Острое повреждение почек у пациентов с острыми химическими отравлениями: опыт токсикологического центра г. Рязани

Relevance. Acute kidney injury (AKI) is one of the leading causes of death worldwide. However, the epidemiology of AKI is not well understood. In Russia, toxic kidney damage plays a significant role in the nosological structure of AKI — 12.2%.Aim of study. To study the features of AKI in patients with acute chemical poisoning.Material and methods. We analyzed 26 case histories of patients with acute chemical poisoning with AKI (according to KDIGO). The comparison group included 25 patients with acute chemical poisoning without AKI. All patients were hospitalized in a toxicological center on the basis of the emergency department of the Ryazan Region State Budgetary Institution “City Clinical Emergency Hospital” (SBI RR “CCH EMC”) in 2016–2018. The analysis of the annual reports of the chief toxicologist of the Ministry of Health of the Ryazan Region for 2016–2018 was carried out. Data processing was performed using Microsoft Office Excel 2013 and on the website medstatistic.ru (Pearson’s chi-square test and Fisher’s exact test).Results. In most patients AKI developed during poisoning with cauterizing action substances - 38.4% (23% - vinegar essence, 15.4% - unidentified cauterizing action substance). The poisoning with alcohol substitutes (12%) took the 2nd place, with narcotic substances (8%) – the 3 rd place. Also, isolated cases of AKI (4% each) were reported in case of poisoning with pregabalin, tramadol, ketorol and ethanol. Poisoning with an unknown toxicant was noted in 29.6% of cases. Most patients (69.2%.) had stage 3 AKI. The second stage was registered in 7.7% of patients, the first — in 23.1%. Proteinuria was detected in all patients who underwent common urine test (CUT). Infusion therapy using crystalloids was performed in 100% of cases.Conclusion. Acute renal injury most often develops in acute poisoning with cauterizing poisons. The development of acute kidney injury in acute chemical poisoning leads to an increased risk of death. Acute kidney injury is the second most common immediate cause of death in acute chemical poisoning. Infusion therapy is an integral part of the management of toxicological patients with acute kidney injury.Актуальность. Острое почечное повреждение (ОПП) — одна из ведущих причин смерти во всем мире. Однако эпидемиология ОПП изучена недостаточно. В России значительную роль в нозологической структуре ОПП играет токсическое поражение почек — 12,2%.Цель. Изучить особенности ОПП у пациентов с острыми химическими отравлениями.Материал и методы. Проанализированы 26 историй болезни пациентов с острыми химическими отравлениями, у которых наблюдалось развитие ОПП (по KDIGO). В группу сравнения вошли 25 пациентов с острыми химическими отравлениями без ОПП. Все пациенты находились на стационарном лечении в ток- сикологическом центре на базе отделения неотложной терапии Государственного бюджетного учреждения Рязанской области «Городская клиническая больница скорой медицинской помощи» (ГБУ РО «ГКБ СМП») в 2016–2018 гг. Проведен анализ годовых отчетов главного специалиста-токсиколога Министерства здравоохранения Рязанской области за 2016–2018 гг. Статистическую обработку данных проводили с помощью программного обеспечения Microsoft Office Excel 2013 и на сайте medstatistic.ru с использованием критерия хи-квадрат Пирсона и точного критерия Фишера.Результаты. У большей части больных ОПП развилось при отравлениях веществами прижигающего действия — 38,4% (23% — уксусная эссенция, 15,4% — неустановленное вещество прижигающего действия). На втором месте — отравления суррогатами алкоголя (12%), на третьем — наркотическими веществами (8%). Также зарегистрированы единичные случаи ОПП (по 4%) при отравлениях прегабалином, трамадолом, кеторолом и этанолом. В 29,6% случаев отмечались отравления неустановленным токсикантом. У большинства пациентов развилось ОПП 3-й стадии — 69,2%. Вторая стадия зарегистрирована у 7,7% больных, первая — у 23,1%. Протеинурия выявлена у всех пациентов, которым был проведен общий анализ мочи (ОАМ). Инфузионную терапию с применением кристаллоидов проводили в 100% случаев.Выводы. Острое почечное повреждение наиболее часто развивается при острых отравлениях веществами прижигающего действия. Развитие острого почечного повреждения при острых химических отравлениях приводит к повышению риска смертельного исхода. Острое повреждение почек — вторая по частоте непосредственная причина смерти при острых химических отравлениях. Инфузионная терапия является неотъемлемой частью ведения токсикологических больных с острым повреждением почек

Modern Digital Technologies as a Tool for Teaching Schoolchildren

В статье раскрывается необходимость освоения современных цифровых технологий и показываются примеры их использования в учебном процессе.The article reveals the need to master modern digital technologies and shows examples of their use in the educational process

Dynamics of lipoperoxidation and amino acid spectrum in patients with delirium after intramedullary osteosynthesis with ropivocaine epidural anesthesia

Introduction: The pathogenesis of postoperative delirium, its causes, and factors contributing to its development remain a subject of debate. We consider it promising to study the dynamics of lipoperoxidation, cortisol levels and amino acid metabolism in patients with postoperative delirium. Such studies will reveal diagnostic and prognostic markers. The aim was to identify differences in the dynamics of lipoperoxidation, amino acid balance and cortisol levels in patients with and without delirium. Materials and methods A total of 41 patients who underwent surgery for a femoral fracture under epidural anaesthesia were included in the study. All patients underwent a daily test, - the Confused Consciousness Assessment Method. If it was positive, delirium was diagnosed; thus, two groups were identified: with postoperative delirium (n = 12) and without delirium (n = 29). Results In the preoperative delirium group, there was a relative lack of glucocorticosteroids as measured by reduced cortisol levels (pU < 0.01) and inhibition of lipid peroxidation as reduced Schiff bases (pU = 0.01). There were no significant differences in amino acid metabolism of the major amino acid pools. The intraoperative period in both groups had similar characteristics and no significant differences. In the postoperative period inhibition of lipoperoxidation in the delirium group changed into its greater activation, which was revealed by increased levels of ketodienes and conjugated trienes in isopropanol phase (pU < 0.01). There was also an increase in the aromatic pool (pU < 0.01) due to an increase in large neutral amino acids (phenialanine, pU = 0.0, tryptophan, pU = 0.02, tyrosine, pU < 0.01) and a decreasein the aliphatic pool (pU < 0.01). Cortisol levels remained significantly lower in the delirium group (pU < 0.01). Discussion The preoperative decrease in the studied indices in the delirium group may indicate initial reductive stress. In the postoperative period, patients with and without delirium differ in their metabolic activity with respect to lipoperoxidation and amino acid metabolism, and cortisol levels remain significantly lower in the delirium group. Conclusion The development of delirium is facilitated by initial reductive stress and a tolerant adaptation strategy.Введение. Патогенез послеоперационного делирия, причины его возникновения, факторы, способствующие его развитию, остаются предметом дискуссий. Представляется перспективным исследование динамики липопероксидации, уровня кортизола и аминокислотного обмена у пациентов с развитием послеоперационного делирия. Подобные исследования позволят выявить диагностические и прогностические маркеры. Цель работы – выявить различия в динамике процессов липопероксидации, аминокислотного баланса и уровня кортизола у пациентов с делирием и без делирия. Материалы и методы. В исследование включен 41 пациент, оперированный по поводу перелома бедренной кости под эпидуральной анестезией. Всем пациентам ежедневно проводился тест Метод Оценки Спутанного Сознания. В случае его положительного результата был диагностирован делирий. Таким образом, выделены две группы: с послеоперационным делирием (n = 12) и без делирия (n = 29). Результаты. В группе делирия до операции выявлена относительная недостаточность уровня глюкокортикостероидов, определяемого по сниженному уровню кортизола (pU < 0,01), и угнетение процессов перекисного окисления липидов в виде снижения оснований Шиффа (pU = 0,01). Показатели аминокислотного обмена не имели значимых различий по основным пулам аминокислот. Интраоперационный период в обеих группах имел сходные характеристики, значимые отличия отсутствовали. В послеоперационном периоде угнетение липопероксидации в группе делирия менялось на большую ее активацию, которую определяли по повышенному уровню кетодиенов и сопряженных триенов в изопропанольную фазу (pU < 0,01). Также было отмечено увеличения пула ароматических (pU < 0,01) за счет увеличения содержания больших нейтральных аминокислот (фениаланина, pU = 0,0, триптофана, pU = 0,02, тирозина, pU < 0,01) и снижения пула алифатических (pU < 0,01). В группе делирия уровень кортизола оставался достоверно ниже (pU < 0,01). Обсуждение. Дооперационное снижение исследуемых показателей в группе делирия может свидетельствовать об исходном редуктивном стрессе. В послеоперационном периоде пациенты с делирием и без делирия по-разному проявляют метаболическую активность в отношении процессов липопероксидации и аминокислотного обмена, уровень кортизола остается достоверно меньше в группе делирия. Заключение. Развитию делирия способствуют исходный редуктивный стресс и толерантная стратегия адаптации

Sanatorium-resort complex as a healthcare integral part in a period of socio-economic instability

The relevance of the research topic is due to the ambiguity of the influence of interrelated factors and conditions of the historical and cultural level of development of the sanatorium and resort complex of a large industrial region of Russia under the influence of changes in the socio-political and economic situation. The article summarizes and systematizes information and analytical materials that reflect the stages of formation and development of sanatorium organizations in the Sverdlovsk region. The author presents an attempt to identify mutually conditioning relationships and contradictions in the development of organizations of the sanatorium complex. The purpose of the study is to identify the influence of socio-cultural factors in the development of sanatorium organizations on increasing the level of competitiveness of tourist destinations in the industrial region of the Urals. Based on the processing, analysis and comparison of information-analytical and regulatory material of official sources of foreign and domestic literature, presented in the article, the author's conclusions are formulated about the role and contribution of the functioning of sanatorium-resort organizations in the socio-cultural and economic development of settlements, small towns and tourist destinations in the Sverdlovsk region

Development of a dialogue of cultures within a local community of citizens with the participation of local authorities: Tacis application form

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Mesenchymal Stem/Stromal Cells in Three-Dimensional Cell Culture: Ion Homeostasis and Ouabain-Induced Apoptosis

This study describes the changes in ion homeostasis of human endometrial mesenchymal stem/stromal cells (eMSCs) during the formation of three-dimensional (3D) cell structures (spheroids) and investigates the conditions for apoptosis induction in 3D eMSCs. Detached from the monolayer culture, (2D) eMSCs accumulate Na+ and have dissipated transmembrane ion gradients, while in compact spheroids, eMSCs restore the lower Na+ content and the high K/Na ratio characteristic of functionally active cells. Organized as spheroids, eMSCs are non-proliferating cells with an active Na/K pump and a lower K+ content per g cell protein, which is typical for quiescent cells and a mean lower water content (lower hydration) in 3D eMSCs. Further, eMSCs in spheroids were used to evaluate the role of K+ depletion and cellular signaling context in the induction of apoptosis. In both 2D and 3D eMSCs, treatment with ouabain (1 &micro;M) results in inhibition of pump-mediated K+ uptake and severe K+ depletion as well as disruption of the mitochondrial membrane potential. In 3D eMSCs (but not in 2D eMSCs), ouabain initiates apoptosis via the mitochondrial pathway. It is concluded that, when blocking the Na/K pump, cardiac glycosides prime mitochondria to apoptosis, and whether a cell enters the apoptotic pathway depends on the cell-specific signaling context, which includes the type of apoptotic protein expressed

Mesenchymal Stem/Stromal Cells in Three-Dimensional Cell Culture: Ion Homeostasis and Ouabain-Induced Apoptosis

This study describes the changes in ion homeostasis of human endometrial mesenchymal stem/stromal cells (eMSCs) during the formation of three-dimensional (3D) cell structures (spheroids) and investigates the conditions for apoptosis induction in 3D eMSCs. Detached from the monolayer culture, (2D) eMSCs accumulate Na+ and have dissipated transmembrane ion gradients, while in compact spheroids, eMSCs restore the lower Na+ content and the high K/Na ratio characteristic of functionally active cells. Organized as spheroids, eMSCs are non-proliferating cells with an active Na/K pump and a lower K+ content per g cell protein, which is typical for quiescent cells and a mean lower water content (lower hydration) in 3D eMSCs. Further, eMSCs in spheroids were used to evaluate the role of K+ depletion and cellular signaling context in the induction of apoptosis. In both 2D and 3D eMSCs, treatment with ouabain (1 µM) results in inhibition of pump-mediated K+ uptake and severe K+ depletion as well as disruption of the mitochondrial membrane potential. In 3D eMSCs (but not in 2D eMSCs), ouabain initiates apoptosis via the mitochondrial pathway. It is concluded that, when blocking the Na/K pump, cardiac glycosides prime mitochondria to apoptosis, and whether a cell enters the apoptotic pathway depends on the cell-specific signaling context, which includes the type of apoptotic protein expressed

Tetraploidization or autophagy: The ultimate fate of senescent human endometrial stem cells under ATM or p53 inhibition

<p>Previously we demonstrated that endometrium-derived human mesenchymal stem cells (hMESCs) via activation of the ATM/p53/p21/Rb pathway enter the premature senescence in response to oxidative stress. Down regulation effects of the key components of this signaling pathway, particularly ATM and p53, on a fate of stressed hMESCs have not yet been investigated. In the present study by using the specific inhibitors Ku55933 and Pifithrin-α, we confirmed implication of both ATM and p53 in H₂O₂-induced senescence of hMESCs. ATM or p53 down regulation was shown to modulate differently the cellular fate of H₂O₂-treated hMESCs. ATM inhibition allowed H₂O₂-stimulated hMESCs to escape the permanent cell cycle arrest due to loss of the functional ATM/p53/p21/Rb pathway, and induced bypass of mitosis and re-entry into S phase, resulting in tetraploid cells. On the contrary, suppression of the p53 transcriptional activity caused a pronounced cell death of H₂O₂-treated hMESCs via autophagy induction. The obtained data clearly demonstrate that down regulation of ATM or p53 shifts senescence of human endometrial stem cells toward tetraploidization or autophagy.</p

Reactive Oxygen Species Are Required for Human Mesenchymal Stem Cells to Initiate Proliferation after the Quiescence Exit

The present study focuses on the involvement of reactive oxygen species (ROS) in the process of mesenchymal stem cells “waking up” and entering the cell cycle after the quiescence. Using human endometrial mesenchymal stem cells (eMSCs), we showed that intracellular basal ROS level is positively correlated with the proliferative status of the cell cultures. Our experiments with the eMSCs synchronized in the G0 phase of the cell cycle revealed a transient increase in the ROS level upon the quiescence exit after stimulation of the cell proliferation. This increase was registered before the eMSC entry to the S-phase of the cell cycle, and elimination of this increase by antioxidants (N-acetyl-L-cysteine, Tempol, and Resveratrol) blocked G1–S-phase transition. Similarly, a cell cycle arrest which resulted from the antioxidant treatment was observed in the experiments with synchronized human mesenchymal stem cells derived from the adipose tissue. Thus, we showed that physiologically relevant level of ROS is required for the initiation of human mesenchymal stem cell proliferation and that low levels of ROS due to the antioxidant treatment can block the stem cell self-renewal