卷 12, 编号 5 (2021)

This review examines the main aspects of the course of a new coronavirus infection in patients with metabolic syndrome, provides up-to-date statistics on morbidity and mortality. Abdominal obesity, insulin resistance, arterial hypertension and dyslipidemia, which form the metabolic syndrome, are independent factors of a severe course of infection with a high risk of developing SARS, various complications, mainly the development of acute respiratory distress syndrome, extrapulmonary systemic inflammation and, finally, death. During the period of anti-epidemic measures, children turn out to be the most vulnerable in terms of losing the rational, healthy stereotypes of nutrition, regulation of “screen time”, responsible planning of study time and leisure, regular and intense physical activity. It requires increased attention of doctors, teachers and rehabilitation specialists to the problem maintaining the commitment of children and parents to a healthy lifestyle. Based on the formed concept of the presence of common links in the pathogenesis of the development of metabolic disorders and the infectious process, the authors identified the most significant issues of therapy and rehabilitation of this category of patients. Taking into account the need of patients for psychological adaptation of the past illness and increasing their resistance to stressful situations, within the framework of providing a personalized approach to the management of patients, may require timely diagnosis of anxiety-depressive disorders with the appointment of appropriate therapeutic measures.

Background. Purulent meningitis occupies one of the important places in the structure of neuroinfectious diseases in children and is the top ten places among the causes of death. The relevance of their study is due to the severity of the course, high rates of disability and deaths (8–39%). Damage to the vascular bed during neuroinfections, including purulent meningitis, is a mandatory component due to the predominantly hematogenous pathway of pathogens. The penetration of microorganisms through the blood-brain barrier into the cranial cavity and their hematogenous intrathecal circulation cause damage to the cerebral veins and arteries, leading to the development of vasculopathies and vasculitis.

Aim: To determine the features of vascular disorders in purulent meningitis in children.

Materials and methods. 100 children with purulent meningitis were examined, aged from 1 to 17 years 11 months, for the period since 2007 to 2020. All patients underwent neurological monitoring, etiological verification of diagnoses, determination of markers of endothelial dysfunction in the blood (D-dimer and desquamated endothelial cells), as well as MRI of the brain and MRI angiography.

Results. A complex lesion of the vascular system in purulent meningitis in children was proved, associated with both structural and functional properties of the vascular wall, as well as damage to the vasomotor function of the endothelium.

Conclusions. With purulent meningitis, there is damage to the vascular bed in the form of systemic vasculitis, including cerebral vessels, as evidenced by the presence of both markers of endothelial damage (desquamated endothelial cells and D-dimer) and changes in MRI and MRI angiography.

研究现实性。各种材料制成的各种产品（天然乳胶、硅胶、硅涂胶乳、聚氯乙烯、聚氨酯等）在姑息医学中用作胃造瘘管。它们对破坏因素、微生物环境和感染时间有不同的抵抗力。

本研究的目的：在体外模型实验中比较不同材料的胃造瘘管对损伤因素的影响。

材料与方法。本实验使用了2根乳胶Pezzer 34号导尿管，2根硅酮包衣乳胶Foley 26 Fr导尿管，2根聚氨 酯18 Fr鼻胃探针，2根硅酮牌24 Fr经皮内窥镜保险杠胃造口管。将导管切成50毫米长的碎片，放在有水 或0.1M盐酸溶液的密封容器中，在36℃下放置14天。

结果。在水和盐酸溶液的影响下，聚氨酯和硅树脂制成的管的质量和线性尺寸的变化很小（0.1—0.5%）。 胶乳和涂硅胶乳管的变化是显著的，由于吸水，质量变化了2—12%，长度变化了1–3.5%。对于乳胶材料，干燥后的质量减少（1%），对于聚氨酯材料，由于暴露于升高的温度，线性尺寸减少。

结论。根据模型实验的结果，硅树脂和聚氨酯管表现出最低的液体吸收，质量和长度的变化。这表明他们在实验中对损伤因素的抵抗力，所以我们可以推荐由这些材料制成的产品用于胃造口术。乳胶导管表现出最大的液体积累，质量和长度的变化，这使其在临床实践中不实用。

Disorders of control mechanisms caused by glucocorticoid hormones of adrenal cortex have a significant role in the pathogenesis of infectious diseases, first of all, due to cortisol, one of the key hormones with anti-inflammatory activity. Currently the conception about the mechanisms of cortisol influence, its functional abilities, connection with immune and nerve cells, involvement in cytokine regulation, features of free-radical oxidation has been extended. There has been identified the dependence of cortisol influence upon the isoform, amount and affinity of its receptors on target cells. The present review describes the study results concerning cortisol level in case of the most often occurring infectious diseases in children – acute respiratory and intestinal infections, infectious diseases of the central nervous system. There has been noticed a considerable data variability about cortisol level in normal state and in pathological one, however, the majority of articles have detected its connection with clinical manifestations and outcomes of the diseases. The study of cortisol level in cerebrospinal fluid is of a special interest in case of neuroinfections, specifying its direct connection with the disease severity and aetiology that gives new possibilities to develop effective diagnostic criteria. In general, the literature data specifies the advanced study of disorders of hypothalamus-hypophysial-adrenal gland functioning, receptor apparatus of target cells, as well as interrelations of cortisol with immune system in case of infectious diseases to reveal new criteria for diagnostics, course prediction and disease outcome, therapy correction.

兔热病是由土拉弗朗西斯菌（Francisella tularensis）引起的一种急性人畜共患的自然发生的病灶性疾病，有多种传播机制。人类通过各种方式感染，主要是通过昆虫叮咬（蚊子、蜱虫）、直接接触受感染的动物和吸入。该病的特点是高烧、中毒、入口处的炎症变化和区域淋巴结炎。由于缺乏特殊的临床表现（发热、中毒、区域性淋巴结炎），早期怀疑兔热病往往很困难。即使在流行地区，大多数病例被诊断为急性呼吸道病毒感染、淋巴结炎和起源不明的发热，导致启动病因治疗的时间较晚。本文介绍了一个13岁儿童的兔热病的临床病例，该病例在患病初期被误诊。只有全面的流行病学史（在流行区停留，被蚊子叮咬）以及对临床和实验室数据的正确评估，才能在第18天将兔热病纳入鉴别诊断，并通过检测血清中抗土拉菌病抗体的最高滴度来确认。因此，在发病率低的背景下，特别是在儿童时期，所有专业的医生都缺乏警惕性，导致诊断过晚，结果是具体治疗开始得晚。所有长期发热并伴有起源不明的淋巴结炎的儿童，如果曾在兔热病易发区，应进行专门检查，以发现轻度和陈旧的疾病形式。

Numerous studies in language acquisition have been revealed that oral discourse plays a crucial role in cognitive development and communicative development and has an impact on the so-called narrative mind, social intelligence, autobiographic memory, and personal identity. The paper is devoted to the main patterns and mechanisms of the acquisition of oral personal discourse along with the early and preschool age. The paper includes the following sub-topics: conversation acquisition, personal narrative and fictional story acquisition, relations between different genres of personal discourse, and cognitive prerequisites for the acquisition of personal discourse. The paper is based on the meta-analysis of numerous studies covering various fields of science (psychology, psycholinguistics, sociolinguistics, and linguistics) and decades of scientific investigations in child development. The main issues discussed in the paper are acquisition and development of interaction structure (the skills necessary to initiate and to close a conversation); acquisition and development of conversation structure (the skills necessary for turn-taking and topic continuation); acquisition and development of some metadiscursive skills necessary for successful communication (e.g. to acknowledge communication breakdowns in a proper way); acquisition and development of some pragmatic skills necessary for successful communication (e.g. to modify speech characteristics according to the social role and status of the interlocutor and the context of the communication, to produce relevant speech acts); acquisition and development of narrative structure (story structure, episode completeness, internal state terms); and acquisition and development of narrative cohesion and coherence. The given issues are discussed from the perspective of the biological age and linguistic, communicative, and cognitive development.