myocardial perfusion leads to a higher mortality rate – from 7.4 to 30.3 %, as well as to more aggressive remodeling of the myocardium. For a long time, distal embolization in percutaneous coronary intervention was considered one of the leading mechanisms. However, the routine use of protective devices did not show a pronounced effect on the outcome and prognosis, although it is justified in certain clinical situations. Ischemic injury directly plays a significant role due to overload of cardiomyocytes with calcium, cellular edema, necrosis and apoptosis, which is significantly aggravated by myocardial reperfusion and forms obstruction at the level of the microcirculatory bed. More data is being accumulated about immune-mediated injury through activation of cellular immunity, intense inflammation and thrombosis in situ. Despite the success in the animal experiment, the clinical use of certain groups of drugs showed an ambiguous results. According to the latest recommendations European Society of Cardiology / European Association for Cardio-Thoracic Surgery (ESC / EACTS) 2018, GPIIb / IIIa platelet receptor inhibitors are recommended in the case of no-reflow. Besides this, according to the literature nicorandil and sodium nitroprusside, as well as IL-1β antagonists, seem to be promising. As a non-drug therapy, selective intracoronary hypothermia also has shown its effectiveness and safety in a pilot study. To date, it is clear that the no-reflow phenomenon is a manifestation of a complex cascade of reactions, including ischemic, reperfusion and immune-related injury, as well as distal embolization. Considering its significant contribution to the frequency of adverse outcomes and late complications, it seems necessary to introduce unified approaches to the diagnosis, prevention and treatment of no-reflow, which requires high-quality clinical studies

Giant and tunable excitonic optical anisotropy in single-crystal CsPbX3_3 halide perovskites

During the last years, giant optical anisotropy demonstrated its paramount importance for light manipulation which resulted in numerous applications ranging from subdiffraction light guiding to switchable nanolasers. In spite of recent advances in the field, achieving continuous tunability of optical anisotropy remains an outstanding challenge. Here, we present a solution to the problem through chemical alteration of the ratio of halogen atoms (X = Br or Cl) in single-crystal CsPbX$_3$ halide perovskites. It turns out that the anisotropy originates from an excitonic resonance in the perovskite, which spectral position and strength are determined by the halogens composition. As a result, we manage to continually modify the optical anisotropy by 0.14. We also discover that the halide perovskite can demonstrate optical anisotropy up to 0.6 in the visible range -- the largest value among non-van der Waals materials. Moreover, our results reveal that this anisotropy could be in-plane and out-of-plane, depending on perovskite shape -- rectangular and square. Hence, it can serve as an additional degree of freedom for anisotropy manipulation. As a practical demonstration, we created perovskite anisotropic nanowaveguides and show a significant impact of anisotropy on high-order guiding modes. These findings pave the way for halide perovskites as a next-generation platform for tunable anisotropic photonics.Comment: 18 pages, 3 figure

WEBT and XMM-Newton observations of 3C 454.3 during the post-outburst phase. Detection of the little and big blue bumps

The blazar 3C 454.3 underwent an unprecedented optical outburst in spring 2005. This was first followed by a mm and then by a cm radio outburst, which peaked in February 2006. We report on follow-up observations by the WEBT to study the multiwavelength emission in the post-outburst phase. XMM-Newton observations on July and December 2006 added information on the X-ray and UV fluxes. The source was in a faint state. The radio flux at the higher frequencies showed a fast decreasing trend, which represents the tail of the big radio outburst. It was followed by a quiescent state, common at all radio frequencies. In contrast, moderate activity characterized the NIR and optical light curves, with a progressive increase of the variability amplitude with increasing wavelength. We ascribe this redder-when-brighter behaviour to the presence of a "little blue bump" due to line emission from the broad line region, which is clearly visible in the source SED during faint states. Moreover, the data from the XMM-Newton OM reveal a rise of the SED in the UV, suggesting the existence of a "big blue bump" due to thermal emission from the accretion disc. The X-ray spectra are well fitted with a power-law model with photoelectric absorption, possibly larger than the Galactic one. However, the comparison with previous X-ray observations would imply that the amount of absorbing matter is variable. Alternatively, the intrinsic X-ray spectrum presents a curvature, which may depend on the X-ray brightness. In this case, two scenarios are possible.Comment: 9 pages, 7 figures, accepted for publication in A&

The impact of terahertz radiation on an extremophilic archaean Halorubrum saccharovorum proteome

Nonthermal effects of terahertz radiation on living objects are currently intensely studied, as more sources of this radiation type and devices employing it are being constructed. Terahertz radiation is increasingly used in security and inspection systems, medical and scientific appliances due to its low quant energy, which does not cause severe effects on organisms as other radiation types with higher quant energies do. The aim of this study was the identification of protein complexes participating in the response of the archaea Halorubrum saccharovorum H3 isolated from an extreme natural environment to terahertz radiation. We developed a microfluidic system for irradiation of bacterial and archaeal cultures with terahertz radiation and performed a 5-hour-long exposure of H. saccharovorum to terahertz radiation at a wavelength of 130 μm and a power density of 0.8 Wt per cm2 for 5 h. We identified under- or overexpressed proteins in response to terahertz radiation using 2D electrophoresis with subsequent MALDI-TOF mass spectrometry. A total of 16 differentially expressed protein fractions with at least 1.5-fold changes in expression level were detected. The obtained data suggest that Halorubrum cells respond to exposure to terahertz radiation by expression changes in gene products involved in translation regulation

The correlated optical and radio variability of BL Lacertae. WEBT data analysis 1994-2005

Since 1997, BL Lacertae has undergone a phase of high optical activity, with the occurrence of several prominent outbursts. Starting from 1999, the Whole Earth Blazar Telescope (WEBT) consortium has organized various multifrequency campaigns on this blazar, collecting tens of thousands of data points. One of the main issues in the study of this huge dataset has been the search for correlations between the optical and radio flux variations, and for possible periodicities in the light curves. The analysis of the data assembled during the first four campaigns (comprising also archival data to cover the period 1968-2003) revealed a fair optical-radio correlation in 1994-2003, with a delay of the hard radio events of ~100 days. Moreover, various statistical methods suggested the existence of a radio periodicity of ~8 years. In 2004 the WEBT started a new campaign to extend the dataset to the most recent observing seasons, in order to possibly confirm and better understand the previous results. In this campaign we have collected and assembled about 11000 new optical observations from twenty telescopes, plus near-IR and radio data at various frequencies. Here, we perform a correlation analysis on the long-term R-band and radio light curves. In general, we confirm the ~100-day delay of the hard radio events with respect to the optical ones, even if longer (~200-300 days) time lags are also found in particular periods. The radio quasi-periodicity is confirmed too, but the "period" seems to progressively lengthen from 7.4 to 9.3 years in the last three cycles. The optical and radio behaviour in the last forty years suggests a scenario where geometric effects play a major role. In particular, the alternation of enhanced and suppressed optical activity (accompanied by hard and soft radio events, respectively) canComment: 6 pages, 4 figure

The unprecedented optical outburst of the quasar 3C 454.3. The WEBT campaign of 2004-2005

The radio quasar 3C 454.3 underwent an exceptional optical outburst lasting more than 1 year and culminating in spring 2005. The maximum brightness detected was R = 12.0, which represents the most luminous quasar state thus far observed (M_B ~ -31.4). In order to follow the emission behaviour of the source in detail, a large multiwavelength campaign was organized by the Whole Earth Blazar Telescope (WEBT). Continuous optical, near-IR and radio monitoring was performed in several bands. ToO pointings by the Chandra and INTEGRAL satellites provided additional information at high energies in May 2005. The historical radio and optical light curves show different behaviours. Until about 2001.0 only moderate variability was present in the optical regime, while prominent and long-lasting radio outbursts were visible at the various radio frequencies, with higher-frequency variations preceding the lower-frequency ones. After that date, the optical activity increased and the radio flux is less variable. This suggests that the optical and radio emissions come from two separate and misaligned jet regions, with the inner optical one acquiring a smaller viewing angle during the 2004-2005 outburst. Moreover, the colour-index behaviour (generally redder-when-brighter) during the outburst suggests the presence of a luminous accretion disc. A huge mm outburst followed the optical one, peaking in June-July 2005. The high-frequency (37-43 GHz) radio flux started to increase in early 2005 and reached a maximum at the end of our observing period (end of September 2005). VLBA observations at 43 GHz during the summer confirm theComment: 7 pages, 4 figures, to be published in A&

Роль кардиоферментов в диагностике инфекционных поражений сердца

Purpose: to evaluate the importance of increasing cardioenzymes in the diagnosis of infectious heart lesions.Object and methods: Under observation were 71 children aged 3 to 17 years (average age – 6.6 ± 0.4 years) who received treatment at the clinic of Pediatric Research and Clinical Center for Infectious Diseases. All children in the acute period of illness and 49 patients with follow-up history were identified with levels of creatine phosphokinase (CPK), MВ fractions of creatine phosphokinase (CPK-MВ), lactate dehydrogenase (LDH), C-reactive protein (CRP), aspartate aminotransferase (AST). Follow-up observation and examination of patients was performed after 1 month and after 1 year. All children were examined for a wide range of pathogens of acute respiratory viral infections, active herpes virus infections (EBV, CMV, HHV-6 type), B19 parvovirus, Chlamydophila pneumoniae, Mycoplasma pneumonia, enteroviruses and bacterial respiratory pathogens. All examined patients underwent electrocardiography and echocardiography.The results of the study. In the examined patients with an increased level of “cardioenzymes” (CPK-MВ, LDH, AST) against the background of acute respiratory infection (ARI), a wide range of diseases was established with damage to both the upper respiratory tract and lower (bronchitis, bronchiolitis, pneumonia), and also other infectious nosologies, including respiratory syndrome (infectious mononucleosis, enterovirus and parvovirus infection). The etiological structure was dominated by a group of herpesvirus (53%) and bacterial infections (25%), as well as their combinations. An analysis of the dynamics of the main biochemical and hematological parameters characterizing the severity of the systemic inflammation syndrome (leukocytes, SRE, CRP, CPK), as well as reflecting myocardial injuries and used in cardiology practice (CPK- MВ, LDH, AST), revealed a long-term (within 1 year observations) the preservation of a moderately elevated level of CPK-MВ, unlike other indicators that returned to normal within 1 month. An increase in CPK-MВ was recorded in 79% of patients with drip infections, while the average level of CPK-MВ in the total sample exceeded the normal values by 1.8-2.4 times.Conclusion. It was found that elevated levels of CPK-MВ and LDH can be used as criteria for the formation of dynamic observation groups and early rehabilitation.Цель: оценить значение повышения кардиоферментов в диагностике инфекционных поражений сердца.Материалы и методы. Под наблюдением находился 71 ребенок в возрасте от 3 до 17 лет, получавший лечение в клинике Детского научно-клинического центра инфекционных болезней. Всем детям в остром периоде заболеваний и 49 пациентам в катамнезе определяли уровни креатинфосфокиназы, МВ-фракции креатинфосфокиназы, лактатдегидрогеназы, С-реактивного белка, аспартатаминотрансферазы. Катамнестическое наблюдение и обследование пациентов проводили через 1 месяц и через 1 год. Все дети обследованы на широкий спектр возбудителей острых респираторных вирусных инфекций, активных герпес-вирусных инфекций (ВЭБ, ЦМВ, ВГЧ-6 типа), парвовирус В19, Chlamydophila pneumoniae, Mycoplasma pneumonia, энтеровирусы, бактериальных респираторных патогенов. Всем обследованным пациентам проводили электрокардиографию и эхокардиографию.Результаты. У обследованных пациентов с повышенным уровнем кардиоферментов (МВ-фракции креатинфосфокиназы, лактатдегидрогеназы, аспартатаминотрансферазы) на фоне острой респираторной инфекции установлен широкий спектр заболеваний с поражением как верхних, так и нижних дыхательных путей (бронхит, бронхиолит, пневмония), а также других инфекционных нозологий, включающих респираторный синдром (инфекционный мононуклеоз, энтеровирусная и парвовирусная инфекция). В этиологической структуре доминировала группа герпес-вирусных (53%) и бактериальных инфекций (25%), а также их сочетаний. Анализ динамики основных биохимических и гематологических показателей, характеризующих выраженность синдрома системного воспаления (лейкоциты, скорость оседания эритроцитов, С-реактивный белок), а также отражающих миокардиальные повреждения и применяющиеся в кардиологической практике (МВ-фракции креатинфосфокиназы, лактатдегидрогеназы, аспартатаминотрансферазы), выявил длительное (в течение 1 года наблюдений) сохранение умеренно повышенного уровня КФК-МВ, в отличие от других, нормализовавшихся в течение 1 месяца показателей. Повышение КФК-МВ регистрировали у 79% больных капельными инфекциями, при этом средний уровень КФК-МВ в общей выборке превышал нормальные значения в 1,8–2,4 раза.Заключение. Установлено, что повышенные уровни КФК-МВ и ЛДГ могут использоваться как критерии для формирования групп динамического наблюдения и ранней реабилитации.

The Spectral Energy Distribution of Fermi bright blazars

(Abridged) We have conducted a detailed investigation of the broad-band spectral properties of the \gamma-ray selected blazars of the Fermi LAT Bright AGN Sample (LBAS). By combining our accurately estimated Fermi gamma-ray spectra with Swift, radio, infra-red, optical and other hard X-ray/gamma-ray data, collected within three months of the LBAS data taking period, we were able to assemble high-quality and quasi-simultaneous Spectral Energy Distributions (SED) for 48 LBAS blazars.The SED of these gamma-ray sources is similar to that of blazars discovered at other wavelengths, clearly showing, in the usual Log $\nu$ - Log $\nu$ F$_\nu$ representation, the typical broad-band spectral signatures normally attributed to a combination of low-energy synchrotron radiation followed by inverse Compton emission of one or more components. We have used these SEDs to characterize the peak intensity of both the low and the high-energy components. The results have been used to derive empirical relationships that estimate the position of the two peaks from the broad-band colors (i.e. the radio to optical and optical to X-ray spectral slopes) and from the gamma-ray spectral index. Our data show that the synchrotron peak frequency $\nu_p^S$ is positioned between 10$^{12.5}$ and 10$^{14.5}$ Hz in broad-lined FSRQs and between $10^{13}$ and $10^{17}$ Hz in featureless BL Lacertae objects.We find that the gamma-ray spectral slope is strongly correlated with the synchrotron peak energy and with the X-ray spectral index, as expected at first order in synchrotron - inverse Compton scenarios. However, simple homogeneous, one-zone, Synchrotron Self Compton (SSC) models cannot explain most of our SEDs, especially in the case of FSRQs and low energy peaked (LBL) BL Lacs. (...)Comment: 85 pages, 38 figures, submitted to Ap