卷 29, 编号 2 (2021)

BACKGROUND: The development of immunosuppression in the acute phase of cerebral stroke may lead to infectious and inflammatory complications. However, data on the functional activity of macrophages are insufficient to understand the pathogenesis of stroke.

AIM: This study aimed to investigate the functional activity of macrophages in the acute period of experimental cerebral stroke (ECS) of different severities.

MATERIALS AND METHODS: In an experimental study on 45 Wistar rats, the functional and spontaneous metabolic activity of macrophages in the spleen and abdominal cavity and the induced metabolic activity of peritoneal macrophages were evaluated through the reduction of nitro blue tetrazolium via spectrophotometry. The spontaneous and induced adhesive activity and the inhibition of the modified adhesive activity of peritoneal macrophages were examined via crystal violet staining by using a colorimetric method. ECS was modeled by the rotational movements of mandrel-knife inserted into the region of capsula interna (c.i.) on the left by guiding a needle–cannula with the subsequent damage of vessels and the formation of mild (local incision of vessels in the region of c.i.), moderate (additional introduction of autologous blood in the area of c.i.), and severe (cutting of vessels from c.i. to pia mater with the subsequent introduction of autologous blood into the damaged area) hemorrhage. Data were evaluated in 72 h after different severities of ECS were modeled.

RESULTS: In 72 h after ECS with different severities was modeled, the functional and spontaneous metabolic activity of splenic macrophages significantly decreased compared with those in the control group. The functional, spontaneous, and induced metabolic activity of peritoneal macrophages significantly reduced compared with those in the control group. The adhesive activity of peritoneal macrophages significantly increased compared with that of the control group. These disorders exacerbated in animal models with a more severe degree of stroke.

CONCLUSION: In the acute period of ECS, the functional activity of macrophages decreased, whereas their adhesive activity increased. These phenomena enhanced in more severe models of stroke.

AIM: This study aimed to explore the pathophysiological mechanisms of resistive breathing by using a model of a conditioned respiratory reflex to external resistance to breathing.

MATERIALS AND METHODS: Inspiratory resistive loads were used 11, 28, 54, and 78 cmAq/l/s to model a conditioned respiratory reflex. External respiration was parametrized on the basis of the analysis of motor and ventilatory outputs. Conditioned signals were pure sounds exceeding the threshold of perception by 10 db at 2000 Hz frequency. All the test persons were divided into two groups (large and small groups) according to the initial reinforcement value. (1) In the large group (37 individuals), the conditioned reflex was formed from 11 cmAq/l/s that was subsequently increased stepwise in the load to 76 cmAq/l/s. (2) In the small group (18 individuals), the initial reinforcements were different gradations of resistive loads, with a stepwise transition to the other parameters of an unconditioned stimulus. The period of the isolated application of a conditioned signal (CS) was 20 s, the interval between signals was not fixed, varying from 2 min to 4 min. Six to eight combinations of the conditioned and unconditioned stimuli were used for 1 day of the experiment.

RESULTS: The increase in the added respiratory resistance was associated with the pronounced reduction of pulmonary and alveolar ventilation, that is, with the hypoventilation type of resistive load realization. Changes in ventilation during the isolated application of a conditioned signal had an alternative character. In particular, as the reinforcement factor increased, a pronounced shift to hyperventilation was noted.

CONCLUSION: The reinforcement value of the conditioned reflex changed stepwise, thereby significantly restructuring the proportion between the effectiveness of the adaptive activity in the realization of external resistance to inspiration (the time of stay under a certain load) and its physiological cost (totalities of the deviations of physiological and energy parameters).

AIM: This study aimed to investigate the dynamics of the volume of medical care (MC) provided to the population within the territorial program of compulsory medical insurance (CMI). This study also aimed to examine the lethal outcomes of insured individuals with respiratory diseases (RD) for 5 months in 2020 and 5 months in 2019 in the Ryazan Region during the COVID-19 pandemic.

MATERIALS AND METHODS: Analysis was carried out on the basis of the paid registers of the accounts submitted by medical organizations to medical insurance organizations. These accounts were grouped in accordance with the order of the Federal CMI Fund No 104 «On Establishment of the Form and Procedure for Reporting on Cases of Providing MC and the Results of Expertise of the Quality of MC» dated June 04, 2018. In this study, all the completed cases of the treatment of the insured individuals with RD (ICD-10 codes: J00-J99) in the medical organizations of the Ryazan Region in 2019–2020 within the compulsory medical insurance were selected. The obtained data were statistically analyzed using the Microsoft Excel application package (Microsoft, USA) and descriptive statistics.

RESULTS: The completed treatment cases of the insured individuals with RD in 2020 were categorized according to the age of patients, nosological form, and conditions for the provision of MC. They had different dynamics of growth/decline relative to the same period in 2019. In the structure of the cases of the MC provision, RD accounted for 13.2% (third place). This tendency was observed in the group of patients aged > 60 years (7.8%). In patients aged 18–60 years, the proportions of RD (18.0%) and diseases of the digestive system (18.1%) were higher than those of the diseases of the circulatory system (14.2%). The total number of cases of the MC provision to patients with this pathology for 5 months in 2020 decreased by 12.9% compared with that for 5 months in 2019 (11.3% in the age group of 18–60 years and 16.6% in individuals aged >60 years). Despite the 38.3% decrease in the number of hospitalizations, the number of the completed cases of specialized MC for pneumonia increased by 27.7% (43.9% in the age group of 18–60 years and 11.4% in the age group of > 60 years). The comparative analysis of 5 months in 2020 and 2019 showed a 57.1% increase in deaths among patients aged > 60 years in the provision of specialized MC and a 20.0% reduction among individuals aged 18–60 years.

CONCLUSION: The number of insured individuals seeking MC for RD increased during the COVID-19 pandemic, and the level of hospital lethality was low. Therefore, the organizational level of MC in the region was high, and medical organizations were adequately prepared for emergency situations with the preserved provision of high-quality MC.

目的：研究结合使用微粉化的纯化黄酮类药物（MPFF）和弹性压缩治疗获得性淋巴郁积患者的有效性。

材料与方法。根据M. Foeldi，该研究包括60例下肢II期继发性淋巴水肿患者。采用包络法随机化，将患者分为两组。第一组（n=30）采用保守治疗（MPFF，1000 mg/d）联合弹性压缩治疗（三级弹力袜）；第二组（n=30）仅接受压迫治疗（三级弹力袜）。患者接受体检，包括测量不同水平的肢体周长。

结果。在第一组患者中，小腿下三分之一的周长在1个月后下降了8.15% （p=0.005），到治疗结束时下降了10.6%（p<0.001），小腿中间三分之一处分别下降了3.15%（p=0.001）和4.78%（p<0.001），小腿上部三分之一处分别下降了4.08%（p<0.001）和5.99%（p<0.001）。随访结束时（3个月），第二组下三分之一组小腿周长（29.68±4.67cm）明显长于第一组（26.65±2.92cm，p=0.035）。MPFF组未发生不良反应。

结论。与单独使用弹性压缩相比，MPFF和弹性压缩联合使用可在更大程度上减少获得性淋巴水肿患者的下肢体积。MPFF治疗下肢继发性淋巴水肿疗效显著，且无不良反应，值得推荐在药物治疗方案中使用。

AIM: This study aimed to analyze the causes, diagnosis, and clinical treatment of postoperative obstructive jaundice (POOJ) in routine surgical practice.

MATERIALS AND METHODS: Twenty-four patients with POOJ that developed in the organs of the hepatobiliary system after surgical interventions were included in this study. The patients were subjected to the following procedures to diagnose the causes of POOJ and choose the treatment methods: general clinical examination, biochemical blood tests, dynamic postoperative ultrasound examination of the abdominal organs, video laparoscopy, computed tomography, magnetic resonance imaging, fistulocholangiography, endoscopic retrograde cholagiopancreatography, and percutaneous transhepatic cholangiostomy.

RESULTS: POOJ occurred in 18 cases after they had different variants of surgical interventions on the biliary tract after traditional (n = 6) and video laparoscopic cholecystectomy (n = 12). POOJ also developed in 6 cases after they underwent surgery on the liver: atypical (n = 2) and anatomical (n = 2) resection of the liver. This condition manifested after the opening and draining of liver abscesses under US control (n = 2). POOJ was treated with different methods to alleviate the developed complications. After surgical interventions on the liver and biliary tract in 6 cases, relaparotomy, sequestrectomy with sanation, drainage of the abdominal cavity (n = 4), and right-sided hemihepatectomy (n = 2) were performed. In 6 other cases, on days 3–4 of the development of POOJ after laparoscopic operation (n = 2), relaparotomy was performed, clips and ligature were removed from the choledoch with the formation of Roux-en-Y hepaticojejunostomy. Minimally invasive methods of POOJ correction were applied to 12 cases. Of the 12 cases, 5, 2, and 1 were subjected to endoscopic papillosphincterotomy with lithoextraction, endoscopic papillosphincterotomy with lithoextraction coupled with nasobiliary drainage, and relaparoscopy and redrainage of the common bile duct, respectively. In 4 cases, percutaneous transhepatic cholangiostomy was performed at the first stage. At the second stage, after POOJ resolution, the following procedures were implemented: redrainage of the common bile duct (n = 2) and dilatation of the orifice of the right hepatic duct with reconstruction of hepaticojejunostomy on the hidden transhepatic drainage.

CONCLUSION: POOJ is still encountered in clinical practice in a sufficient number of cases. Treatment results largely depend on the time of diagnosis and the choice of optimal surgical strategies. The main causes of POOJ are tactical and technical diagnostic and treatment errors. POOJ is diagnosed on the basis of the data of modern radiation and laboratory and instrumental examination methods. Surgical tactics for POOJ are individually active and dependent on the severity, time, and causes of development. They also depend on the general condition of patients. Along with minimally invasive interventions for POOJ, early relaparotomy is less dangerous than passive expectation tactics.

术后腹壁疝（POVH）的问题在腹部手术中仍然是相关的，因为其形成的频率在开腹术后达到10—30.7%。

目的：开发一种使用补片假体内窥镜初步闭合剖腹手术伤口的方法，该方法超越了使用传统缝合材料的腹腔镜技术的形态物理特性。

材料与方法。为了预防疝出，作为预防性修复术的替代选择，其适应症较窄，我们开发了一种使用“网状线”的腹腔镜检查方法（发明专利RUS No. 2714439，于2020年2月14日的基础）。为了确定该方法的有效性和安全性，我们进行了一项实验研究，分别对缝合区创面过程进行了14天和60天的研究。

结果。根据视频腹腔镜资料，术后14天和60天未见内脏器与腹腔镜区粘连，白线腱膜缝合区也未见缺损。在切口处，“网状线”完全融入了再生，包括在节点处，随着细胞的萌发。第14天，使用网状线缝合时，再生强度大于未使用网状线缝合时（t_St=11.198±1.499，p<0.01）。与棋盘强化缝合线、网状线和网状假体内条相比，“网状缝合线”的肉芽和纤维化面积都更高，这一事实证实了这一点。补片假体内新形成的结缔组织的另一个特点是，胶原原纤维以“网状线”的形式位于同心的位置，而不像网片，它们有平行于假体的纵向方向。在实验的第60天，在所有系列中观察到结缔组织成熟的迹象，以纤维占优势的形式超过细胞元素和它们的紧实。“网状缝合线”组的纤维化和肉芽化区域仍普遍存在，与补片缝合、“网状线”和补片缝合后相比，假体内细胞中有更明显的新胶原生成。

结论。伤口没有并发症，对周围组织没有负面影响，这表明使用“网状缝合线”是安全的，与创面特征相关的最佳强度特征表明其在预防术后疝的有效性。这使得我们可以在临床实践中使用这种方法。

In this work, a rather rare (morbidity of about 1–2 cases per 1 million of adult population per year) and interesting clinical case of the diagnosis of idiopathic pulmonary artery hypertension (IPAH) was described. This case was also known as Ayerza disease or Ayerza–Arilago syndrome. At the initial stage, this pathology was characterized by an asymptomatic course that caused certain difficulties in making a correct diagnosis. In general, this disease had a poor prognosis. The main cause of death was decompensated right ventricular failure. The occurrence of complications could be significantly reduced and the life quality of such patients could be improved by the timely diagnosis and correct approach.

AIM: This study aimed to summarize information on the formation of the natural and anthropogenic biogeochemical province of the biosphere over Cherepovets, develop biogeochemical standardization, and prevent environmentally conditioned human diseases.

The migration of biogenic elements through food chains is analyzed. A significant flow of toxic elements entering the natural environment in the course of human industrial activity leads to the formation of anthropogenic biogeochemical provinces. In these geochemical zones and landscapes, the natural endemic environment interacts with chemical elements. As a result, biogeochemical cycles are altered, and vital elements are replaced with toxic metals. With these changes, intracellular biochemical reactions are disrupted. In this study, information on Cherepovets biogeochemical province formed in the 1960s was examined in the presence of intense industrialization. Data on high concentrations of heavy metals in the soil horizons of the given province were examined. Toxic elements actively accumulated in plants growing in the Cherepovets territory and vegetables growing in household plots within the city and the nearest 10 km zone. Metals accumulated in soil, different components of land ecosystems, and organs and tissues of carnivores.

CONCLUSION: A high load in the Cherepovets biogeochemical province poses certain risks to the health of the population and causes the development of endemic diseases, microelementoses, and exogenous toxicoses in humans.