卷 6, 编号 3 (2015)

The results of joint studies and approaches to solve difficult problems of pathogenesis and treatment of patients in the departments of nephrology and pulmonology were analyzed. The studies have been done over 40 years in common by workers of Pediatric University and Sechenov Institute of Evolutionary Physiology and Biochemistry of Russian Academy of Sciences. The paper is focused on the discussion of choice motivation of research issue and approaches of treatment based on fundamental investigations. The paradoxical phenomenon is revealed - in patients with nocturnal enuresis diuresis increased simultaneously with the rise of solute free water reabsorption. The essence of this phenomenon is established, the use of desmopressin or diclofenac in dependence of disease form ensured treatment of nocturnal enuresis. Green fluorescent protein is applied for study of absorption of native proteins in the intestine, the role of kidneys in protein metabolism and in redistribution of the amino acids in the body was shown. The efficacy of diuretics during the development of renal function is ascertained in children of different age; the cause of renal refractoriness to furosemide in patients with chronic renal failure is established. Measuring the ratio of furosemide/sodium excretion in patients with chronic renal failure showed that the reduction in diuretic delivery to site of action but not the defect of Na,K,2Cl-cotransporter underlay the lower renal response to the same dose of the drug. The effective treatment based on increase in furosemide delivery to thick ascending limb of Henle loop is developed. The new nonapeptide analogue is synthesized; its natriuretic effect is 50 000-fold greater than action of furosemide. The clinical significance of inadequate antidiuretic state in children with severe pneumonia is shown. As a result of these studies, graduates of Pediatric University L. P. Peresheina, L. N. Kosheleva, E. A. Zhukovskaya, V. V. Archipov, A. A. Kuznetsova, A.A. Kanashkina, A. S. Marina, M. V. Burmakin and others defended theses.

The paper analyses the experience in palliative surgery in 137 patients with locally advanced forms of differentiated thyroid cancer. The paper describes the resections of the thyroid gland without the tumor tissue that germinated into the vital organs of neck or mediastinum. In some cases - the tumor was completely removed in patients with distant metastases. Such operations had to be performed in every fourth patient out of 464 patients with locally advanced carcinoma of the thyroid gland. Most of the patients undergoing palliative interventions, were elderly patients, that often had other illnesses. The need for such transactions occurred at the prospect of further treatment of patients with non-surgical methods, and serious complications of life-threatening tumors. In more than one in ten patients the palliative operation had to be completed with a temporary or permanent tracheostomy performed using the original method. The postoperative mortality rate was 4.3 % (6 cases). The causes of death were pulmonary embolism (2 patients), acute myocardial infarction (1 patient), purulent-septic complications (2 patients), acute cerebrovascular accident (1 case). The postoperative complications were: festering wounds (10 cases or 7.3 %), hypostatic pneumonia (21 patients or 15.3 %), bleeding (3 cases or 2.2 %). The 5-year survival rate after palliative surgery in patients with papillary cancer was higher compared to the group of patients with follicular carcinoma (43.0 % and 37.9 %, respectively). The same figures in patients with medullary carcinoma were significantly (p < 0.05) lower compared with those with papillary and follicular thyroid cancer and they amounted to 18.1 %. After the palliative surgery more than a third of patients survived for 5 years or more. That proves the validity of palliative interventions in this group of patients, and the relatively favorable current differentiated forms of thyroid cancer.

It is known that damage organs and systems largely determines the course and outcome of brucellosis, with one of the most frequently involved in the pathological process in the brucellosis infection is the cardiovascular system. The highest incidence of brucellosis in the Republic of Dagestan occur among those aged 15-39 years, the share of this age group accounts for 75 % of all cases of brucellosis in the Republic, which determines a great social and economic costs of brucellosis infection. The article presents the results of a study of the functional state of the cardiovascular system in 222 patients with brucellosis defeat of the cardiovascular system at the age of 16 to 45 years, of which 110 (49.5 %) patients with acute brucellosis, 112 (50.4 %) patients chronic brucellosis. The diagnosis of brucellosis infection was put up on the basis of clinical, laboratory and instrumental complex examination including, including serological tests Heddlsona and Wright, as well as an intradermal allergy test Burne. Identified clinical laboratory, ECG changes and echocardiographic data suggest that it is expedient to use diagnosicheskih complex investigations: Holter ECG, echocardiogram and determination of cardiac enzymes that allow the early period to identify heart disease as well as provide a timely opportunity to assess the severity of of the disease, identify the symptoms of latent myocardial damage, to decide on the necessary treatment, including etiotropic and pathogenic treatment.

The purpose was to assess neuroprotective effects of cortexin and ischemic preconditioning in rats with occlusion of both carotid arteries. Methods. The Wistar rats were divided into two groups according to their resistance to hypoxia. All rats were raised in barocamera on altitude 11 000 m with speed 50 m/sec and exposition up to agonal breath. Rats resistant to hypoxia more than 10 min were qualified as high resistant (HR), less than 5 min as low resistant (LR) to hypoxia. Ischemic preconditioning was reproduced by the 3-times temporary occlusions of common carotid arteries (5 min each) with 15-min reperfusion interval between occlusions. The chronic ischemia was modeled by means of ligation (permanent occlusion) of both carotid arteries in 1 h (early preconditioning) or 24 h (delayed preconditioning) after preconditioning procedure. Cortexin 1 mg/kg was administered intraperitoneally 7 days after occlusion of carotid arteries. Neurological status was assessed using McGrow’s stroke-index. Results. In postischemic period, the functional and metabolic changes in the brain of HR and LR rats were more significant in conditions of delayed preconditioning. In group of early preconditioning, a number of survival rats on 7th day was more than in delayed preconditioning group. Cortexin administration (1 mg/kg, 7 days) increased quantity of survival rats, especially in delayed preconditioning group. The maximal effect of cortexin was observed in delayed preconditioning group. Also cortexin decreased malonic dialdehyde level and increased superoxide dismutase activity of the brain tissue in all groups of rats. Conclusion. The course administration of polypeptide drug cortexin reduces neurological deficit signs, recovers structure of individual behavior of rats with different resistance to hypoxia and performs antioxidant action in chronic ischemic damage of the brain on the background of early and delayed preconditioning.

Minor bleeding is quite common in children and in some cases masks the serious disease of blood clotting. As a rule, this rare inherited disease associated with deficiency of coagulation factors as the I, II, V, VII, X, XI and XIII, as well as deficiency conjugate, most often, the joint failure factors V and VIII and factor whose synthesis associated with vitamin K. The pediatric clinic is difficult to fulfill a randomized trial because of the difficulty of identifying such children carriers of genetic abnormalities at a specific blood clotting factor. In connection with the model of deficiency of coagulation factor XI in a mammals (Bos Taurus L) with autosomal recessive type of inheritance is particularly promising. Deficiency of coagulation factor XI in cattle is inherited autosomal recessive defect. At the first time this pathology was recognized in Holstein cows in 1969. Frequently the etiologic factor of most hidden genetic defects in animals are point mutations in the coding region of the respective genes. On the contrary it has been found that deficiency of coagulation factor XI cattle (FXID) is a consequence of the insertion of nucleotide sequences within exon 12 of the gene FXI length of 76 base pairs. STOP codon (TAA) was resulted from insertion. Phenotypically deficiency of factor XI (FXID) in calves is resulted in disturbance of blood clotting and characterized by prolonged bleeding from the umbilical cord and anemia. Cows which are heterozygous in deficiency of coagulation factor XI have colostrum pink color. Those animals are frequently suffered from pneumonia, mastitis and endometritis. We monitored the breeding sires and Holstein cows on the carrier of the genetic disease: deficiency of coagulation factor XI. To detect the insertion of nucleotide sequences of 76 bp in size it is recommended to use the polymerase chain reaction.

At present the need for a comprehensive approach to the treatment of patients with addictive disorders unchallenged. The choice of pharmacological agents used for the relief of symptoms of the disease at different stages is quite wide. This indicates for the need to optimize the therapeutic approaches to apply differentiated complex programs for using a specific drug therapy in different groups of patients. In recent years the great interest was attracted to pharmacological means and methods for improving utilization by the organism of oxygen circulating in it, reducing the oxygen demand of organs and tissues, thereby contributing to reduction of hypoxia and increase resistance to oxygen deficiency. Hypoxenum was allowed for medical use since 1996 year. Hypoxenum is able to both increase efficiency of oxygen use by mechanism of coupling effect due to a specific interaction with a first set of the respiratory chain of mitochondria and alter the conformation of the porphyrin resulting in decreased affinity for oxygen. Simultaneously the modification of ion transportation system in erythrocyte takes place. As a result the oxygen associated with hemoglobin easily desorbed and diffused into the cells and CO2, otherwise, more intensively binds porphyrin complex of erythrocytes. In our study we reproduced a double-blind, placebo-controlled, randomized, comparative clinical study of the efficacy hypoxenum (0.5 g/day, 14 days) after the relief of alcohol withdrawal in 40 patients with alcohol abuse. Our study revealed a pronounced effect of the drug on emotional and motivational status of patients. It was concluded that hipoxenum possesses high efficiency in group of patients in the period of postabstinence.

The article concerns genetic factors that determine efficiency of steroid treatment for chronic inflammatory bowel diseases (IBD) in children, focused, mostly, on Crohn disease and nonspecific ulcerative colitis. Their incidence comprises 5 to 15 per 100 000 children and adolescents. In acute phase, therapy of these diseases is based on salicylates and glucocorticoids which regulate cytokine network and immune cell functions. Application of high-dose glucocorticoids (GCs) exerts а sufficient immunosuppressive action. These effects are performed via specific GC receptors in the target cell populations. Hence, numbers and functionality of GC receptors are important for clinical response to GC treatment. The aim of this review is discern major genetic effects upon functioning of glucocorticoid receptors. Here we discuss effects of N363S, ER22/23EK, and NR3C1 variants, the most known GC functional gene polymorphisms. These gene variants are often associated with altered GC gene expression in individual cases of IBD. Moreover, some other gene variants are able to modulate the GC receptor expression, thus making it difficult to assess genetic predisposition to altered clinical response to glucocorticoids. Hence, the regulatory effects of single gene variants upon GC receptors may not show direct correlations with clinical effects of the drug. Therefore, we propose an immediate way to assess the gene activity, i. e., quantitative analysis of the gene transcription (mRNA detection) in the patients’ cells before and during glucocorticoid therapy, presuming further application of this parameter as a predictive marker for evaluation of optimal therapeutic response in the individual IBD patients.

The paper deals with redistribution of energetic and plastic resources in the organism during stress, acute phase response and diabetes mellitus. Assuming metabolic regulation is based upon balanced contradictory influences of diverse chemical signals (substrates, ions, autacoids, hormones, neurotransmitters, physiological autoantibodies) the peculiarities of insulin- and counter-insulin effects during acute and chronic adaptation under stress, acute phase response and diabetes mellitus have been discussed. The role of chronic stress and accompanying metabolic disorders has been accentuated as a basis for stress-associated diseases’ development. The role of outstanding Argentinean pathophysiologist Bernardo Alberto Houssay (1887-1971) is discussed. He had devoted himself to studies of pituitary bioregulators’ influence on insulin effects immediately after insulin discovery and had established in 1924 that pituitary removal is able to increase sensitivity to insulin in dogs, and developed “secondary diabetes mellitus” concept as a result of counter-insulin hormones’ excess (especially hormones of adenohypophysis and the adrenal glands (“steroid diabetes”). Bernardo Alberto Houssay was really the first to experimentally prove pituitary and adrenal bioregulators to oppose the insulin effects. Bernardo Alberto Houssay has been 46 times nominated for the Nobel prize for 17 years (1931 through 1947), and finally was awarded the Nobel prize in 1947 for achievements in Physiology and Medicine for disclosing the role of pituitary in carbohydrate metabolism (he was the first ever Nobel prize winner from Latin America). The paper discusses publications by B. A. Houssay, current development of his ideas, as well as historical and biographical information on his research and his scientific school of endocrinologists-pathophysiologists in the context of his epoch, on the background of history of Argentina [3 figs, bibliography: 34 refs].

In accordance with the order of the Ministry of Health and Social Development of the Russian Federation from January 15, 2007 N 30 to participate in the delivery of health care to citizens admitted students who have successfully completed the theoretical training and have practical skills acquired on models (phantoms). In 2013, in order to introduce innovative forms of learning SPbGPMU formed Center of modern educational technologies. For the development of all necessary manipulations in the Centre created a special phantom-simulation classes. In order to establish the required number of repetitions in the course teaching practical skills learning outcomes analyzed 252 5th year students of pediatric faculty. It was found that a great development of the 5th year students of medical procedures require at least 5 repetitions of each student with a teacher or a mandatory correction loop simulator. To master the algorithm requires the help of at least 7 repeats the clinical scenario, with enough 1-2 times the direct participation of the remaining repetitions of the student can observe and participate in the discussion of errors. The introduction of phantom-simulation training for students not only increases the interest in learning, but also makes it possible to repeatedly perform any medical procedures or diagnostic procedure without risk to the patient, and subsequently apply their skills confidently during practical training. Using simulators, mannequins, phantoms and dummies can not only master the different skills each student physicians, but also to develop the ability to interact with each other and work as a team by simulating real conditions. The possibility of multiple repetition of the same scenario allows you to bring the mastery of skills to automaticity.