卷 28, 编号 3 (2020)

Aim. A comparative study of the influence of nitric oxide synthase (NO-synthase) inhibitors on the parameters of anxiety, motor activity and pain sensitivity of rats.

Materials and Methods. The work was conducted on male rats of Wistar line. The anxiety level and locomotor activity of rats were studied in the «elevated plus maze» (EPM) test. Pain sensitivity of the animals was tested on the «hotplate» apparatus. In the work, selective inhibitor of inducible isoform of NO-synthase – aminoguanidine – at a dose of 50 mg/kg, and non-selective inhibitor of this enzyme – N-nitro-L-arginine – at a dose of 50 mg/kg, were used. Rats of the control group were introduced the equivalent quantity of normal saline.

NO-synthase inducible inhibitor – aminoguadinine did not produce any influence on the anxiety level, but led to reduction of the horizontal motor activity of rats. Introduction of non-selective NO-synthase inhibitor – N-nitro-L-arginine – was accompanied by reduction of the anxiety and of the locomotor activity of animals in the EPM test. Both investigated NO-synthase inhibitors induced alteration of pain sensitivity of rats in the form of hypoalgesia. Here, the most pronounced nociceptive effect was observed with introduction of non-selective NO-synthase inhibitor.

Conclusion. In the work the evidence of participation of inducible isoform of NO-synthase in realization of the motor activity and pain sensitivity processes in rats is shown. In result of the conducted experiments it was found that introduction of non-selective NO-synthase inhibitor N-nitro-L-arginine was accompanied by evident alterations of anxious behavior, locomotor activity and nociceptive sensitivity of rats. The results obtained confirm the important role of the system of regulation of nitric oxide synthesis in neurochemical mechanisms of behavioral reactions in rats.

目的：研究动态呼出气二氧化碳监测检查指标对慢性心力衰竭（CHF）患者进行6分钟步行试验时呼吸系统参数综合评估的预后价值。

材料与方法：共检查73例：研究组为48例IIA期或IIB期CHF患者（平均年龄为57.9±4.6岁，男性23例），对照组为25例实际健康志愿者（平均年龄为47.6±3.5岁，男性9例）。患者接受了呼吸系统参数的全面确定：6分钟步行试验 （6MWT）前后的临床评分，运动前、运动中、运动后的仪器方法包括肺量测定、呼出气二氧化碳监测检查和脉搏血氧测定。生存分析基于患者5年（60个月）的动态随访。

结果。分析休息时呼吸急促的各项指标发现，CHF组各项指标均高于对照组（p<0.05）。CHF患者在6分钟内的距离为488.23±90.84米，明显低于对照组的指标（815.60±53.89米，p=0.009）。CHF患者在6MWT期间因呼吸短促而停止/减慢行走速度的记录也较多（93.8±3.0%和48.0±5.1%，p=0.049）。此外，在进行6MWT时，患者注意到：腿无力（CHF组的50.1±5.0%，对照组的40.0±5.0%，p=0.014），心悸（分别为29.0±4.6％和20.0±4.1％，p=0.004）。CHF患者6MWT期间呼吸困难指标的恶化较对照组更明显（p<0.01）。CHF组在执行6MWT时检测到低碳水化合物通气，在分析РЕТСО2趋势曲线图时，发现指标呈波状增加，即所谓的《周期性呼吸》（PB）。CHF组CO2变化趋势为58.3±1.0%例（p= 0.046），心率变化趋势为18.8±0.3%（p=0.027）。对CHF患者Cox死亡率风险的比例回归分析显示了包含以下患者参数的复杂模型的预后价值：病人身体质量指数（p = 0.005），最后左心室的舒张压大小（p = 0.034），最后收缩期左心室大小（p = 0.002），左室射血分数（p = 0.041），6MWT距离（p = 0.004），减饱和（p = 0.009），6MWT时周期性呼吸的存在（p = 0.005）。模型系数有统计学意义，p<0.0001。

结论。动态呼出气二氧化碳监测检查和脉搏血氧仪可检测CHF患者在进行6MWT期间《周期性呼吸》的体征，这可以加深对CHF患者心肺系统参数的综合评估，以确定对体力活动的耐受性以及治疗的有效性。对CHF患者的生存率进行综合评估，发现以下患者参数具有预后价值：体重指数，左心室舒张末期大小，左心室收缩末期大小，左心室射血分数，6分钟步行距离，减饱和，6MWT期间的周期性呼吸。

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE).

Materials and Methods. The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1^st group – in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2^nd group – in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3^rd group – in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4^th group – in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.8±12.5 months.

Results. In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р=0.16)); myocardial infarction ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0%; group 4 – 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 – 4.2% (n=1); group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р_1-2=0.01; р_1-3=0.009; р_1-4=0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 – 4.2% (n=1), in group 2 – 1.2% (n=6), in group 3 – 0.4% (n=2), in group 4 – 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 – 25% (n=6); group 2 – 5.5% (n=27); group 3 – 7.3% (n=35); group 4 – 14% (n=16); р_1-2=0.002; р_1-3=0.008; р_2-4=0.012)); lethal outcome from cardiovascular causes ((group 1 – 4.2% (n=1); group 2 – 3.6% (n=18); group 3 – 4.8% (n=23); group 4 – 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 – 12.5% (n=3); group 2 – 3.6% (n=18); group 3 – 5.4% (n=26); group 4 – 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 – 16.6% (n=4); group 2 – 6.3% (n=31); group 3 – 6% (n=29); group 4 – 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 – 54.2% (n=13); group 2 – 15.4% (n=76); group 3 – 18.7% (n=90); group 4 – 31.3% (n=36); р_1-2=0.0001; р_1-3=0.0001; р_1-4=0.005; р_2-4=0.0006; р_3-4=0.012)).

Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.

目的：目的探讨腹腔镜腹股沟异源疝修补术对腹股沟隐匿性疝的诊断价值。

材料与方法。本研究是在腹股沟疝患者手术治疗结果的基础上进行的，从2015年到2020年（n = 207）在俄罗斯联邦卫生部高等教育的联邦国家教育机构的Ryazan state medical University在梁赞地区联邦国家预算机构的急救医院和外科学系、妇产科、学院研究了生教育在梁赞地区咨询诊所的接受手术治疗。手术是在对麻醉和二氧化碳气腹无禁忌症的情况下进行的，并如果病人想要按照建议的方式进行手术。所有纳入研究的患者都接受了腹腔镜下疝成形术，并在腹膜前间隙放置网状内假体。为了实验的纯度，只使用了聚丙烯网状内假体。使用了表面密度为65-80 g/m2、体积孔隙率为80-85%的标准单丝聚丙烯网格。网状内假体大小为15x15厘米，导管7.5 厘米，切断角度。

结果。207例患者中28例因双侧腹股沟疝接受手术治疗。其中只有1例患者在术前阶段诊断为疝气。其余27例患者的隐匿性疝气发生在与先前诊断的一侧相反的一侧。除术前和术中诊断的患者外，17例患者在腹膜前间隙的解剖过程中也发现了隐匿性疝气。

结论。腹腔镜下腹股沟异源疝修补术可以诊断术前检查未发现的隐蔽性疝：股疝、闭孔疝、对侧和/或单侧腹股沟疝。这使得可以在一个手术干预中进行疝成形术，考虑到术中发现，并且不会让患者重复住院，接受麻醉和手术。

下肢静脉曲张是最常见的下肢血管疾病，发生在工作年龄的人，并导致慢性静脉功能不全。在大多数情况下，静脉功能不全的临床病程和程度是由于浅静脉和穿静脉的失败，与此同时，由于主要浅表静脉的病理性血流仅为一次体位反应，因此，水平反流仍是营养障碍发病机制中的主要作用。同时，慢性静脉功能不全的原因之一可能是心脏的病理。本文介绍一例下肢静脉系统合并心脏病临床观察的患者，三尖瓣反流引起浅表静脉网永久性回流，进而发展为下肢皮肤组织的营养性改变。

尽管现代医学已经取得了所有的成就，慢性阻塞性肺病（COPD）的问题并没有失去它的相关性。目前的模式假设巨噬细胞在COPD炎症中起关键作用。巨噬细胞的功能是异质的。这种异质性是由它们的免疫代谢谱以及细胞的脂质稳态特征决定的。
目的：ABCA1转运体，ABC亚家族A成员，在COPD发病中的作用分析。ABCA1在肺组织中的表达仅次于肝脏，说明转运体和脂质稳态在肺功能中的重要作用。 通过文献资料分析，转运蛋白在炎症中的作用是调节细胞膜《脂质筏》中胆固醇的含量，以及在吞噬和凋亡中的作用。
结论。ABCA1通过调节肺巨噬细胞中胆固醇逆向运输的过程，可以改变其炎症反应，对COPD的发病机制做出重要贡献。

多发性硬化症（MS）是一种广泛存在的中枢神经系统免疫异常神经退行性疾病，病因不明。尽管MS医学治疗取得了重大进展，但进展性残疾和早逝的比率仍然令人担忧。这篇综述的主要目的是详细介绍治疗MS的新药。提出了临床前和临床研究的数据，并提出了已开发药物的作用机制的描述。MS发展治疗的新方法是现代科学的重大兴趣。这篇综述强调了目前正在进行临床试验的新疗法，并有可能在不久的将来应用于临床实践。

Aim. Analysis of some controversial provisions of Article (Art.) 66 «Determination of the Moment of Death of a Person and of Termination of Resuscitation Activities» of Federal law «On Fundamental Healthcare Principles in the Russian Federation» of November 21, 2011 №323-FL (FL 323) directly concerning the issue of death of a person, and justification of making amendments to the title and text of the above mentioned norm.

Due to the absence of definition of the concept of «death» in FL 323, the author presents his own definition of death of a person. The used term «the moment of death of a person» as a determinant/indicator of the occurrence of death seems to be erroneous. This term cannot be extended to the fact of biological death. Under FL 323, death of the brain is considered to be equivalent to death of a person and today is inextricably linked with organ transplantation. However, in reality it is not so, and in this sense it is a typical juridical fiction that justifies legal removal of organs from living patients. Amendments to the title and wording of Article 66 FL 323 are proposed.

这封信的目的是为了引起杂志读者对外泌体研究作为肿瘤学发展的一个重要方向的关注，特别是前列腺癌的诊断和治疗。 外泌体由肿瘤细胞产生，并调节增殖、转移和化疗耐药性的发展。 它们从生物液体中提取，可以进一步利用这些小泡作为前列腺癌的潜在生物标记。在未来，外泌体可以成功地用于药物和其他抗肿瘤物质向癌细胞的递送。