Vol 9, No 3 (2018)

Infants with severe and moderate bronchopulmonary dysplasia (BPD) are characterized by long-term persistence of apnea of prematurity and often have a pulmonary hypertension (PH). Respiratory pauses, accompanied by intermittent hypoxia, do not clinically manifest themselves, therefore cardiorespiratory monitoring (CRM) is required. We hypothesized that the persistent of apnea, as the cause of hypoxemia episodes, may be associated with the persistence of PH in infants with BPD.

The aim of the study was to evaluate the dynamics of cardiorespiratory parameters and to study the relationship between obstructive apnea and PH during the first year of life of premature infants with BPD + PH.

Materials and methods. CRM was performed in 58 infants were born at 26 0/7-31 0/7 weeks gestation and with birth weight less than 1500 grams, before discharge from the hospital (35-44 weeks of post menstrual age). 14 infants did not have BPD (group without BPD). 44 infants had BPD and 17 of them had a complication of this disease PH (BLD + PH group). Other infants with BPD did not have PH (BLD-PH group). Eight infants with BPD also underwent a study at home (aged 9 to 10 months of life).

Results. Preterm infants with BPD + PH were more significant decrease in the average SpO2, higher desaturation index and more a number of desaturation episodes of <10% compared to infants with BPD-PH and without BPD. There was no difference in the apnea/hypopnea index and frequency of occurrence of different types of apnea between groups. There was no difference in cardiorespiratory performance in infants with BPD+PH compared to infants with BPD-PH in 9-10 months of life.

Conclusions. There was a positive dynamics of cardiorespiratory parameters in infants with BPD+PH in 9-10 months after discharge from the hospital. The number of infants with an index of OA> 1/hour is higher in the group BPD+LH.

Objective. To increase the effectiveness of neurological evaluation in detecting traumatic intracranial injures in children under 18 years old with clinical criteria of mild traumatic brain injury.

Materials and methods. Clinical and clinical-sonographic evaluations of 256 patients aged 0-18 years with clinical criteria of mild traumatic brain injury were performed. Depending of detected clinical and neurological risk factors and the results of the primary clinical and sonographic examination, children were divided into two groups: group I (high or medium risk of traumatic intracranial injury) – 174 (67.9%), group II (low/no risk of traumatic intracranial injury) – 82 (32.1%). Verification of important traumatic and non-traumatic intracranial changes revealed by primary sonographic exam was confirmed by using computerized tomography.

Results and conclusion. Identification of traumatic intracranial injures by results of primary clinical examination is most effective when two or more higher or medium risk factors were detected. Application of primary clinical and sonographic examination increases diagnostic efficiency of neurological evaluation to 10.1% and the possibility of detecting traumatic intracranial injures to 57.1%. In 7.0% of cases emergency computed tomography were determined, dynamic observation was performed in 32.1% of cases. Significant non-traumatic brain diseases (cysts, hydrocephalus, congenital malformations) were diagnosed in 3.6% of cases by results primary clinical and sonographic examination.

In recent years, viral lesions of the gastrointestinal tract take the leading place in the etiological structure of acute intestinal infections. The study of the clinical course and treatment of viral diarrhea in children is an urgent task in modern conditions. We analyzed the disease of 2568 children aged 1 month to 17 years who were hospitalized in a Hospital No 3 in St. Petersburg in the period of 2016-2017. All patients underwent a standard laboratory examination. The etiological interpretation was carried out with the help of polymerase chain reaction, bacteriological and serological methods of investigation. Of the 2568 children in 1502 (58.5%) patients, the diagnosis was confirmed. The share of bacterial diarrhea was 31.8%, viral lesions of the gastrointestinal tract – 68.2%. Among the decoded viral lesions of the gastrointestinal tract, the share of rotavirus infection was 52.8%, norovirus infection – 24.8%, mixed infection – 19.6%. A high proportion of viral lesions of the gastrointestinal tract was established in children under 3 years of age (71.7%). The main reason for hospitalization of children under 5 years of age is rotavirus infection, from 5 to 12 years – norovirus infection. Almost always (87.6%), viral diarrhea proceeded in a moderate form. In infants, mixed viral infection was recorded in severe form. The use of Viferon® in the form of rectal suppositories to supplement the basic therapy of viral intestinal infections significantly reduces the duration of intoxication syndrome, fever, diarrhea, catarrhal syndrome, the duration elimination of viruses, and the length of stay in the hospital.

The inhibitor of serotonin (5-HT) reuptake fluoxetine does not cause any improvement in every patient suffering from depression; moreover, fluoxetine during pregnancy disrupts the normal development of the fetus. Clinical observations in adult patients suggest that treatment of depression with a combination of fluoxetine and 5-HT1A receptor agonists has a higher therapeutic effect than the effect of a single fluoxetine. In the present study, the effect of chronic management of the combination of fluoxetine and a 5-HT1A receptor agonist anxiolytic buspirone was examined in order to correct the adverse effects of prenatal stress on pain and affective behavior in the female offspring during the prepubertal period of development. It was found that the immobilization stress of rat dams in the last third of pregnancy (the stress of rat dams during pregnancy is used as a model of human depression) caused in the offspring the increased functional activity of the pain system, an increase in the level of depressive-like behavior. Chronic administration to pregnant dams of fluoxetine, buspirone, or their combination has improved the characteristics under study in the female offspring. The results indicate that the chronic administration of a combination of fluoxetine and buspirone during the gestation of rat dams neutralized the negative effect of prenatal stress in female offspring. More effective action of the combination of the drugs compared with the action of fluoxetine was revealed in the pain sensitivity to thermal stimulus and in the first acute phase of pain behavior in the formalin test. Undesirable deviations in the investigated types of behavior in female rats subjected to pharmacological effects of each of the drugs during the prenatal period were not revealed.

At present, the state of health of young men deserves special attention on the part of the state, since they are not only the economic, social, demographic, but also the defense potential of the country. The evaluation of the health of young people of their own health in terms of the ability to perform certain social functions and roles, that is, self-evaluation of health, is important in assessing health. In order to study the opinion of the young men about their health and their compliance with the requirements of military service, an anonymous survey of 325 senior pupils of four Yakutsk general education schools was conducted. It was found that many young men of Yakutsk low estimate their readiness for military service. An analysis of the self-assessment of the degree of physical training made it possible to establish that more than a third of high school students believe that they have poor or insufficient physical training, more than a quarter believe that they are not physically ready for military service. At the same time, less than a third seek to improve their physical training through regular physical training and sports, the remaining boys regularly do not engage in physical culture and sports, explaining this subjective reasons. Most know that there are such diseases in which one does not join the army, and one in four believes that he has such a disease. Of the 100 senior pupils, 8,2 ± 1,5 assess their health as bad, 11,2 ± 1,8 consider that for health reasons they are not fit for military service, at the same time 42,4 ± 2,8 believe that to military service they are only limitedly fit or temporarily unfit. Statistically significant differences in the self-assessment of health and the degree of physical fitness between the Yakuts and the Russians were not established.

One of the main problems of modern sport is propensity for various kinds of sport activity and individualization of the training process. To solve this problem effectively, the Center of testing, selection and support for sports-gifted children and adolescents has been created on the basis of Lesgaft National State University of Physical Education, Sport and Health. The structure of the Center includes the medical and biological department, the genetic department, the department of psychological evaluation and support, the sports and pedagogical department. In each department the individual quotients, based on the collected and analyzed information about the individual's makings and abilities, are compared with the standard requirements in a particular kind of sport. After that the opinion about the general and special sports talent of person is made. Coordination interaction between departments is provided by the Information and Organizational Department of the Center, which conducts final sports consultancy and support on the basis of the complex opinion of the individual profile of the child's sports talent. Individual profile of sports talent allows to determine the degree of development and retardation of main physical qualities and abilities, to define the directions of sport specialization, to develop a training program, to make amendments. Innovative programs of individualizing training process, which are provided in this center, are based on long-term practical experience in sports pedagogic, sports genetics, sports psychology and sports medicine. The center of testing, selection and support to sports-gifted children and adolescents is an innovative institution that has no analogues.

The article presents clinical case surgical treatment of obesity in the patient with Prader-Willy-Labhart syndrome (PWS). The patient had characteristic phenotypic features of the disease: low growth, narrow temporal part of the skull, dolichocephaly, acromicria. There was a delay in psychomotor development, hypogonadism. Excess body weight was noted from three years old with a gradual progression of obesity. Now patient is 23 and her weight is 159 kg with an increase of 150 cm (BMI 70.7 kg/m2). The co-morbidities were represented by arterial hypertension, type 2 diabetes and bronchial asthma. The indication for surgical treatment was the morbid (III degree) obesity by the Prader-Willy-Labhart syndrome, complicated by the development of diseases associated with overweight and non-medicated therapy. After a long (three-week) preoperative preparation aimed at correcting the manifestations of bronchial asthma and obesity-related diseases, laparoscopic sleeve gastrectomy was performed. The choice of the procedure of operation was determined by its pathogenetic reasonability (resection the most part of the stomach, which is producing ghrelin), and severe comorbid background (which is limiting the time of surgery) and severe hyperphagia (which is requiring a procedure with a predominantly restrictive mechanism of action). After operation period flowed without complications. The patient noted decrease of the appetite and the relief keeping nutrition's regime. A year after laparoscopic sleeve gastrectomy the patient achieved reduction of 59 kg body mass and remission of co-morbidities. A positive effect in metabolic profile allows us to consider laparoscopic sleeve gastrectomy as an effective method for treating patients with Prader-Willy-Labhart syndrome.

Clinical case of surgical treatment of advanced congenital kyphoscoliosis in 12 years old child is reported. Radiographs and CT at presentation failed to reveal the entire anomaly. By analysis of priorly made radiographs hemivertebra L1 was recognized. At genitourinary assessment L-shaped kidney was detected. A full-size 3D-printed model was used for surgical planning. Vertebral column resection as treatment option was discussed, but due to high neurologic complication rate this approach was refused. After preoperative 35 days halo-femoral traction anterior instrumented fusion was performed. Right ureter was stented for intraoperative urologic injury prevention. Scoliosis correction of 32% and kyphosis of 14% was achieved. 5 months later definitive posterior uninstrumented fusion was performed. Spinal deformities caused by vertebral malformations progress dramatically unless they are treated early. An advanced case is a clinical challenge because of technical difficulties and poor result. Vertebral column resection is a treatment option for severe kyphoscoliosis, but it’s indications should be strictly individualized. Preoperative halo-femoral traction is the most safe correction method in spinal deformity due to prolonged and gradual action. 3d-printed models are practical for surgical planning. The model may be used intraoperatively as a 3D-reference. In congenital scoliosis genitourinary system should be assessed meticulously, and urologist advice in relevant case is necessary.

Development context of scientific thought in the early 20 century let us see the origins of many ideas, that became fundamental in Russian philosophical anthropology. Ukhtomsky’s theory about dominant – the one of the most important in the psycho-physiological development of the 20th century. His ideas useful not only for theoretical physiology, anthropology, psychology, but also in practice, for labor, science and creative activity optimization. Dominant principle – is not only the main way of brain centers cooperation, but also all nervous system and body as a whole. It gives an opportunity to learn the contradictory and hard structure of human behavior, of a moral and creative person components, describes way of human attitude to the external environment as an active, not passive observer. Dominant connects rather elements in a single unit, moving in one direction, and present not only in physiology, but also in psychic experience, literature and art. In the philosophical-ethical attitude A.A. Ukhtomsky was developing the conception of “dominant on the other face”. It addresses on original person, see Interlocutor in his identity and uniqueness. The concept of morality of A.A. Ukhtomsky is based on the definitions of “honored interlocutor” and “double”. Deserve the Interlocutor – means to see in him something bigger, than own reflection. In the science work of A.A. Ukhtomsky we see systematic approach to the study of physiological discoveries and solving real-life problems. In an effort to understand, what a person is, how his mental development takes place, he doesn’t only makes actual discoveries, but also try to give them general scientific significance, to enter them into the general scientific system of knowledge. The systematic scientific approach is particularly relevant at the present time, when the amount of various information is growing exponentially, and the general concept of scientific knowledge, which allows to combine work in various fields of science, doesn’t exist. In our opinion, its base can give us the A.A. Ukhtomsky’s dominant principle.