卷 29, 编号 3 (2021)

BACKGROUND: Preeclampsia is a serious complication of pregnancy which augments the risk of cognitive disorders in the offspring at different stages of life. Presently, there are no methods with proven effectiveness for correction of post-hypoxic disorders in children of mothers with preeclampsia.

AIM: To assess the cognitive functions of the offspring of rats with experimental preeclampsia (EP) through early (40^th to 70^th day of life) and late (24^th to 25^th month of life) pharmacological correction with gamma aminobutyric acid (GABA) derivatives: Succicard, Salifen, Phenibut, and the drug of comparison–Pantogam.

MATERIALS AND METHODS: EP was modeled by replacing drinking water with 1.8% sodium chloride solution in rats from the first day of pregnancy to delivery. In the offspring, short-term and long-term memory was studied at the age of 3–4, 18–19, and 25–26 months in the Novel object recognition test and Barnes Maze test. The functioning of the GABAergic and dopaminergic systems (which play an essential role in the development of memory) was evaluated by cases of convulsions after administering corazol at a dose of 20 mg/kg intraperitoneally (model of corazol kindling) and by haloperidol-induced catalepsy (haloperidol at a dose of 0.3 mg/kg intraperitoneally), respectively.

RESULTS: Early and late pharmacological correction with GABA derivatives–succicard, Salifen, Phenibut, and comparison drug, Pantogam–neutralized the negative effect of EP on the function of GABAergic and dopaminergic systems in the offspring of the experimental groups. Therapy with Succicard in puberty and long-term periods of life contributed to the improvement of short-term and long-term memory in the offspring of rats with EP. Thus, it could be reasonable enough to develop a drug against cognitive disorders in children of mothers with preeclampsia.

CONCLUSION: In the offspring of rats with EP, short-term and long-term disorders of memory in the functioning of the GABAergic and dopaminergic systems were noted in the early and late stages of the individual development. Pharmacological correction with GABA derivatives improves cognitive processes and the functioning of neurotransmitter systems in the offspring of rats with complicated pregnancy. The highest effectiveness was demonstrated by succicard, and was comparable with or superior to the Pantogam (standard drug).

AIM: This study aimed to identify the main trends of the epidemiology of tuberculosis in children and adolescents in the Ryazan Region (RR) by analyzing the main epidemiological parameters of morbidity in 2010–2019.

MATERIALS AND METHODS: The morbidity of children and adolescents with tuberculosis in the RR was subjected to retrospective epidemiological analysis. The data of the official and reporting documentation of the Ryazan Regional Clinical Antituberculosis Dispensary and the materials of the state reports of Territorial Administration of Rospotrebnadzor (On the Condition of Sanitary–Epidemiological Well–Being of Population) in 2010–2019 were used. The main epidemiological parameters of morbidity due to tuberculosis were calculated using mathematical methods.

RESULTS: The proportion of children and adolescents in the structure of morbidity due to tuberculosis in the RR in 2010–2019 decreased by 3.9 times and reached 6.09% in 2019. The morbidity caused by the active form of tuberculosis in children (0–14 years) and adolescents (15–17 years) evidently declined by -20.7% and -11.5%, respectively. In children, respiratory tuberculosis predominated (55%–100%), and the leading clinical form was tuberculosis in intrathoracic lymph nodes (77%). In adolescents, only pulmonary tuberculosis was identified, and focal tuberculosis was the predominating clinical form (43%). In the study period, the highest morbidity in children was recorded at the age of 7–14 years. No cases of mortality among children and adolescents with tuberculosis were recorded in 2010–2019. In 2018–2019, the primary infection and the risk of infection among children under 14 years of age increased from 1.3% (2018) to 1.8% (2019) and from 2.6% (2018) to 3.3% (2019), respectively. This result might indicate that morbidity due to tuberculosis increased. The majority of ill children and adolescents were identified among vaccinated ones, suggesting that the protective properties of the vaccine were insufficient (80%).

CONCLUSION: The morbidity of children and adolescents with tuberculosis decreased, and this decrease directly associated with the general improvement in the status of tuberculosis in the country; in particular, tuberculosis foci in the RF decreased by 2.2 times [4]. In the study period, the morbidity of children (0–14 years) decreased by 3.5 and 2.1 times in the RR and RF, respectively. The morbidity of adolescents (15–17 years) decreased by 3.1 and 2.2 times in the RR and RF, respectively. The mortality of children and adolescents in the RP was 0.0 per 100,000 population of the given age groups. In the RF, their mortalities reduced by 6.5 and 1.6 times, respectively [4].

BACKGROUND: The search for rational methods of primary, secondary, and tertiary prevention of coronary heart disease. To date, there are several publications on heart rate variability in ischemic heart disease.

AIM: To study the state of the regulatory systems in the organism of patients with acute coronary syndrome without ST segment elevation based on the heart rhythm, and their relationship with the clinical, biochemical and instrumental parameters of the disease.

MATERIALS AND METHODS: The open comparative study included 76 patients (62 men, 14 women) of mean age, 61.0 ± 0.9 years, who were admitted to the Emergency Cardiology Department diagnosed of acute coronary syndrome without ST segment elevation. On admission, cardiointervalometry was performed using Varicard 2.51 apparatus, and a number of clinical and biochemical parameters were evaluated

RESULTS: Multiple correlations of parameters of heart rate variability and clinical, biochemical and instrumental parameters were observed. From this, a cluster analysis of cardiointervalometry was performed, thereby stratifying patients into five clusters. Two extreme variants of dysregulation of the heart rhythm correlated with instrumental and laboratory parameters. A marked increase in the activity of the subcortical nerve centers (maximal increase of the spectral power in the very low frequency range with the underlying reduction of SDNN) in cluster 1 was associated with reduction of the left ventricular ejection fraction: cluster 1–47.0 [40.0; 49.0], cluster 2–60.0 [58.0; 64.0], cluster 3–60.0 [52.5; 64.5] % (the data are presented in the form of median and interquartile range; Me [Q25; Q75], p < 0,05). Cluster 5 showed significant reduction in SDNN (“monotonous rhythm”), combined with increased level of creatine phosphokinase (CPC): cluster 5–446,0 [186.0; 782.0], cluster 4–141.0 [98.0; 204.0] IU/l; Me [Q25; Q75], p < 0.05) and MВ-fraction of creatine phosphokinase; cluster 5–32.0 [15.0; 45.0], 4 cluster 4–12.0 [9.0; 18.0] IU/l; Me [Q25; Q75], p < 0.05).

CONCLUSIONS: In patients with acute coronary syndrome without ST segment elevation, cluster analysis of parameters of heart rate variability identified different peculiarities of regulation of the heart rhythm. Pronounced strain of the regulatory systems of the body was found to be associated with signs of severe pathology: the predominance of VLF (spectral power of the curve enveloping a dynamic range of cardiointervals in the very low frequency range) in spectral analysis with an underlying reduced SDNN is characteristic of patients with a reduced ejection fraction, and a “monotonous rhythm” is characteristic of patients with an increased level of creatine phosphokinase and MB-fraction of creatine phosphokinase.

论证。内皮细胞 (EC) 产生抗凝血因子和促凝血因子，尤其是血管性血友病因子 (vWF)。 vWF 导致血小板活化并引发其聚集，并且在调节血管炎症方面也很重要。

目的：研究外周动脉粥样硬化患者下肢动脉血管内或开放手术时vWF的水平和活性。

材料与方法。根据A.V. Pokrovsky–Fontaine该研究包括115名IIb–IV期慢性下肢缺血患者。55名患者接受了下肢动脉血管内介入治疗，60名患者接受了开放式分流术。治疗前和治疗后3个月，所有患者均进行外周血取样，以评估vWF抗原（AH）水平和vWF活性。年内每3个月对患者进行一次随访，评估不良后果的发展，包括疾病进展、再狭窄、重建区血栓形成、癌症、心肌梗死（MI）、肢体丧失、中风和死亡。

结果。血管内手术组的患者中，检测到AH vWF的最大值为多层次病变类型-1.25微克/毫升（vs 0.2微克/毫升，95%可信区间（CI）0.72–3.21微克/毫升，p=0.019）；3个月内。类似的趋势仍在继续。血管内干预组中与无心脏病发作的患者（0.9微克/毫升，95%可信区间0.78–1.01微克/毫升，p=0.015）相比，随后发生心肌梗死的患者的“AH-vWF”在统计学上显著高于无心脏病发作的患者（1.15微克/毫升，95%可信区间1.05–1.18微克/毫升）。此外，在一年中具有致死结果的患者中3 个月的 AH vWF 增加达到 1.06微克/毫升（95% CI 0.96–1.18 微克/毫升，p = 0.031）。血管内治疗后一年内发生心肌梗死的个体的 vWF 活性比没有心肌梗死的个体高 4 倍（p = 0.022）； 在死亡的发展方面观察到类似的趋势（p = 0.009）。 3 个月内开放手术组的患者中，观察到最高的 vWF 活动与动脉床的近端病变呈回股股骨闭塞的形式（1200%，95% CI 640-1200%）和 IV 期疾病(770%, 95% CI 320 –1200%, p <0.05)。 ROC分析显示，血管内手术组患者的vWF活性等于或高于620%时可预测致死结果； 该方法的灵敏度和特异性分别为 83.3% 和 75.5%。

结论。外周动脉粥样硬化患者的特征是抗原和vWF活性增加，在动脉床多层次病变和严重缺血的情况下达到最大值。 下肢动脉血管内手术后患者的抗原和vWF活性增加的特点是在观察的一年内发生MI和死亡。

论证。静脉血管造影的切除干预涉及大面积失血的风险，并不总是能够保证血管瘤组织的完全切除和良好的美容效果结果。 在世界实践中，与开放式手术相比，巩膜置换术是一种微创技术，这包括在静脉空泡腔中引入硬化剂，从而导致闭塞。

目的：评价静脉畸形患者微创巩膜置换术的应用效果。

材料与方法。2006-2020年间采用硬化法治疗各种部位的静脉海绵状血管瘤41例，其中19例患者接受综合治疗，包括该技术与其他手术干预（血管瘤组织切除、激光和射频消隐）。

结果。38 名患者获得了临床改善。 根据超声控制数据，25例患者闭塞区无血流，干预后随访1年内初始症状消退。 随着血管瘤过程的局部扩散，治疗结果变得更好（对于弥漫性形式，不可能在 3 名患者中取得积极效果）。

结论。硬化症可以作为一种独立的方法在治疗静脉海绵状血管发育不良患者中提供积极的结果，并结合其他微创技术和血管瘤组织切除术。

ABSTRACT

The clinical picture and long-term prognosis of chronic obstructive pulmonary disease (COPD) largely depend on comorbid conditions, thereby prompting a relevant search for predictive and preventive methods in the pathogenesis of the disease. Cardiovascular diseases are highly prevalent among patients with COPD. Cardiovascular risks in patients with COPD are associated with changes in the activity of vasoactive mediators, with nitric oxide (NO) being the most important. The important role of nitric oxide in the body prompts it being studied as a biomarker of many diseases; however, its short half-life and rapid clearance prevent its direct assessment in the blood. In the body, nitric oxide is formed from L-arginine with the help of enzymes of NO-synthase group. NO oxide synthesis depends on the concentration of L-arginine, arginase and asymmetric dimethylarginine (inhibitory effect on NO-synthase). The presented literature review highlights modern views on the importance of nitric oxide and regulators of its synthesis in the pathogenesis of chronic obstructive pulmonary disease. It also indicates their role in the formation of comorbid conditions, and highlights processes of NO formation in the body.

CONCLUSION: The components of the nitric oxide system (nitric oxide metabolites, L-arginine, arginase, dimethylarginine dimethylaminohydrolase, asymmetric and symmetric dimethylarginine) can be considered as potential biomarkers of COPD, especially in conditions of cardiovascular comorbidity. Further studies on the nitric oxide system are recommended for assessing the prognosis of the course of diseases and the effectiveness of the current therapy.

在本文中，一组早期职业精神病学家对注意力缺陷多动障碍（ADHD）与成瘾之间的关系进行了讨论，并呈现了其讨论结果。本文介绍了注意力缺陷多动障碍和成瘾在遗传、形态和功能水平上的共性方面的各种现代观点，描述了可能的临床表现和共病发生率，详细讨论了分别用现代药理学和非药理学治疗这些共病的方法，强调了注意力缺陷多动障碍与各种成瘾结合治疗的特点。