Peculiarities of the influence of sorbilact and its combination with L-arginine on the level of toxemia and detoxification function of the kidneys in the period of development of endogenous intoxication syndrome

Kidney injury in case of endogenous intoxication syndrome of purulent-septic genesis necessitates nephroprotective therapy. The aim of the work was to determine effects of combined use of sorbilact and L-arginine to levels of toxemia and the detoxification function of the kidneys in endogenous intoxication syndrome during the period of it’s development. Methods. Kidneys’ detoxication function have been studied in patients of the following groups. The first group (І, control) consisted of 31 patients with systemic inflammatory response syndrome (SIRS, ICD-10: R-65.2). The second group (ІІ) consisted of 27 patients with endogenous intoxication syndrome who were treated according to Surviving Sepsis Campaign 2016 (standard therapy) [9]. The third group (IІІ) consisited of 29 patients with endogenous intoxication syndrome, who received sorbilact in addition to standard therapy. The fourth group (IV) included 30 patients with endogenous intoxication syndrome who received sorbilact and L-arginine in addition to standard therapy. Sorbilact infusion to patients of III and IV groups was performed at a rate of 6-7 ml/kg body weight, intravenously dripping at a rate of 7-8 ml/min. After the end of infusion of sorbilact, patients of IV group were infused with 4.2% solution of L-arginine (“Tivortin” intravenous drip according to the instructions). Data were obtained and results gathered on the application of drugs in the period of stabilization (according to the state of volumoregulatory and osmoregulatory function) of secondary toxic autoagresion (fourth day of drugs’ application). As a single-celled receptor-effector system, the Paramecium caudatum culture was used. Low Molecular Weight Proteins (LMWP) concentration in blood and urine were determined using a modified method. Results. Development of the syndrome of endogenous intoxication was accompanied by a manifestation of kidney injury. Infusion of sorbilact as a part of complex intensive therapy of endogenous intoxication syndrome has allowed to find out its influence on detoxification functions of the kidneys after a single administration. Under these conditions, sorbilact regulates the ability of the kidneys to excrete toxic substances (р˂0,05). Conclusion. Combination of sorbilact with L-arginine according corresponding indicators of total clearance of toxic substances and Low Molecular Weight Proteins after the first infusion leads to the potentiation of the detoxication effect of sorbilact

Features of sorbilact-L-arginine-combined action on the kidneys’ volumoregulatory function of patients with purulent-septic complications

The purpose of the work is to investigate the effect of combined use of sorbilact and L-arginine on the kidneys’ volume-regulatory function of patients with endogenous intoxication syndrome (EIS) of purulent-septic origin in the period of stabilization of secondary toxic autoagression.Methods. Indicators of kidney volume receptor function have been studied in patients of the following groups. The first group (І, control) consisted of 31 patients with systemic inflammatory response syndrome (SIRS). The second group (ІІ) consisted of 22 patients with EIS who were treated according to Surviving Sepsis Campaign 2016 (standard therapy) [9]. The third group (ІІ) consisited of 24 patients with EIS, who received sorbilact in addition to standard therapy. The fourth group (IV) included 21 patients with SEI who received standard therapy as well as Sorbilact and L-arginine. Sorbilact infusion to patients of III and IV groups was performed at a rate of 6-7 ml/kg body weight, intravenously dripping at a rate of 7-8 ml/min. After the end of infusion of sorbilact, patients of IV group were infused with 4.2% solution of L-arginine (“Tivortin” intravenous drip according to the instructions). Data was obtained and results gathered on the application of drugs in the period of stabilization of secondary toxic autoagresion (fourth day of drugs’ application).Findings. In the period of stabilization there is a restoration of the volume-regulatory function of the kidneys under standard therapy of endotoxicosis of purulent-septic genesis. The use of sorbilact with standard therapy activates the volume-regulatory function of the kidneys (in terms of sodium clearance by 31%, p &lt;0,05) in the period of stabilization of toxic autoaggression. The combination of sorbilact with L-arginine increases the activity of sodium clearance by 12% (p &lt;0,05) induced by sorbilact.Conclusions. The investigated features of basic adjuvant therapy with L-arginine and sorbilact can be recommended for use in order to restore the volume-regulatory function of the kidneys in cases of endotoxicosis of purulent-septic genesis.</p

The peculiarities of cross-correlation between two secondary precursors - radon and magnetic field variations, induced by stress transfer changes

A model of precursor manifestation mechanisms, stimulated by tectonic activity and some peculiarities of observer strategy, whose main task is the effective measurement of precursors in the spatial area of their occurrence on the Earth's daylight, are considered. In particular, the applicability of Dobrovolsky's approximation is analyzed, when an unperturbed medium (characterized by the simple shear state) and the area of tectonic activity (local inhomogeneity caused by the change only of shear modulus) are linearly elastic, and perturbation, in particular, surface displacement is calculated as a difference of the solutions of two independent static problems of the theory of elasticity with the same boundary condition on the surface. Within the framework of this approximation a formula for the spatial distribution (of first component) of magnetic field variations caused by piezomagnetic effect in the case of perturbed regular medium, which is in simple shear state is derived. Cogent arguments in favor of linear dependence between the radon spatial distribution and conditional deformation are obtained. Changes in magnetic field strength and radon concentrations were measured along a tectonomagnetic profile of the total length of 11 km in the surroundings of the "Academician Vernadsky" Station on the Antarctic Peninsula (W 64{\deg}16', S 65{\deg}15'). Results showed a positive correlation between the annual surface radon concentration and annual changes of magnetic field relative to a base point, and also the good coincidence with theoretical calculation.Comment: 27 pages, 11 figures, 3 tables (a substantially revised and extended edition; v3 -- some analysis of recent publications added

Метаболізм аргініну: перспективи клінічного використання (огляд літератури)

Review of the literature deals with metabolism of arginine and its possible clinical application. In particular the article provides information about clinical effects of both the arginine and its metabolites.Обзор литературы посвящен вопросам метаболизма аргинина и возможностям его клинического применения. В частности приведены сведения о клинических эффектах как самого аргинина, так и его метаболитов.Огляд літератури присвячений питанням метаболізму аргініну та можливостям його клінічного застосування. Зокрема, наведені відомості про клінічні ефекти як самого аргініну, так і його метаболітів

Features of sorbilact-L-arginine-combined action on the kidneys’ volumoregulatory function of patients with purulent-septic complications

The purpose of the work is to investigate the effect of combined use of sorbilact and L-arginine on the kidneys’ volume-regulatory function of patients with endogenous intoxication syndrome (EIS) of purulent-septic origin in the period of stabilization of secondary toxic autoagression. Methods. Indicators of kidney volume receptor function have been studied in patients of the following groups. The first group (І, control) consisted of 31 patients with systemic inflammatory response syndrome (SIRS). The second group (ІІ) consisted of 22 patients with EIS who were treated according to Surviving Sepsis Campaign 2016 (standard therapy) [9]. The third group (ІІ) consisited of 24 patients with EIS, who received sorbilact in addition to standard therapy. The fourth group (IV) included 21 patients with SEI who received standard therapy as well as Sorbilact and L-arginine. Sorbilact infusion to patients of III and IV groups was performed at a rate of 6-7 ml/kg body weight, intravenously dripping at a rate of 7-8 ml/min. After the end of infusion of sorbilact, patients of IV group were infused with 4.2% solution of L-arginine (“Tivortin” intravenous drip according to the instructions). Data was obtained and results gathered on the application of drugs in the period of stabilization of secondary toxic autoagresion (fourth day of drugs’ application). Findings. In the period of stabilization there is a restoration of the volume-regulatory function of the kidneys under standard therapy of endotoxicosis of purulent-septic genesis. The use of sorbilact with standard therapy activates the volume-regulatory function of the kidneys (in terms of sodium clearance by 31%, p <0,05) in the period of stabilization of toxic autoaggression. The combination of sorbilact with L-arginine increases the activity of sodium clearance by 12% (p <0,05) induced by sorbilact. Conclusions. The investigated features of basic adjuvant therapy with L-arginine and sorbilact can be recommended for use in order to restore the volume-regulatory function of the kidneys in cases of endotoxicosis of purulent-septic genesis

МЕТОДИ СТРАТИФІКАЦІЇ СТУПЕНІВ ТЯЖКОСТІ СТАНУ ПАЦІЄНТІВ ІЗ СЕПСИСОМ. ОГЛЯД ЛІТЕРАТУРНИХ ДАНИХ

Abstract. In this article, the current views on the establishment of severity level in the patients with sepsis are outlined. The generalization and synthesis of available data, their advantages and existing limitations are analyzed.Резюме. В статье освещены современные взгляды на определение степени тяжести пациентов с сепсисом. Осуществлено обобщение и синтез имеющихся данных, проанализированы их мотивации и возможные ситуационные недостатки.Резюме. В статті висвітлені останні погляди на визначення ступенів тяжкості пацієнтів із сепсисом. Здійснено узагальнення та синтез наявних даних, проаналізовані їх мотивації та можливі ситуаційні недоліки

Possibilities of renoprotection in the syndrome of endogenous intoxication of purulent-septic genesis in the period of development of secondary toxic autoagression

The purpose of the work is to investigate the range of renoprotection, in particular osmotic and volumoregulatory functions, with combined application of sorbitol and L-arginine in patients with endogenous intoxication syndrome of purulent-septic genesis in the period of development of secondary toxic autoagression. Materials and methods. The indices of volumо-, and osmoregulatory functions of the kidneys in three groups of patients were investigated. The first group (control) included 31 patients with systemic inflammatory response syndrome (SIRS). The second group consisted of 27 patients with endogenous intoxication syndrome (EIS) who received standard therapy. The third group consisted of 29 patients with EIS, which on the basis of standard therapy were administered sorbilact. The fourth group included 30 patients with EIS, which on the basis of standard treatment were administered a combination of sorbilact and L-arginine. Infusion of sorbilact for patients of Groups III and IV was carried out at a rate of 6-7 ml/kg bodyweight intravenously at a rate of 7-8 ml/min. After the end of infusion of sorbilact, patients in group IV were infused with 4.2% solution of L-arginine (Tivortin® intravenously according to the instructions). The results of application of the drug in the period of development of secondary toxic autoaggression are presented. Results A decrease in the velocity of glomerular filtration (GFR) was established as 66 ± 2.1 ml/min in patients of group II. The use of sorbitol on the first day of the study in patients with EIS (Group III) increased the GFR and caused increased diuresis. This study establishes that the filtration fraction of sodium and cation excretion increase under the influence of sorbilact. Clearance of osmotically active substances (OAS) in patients with EIS is reduced by 30-35% of the control level (SIRS). Infusion of sorbilact in patients with EIS during the development of early toxic autoaggression while undergoing standard treatment was accompanied by a statistically significant increase in plasma osmolarity, and the filtration fraction of OAS (in relation to the second group). The combined use of sorbilact and L-arginine resulted in statistically significant increases in GFR and sodium clearance. Conclusion. Under conditions of medium-severe EIS, sorbilact corrects the integrity of lost osmotic and volumiregulatory functions of the kidneys, but does not restore them to the control level, in particular the degree of oppression is determined respectively at the level of 37% and 22% (p˂0.05). The combination of sorbilact with L-arginine according to the corresponding indicators of clearance after the first session reduces the deficit of compensating volumuminescence (up to 28%, p˂0.05) and osmoregulatory (up to 15%, p˂0.05) renal functions. The obtained results are the basis for the introduction of the sorbilact-L-arginine complex into the program of intensive therapy for the purpose of renoprotection

Проблеми моніторингу ендотоксикозу септичного генезу (огляд літератури)

This review of the literature is devoted to contemporary perceptions of endogenous intoxication, and is focused on the methods of diagnosis. The main elements of pathogenesis and peculiarities of their application of sepsis are also highlighted.Обзор литературы посвящен современным представлениям о эндогенной интоксикации. Освещены основные звенья ее патогенеза. Сосредоточено внимание на методах диагностики и особенностях их применения при сепсисе.Огляд літератури присвячений сучасним уявленням про ендогенну інтоксикацію. Висвітлено основні ланки її патогенезу. Зосереджено увагу на методах діагностики та особливостях їх використання при сепсисі

Можливості ренопротекції при синдромі ендогенної інтоксикації гнійно-септичного генезу в періоді розвитку вторинної токсичної ауто агресії

The purpose of the work is to investigate the range of renoprotection, in particular osmotic and volumoregulatory functions, with combined application of sorbitol and L-arginine in patients with endogenous intoxication syndrome of purulent-septic genesis in the period of development of secondary toxic autoagression.Materials and methods. The indices of volumо-, and osmoregulatory functions of the kidneys in three groups of patients were investigated. The first group (control) included 31 patients with systemic inflammatory response syndrome (SIRS). The second group consisted of 27 patients with endogenous intoxication syndrome (EIS) who received standard therapy. The third group consisted of 29 patients with EIS, which on the basis of standard therapy were administered sorbilact. The fourth group included 30 patients with EIS, which on the basis of standard treatment were administered a combination of sorbilact and L-arginine. Infusion of sorbilact for patients of Groups III and IV was carried out at a rate of 6-7 ml/kg bodyweight intravenously at a rate of 7-8 ml/min. After the end of infusion of sorbilact, patients in group IV were infused with 4.2% solution of L-arginine (Tivortin® intravenously according to the instructions). The results of application of the drug in the period of development of secondary toxic autoaggression are presented.Results A decrease in the velocity of glomerular filtration (GFR) was established as 66 ± 2.1 ml/min in patients of group II. The use of sorbitol on the first day of the study in patients with EIS (Group III) increased the GFR and caused increased diuresis. This study establishes that the filtration fraction of sodium and cation excretion increase under the influence of sorbilact. Clearance of osmotically active substances (OAS) in patients with EIS is reduced by 30-35% of the control level (SIRS). Infusion of sorbilact in patients with EIS during the development of early toxic autoaggression while undergoing standard treatment was accompanied by a statistically significant increase in plasma osmolarity, and the filtration fraction of OAS (in relation to the second group). The combined use of sorbilact and L-arginine resulted in statistically significant increases in GFR and sodium clearance.Conclusion. Under conditions of medium-severe EIS, sorbilact corrects the integrity of lost osmotic and volumiregulatory functions of the kidneys, but does not restore them to the control level, in particular the degree of oppression is determined respectively at the level of 37% and 22% (p˂0.05). The combination of sorbilact with L-arginine according to the corresponding indicators of clearance after the first session reduces the deficit of compensating volumuminescence (up to 28%, p˂0.05) and osmoregulatory (up to 15%, p˂0.05) renal functions. The obtained results are the basis for the introduction of the sorbilact-L-arginine complex into the program of intensive therapy for the purpose of renoprotection.    Цель работы – исследовать спектр ренопротекции, в частности осмо- и волюморегуляторних функций при совместном применении сорбитола и L-аргинина у больных с синдромом эндогенной интоксикации гнойно-септического генеза в периоде развития вторичной токсической аутоагрессии.Материалы и методы. Исследованы показатели волюмо- и осморегуляторных функции почек у пациентов трех групп. I группа (контрольная) – 31 больной с синдромом системного воспалительного ответа (ССВО). II группа включала 27 больных с синдромом эндогенной интоксикации (СЭИ), которые получали стандартную терапию. III группа – 29 больных с СЭИ, которым на базе стандартной терапии вводили сорбилакт. IV группа – 30 больных с СЭИ, стандартное лечение которых дополнено совместным применением сорбилакта и L-аргинина. Инфузию сорбилакта пациентам III и IV групп проводили из расчета 6–7 мл/кг массы тела внутривенно капельно со скоростью 7–8 мл/мин. После окончания инфузии сорбилакта пациентам IV группы проводили инфузию 4,2 % раствора L-аргинина (тивортин внутривенно капельно согласно инструкции). Приведены результаты применения препаратов в период развития вторичной токсической аутоагрессии.Результаты. Установлено уменьшение скорости клубочковой фильтрации (СКФ) до 66,0 ± 2,1 мл/мин у больных II группы. Применение сорбилакта на первый день исследования у больных с СЭИ (ІІІ группа) увеличивает СКФ и приводит к повышению диуреза. Установлен рост фильтрационной фракции натрия и увеличение экскреции катиона под влиянием сорбилакта. Клиренс осмотически активных веществ (ОАР) у больных с СЭИ снижается на 30–35 % от уровня контроля (ССВО). Инфузия сорбилакта пациентам с СЭИ в период развития ранней токсической аутоагрессии на фоне стандартной терапии сопровождалась статистически достоверным повышением осмолярности плазмы, фильтрационной фракции ОАР (по отношению к пациентам II группы). Совместное применение сорбилакта и L-аргинина приводило к статистически достоверному повышению СКФ и клиренса натрия.Выводы. В условиях средне-тяжелого течения СЭИ сорбилакт корректирует целостность потерянных осмо- и волюморегуляторних функции почек, но не восстанавливает их до контрольного уровня, в частности степень угнетения определяется на уровне 37 % и 22 % соответственно (р ˂ 0,05). Сочетание сорбилакта с L-аргинином по соответствующим показателям клиренсов после первого сеанса уменьшает дефицит компенсации волюмо- (до 28 %, р ˂ 0,05) и осморегуляторных (до 15 %, р ˂ 0,05) функций почек. Результаты являются основанием для введения в программу интенсивной терапии СЭИ сорбилакт-L-аргининового комплекса с целью нефропротекции.  Мета роботи – дослідити спектр ренопротекції, зокрема осмо- та волюморегуляторних функцій при поєднаному застосуванні сорбілакту та L-аргініну у хворих із синдромом ендогенної інтоксикації гнійно-септичного генезу в періоді розвитку вторинної токсичної аутоагресії.Матеріали та методи. Дослідили показники волюмо- та осморегуляторної функції нирок у пацієнтів трьох груп. І група (контрольна) – 31 хворий із синдромом системної запальної відповіді (ССЗВ). ІІ група ؘ – 27 хворих із синдромом ендогенної інтоксикації (СЕІ), які отримали стандартну терапію. ІІІ група – 29 хворих із СЕІ, яким на базі стандартної терапії вводили сорбілакт. IV група – 30 хворих із СЕІ, стандартне лікування, яких доповнили поєднаним застосуванням сорбілакту та L-аргініну. Інфузію сорбілакту пацієнтам ІІІ та IV груп виконали з розрахунку 6–7 мл/кг маси тіла внутрішньовенно краплинно зі швидкістю 7–8 мл/хв. Після завершення інфузії сорбілакту пацієнтам IV групи виконували інфузію 4,2 % розчину L-аргініну (тівортін внутрішньовенно краплинно згідно з інструкцією). Наведено результати застосування препаратів у періоді розвитку вторинної токсичної аутоагресії.Результати. Встановили зменшення швидкості клубочкової фільтрації (ШКФ) до 66,0 ± 2,1 мл/хв у хворих ІІ групи. Застосування сорбілакту на перший день дослідження у хворих із СЕІ (ІІІ група) збільшує ШКФ і зумовлює підвищення діурезу. Виявили зростання фільтраційної фракції натрію та збільшення екскреції катіону під впливом сорбілакту. Кліренс осмотично активних речовин (ОАР) у хворих із СЕІ знижується на 30–35 % від рівня контролю (ССЗВ). Інфузія сорбілакту пацієнтам із СЕІ в період розвитку ранньої токсичної аутоагресії на тлі стандартної терапії супроводжувалась статистично вірогідним підвищенням осмолярності плазми, фільтраційної фракції ОАР (щодо ІІ групи). Сумісне застосування сорбілакту та L-аргініну зумовлювало статистично вірогідне зростання ШКФ і кліренсу натрію.Висновки. За умов середньо-тяжкого перебігу СЕІ сорбілакт корегує цілісність втраченої осмо- та волюморегуляторної функції нирок, але не відновлює їх до контрольного рівня, зокрема ступінь пригнічення визначається на рівні 37 % та 22 % відповідно (р ˂ 0,05). Поєднання сорбілакту з L-аргініном за відповідними показниками кліренсів після першого сеансу зменшує дефіцит компенсації волюмо- (до 28 %, р ˂ 0,05) та осморегуляторної (до 15 %, р ˂ 0,05) функції нирок. Результати є підставою для введення у програму інтенсивної терапії СЕІ сорбілакт-L-аргінінового комплексу для нефропротекції.