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HERALD of North-Western State Medical University named after I.I. Mechnikov最新文献

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Diagnosis and prognosis of inflammatory bowel diseases: modern view 炎症性肠病的诊断与预后:现代观点
Pub Date : 2021-10-15 DOI: 10.17816/mechnikov77646
I. Bakulin, I. Rasmagina, M. Skalinskaya
About 5% of the population suffer from chronic diarrhea. Intestinal infections are the most common cause of diarrheal syndrome. However, if they are excluded, it is necessary to check for other possible reasons: vascular, oncological, rheumatic, drug-induced, radiation diseases and other gastroenterological pathology except from inflammatory bowel diseases. When predicting and detrcting new predictors of unfavorable outcomes and progression of inflammatory bowel diseases, special attention has been recently paid to serological markers and genetic research, which have not yet entered clinical practice due to their high cost. Inflammatory bowel diseases is a diagnosis of exclusion, which is made after a comprehensive assessment of clinical, laboratory, endoscopic, and morphological data. In case of the development of complications, it needs to investigate new available prognostic markers of inflammatory bowel diseases course.
大约5%的人口患有慢性腹泻。肠道感染是腹泻综合征最常见的原因。然而,如果他们被排除在外,有必要检查其他可能的原因:血管、肿瘤、风湿病、药物引起的、辐射疾病和其他肠胃疾病,除了炎症性肠病。在预测和检测炎症性肠病不良结局和进展的新预测因子时,最近特别关注血清学标记物和遗传学研究,但由于其成本高,尚未进入临床实践。炎症性肠病是一种排除性的诊断,是在综合评估临床、实验室、内镜和形态学资料后做出的。在发生并发症的情况下,需要研究新的可用的炎症性肠病病程预后标志物。
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引用次数: 2
Systemic transtiretin amyloidosis in the elderly patient with recurrent pleural effusions 老年反复胸腔积液患者的系统性转运蛋白淀粉样变
Pub Date : 2021-10-15 DOI: 10.17816/mechnikov79512
S. Boldueva, Dmitriy S. Evdokimov, N. S. Shvets, A. Shahbazyan, E. Kalinina, L. Mitrofanova
Systemic amyloidosis is a group of diseases associated with extracellular deposition of fibrillar proteins, which leads to a loss of normal organ structure and function. Transthyretin amyloidosis occurs with the deposition of amyloid, consisting of transthyretin transport protein, and can be a genetic or degenerative disease of senility (acquired from the deposition of wild-type transthyretin). The article describes the clinical case of transthyretine amyloidosis in elderly patient, manifested by recurrent pleural effusions and biventricular heart failure demonstrating the complexity of timely diagnosis of wild-type transthyretin amyloidosis.
系统性淀粉样变性是一组与细胞外纤维蛋白沉积相关的疾病,可导致正常器官结构和功能的丧失。转甲状腺素淀粉样变性发生于由转甲状腺素转运蛋白组成的淀粉样蛋白沉积,可能是一种遗传性或退行性衰老疾病(由野生型转甲状腺素沉积获得)。本文描述了老年经甲状腺蛋白淀粉样变患者的临床病例,表现为反复胸腔积液和双心室心力衰竭,说明野生型经甲状腺蛋白淀粉样变的及时诊断的复杂性。
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引用次数: 1
H. pylori eradication therapy: impact of gastric mucosa atrophy on transport of amoxicillin to H. pylori colonization area 幽门螺杆菌根除治疗:胃黏膜萎缩对阿莫西林向幽门螺杆菌定植区转运的影响
Pub Date : 2021-08-30 DOI: 10.17816/mechnikov70280
A. Sablina, O. Sablin, J. Andreeva, G. G. Rodionov, I. Shantyr, I. E. Ushal, I. Samusenko
AIM: The aim was to assess systemic transport of amoxicillin, the most common antibiotic in H. pylori eradication regimens to the gastric in atrophic gastritis. MATERIALS AND METHODS: Systemic transport of amoxicillin to the gastric lumen of rats was evaluated in washes from the gastric mucosa in the model of atrophic gastritis after intravenous drug infusion. Transport of amoxicillin from bloodstream to the gastric lumen was also assessed in patients with atrophic and non-atrophic gastritis in aspirated via nasogastric probe gastric juice after oral drug administration. Amoxicillin concentration was measured in samples using liquid chromatography-mass spectrometry. RESULTS: In rats with induced atrophic gastritis, hyperemia and acute erosions of the gastric mucosa, as well as microscopic signs of non-active chronic body gastritis and non-active antral atrophic gastritis were found. Amoxicillin concentration in washes from the gastric mucosa was significantly (p 0.01) higher in rats of experimental group than in control group at all time points (30, 60, 120, 240 min after drug infusion). The lowest mean amoxicillin concentration in gastric juice was observed in patients with antral atrophy (p 0.01). The maximum amoxicillin concentration in gastric secretion was found at the 180th min of aspiration in patients with atrophy of gastric mucosa, while in patients of the group of comparison it was found at 30-120th min of aspiration. CONCLUSIONS: Acute gastric mucosa erosions enhance amoxicillin delivery to gastric lumen in rats. Atrophy of antral mucosa more than in the corpus is characterized by decreased amoxicillin transfer from systemic bloodstream to gastric lumen in patients after oral amoxicillin intake. The gastric mucosa atrophy should be taken into consideration while predicting the efficacy of H. pylori eradication therapy in patients with chronic gastritis.
目的:目的是评估阿莫西林的全身转运,阿莫西林是萎缩性胃炎患者幽门螺旋杆菌根除方案中最常见的抗生素。材料与方法:观察萎缩性胃炎模型大鼠静脉输注阿莫西林后胃粘膜的全身转运情况。对萎缩性和非萎缩性胃炎患者口服药物后经鼻胃探查胃液吸入阿莫西林从血流到胃腔的转运情况也进行了评估。采用液相色谱-质谱联用法测定样品中阿莫西林的浓度。结果:萎缩性胃炎大鼠出现充血、急性胃黏膜糜烂,镜下可见非活动性慢性体性胃炎和非活动性胃窦性萎缩性胃炎征象。实验组大鼠胃粘膜冲洗液中阿莫西林浓度在给药后30、60、120、240 min各时间点均显著高于对照组(p < 0.01)。胃窦萎缩组胃液中阿莫西林平均浓度最低(p < 0.01)。胃黏膜萎缩组患者胃分泌物中阿莫西林浓度最大值出现在吸痰后180 min,对照组患者则出现在吸痰后30 ~ 120 min。结论:急性胃黏膜糜烂可促进阿莫西林向大鼠胃腔的输送。患者口服阿莫西林后,胃窦黏膜比胃腔萎缩更严重,其特征是阿莫西林从全身血流到胃腔的转移减少。在预测慢性胃炎幽门螺杆菌根除治疗的疗效时,应考虑胃黏膜萎缩。
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引用次数: 0
Disorders of lipid metabolism in the liver in patients with chronic viral hepatitis 慢性病毒性肝炎患者肝脏脂质代谢紊乱
Pub Date : 2021-08-30 DOI: 10.17816/mechnikov71418
V. Tsvetkov, I. Tokin, O. E. Nikitina, D. Lioznov
The review article is devoted to the problem of lipid metabolism disorders in the liver in patients with chronic hepatitis B and chronic hepatitis C. The results of modern biological, epidemiological and clinical studies aimed at studying the causes and mechanisms of the formation of liver steatosis and steatohepatitis, their prevalence and influence on the course of infectious pathology are presented. Particular attention is paid to the generalization and systematization of the currently available data on the mechanisms of lipid metabolism disorders in the liver, mediated by the molecular structures of hepatitis B and C viruses. In conclusion, the need for timely diagnosis and treatment of pathological conditions caused by the development of lipid metabolism disorders in the liver is substantiated in order to increase the quality of medical care for patients with chronic hepatitis B and C.
本文综述了慢性乙型肝炎和慢性丙型肝炎患者肝脏脂质代谢紊乱的问题,介绍了现代生物学、流行病学和临床研究的结果,旨在研究肝脏脂肪变性和脂肪性肝炎的形成原因和机制,以及它们的流行情况和对感染病理过程的影响。特别关注的是推广和系统化目前可用的数据在肝脏脂质代谢紊乱的机制,由乙型和丙型肝炎病毒的分子结构介导。综上所述,为了提高慢性乙型和丙型肝炎患者的医疗服务质量,需要及时诊断和治疗肝脏脂质代谢紊乱发展引起的病理状况。
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引用次数: 0
New opportunities in the diagnosis of asthma with sensitization to Aspergillus spp. 曲霉致敏在哮喘诊断中的新机遇。
Pub Date : 2021-08-30 DOI: 10.17816/mechnikov71585
Y. Kozlova, A. Uchevatkina, L. Filippova, O. Aak, V. Kuznetsov, E. Frolova, N. Vasilyeva, N. Klimko
BACKGROUND:Diagnosis of asthma with sensitization toAspergillusspp. is becoming increasingly important due to the severe, uncontrolled course of the disease and the possibility of the formation of allergic bronchopulmonary aspergillosis. AIM:To evaluate the possibility of using the basophil activation test using flow cytometry for the diagnosis of asthma with sensitization toAspergillusspp. MATERIALS AND METHODS:118 patients with asthma were examined. The levels of total IgE and specific IgE to aeroallergens were determined in the blood serum by the enzyme immunoassay. Basophil activation was studied by flow cytometry using the Allergenicity kit (Cellular Analysis of Allergy, Beckman-Coulter, USA). The allergenAspergillus fumigatus(Alcor Bio, Russia) was used to stimulate basophils. RESULTS:The first group consisted of 57 patients with asthma without sensitization toAspergillusspp. The second group included 36 patients with asthma with sensitization toAspergillusspp. The third group consisted of 25 patients with allergic bronchopulmonary aspergillosis. The number of basophils activated by theAspergillusfumigatusallergen in patients with asthma with sensitization toAspergillusspp. and allergic bronchopulmonary aspergillosis was significantly higher than in the asthma group and amounted to 8.1 [5.2; 20.9]% and 84.6 [75.7; 94.0]%, respectively (p 0.001). The stimulation index in the study groups ranged from 0.7 to 72.6. The optimal diagnostic point (cut off) for identifying patients with asthma withAspergillusspp. sensitization there was an stimulation index value of more than 2.4, and for patients with allergic bronchopulmonary aspergillosis 15.95. Among all patients with sensitization toAspergillusspp. a positive correlation was established between the level of specific IgE toAspergillusspp. and the percentage of basophils activated by the allergenAspergillusfumigatus(r= 0.792,p 0.001) and stimulation index (r= 0.796,p 0.05). CONCLUSIONS:The basophil activation test can be used as an additional diagnostic method for asthma with sensitization toAspergillusspp. and allergic bronchopulmonary aspergillosis.
背景:对曲霉菌致敏的哮喘诊断。由于病情严重,病程不受控制,并有可能形成过敏性支气管肺曲霉病,因此变得越来越重要。目的:探讨流式细胞术嗜碱性粒细胞活化试验诊断曲霉致敏哮喘的可行性。材料与方法:对118例哮喘患者进行检查。采用酶免疫分析法测定血清中总IgE和对空气过敏原的特异性IgE水平。采用致敏性试剂盒(Cellular Analysis of Allergy, Beckman-Coulter, USA)流式细胞术研究嗜碱性粒细胞活化。用变应原烟曲霉(Alcor Bio, Russia)刺激嗜碱性细胞。结果:第一组57例哮喘患者对曲霉菌不敏感。第二组包括36例对曲霉菌过敏的哮喘患者。第三组包括25例过敏性支气管肺曲菌病患者。对曲霉菌致敏的哮喘患者被烟曲霉变应原激活的嗜碱性细胞数量。变应性支气管肺曲霉病明显高于哮喘组,达8.1 [5.2];20.9 %和84.6 % [75.7;94.0]%,差异有统计学意义(p 0.001)。实验组的刺激指数在0.7 ~ 72.6之间。鉴别曲霉菌哮喘患者的最佳诊断点(切点)。致敏刺激指数大于2.4,过敏性支气管肺曲菌病患者刺激指数为15.95。在所有对曲霉菌过敏的患者中。特异性IgE水平与曲霉菌呈显著正相关。被变应原烟曲霉激活的嗜碱性细胞百分比(r= 0.792,p 0.001)和刺激指数(r= 0.796,p 0.05)。结论:嗜碱性粒细胞活化试验可作为对曲霉菌致敏哮喘的附加诊断方法。过敏性支气管肺曲霉菌病。
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引用次数: 0
Experience of surgical treatment of a patient with fractures of both necks of the femur on the background of severe osteoporosis 一例严重骨质疏松伴双颈股骨骨折的手术治疗体会
Pub Date : 2021-08-30 DOI: 10.17816/mechnikov64889
O. N. Yamshchikov, S. Emelyanov, S. A. Mordovin, A. Petrukhin, E. Kolobova, N. I. Voronin
The article shows the observation of the successful treatment of a patient with alternate fractures of the femoral necks against the background of osteoporotic lesions of the bone skeleton, examination of the patient and osteosynthesis with 3 AO screws in the operating room. The presented clinical case demonstrates the feasibility of osteosynthesis in a patient with severe osteoporosis.
本文报道了在骨质疏松性病变背景下成功治疗1例股骨颈交替骨折患者的观察,患者的检查和在手术室使用3枚AO螺钉进行骨固定。本文的临床病例证明了骨融合术治疗严重骨质疏松症的可行性。
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引用次数: 0
Differentiated approach to radical surgical treatment of elderly patients with tumor diseases of the pancreatoduodenal zone 老年胰十二指肠区肿瘤根治性手术治疗的鉴别方法
Pub Date : 2021-08-30 DOI: 10.17816/mechnikov70149
B. Sigua, V. Zemlyanoy, A. Gulyaev, M. Tsikoridze, Evgeny A. Zakharov
BACKGROUND: In recent years, there has been a widespread increase in the incidence of tumors of the pancreatoduodenal zone, especially noticeable in the older age group. A decrease in the incidence of postoperative complications and mortality after pancreatoduodenal resection made it possible to expand the indications for surgical treatment of elderly and senile patients. AIM: Improvement of the immediate results of pancreatoduodenal resection in the treatment of elderly and senile patients suffering from tumor diseases of the pancreatoduodenal zone. MATERIALS AND METHODS: Pancreatoduodenal resection was performed in 61 elderly and senile patients with tumors of the pancreatoduodenal zone. The main group consisted of 32 patients, whose treatment was carried out in accordance with the developed algorithm for choosing a method for forming a pancreatodigestive anastomosis based on a scale for assessing the risk of developing pancreatic fistulas. The comparison group consisted of 29 patients in whom the method of forming a pancreatodigestive anastomosis was carried out in accordance with the preferences of the operator without taking into account the risk of developing a pancreatic fistula. RESULTS: In the main group, compared with the control group, pylorus-saving interventions were performed significantly more often 27 (84.4%) and 14 (48.3%) (p 0.01). There was also a decrease in the frequency of performing pancreaticojejunostomy 16 (50%) and 22 (75.9%) (p 0.05), due to the use of reservoir terminolateral pancreatojejunostomy 8 (25%) and 0, respectively (p 0.01). Postoperative complications were observed in 14 (43.8%) of the study group and in 21 (72.4%) patients of the comparison group (p 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 8 (27.6%) to 2 (6.2%) (p 0.05) in the study group. Repeated surgery was required in 5 (15.6%) patients of the main group and 11 (37.9%) in the comparison group (p 0.05). The lethal outcome was recorded in 3 (9.4%) patients of the main group and in 7 (24.1%) in the comparison group (p 0.05). CONCLUSIONS: The results of performing pancreatoduodenal resection in the treatment of elderly and senile patients can be comparable with the results of treatment of the general population. The use of the developed algorithm made it possible to reliably reduce the incidence of complications from 72.4 to 43.8% (p 0.05), postoperative pancreatic fistulas from 27.6 to 6.2% (p 0.05), as well as the frequency of repeated interventions. from 37.9 to 15.6 % (p 0.05). In addition, a downward trend in mortality was achieved from 24.1% to 9.4%.
背景:近年来,胰十二指肠区肿瘤的发病率普遍增加,在老年人群中尤为明显。胰十二指肠切除术后并发症发生率和死亡率的降低,为扩大老年患者手术治疗的适应症提供了可能。目的:提高胰十二指肠切除术治疗中老年胰十二指肠区肿瘤患者的即时疗效。材料与方法:对61例中老年胰十二指肠区肿瘤患者行胰十二指肠切除术。主组32例患者,根据胰瘘发生风险评估量表,按照制定的胰消化吻合术形成方法选择算法进行治疗。对照组29例患者,根据术者的喜好进行胰消化吻合术,不考虑发生胰瘘的风险。结果:与对照组相比,主治疗组的保幽门干预率分别为27例(84.4%)和14例(48.3%),差异有统计学意义(p < 0.01)。由于采用储液池端外侧胰空肠吻合术,分别减少了16例(50%)和22例(75.9%)(p 0.05),分别为8例(25%)和0例(p 0.01)。研究组术后并发症14例(43.8%),对照组术后并发症21例(72.4%),差异有统计学意义(p < 0.05)。研究组的术后胰瘘发生率从8例(27.6%)降至2例(6.2%)(p 0.05)。主组5例(15.6%)患者需要重复手术,对照组11例(37.9%)患者需要重复手术(p < 0.05)。治疗组死亡3例(9.4%),对照组死亡7例(24.1%)(p < 0.05)。结论:行胰十二指肠切除术治疗中老年患者的结果可与普通人群的治疗结果相媲美。使用开发的算法可以可靠地将并发症发生率从72.4降低到43.8% (p 0.05),术后胰瘘发生率从27.6%降低到6.2% (p 0.05),以及重复干预的频率。37.9% ~ 15.6% (p < 0.05)。此外,死亡率呈下降趋势,从24.1%降至9.4%。
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引用次数: 0
Paraneoplastic neurological syndrome in onset of Hodgkin lymphoma 霍奇金淋巴瘤发病的副肿瘤神经综合征
Pub Date : 2021-08-30 DOI: 10.17816/mechnikov60133
E. S. Pavlyuchenko, Павлюченко Елена Сергеевна, A. A. Mirsaitov, Мирсаитов Александр Андреевич, Mariya N. Diakonova, Дьяконова Мария Николаевна, E. Karev, Карев Егор Александрович
Hodgkin lymphoma is a malignant disease with clonal proliferation of B-cells and high-level reactive inflammatory microenvironment. The main clinical sings are lymphadenopathy and toxic symptoms. Neurological symptoms as usual can be a result of compression or tumor infiltration of nervous structures. The primary damage of CNS occurs from 0,2% to 0,5% of all cases HL. Paraneoplastic neurological syndrome is a group of rare (an average 1 case on 10000 patients) neurological disorders against the background of oncological process. The pathophysiologic mechanism is due to production of antibody which is both to tumor cells and nerve cells. These antibodies are called onconeural autoantibodies. The hallmark which make diagnostics harder is the fact that onconeural autoantibodies rare take place in patients with lymphomas unless anti-Tr and anti-mGluR1 in patients with limbic encephalitis or paraneoplastic cerebellar degeneration. There are two case reports about patients with PNS in onset of Hodgkin lymphoma in article.
霍奇金淋巴瘤是一种b细胞克隆性增殖和高水平反应性炎症微环境的恶性疾病。临床主要表现为淋巴结病变和中毒症状。神经系统症状通常是神经结构受压或肿瘤浸润的结果。中枢神经系统的主要损害发生在所有HL病例的0.2%至0.5%之间。副肿瘤神经系统综合征是一组罕见的以肿瘤过程为背景的神经系统疾病(10000例患者中平均1例)。其病理生理机制是产生针对肿瘤细胞和神经细胞的抗体。这些抗体被称为神经自身抗体。使诊断更加困难的标志是肿瘤神经自身抗体很少出现在淋巴瘤患者中,除非在边缘脑炎或副肿瘤小脑变性患者中出现抗tr和抗mglur1抗体。本文报道两例霍奇金淋巴瘤发病时伴有PNS的病例。
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引用次数: 0
Shared pathological mechanisms of systemic lupus erythematosus and affective disorders 系统性红斑狼疮与情感性疾病的共同病理机制
Pub Date : 2021-08-30 DOI: 10.17816/mechnikov61262
G. Rukavishnikov, A. Smirnova, N. Neznanov, V. Mazurov, G. Mazo
The high prevalence and variability of neurological and psychiatric symptoms in systemic lupus erythematosus has become the basis for emphasizing the special neuropsychiatric form of the disorder. Affective disorders (pathological changes in mood and anxiety) are the second most common neuropsychiatric manifestations in patients with systemic lupus erythematosus. However, the current nomenclature primarily focuses on the general clinical manifestations of affective disorders in neuropsychiatric form systemic lupus erythematosus, without evaluating the problems of their etiopathogenesis. Thereby, the aim of this review is the integration of information on the pathological mechanisms of depression and anxiety in patients with systemic lupus erythematosus. The available data on the biological aspects of the anxiety and depression in systemic lupus erythematosus indicate that the complex pathological models may be the best approach for studying, diagnosing, and treating comorbid pathology. The latter can be based on expanding the existing clinical categories, supplementing them with data on pathological mechanisms specific to particular sub-cohorts of patients. Such an approach can provide the specific and most effective preventive, diagnostic and therapeutic measures for each category of patients.
系统性红斑狼疮的神经和精神症状的高患病率和变异性已成为强调该疾病特殊的神经精神形式的基础。情感性障碍(情绪和焦虑的病理改变)是系统性红斑狼疮患者第二常见的神经精神表现。然而,目前的命名主要集中在神经精神形式的系统性红斑狼疮的情感障碍的一般临床表现,而没有评估其发病机制的问题。因此,本综述的目的是整合系统性红斑狼疮患者抑郁和焦虑的病理机制信息。关于系统性红斑狼疮焦虑和抑郁的生物学方面的现有数据表明,复杂的病理模型可能是研究、诊断和治疗共病病理的最佳方法。后者可以基于扩大现有的临床分类,补充特定亚群患者的病理机制数据。这种方法可以为每一类患者提供具体和最有效的预防、诊断和治疗措施。
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引用次数: 0
Modern principles of cardiovascular disease prevention 现代心血管疾病预防原则
Pub Date : 2021-08-30 DOI: 10.17816/mechnikov75696
L. Bershtein
Atherosclerotic cardiovascular disease is the leading cause of death in the world, primarily in low-and middle-income countries, including Russian Federation. According to WHO experts, the global atherosclerotic cardiovascular disease epidemic can be brought under control mainly by improving the cardiovascular prevention. This paper describes the modern principles of risk assessment in people without manifested atherosclerotic cardiovascular disease, as well as considers drug and non-drug methods of primary prevention.
动脉粥样硬化性心血管疾病是世界上的主要死亡原因,主要发生在包括俄罗斯联邦在内的低收入和中等收入国家。世界卫生组织专家认为,全球动脉粥样硬化性心血管疾病的流行主要可以通过加强心血管预防来控制。本文介绍了无明显动脉粥样硬化性心血管疾病人群风险评估的现代原则,并考虑了药物和非药物一级预防方法。
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引用次数: 0
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