Vol 9, No 4 (2018)

Contemporary aspects of innovative visualization digital medical technologies’ introduction into clinical practice and education
Aronov A.M., Pastushenko V.L., Ivanov D.O., Rudin Y.V., Drygin A.N.

The paper portrays the elaboration and characters of digital hardware and software complex targeted at automatic forming, registration and processing of biomedical object images for non-invasive diagnostics based upon digital microscopy and endoscopia. Digital hardware and software complex is collecting, preliminary analyzing and compressing video-information for transmission along telecommunication channels. Complexes of this kind may serve as a basis for elaboration and introduction of new prospective medical technologies like visual and digital databases for education programs and atlases for discrimination of pathological cells and states. For a starter an aggregation of clinical and laboratory diagnostics systems has been chosen utilizing images from the outputs of digital microvisual and endoscopical systems for elaboration of optical digital diagnostics complexes. Microvisional digital multispectral analysis system ensures forming and visualization of biological tissues’ and medical slides’ microimages. The videoendoscopic system is intended for endoscopic examination of gastrointestinal tract with forming and visualization of endoscopic images, documenting and archiving of data. This system is networked according to TCP/IP protocol. The microvisional and vi deoendoscopic systems grant distant access to images and control functions for remote users from local networks or through WEB-interface.

Pediatrician (St. Petersburg). 2018;9(4):5-11
Experience of stem cell use in treatment of skin burns
Zinovyev E.V., Yudin V.E., Asadulaev M.S., Tsygan V.N., Kostyakov D.V., Shabunin A.S., Smirnova N.V., Kryukov A.E., Paneiakh M.B., Lukyanov S.A., Artsimovich I.V., Lopatin I.M., Zubov V.V., Krylov P.K., Vagner D.O., Osmanov K.F., Bagaturia G.O.

The results of three-year research on the use of allogeneic mesenchymal stem cells of adipose tissue (AMSCs) in the treatment of skin burns of II-III degree are presented. in a complex with wounds dressing of nanofibers chitosan and copolyamide, hyaluronic acid. It was found that with surgical necrectomy, introduction of AMSCs and substitution of defects with natural polymer coatings, the healing time is reduced by 89% (p < 0.05). Isolated administration of MSC reduces the healing period by no more than 5% (p > 0.05). The combined use of wounds dressings of nanofibers chitosan and copo lyamide with MSC accelerates the regeneration process by 26% (p < 0.05), with the introduction of AMSCs accelerating the development of granulation tissue by the fifth day of observation by 83% (p < 0.01). Joint use of wound coverings on the basis of hyaluronic acid with AMSCs is accompanied by an increase in the number of vessels of the microcirculatory bed in the defect area by 185% (p < 0.01). Clinical evaluation of the effectiveness of drugs with stem cells – a gel for topical application and a suspension of MSC LC for injection administration demonstrate their ability to optimize regeneration in the burn zone. Application of gel with AMSCs reduces the duration of epithelialization of border (dermal) burns by 2.2-2.4 times, with the final healing period being reduced by 59% (p < 0.01) and the suppuration frequency by 30% (p < 0.05). The introduction of a suspension of AMSCs into the zone of deep burn increases the frequency of engraftment of autografts, stimulates angiogenesis and proliferation of fibroblasts in the superficial and deep layers of the dermis. In the area of MSC administration, the LC perfusion level and the amplitude of blood flow fluctuation are twice as high as the values in the zones without the introduction of cells.

Pediatrician (St. Petersburg). 2018;9(4):12-27
The possibilities of computed tomography using heart-axis-oriented multiplanar reformations in diagnostics of the great arteries transposition
Sadykova G.K., Ivanov D.O., Bagaturia G.O., Ipatov V.V., Ryazanov V.V.

This article contents the results of computed tomography with intravenous bolus contrast media administration data analysis in children with transposition and congenitally corrected transposition of the great arteries with the consequental performing of the multiplanar heart-axis-oriented reformations. Among 148 examined children transposition of great arteries was detected in 13 patients (9 boys and 4 girls aged 1-144 day of life); congenitally corrected transposition was found in 4 cases of children aged from 6 months to 15 years and 6 months (2 boys and 2 girls). In this article comprehensive anatomical criteria of each heart chamber morphology are presented and reformations where these criteria can be seen are shown. Also in the article is given comparative characterization of heart and great arteries structures in transposition and congenitally corrected transposition in every certain heart-axis-oriented reformation. By the results of consequently performed heart-axis-oriented reformations data analysis the peculiar anatomical signs of transposition and congenitally corrected transposition are determined. The results of data analysis show that from the list of offered reformations the peculiar anatomical signs of both kinds of transposition are significantly determined in long-axis of right ventricle inflow tract reformation, left heart chambers reformation, supply ventricle division reformation, short-axis reformation at the level of great arteries. Computed tomographic angiocardiography heart-axis-oriented multiplanar reformations permit full and correct assessment of heart and main vessels, which is important for planning of surgical treatment in congenital heart diseases.

Pediatrician (St. Petersburg). 2018;9(4):28-35
Vegetative regulation in the first three months of life in premature infants born with intrauterine growth retardation
Bliznetsova E.A., Antonova L.K., Malinin A.N.

Goal. To study the dynamics of vegetative states in preterm infants with intrauterine growth retardation (IUGR) during the first three months of life.

Materials and methods. Examined 34 preterm infants with IUGR – 1st group (GA – 33,3 ± 1,4 weeks, body weight – 1557,8 ± 63,8 g, length – 41,2 ± 1,7 cm) at the age of 5 days and 3 months of life; 51 premature infants without IUGR (GA – 33,2 ± 1,02 weeks, body weight 2062,0 ± 63,9 grams, length – 44,0 ± 1,4 cm) – 2nd group; a control group included 31 healthy full-term infants (GA – 38,8 ± 1,5 weeks, body weight – 3355,4 ± 147,6 grams, length – 52,7 ± 2,3 cm). The vegetative tester “Polispektr-8E/88” (2000 Hz, 12 bit), from the Russian firm “Neurosoft”, was used. Indicators of the cardiointervalogram (CIG) and spectrogram were determined in the baseline sample and in the orthostatic test (tilt-test).

Results. Among the indicators of CIG there was a noticeable decrease of mode (Mo, s) in 2 groups of preterm infants at 5 days of life (p < 0,05) and an increase in stress-index by 3 months of age in 1 group (p < 0,05). The study revealed the predominance in the structure of the wave spectrum of the VLF-component in all groups of children to 3 months; children 1 group had a lower value of this indicator, but they also had a higher proportion of high frequency component (HF, %) (p < 0,05). Vagotonic initial vegetative tonus (IVT) was defined only in 1 group, while the frequency of sympathicotonic and hypersympathicotonic IVT decreased (p < 0,05). Asympathicotonia vegetative reactivity (AST VR) in premature infants with IUGR was increased from 38, to 72,7% to 3 months (p < 0,05).

Conclusion. The study revealed the lack of influence of the Central contour vegetative regulation, more intense adaptation and high exhaustion of the functional reserve in preterm infants with IUGR to 3 months of life.

Pediatrician (St. Petersburg). 2018;9(4):36-43
Pregnancy outcomes in women of different body types in cervical insufficiency
Loseva O.I., Komissarova E.N., Karelina N.R., Gaiducov S.N.

The rate of preterm birth remains high and has no downward trend, despite the introduction of new technologies. Isthmic-cervical insufficiency is one of the most important causes of premature birth. At the same time, many issues related to the prediction and treatment of isthmic-cervical insufficiency remain open. There is now a sufficient number of studies showing the relationship between somatotype, course and outcome of the disease. At the same time, stu dies related to the study of somatotypes in obstetric pathology are not enough.

The aim of the work is to assess the outcomes of pregnancy in women with isthmic-cervical insufficiency, taking into account the type of physique.

Materials and methods. the course and outcomes of pregnancy in 164 women with cervical insufficiency were studied. A computer somatotropina by R.N. Dorokhov all the best for measured strength of the pelvic floor muscles using a device pelvic muscle trainer.

Conclusions. The most frequently CI was found in women with mesosomatic and micro mesosomatic somatotype. Women macromesosomatic and micromesosomatic body types revealed low levels of muscle strength of the pelvic floor and a higher percentage of premature births. In groups macrosomy, macromesosomatic, microsomal body types often use different methods of correction CI. At the same time, the highest percentage of surgical correction of CI was observed in patients with macrosomatic type of physique. In other patients with different somatotypes, a non-surgical correction method was used.

Pediatrician (St. Petersburg). 2018;9(4):44-49
Neurophysiology of Guillain-Barré syndrome in children
Voitenkov V.B., Skripchenko N.V., Klimkin A.V., Grigoriyev S.G.

Our aim was to evaluate sensitivity and specificity of conduction studies parameters for prognosis and differential diag nosis in children with acute motor axonal neuropathy (AMAN) & acute inflammatory demyelinating polyneuropathy (AIDP).

Methods. 40 children were included: 20 healthy controls (7-14 years) and 20 patients (8-15 years) with AIDP or AMAN. All underwent conduction studies on 3-7 day since the clinical symptoms onset. We registered and evaluated motor conduction velocity, compound muscle action potential (CMAP) amplitude of nn. tibialis, peroneus, medianus, ulnaris; sensory conduction velocity & sensory nerve action potential (SNAP) amplitude for nn. medianus, suralis, peroneus superficialis, ulnaris, H-reflex threshold & latency, reactivity of neural conductivity (RNC) in short-term hand ischemia in acute phase (3-14 day since the disease onset) and in early recovery period (15-30 day since the symptoms onset). ROC-analysis was performed.

Results. In 95% of the patients with Guillain-Barré syndrome H-reflex was absent. In first 10 days SNAP amplitude of median nerve >8.9 µV, peroneal nerve >3.6 µV, CMAP of peroneal nerve ≤0,4 µV with normal motor conduction velocity indicates AMAN presence. Motor axons of peripheral nerves in children in acute and recovery phase of AIDP are resistant towards ischemia. Prognostic criteria for long period of walk recovery (more than 30 days) in these patients are RNC on 10th minute of local ischemia ≤2.5%, ulnar nerve CMAP amplitude ≤1,1 mV and distal CMAP amplitude from median nerve ≤1.6 mV.

Conclusions. Conduction studies may be implemented on all phases of Guillain-Barré syndrome in children for prognosis and differential diagnosis between its axonal and demyelinating forms. H-reflex absence in children in the first 5 days of acute polyneuropathy may serve as additional diagnostic criteria for Guillain-Barré syndrome. RNC parameters may be implemented for the prognosis of the walk period recovery duration.

Pediatrician (St. Petersburg). 2018;9(4):50-57
The diagnosis of celiac trunk compression syndrome combined with gastroesophageal reflux disease
Balandov S.G., Vasilevsky D.I., Ignashov A.M., Anisimova K.A., Davletbaeva L.I.

The celiac trunk compression syndrome and the gastroesophageal reflux disease are quite common pathological conditions in the population of economically developed countries. The frequency of combining and the semiotics these illness has not been studied. There are no approaches to the diagnosis and treatment of gastroesophageal reflux disease, which developed on background of chronic ischemia of the abdominal cavity organs due to occlusion of the celiac trunk. Few papers devoted to this subject are limited to a small series of clinical observations without a detailed understanding of the problem and finding answers to these questions. The article presents an analysis of the clinical manifestations and results of instrumental diagnosis in 84 patients with a combination of the celiac trunk compression syndrome and the gastroesophageal reflux disease treated from 2011 to 2015 years. In this work the main symptoms characteristic of both diseases combination have been identified. A detailed description and characteristic of the basic methods of diagnostics are given. A practical algorithm for the detection of gastroesophageal reflux disease links with the celiac trunk compression syndrome is presented and justified in approach.

Pediatrician (St. Petersburg). 2018;9(4):58-63
The stomach as the target organ of celiac disease
Novikova V.P., Shapovalova N.S., Revnova M.O., Melnikova V.F., Lapin S.V., Guseva V.I., Gurina O.P., Dementieva E.A., Klikunova K.A.

The aim of this study was to observe the features of chronic gastritis in children with celiac disease (СD).

Materials and methods. 176 children with chronic gastritis (CG) aged from 3 to 16 years were examined. Group I consisted 58 child ren with CG and newly diagnosed CD not adherent to the gluten-free diet (GFD), group II consisted 49 children with CG and CD, adherent to the GFD. In the group III of comparisons were 69 children with CG and excluded CD. The exa mination included serological, morphological methods to confirm or exclude CD. The histological examination of the biopsy specimens of the gastric mucosa, the determination of antiparietal antibodies by the method of iIFR and ELISA (antibodies to Castle’s intrinsic factor and Anti-H+/K+ ATPase antibodies) were carried out.

Results. Helicobacter pylori infection was diagnosed in vast majority of patients in all groups. Autoantibodies to the gastric mucosa were found in every tenth patient in groups I and III, and did not occur in group II. In group II statistically significant the etiology of gastritis remained not determined. Endoscopically the gastric mucosa in groups I and II often remained intact. Accor ding to the morphological study in groups I and II, the pathological process was more often localized in the body of the stomach, and in group III in the antrum. Autoimmune gastritis is presented in groups without a statistically significant difference.

Conclusion. Chronic gastritis is a frequent co-morbid pathology in СD, and it is also not uncommon in these patients. Data of endoscopy in children, regardless of diet, does not reflect the complete picture of CG. All children with CD, regardless of compliance with GFD, are recommended to take biopsy specimens of the gastric mucosa for histological examination in order to exclude CG, and in case of detecting atrophic changes in the gastric mucosa to define the antiparietal antibodies.

Pediatrician (St. Petersburg). 2018;9(4):64-72
The prevalence of neurocirculatory astheniaamong adolescents and young men of military age with bradyarrhythmia based on the results of screening diagnostics
Klubkova I.A., Avdeeva M.V., Shcheglova L.V., Kiryanova D.R., Erina M.Y.

The article presents the results of clinical and instrumental examination of adolescents and young men of military age with bradyarrhythmia. The study involved 2067 people (mean age19,7 ± 2,7 years), subject to conscription (from 17 to 27 years) and potential conscripts (16-year-olds). According to the results of the screening ECG, bradyarrhythmia (sinus bradycardia, sinus bradyarrhythmia, rhythm and conduction disorders) was diagnosed in 630 adolescents and young men of military age. We studied the functional status of the autonomic nervous system on the device “Cardiometry-MT” (Russia). The functional state of the autonomic nervous system was studied on the basis of cardiointervalography and correlation rhythmography. Evaluation of the functional state of the autonomic nervous system was carried out according to three parameters: the type of vegetative regulation of the heart rhythm (normotonic, vagotonic, sympathicotonic); reactivity of the sympathetic and parasympathetic parts of the autonomic nervous system (normal reactivity, hyperreactivity, low reactivity, and paradoxical reactions); nature of vegetative maintenance of cardiac activity (normal vegetative maintenance of cardiac activity, vegetative maintenance with adaptation, vegetative maintenance with disadaptation). According to the results of respiratory samples from 81,9% of adolescents and young men of military age with bradyarrhythmia diagnosed neurocirculatory asthenia, of whom 63,6% – light, while 18,3% – severe degree. With a mild form of neurocirculatory asthenia, compensatory mechanisms are connected, so vegetative homeostasis is not generally disturbed and the heart rhythm responds adequately to the effect of physiological stimuli. Severe form of neurocirculatory asthenia is characte rized by disadaptation of vegetative maintenance of cardiac activity. Such patients need regular follow-up because they are at risk for developing cardiovascular diseases.

Pediatrician (St. Petersburg). 2018;9(4):73-80
The effectiveness of anti-helicobacter therapy in the treatment of chronic gastroduodenal pathology in children with different levels of compliance
Nalyotov A.V., Nalyotov S.V., Barinova A.S., Gorshkov O.G.

At the present time, the therapy of most diseases requires special attention not only from the treating physician, but also from the patient. In turn, in the treatment of children, the monitoring of compliance with the treatment is carried out not by the patient, but by his parents who control the regimen of taking medications. The aim of the study was to determine the efficiency of traditional anti-H. pylori regimen in the treatment of chronic gastroduodenal pathology in children with various level of parental compliance. 80 children of school age suffering from peptic ulcer disease duodenal ulcer associated with H. pylori from families with different levels of parental compliance were examined. The traditional anti-H. pylori therapy scheme containing omeprazole, clarithromycin lasting 14 days was prescribed for all children with chronic gastroduodenal pathology. It is established that strict adherence to the regimen and duration of administration of prescribed drugs allows achieving a high level of eradication of H. pylori even with the use of the traditional anti-Helicobacter pylori. Conducting a “compliance training” before starting therapy is an important factor that increases the level of parental compliance in patients with inflammatory-destructive diseases of the stomach and duodenum. Establishment of interpersonal relationships in the “doctor-patient-parent” system, working with parents, aimed at explaining the essence of the disease, the consequences of the disease, treatment tactics are an important stage in the therapy of a sick child.

Pediatrician (St. Petersburg). 2018;9(4):81-86
History of surgical treatment of obesity and metabolic disorders
Vasilevsky D.I., Sedletsky Y.I., Anisimova K.A., Davletbaeva L.I.

Surgery of obesity (bariatric surgery) as a separate area of medical science dates back its history from the middle of the previous century. The foundation for its development was based on the ideas of physiology of digestion, the causes and mechanisms of its disturbances that had been formed at that time. An important role was played by achievements in related areas of medicine: anesthesiology, transfusiology. Before that effective antibacterial drugs have already been created. Rich experience in various fields was brought for medicine by the Second World War. The return of society to pre-war cultural values became the impetus for bariatric surgery genesis. For two first decades, the main method of surgical treatment of overweight was shunting operations in the small intestine, aimed at reducing absorption of nutrients (malabsorption techniques). However, a significant number of negative side effects gradually forced to abandon this group of procedures and were the basis for the search for other options in surgical interventions. Since the late 60-es of the 20th century for two decades, methods have been actively developed that limited the flow of nutrients (restrictive approach). The main idea in the development of this group of operations was to reduce the volume of the stomach. At the same time, attempts were made to combine both malabsorptive and restrictive mechanisms in one technique. By the beginning of the 90-es, practically all the available variants of surgical interventions have been proposed and introduced into clinical practice. At the same time, minimally invasive surgical technologies began to be actively introduced into this area of medicine. By the beginning of the 21st century almost all surgical techniques have been adapted to endovideo- (laparoscopic-) surgery. Over the past decade, intraluminal (endoscopic) methods for reducing stomach volume and reducing nutrient absorption have been developed.

Pediatrician (St. Petersburg). 2018;9(4):87-104
Visualization capabilities of experimental oncological models in small laboratory animals
Pechatnikova V.A., Trashkov A.P., Zelenenko M.A., Verlov N.A., Chizh G.A., Khotin M.G., Vasiliev A.G.

For a long time non-invasive imaging methods have been inaccessible in preclinical practice; their introduction lately has broadened the boundaries of relevant studies and felicitated new approaches to solving fundamental problems. Up-to-date imaging methods constitute an essential component of preclinical and translational biomedical research allowing quick and non-invasive extended representation of structural organization and functional characteristics of pathological processes in vivo. Methods of radiation diagnosis and nuclear magnetic resonance allow to assess the state of bones, soft tissues, internal organs, blood vessels and peripheral nerve fibers in various animals, not only mammals, but also fish, amphibians, reptiles and insects. Multiparametric studies can uniquely localize any anatomical structure or pathological process. However, not all existing techniques are applicable to various oncological models of small laboratory animals.

Pediatrician (St. Petersburg). 2018;9(4):105-112
Forensic medical evaluation of the role of the formation of ascending amniotic infection in the event of intrauterine fetal death
Davydova Z.V., Sokolova O.V.

The analysis of expert practice and scientific research conducted during the last decade show that the greatest number of claims to the correctness of the provision of medical care are made by doctors of surgical specialties, including obstetrician-gynecologists, and, at the same time, inspections for “medical cases”, including profile “obstetrics and gynecology” are complex and time-consuming. The article considers the problem of the unfavorable outcome of medical care in obstetric practice. The questions of etiology, pathogenesis, diagnosis of intrauterine infection (VUI), which largely determines the frequency of perinatal morbidity and mortality, are also analyzed and analyzed questions of the prescription of the pathological process in the amniotic membranes, its role in the formation of fetal death. On a concrete example, expert practice shows how the forensic medical commission, taking into account the data of medical documents, as well as the results of macroscopic and microscopic studies, solves the problem of the immediate cause of antenatal death and establishes the role of intrauterine infection in the death of the fetus, the timing and causes of its formation. The information that is relevant to the practice of forensic medical examinations is presented, which allows us to formulate objective and scientifically substantiated conclusions about the existence of cause-effect relationships between the defects in the provision of medical care and the onset of an unfavorable outcome of medical care in similar cases.

Pediatrician (St. Petersburg). 2018;9(4):113-117
Self-relation and relation to other people among women who have AIDS virus
Titova M.D., Zakharova M.L.

The human immunodeficiency virus (HIV) is a stigmatizing disease that will remain with a person for life, turning it into a series of stressful situations and strong, often negative experiences. People living with HIV are under pressure of public stereotypes, pressure of feelings of guilt, shame and social exclusion. The new situation requires adaptation. It is success depends not only on the external factors of the environment in which the person resides, but also on subjective factors, on how the person perceives what is happening, how he assesses himself in the current situation. The aim is to study the characteristics of self – relation and relation to other people among women who living with HIV-positive status. The study involved 30 women living with HIV and 30 healthy women. The results show that self-incrimination and guilt predominate in the self-relation of women living with HIV-positive status. Attitudes towards other people can be called distrustful and alienated. Features of the emotional status of women are mistrust of surrounding people, incertitude in the situation of communication and feelings of anxiety. For women of this group, it is characteristic to evaluate yourself as unattractive in the eyes of others, expecting disrespect from others and attributing to oneself a low social reputation. The results make it possible to pay attention to the need to provide psychological help that promotes a sense of self-worth and self-confidence. Psychological help can have a significant impact on the physical condition of women with HIV-positive status.

Pediatrician (St. Petersburg). 2018;9(4):118-123
Faithful until the very end (on the occasion of the 100th anniversary of the death of Evgeny Sergeevich Botkin)
Ovsyannikov D.Y., Siluyanova I.V.

In 2018 marks the 100th anniversary of the death of Evgeny Sergeevich Botkin, who was the last medical doctor of the last Russian emperor Nicholas II and voluntarily went to his death with his patients. The article considers the main stages of the life and professional path of E.S. Botkin, his contribution to the development of national medicine is estimated. His scientific, pedagogical and social activities are described, and basic biographical data are presented. Separately, ethical views on the doctor's duty, based on the principle of the dominant interests of the patient, are characterized.

Pediatrician (St. Petersburg). 2018;9(4):124-129

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