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Palliative medical care for children at the federal and regional levels: analysis of expert opinions and new challenges to the healthcare system 儿童在联邦和地区层面的姑息治疗:专家意见的分析和对医疗保健系统的新挑战
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.20953/1817-7646-2022-5-36-42
V. Stupak, E. S. Feduleeva, A. Ishutin, L. S. Zolotareva
The Resolution on Palliative Care (PC) adopted by the World Health Assembly in 2014 implies PC integration into healthcare at all levels. In the Russian Federation, PC management and improvement are regulated by territorial health development programs. Objective. To analyze expert opinions on the quality of PC in various regions of the Russian Federation to optimize pediatric PC. Materials and methods. This prospective cohort study was conducted in 80 regions of the Russian Federation in October–December 2020. We interviewed 276 chief consultants, top healthcare executives, heads of healthcare institutions, pediatric departments, neonatology departments, and gynecological departments. Results. Respondents reported high quality of PC and equipment in healthcare institutions. However, they also marked limited territorial accessibility and volume of PC. They believe that PC in Russia requires better funding and expansion of home care, medical care in day hospitals and regular hospitals, and improvement of legal protection of patients. Conclusion. PC in the Russian Federation is one of the top priorities in healthcare. Several regulatory documents (including orders No 345n/372n and No 348n, resolution No 813, orders for the Moscow Region No 4-r and No 87-r) have been implemented. However, organizational problems still exist in some regions, which requires the improvement of the regulatory framework. Key words: pediatric palliative care, children, hospice and palliative care, medical and organizational measures, quality of life, suffering alleviation
2014年世界卫生大会通过的关于姑息治疗(PC)的决议意味着将姑息治疗纳入各级卫生保健。在俄罗斯联邦,个人保健的管理和改进是由领土卫生发展方案规定的。目标。分析专家对俄罗斯联邦各地区PC质量的意见,以优化儿科PC。材料和方法。这项前瞻性队列研究于2020年10月至12月在俄罗斯联邦的80个地区进行。我们采访了276名首席顾问、顶级医疗管理人员、医疗机构负责人、儿科、新生儿科和妇科。结果。受访者表示,医疗机构的个人电脑和设备质量很高。然而,它们也标志着有限的领土可达性和PC数量。他们认为,俄罗斯的PC需要更好地资助和扩大家庭护理、日间医院和正规医院的医疗服务,以及改善对患者的法律保护。结论。在俄罗斯联邦,PC是医疗保健领域的首要任务之一。一些规范性文件(包括第345n/372n和第348n号命令,第813号决议,莫斯科地区第4-r和第87-r号命令)已经实施。但部分地区仍存在组织性问题,需要完善监管框架。关键词:小儿姑息治疗,儿童,安宁与姑息治疗,医疗与组织措施,生活质量,减轻痛苦
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引用次数: 0
Formation of pyeloenteroureteroanastamosis in a child with recurrent hydronephrosis caused by long-term ureteral stenosis 长期输尿管狭窄引起复发性肾积水儿童肾盂肠输尿管吻合的形成
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.20953/1817-7646-2022-6-121-124
S. Sharkov, O. Shmyrov, A.Yu. Lobach, A. Kulaev, R. V. Surov, M. N. Lazishvili, A. Kovachich
Hydronephrosis is a disease characterized by expansion of the renal pelvis and calyces resulted from improper urine outflow in the pelvic ureter that causes damage to the kidney parenchyma and a progressive decrease in its function. Anderson–Hynes pyeloplasty is a highly effective surgical method for this disease. The recurrence rate after this procedure does not exceed 3–5%. One of the possible causes of relapse is long-term ureteral stenosis, which requires a repeated reconstructive surgery. We report a case of recurrent hydronephrosis associated with long-term ureteral stenosis. The patient has undergone laparoscopic surgery with the formation of pyeloenteroureteroanastamosis. Key words: hydronephrosis, relapse, laparoscopy, pyeloenteroureteroanastamosis, pyeloplasty
肾积水是一种以肾盂和肾盏扩张为特征的疾病,其特征是由于盆腔输尿管不适当的尿液流出导致肾实质损害和其功能的进行性下降。安德森-海因斯肾盂成形术是治疗这种疾病的一种非常有效的手术方法。术后复发率不超过3-5%。复发的可能原因之一是长期输尿管狭窄,这需要反复的重建手术。我们报告一例复发性肾积水合并长期输尿管狭窄。患者已接受腹腔镜手术形成肾盂肠输尿管吻合。关键词:肾积水,复发,腹腔镜,肾盂肠输尿管吻合,肾盂成形术
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引用次数: 0
Secondary hemophagocytic lymphohistiocytosis: prognostic model and early markers in patients with systemic juvenile idiopathic arthritis. Results of a cohort retrospective study 继发性噬血细胞性淋巴组织细胞增多症:系统性幼年特发性关节炎患者的预后模型和早期标志物。队列回顾性研究结果
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.20953/1817-7646-2022-6-17-24
I. Kriulin, E. Alexeeva, Ilia Y. Shilkrot, T. Dvoryakovskaya
Background. Secondary hemophagocytic lymphohistiocytosis (sHLH) is a potentially fatal complication of systemic juvenile idiopathic arthritis (sJIA) characterized by hyperinflammation and a variety of clinical and laboratory manifestations. This condition is also referred to as macrophage activation syndrome (MAS) in patients with rheumatic diseases, including those with sJIA. In this article, we use the term sHLH. Approximately 40% of sHLH cases are asymptomatic, especially in patients who receive biologicals. Thus, the development of a prognostic model and identification of early sHLH markers in sJIA patients will enable timely initiation of anti-inflammatory and immunosuppressive therapy. Objective. To develop a prognostic model and identify early sHLH markers in sJIA patients. Methods. This study included 100 sJIA patients who were examined and treated in the Department of Rheumatology, National Medical Research Center for Children's Health between August 2010 and May 2021. A total of 114 sHLH episodes were registered among study participants. We analyzed medication history, as well as clinical and laboratory parameters reflecting the activity of sHLH and sJIA as potential early markers of sHLH. Multivariate logistic regression analysis was used to assess the predictive value of these markers for sHLH development. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for each factor to evaluate its significance. Receiver operating characteristic (ROC) curves were constructed to assess the sensitivity and specificity of the model. Results. We analyzed a number of factors as potential early sHLH markers, including medication history (treatment with oral or injectable glucocorticoids (GCs) before sHLH, immunosuppressants (methotrexate, cyclosporine, or leflunomide), and biologicals (tocilizumab, canakinumab, adalimumab, etanercept)), clinical signs (fever, rash, hepatomegaly, splenomegaly, lymphadenopathy, myalgia, hemorrhagic syndrome, central nervous system (CNS) lesions, kidney lesions, lung lesions, heart lesions), and laboratory parameters (hemoglobin, absolute count of red blood cells (RBCs), white blood cells (WBCs), neutrophils, lymphocytes, and platelets, erythrocyte sedimentation rate (ESR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), creatinine, blood urea, c-reactive protein (CRP), ferritin, triglycerides, procalcitonin (PCT), total protein, albumin, blood electrolytes (sodium, potassium, chlorides, iron), coagulation parameters (Quick prothrombin, thrombin time, prothrombin time, international normalized ratio (INR), partial thromboplastin time (APTT), D-dimer, fibrinogen, fibrin monomer, von Willebrand factor, protein S, and protein C). Our prognostic model demonstrated that the following variables were significant predictors of sHLH in sJIA patients: lymphadenopathy, red blood cell count <4.34 × 106 cells/mL, platelets <208 × 103 c
背景。继发性噬血细胞性淋巴组织细胞增多症(sHLH)是全身性幼年特发性关节炎(sJIA)的一种潜在致命并发症,其特征是过度炎症和多种临床和实验室表现。在风湿病患者,包括sJIA患者中,这种情况也被称为巨噬细胞激活综合征(MAS)。在本文中,我们使用术语sHLH。大约40%的sHLH病例无症状,特别是在接受生物制剂治疗的患者中。因此,sJIA患者预后模型的建立和早期sHLH标志物的鉴定将有助于及时启动抗炎和免疫抑制治疗。目标。目的:建立sJIA患者的预后模型并识别早期sHLH标志物。方法。本研究纳入2010年8月至2021年5月在国家儿童健康医学研究中心风湿病科接受检查和治疗的100例sJIA患者。研究参与者共记录了114例sHLH发作。我们分析了用药史,以及反映sHLH和sJIA活性的临床和实验室参数,作为sHLH的潜在早期标志物。采用多变量logistic回归分析评估这些标志物对sHLH发展的预测价值。计算每个因素的优势比(ORs)和95%置信区间(CIs),以评估其显著性。构建受试者工作特征(ROC)曲线,评估模型的敏感性和特异性。结果。我们分析了许多可能作为sHLH早期标志物的因素,包括用药史(sHLH前口服或注射糖皮质激素(GCs)治疗,免疫抑制剂(甲氨喋呤、环孢素或来氟米特)和生物制剂(托珠单抗、canakinumab、阿达木单抗、依那西普),临床症状(发烧、皮疹、肝肿大、脾肿大、淋巴结病、肌痛、出血性综合征、中枢神经系统(CNS)病变、肾脏病变、肺部病变、心脏病变),和实验室参数(血红蛋白、红细胞(rbc)、白细胞(wbc)、中性粒细胞、淋巴细胞、血小板、红细胞沉降率(ESR)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ -谷氨酰转移酶(GGT)、乳酸脱氢酶(LDH)、肌酐、血尿素、c反应蛋白(CRP)、铁蛋白、甘油三酯、降钙素原(PCT)、总蛋白、白蛋白、血电解质(钠、钾、氯化物、铁)、凝血参数(快速凝血酶原、凝血酶时间、凝血酶原时间、国际标准化比率(INR)、部分凝血活素时间(APTT)、d -二聚体、纤维蛋白原、纤维蛋白单体、血管性血友病因子、蛋白S和蛋白C)。我们的预后模型显示,以下变量是sJIA患者sHLH的显著预测因子:淋巴结病变、红细胞计数412单位/L。模型的特异性为98.0%;总体准确率为95.6%。roc曲线下面积(AUC)为0.954±0.027 (95% CI 0.902 ~ 1.000;< 0.001)。结论。sJIA患者sHLH最可靠的预后指标无疑是原发性(家族性)噬血细胞淋巴组织细胞增多症基因的杂合突变。此外,sJIA患者的淋巴结病变、红细胞和血小板计数减少、血清氯化物水平降低、血清LDH升高可被解释为sHLH的早期标志物,因此可作为加强抗炎和免疫抑制治疗的指征。关键词:继发性噬血细胞淋巴组织细胞增多症,全身性幼年特发性关节炎,早期标志物,预后模型
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引用次数: 0
Necrotizing enterocolitis in newborns with congenital heart defects: incidence and risk factors 新生儿先天性心脏缺陷的坏死性小肠结肠炎:发病率和危险因素
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.20953/1817-7646-2022-6-62-73
A. Kaplina, N. Petrova, V. Nikiforov, T. Pervunina, A. I. Khavkin, Y. Markova, A. Sukhotskaya, T.V. Podgurskaya, S. Sitkin
Necrotizing enterocolitis (NEC) is a serious complication in newborns with critical congenital heart disease (CHD), prolonging hospital stay, worsening neurological prognosis, and increasing mortality. The leading role in the pathogenesis of NEC in these infants is the violation of mesenteric perfusion. A decrease in arterial blood oxygenation may be an additional risk factor for intestinal hypoxia. Objective. To assess the incidence and risk factors for NEC in full-term newborns with CHD born in 2019–2021 at the Perinatal Center of Almazov National Research Medical Center. Patients and methods. The article presents an analysis of the frequency and risk factors of NEC in children with CHD born at the Almazov National Medical Research Centre in 2019–2021. In the group of critical and duct-dependent CHD (n = 264), the overall incidence of NEC was 15.9% (42 cases). The frequency of surgical stages of NEC (IIIA) was 1.1% (3 cases). In the preoperative period, there was a trend towards a higher frequency of inotropic therapy in a subgroup of children who subsequently developed NEC. NEC in newborns with duct-dependent CHD developed mainly in the early postoperative period after cardiac surgery. In children with duct-dependent pulmonary blood flow, a higher incidence of NEC after surgery was noted compared to children with duct-dependent systemic blood flow. Conclusion. Risk factors for NEC in the postoperative period were arterial hypotension and hemodynamically significant cardiac arrhythmias. Dysbiosis of the gut microbiota and changes in microbial metabolism may be additional risk factors for NEC in children with CHD. Key words: necrotizing enterocolitis, risk factors, congenital heart disease, cardiopulmonary bypass, intestinal microbiome, metabolomics
坏死性小肠结肠炎(NEC)是新生儿重症先天性心脏病(CHD)的严重并发症,可延长住院时间,恶化神经预后,增加死亡率。这些婴儿NEC发病机制的主要作用是肠系膜灌注的破坏。动脉血氧合降低可能是肠道缺氧的另一个危险因素。目标。目的:评估2019-2021年在Almazov国家研究医学中心围产期中心出生的CHD足月新生儿NEC的发病率及危险因素。患者和方法。本文分析了2019-2021年在Almazov国家医学研究中心出生的CHD儿童NEC的频率和危险因素。在危重型和导管依赖性冠心病组(n = 264)中,NEC的总发病率为15.9%(42例)。NEC (IIIA)手术分期占1.1%(3例)。在术前,在随后发展为NEC的儿童亚组中,有更高频率的肌力治疗的趋势。导管依赖性冠心病新生儿NEC主要发生在心脏手术后早期。在导管依赖肺血流的儿童中,手术后NEC的发生率高于导管依赖全身血流的儿童。结论。术后发生NEC的危险因素是动脉低血压和血流动力学上显著的心律失常。肠道菌群失调和微生物代谢的改变可能是冠心病患儿NEC的额外危险因素。关键词:坏死性小肠结肠炎,危险因素,先天性心脏病,体外循环,肠道微生物组,代谢组学
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引用次数: 0
Role of antiviral therapy in respiratory infections in children: analysis of clinical and laboratory observations 抗病毒治疗在儿童呼吸道感染中的作用:临床和实验室观察分析
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.20953/1817-7646-2022-6-45-54
M. Savenkova, E. Isaeva, E. Vetrova, G. Kraseva, N. A. Abramova, M. Shabat, R. Dushkin, S. Fadeeva, S. Kontio, M. P. Savenkov
Objective. To evaluate the efficacy of therapy for acute respiratory viral infections (ARVIs) in children with antiviral medications: inosine pranobex (Groprinosin®, Gedeon Richter) and Kagocel (Kagocel®, Niarmedic Pharma LLC) in comparison with symptomatic treatment without etiotropic agents based on clinical and laboratory parameters. Patients and methods. The clinical and laboratory observation was conducted in an outpatient setting in the pre-COVID-19 period between 2018 and 2020. Acute respiratory infections were diagnosed using licensed testing systems by multiplex polymerase chain reaction (PCR) with detection of nucleic acid viral genomes: influenza, rhinovirus, respiratory syncytial virus, metapneumovirus, parainfluenza, seasonal coronaviruses, adenoviruses, and bocavirus). A total of 151 children aged 3 to 15 years were examined and monitored in dynamics, with 78.7% of positive and 21.3% of negative results detected by PCR in the nasopharyngeal and oropharyngeal swabs. The patients were randomized into three groups depending on the antiviral medication prescribed: group 1 (53 children) received Groprinosin®; group 2 (52 children) received Kagocel®; group 3 (control, 46 children) received only symptomatic therapy without antiviral agents. Results. The study demonstrated a significant positive effect in patients in group 1 treated with Groprinosin® (n = 53). At the end of therapy for both mono- and mixed infections, there were 95.8% of negative results (according to PCR diagnosis, that is, the absence of viral genome). In children in group 2 (n = 52) treated with Kagocel®, the absence of viral nucleic acids (NAs) was observed less frequently (in 77.3% of cases). In children in group 3 (n = 46) who did not receive etiotropic antiviral therapy, there were only 40.3% of negative results after the end of treatment, and viral NAs were detected in 59.7% of patients. In this case, a 5-day course of Groprinosin® was prescribed, after which the PCR results became negative in all patients. Therefore, children with recurrent respiratory infections, mixed infections, and herpesvirus infections require longer therapy. Additionally, a high frequency of ARVI complications was noted in group 3 (5 (10.9%) patients, where otitis was observed in 1 case, sinusitis – in 2 cases, bronchitis – in 2 cases), whereas 1 (1.8%) patient taking Groprinosin® had otitis, and 1 (1.9%) patient taking Kagocel® had pneumonia. Conclusion. This study was the first to investigate antibody titers to respiratory viruses in dynamics at 3, 6 and 12 months after the onset of ARVI. It showed that the development of antibodies to respiratory viruses is very unstable and does not occur in all patients. Antibodies almost disappeared by the third month after ARVI and were no longer detectable by the sixth month. After 12 months, patients suffered a new ARVI and developed the corresponding antibodies. This information will be especially relevant in conditions of the rise in the incidence
目标。基于临床和实验室参数,评估使用抗病毒药物:肌苷pranobex (Groprinosin®,Gedeon Richter)和Kagocel (Kagocel®,Niarmedic Pharma LLC)治疗儿童急性呼吸道病毒感染(ARVIs)的疗效,并与不使用致病因药物的对症治疗进行比较。患者和方法。2018年至2020年在门诊进行临床和实验室观察。急性呼吸道感染的诊断使用经许可的检测系统,采用多重聚合酶链反应(PCR)检测核酸病毒基因组:流感、鼻病毒、呼吸道合胞病毒、偏肺病毒、副流感、季节性冠状病毒、腺病毒和bocavavirus)。对151名3 ~ 15岁儿童进行了动态检查和监测,鼻咽和口咽拭子PCR检测结果为78.7%阳性,21.3%阴性。根据所开的抗病毒药物,患者被随机分为三组:第一组(53名儿童)接受Groprinosin®;第二组(52名儿童)接受Kagocel®治疗;第三组(对照组46例)仅对症治疗,不使用抗病毒药物。结果。研究显示,第1组接受Groprinosin®治疗的患者(n = 53)有显著的积极效果。在治疗结束时,无论是单一感染还是混合感染,均有95.8%的阴性结果(根据PCR诊断,即病毒基因组缺失)。在Kagocel®治疗的第2组儿童(n = 52)中,观察到病毒核酸(NAs)缺失的频率较低(77.3%的病例)。第3组(n = 46)未接受致病因抗病毒治疗的患儿,治疗结束后阴性结果仅为40.3%,59.7%的患者检出病毒NAs。在这种情况下,处方5天疗程的Groprinosin®,之后所有患者的PCR结果均为阴性。因此,复发性呼吸道感染、混合性感染和疱疹病毒感染的儿童需要更长时间的治疗。此外,第3组ARVI并发症的发生率较高(5例(10.9%)患者,其中1例出现中耳炎,2例出现鼻窦炎,2例出现支气管炎),而服用Groprinosin®的1例(1.8%)患者出现中耳炎,服用Kagocel®的1例(1.9%)患者出现肺炎。结论。这项研究首次调查了ARVI发病后3、6和12个月呼吸道病毒抗体滴度的动态变化。这表明呼吸道病毒抗体的产生是非常不稳定的,并不是所有患者都会产生抗体。抗体在ARVI后的第3个月几乎消失,到第6个月已无法检测到。12个月后,患者再次发生ARVI并产生相应的抗体。在抗逆转录病毒药物发病率上升以及近年来观察到的COVID-19大流行的情况下,这一信息将特别具有相关性。关键词:抗病毒药物,聚合酶链反应,急性呼吸道病毒感染特异性抗体,儿童,临床和实验室动力学,肌苷pranobex, Groprinosin®,Kagocel®
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引用次数: 0
Comparative analysis of physical development indicators of adolescent boys in the 20th and 21st centuries (secular trend) on the model of the Republic of Dagestan 基于达吉斯坦共和国模型的20世纪和21世纪青春期男孩身体发育指标的比较分析(长期趋势)
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.20953/1817-7646-2022-1-142-149
K. G. Kamalov, A. Arslanbekova, D.A. Arslanbekova, I. M. Magomedova
The study of the physical development of adolescent population in the Republic of Dagestan is insufficient and attracts the attention of endocrinologists. A detailed examination of the features of physical development in this region could help to clarify the general patterns of acceleration or deceleration taking place in this territory of the Russian Federation. Objective. To conduct a comparative analysis of physical development indicators of adolescent boys during puberty in 1970-1990 with similar indicators of 2005-2010. Methods. The physical development of adolescents aged 11-17 years was examined in the mountain, foothill, and plain ecological and geographical zones of the Republic of Dagestan. Results. The physical development of boys aged 11-14 years in all ecological and geographical zones of the Republic of Dagestan in both groups was comparable (p > 0.05). Adolescents in the older age group of 15-16 years (group 1) outperformed their peers (group 2) by an average of 0.6-2.1%. From the age of 16, there was a “crossing” of the centile curves of physical development, and adolescents aged 16–17 years (group 2) already outperformed their peers (group 1) in all ecological and geographical zones of the Republic of Dagestan. This was most evident when comparing the physical development of the boys living in the foothill zone, where this difference was significant at 4.0-7.5% (p < 0.04) when comparing the two age groups (group 1 and 2). Final height by the end of puberty in adolescents in group 1 was in the range of 152.0 ± 2.7 cm and 163.0 ± 1.3 cm and in group 2 – 156.3 ± 0.7 cm and 167.7 ± 0.9 cm. Conclusion. The analysis and general secular trend of physical development indicators of adolescents at the turn of the 20th and 21st centuries on the model of the Republic of Dagestan showed that anthropometric parameters of adolescents in the Russian Federation demonstrate the presence of specific regional features – environmental, socio-economic, and anthropogenic. Key words: anthropometric data, Republic of Dagestan, retrospective indicators of adolescents, secular trend, comparative analysis, physical development
达吉斯坦共和国青少年体质发育的研究不足,引起了内分泌学家的关注。对这一地区物质发展特点的详细研究有助于澄清在俄罗斯联邦这一领土上发生的加速或减速的一般模式。目标。对1970-1990年青春期男孩身体发育指标与2005-2010年相似指标进行对比分析。方法。在达吉斯坦共和国的山区、丘陵和平原生态和地理区域对11-17岁青少年的身体发育进行了调查。结果。达吉斯坦共和国所有生态和地理区域11-14岁男孩的体格发育在两组间具有可比性(p < 0.05)。15-16岁年龄组(第1组)的青少年平均比同龄人(第2组)高出0.6-2.1%。从16岁开始,身体发育的百分位曲线出现了“交叉”,16 - 17岁的青少年(第二组)在达吉斯坦共和国所有生态和地理区域的表现都超过了同龄人(第一组)。这在比较山麓地区男孩的身体发育时最为明显,在比较两个年龄组(1组和2组)时,差异显著,为4.0-7.5% (p < 0.04)。青春期结束时,1组青少年的最终身高在152.0±2.7厘米和163.0±1.3厘米之间,2组在156.3±0.7厘米和167.7±0.9厘米之间。结论。以达吉斯坦共和国为模型,对20世纪和21世纪之交青少年身体发育指标的分析和总体长期趋势表明,俄罗斯联邦青少年的人体测量参数显示出特定的区域特征——环境、社会经济和人为因素。关键词:人体测量数据,达吉斯坦共和国,青少年回顾性指标,长期趋势,比较分析,身体发育
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引用次数: 0
Functional gastrointestinal disorders in infants: is it possible to treat them with infant formulas? 婴儿功能性胃肠疾病:是否可以用婴儿配方奶粉治疗?
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.20953/1817-7646-2022-1-157-166
I.N.Kholodova I.N.Kholodova, E.S.Kiseleva E.S.Kiseleva
The etiology, pathogenesis, and characteristics of neonatal colic are being actively explored by clinicians and researchers. The impact of nutrition on colic in newborns is still not fully understood and requires further investigations. This article discusses the role of functional nutrients of infant formulas (including prebiotics and probiotics) in the prevention and correction of colic in newborns and their impact on the formation of the intestinal microbiota. It also focuses on the effect of prebiotics in the diet on the intestinal microbiome composition, severity of colic in newborns, and association between the presence of probiotic cultures in the diet and development of colic. We emphasize the importance of studying microbiome composition and metabolites produced by intestinal commensals, including short-chain fatty acids. We also describe possible prebiotic and probiotic effects of infant formula containing goat milk. Key words: infantile colic, infant formula, prebiotics, prebiotics, oligosaccharides 2'-FL, GOS, Bifidobacterium lactis, gut microbiota, goat milk
新生儿绞痛的病因、发病机制和特点正被临床医生和研究人员积极探索。营养对新生儿肠绞痛的影响尚不完全清楚,需要进一步调查。本文讨论了婴儿配方奶粉中功能性营养素(包括益生元和益生菌)在预防和纠正新生儿肠绞痛中的作用及其对肠道菌群形成的影响。它还侧重于饮食中益生元对肠道微生物组组成的影响,新生儿肠绞痛的严重程度,以及饮食中益生菌培养物的存在与肠绞痛发展之间的关系。我们强调研究肠道共生菌产生的微生物组组成和代谢物的重要性,包括短链脂肪酸。我们还描述了含有羊奶的婴儿配方奶粉可能产生的益生元和益生菌效应。关键词:婴儿肠绞痛,婴儿配方奶粉,益生元,益生元,低聚糖2′-FL, GOS,乳酸双歧杆菌,肠道菌群,羊奶
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引用次数: 0
Changes in the body mass index of children, adolescents, and youth: trends observed in the end of the 20th century and beginning of the 21st century 儿童、青少年和青年体重指数的变化:20世纪末和21世纪初观察到的趋势
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.20953/1817-7646-2022-1-185-189
V. Lyakh, S. Levushkin, N. Skoblina
The investigation of changes in the parameters reflecting physical development of children, adolescents, and youth under the influence of genetic, environmental, social, and other factors has both scientific and practical value. Objective. To analyze changes in the body mass index (BMI) of children, adolescents, and youth in the late 20th century and early 21st century in different countries. We used the information form the Scopus database and Russian citation databases. We observed global secular trends demonstrating increasing BMI index and the number of overweight and obese children, adolescents, and youth. The last 40 years were characterized by particularly worrying trends with the proportion of overweight and obese children and adolescents reaching 25.0%. From pathophysiological point of view, this leads to a number of metabolic diseases. In countries with a well-developed industrial sector, the secular trends in height of children, adolescents, and youth weakened in the last decade of the 20th century and in the beginning of the 21st century. By contrast, their body weight continued to increase during this period. Conclusion. Overweight and obesity have become so widespread globally that many researchers are currently talking about an obesity epidemic. Key words: children, body mass index, physical development
研究遗传、环境、社会等因素影响下儿童、青少年身体发育参数的变化,既有科学价值,也有实用价值。目标。分析20世纪末和21世纪初不同国家儿童、青少年和青年体重指数(BMI)的变化。我们使用了来自Scopus数据库和俄罗斯引文数据库的信息。我们观察到全球长期趋势表明BMI指数和超重和肥胖儿童、青少年和青年的数量不断增加。过去40年的特点是特别令人担忧的趋势,超重和肥胖儿童和青少年的比例达到25.0%。从病理生理学的角度来看,这导致了许多代谢性疾病。在工业部门发达的国家,儿童、青少年和青年身高的长期趋势在20世纪最后十年和21世纪初有所减弱。相比之下,他们的体重在此期间继续增加。结论。超重和肥胖在全球范围内变得如此普遍,以至于许多研究人员目前都在谈论肥胖流行病。关键词:儿童,体重指数,身体发育
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引用次数: 1
Infants after artificial lung ventilation. New approaches to rehabilitation 婴儿人工肺通气后。康复的新方法
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.20953/1817-7646-2022-1-24-35
P. V. Morozov, S.V. Novoseltsev
Objective. To improve rehabilitation of infants who received respiratory support at birth. Patients and methods. This prospective comparative study was conducted in the Children's City Polyclinic No 13 of Yekaterinburg and included 131 infants who received different types of artificial lung ventilation (ALV) for some respiratory disorders. All patients were followed up by a pediatrician, neurologist, pulmonologist, and an infectious disease specialist; all of them received appropriate therapy. The experimental group comprised 99 infants who additionally received a course of osteopathic (manual) correction for 8–10 weeks, whereas the control group included 32 infants who received standard therapy only. Patients in the experimental and control groups were matched for all parameters. In addition to chest X-ray, all study participants underwent an assessment of their neurological, somatic, and biomechanical statuses. Osteopathic treatment (4 to 6 sessions lasting 30–40 minutes each) was performed by one osteopathic doctor. Statistical analysis was conducted using the SPSS Statistics.26 software; we calculated Pearson's linear correlation coefficient and used Fisher's exact test and McNemar's test. Differences were considered significant at p < 0.05. Results. Seventy-nine infants (79.8%) initially had both neurological and somatic disorders. Ten patients (10.1%) had either somatic disorders (such as labored nasal breathing, regurgitation, constipation, thermoregulation disorder) or neurological disorders (weather sensitivity, sleep disorders, delayed motor and/or neuropsychiatric development, impaired blood and cerebrospinal fluid dynamics) alone. We identified three groups of major somatic dysfunctions (SDs) in the biomechanical status: local (levels: С0–СI, sternum, thoracoabdominal diaphragm, sacrum); regional (cervical spine–level СII–СVI, laryngopharyngeal complex, lungs, abdominal cavity, skull); and global dysfunction of the dura mater. After treatment, the frequency of all neurological and somatic disorders, as well as the frequency of all SDs reduced in the experimental group (p < 0.001). Pathological changes on chest X-rays (elevated diaphragm, low mobility of the thoracic diaphragm, bullae, pleurodiaphragm atic adhesions, etc.) were detected in 89 patients (67.9%), including 66 infants from the experimental group (66.7%) and 23 infants from the control group (71.8%). Osteopathic (manual) treatment significantly reduced the number of patients with abdominal diaphragm dysfunction (56.6% vs. 26.3%), bullae (35.3% vs. 11.1%), and middle lobe syndrome (8.1% vs. 2%) (p < 0.001). The number of patients with thoracoabdominal diaphragm dysfunction in the control group did not change (n = 18; 56.2%). Positive radiological dynamics was observed in 90.9% of patients from the experimental group and 43.5% of patients from the control group. Moreover, only infants from the control group demonstrated negative radiological dynamics (17.4%). Conclusion. Newb
目标。改善出生时接受呼吸支持的婴儿的康复。患者和方法。本前瞻性比较研究在叶卡捷琳堡第13儿童城市综合医院进行,纳入131名接受不同类型人工肺通气(ALV)治疗某些呼吸系统疾病的婴儿。所有患者均由儿科医生、神经科医生、肺科医生和传染病专家进行随访;所有患者均接受了适当的治疗。实验组包括99名婴儿,他们额外接受8-10周的整骨疗法(手工)矫正,而对照组包括32名婴儿,他们只接受标准治疗。实验组与对照组患者各项参数匹配。除了胸部x光检查外,所有研究参与者还接受了神经、身体和生物力学状态的评估。整骨疗法(4 - 6个疗程,每次30-40分钟)由一名整骨医生进行。采用SPSS Statistics.26软件进行统计分析;计算Pearson线性相关系数,采用Fisher精确检验和McNemar检验。p < 0.05认为差异有统计学意义。结果。79名婴儿(79.8%)最初同时患有神经和躯体疾病。10例患者(10.1%)有躯体疾病(如鼻呼吸困难、反流、便秘、体温调节障碍)或神经系统疾病(天气敏感性、睡眠障碍、运动和/或神经精神发育迟缓、血液和脑脊液动力学受损)。我们确定了三组生物力学状态下的主要躯体功能障碍(SDs):局部(水平:С0 -СI、胸骨、胸腹横膈膜、骶骨);区域(颈椎水平СII -СVI,喉咽复合体,肺,腹腔,颅骨);以及硬脑膜的整体功能障碍。治疗后,实验组所有神经和躯体疾病的频率以及所有SDs的频率均降低(p < 0.001)。89例(67.9%)患者胸部x线表现为横膈膜升高、横膈膜低活动、大泡、胸膜粘连等病理改变,其中实验组66例(66.7%),对照组23例(71.8%)。整骨疗法(手工)治疗显著减少了腹膈功能障碍(56.6%比26.3%)、大泡(35.3%比11.1%)和中叶综合征(8.1%比2%)的患者数量(p < 0.001)。对照组胸腹横膈膜功能障碍患者人数无变化(n = 18;56.2%)。实验组90.9%患者放射动力学阳性,对照组43.5%患者放射动力学阳性。此外,只有对照组的婴儿表现为阴性放射动力学(17.4%)。结论。不同呼吸系统疾病的新生儿(包括早产儿和足月新生儿)接受了所有类型的ALV,发现有典型的SDs谱。其发病机制的关键方面是膈神经的原发性病变。骨病手法矫正SDs明显提高综合治疗的疗效,x线检查结果证实了这一点。关键词:躯体功能障碍,胸膈,膈神经,人工通气,手工治疗,早产儿,新生儿,骨科矫正
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引用次数: 1
Assessment of spraying characteristics of two nasal sprays containing framycetin 两种含真菌素鼻腔喷雾剂的喷雾特性评价
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.20953/1817-7646-2022-2-109-116
S. Gribanova, V. Yankova, O. Gobyzov, M. Ryabov, A. Karpova, S. Kedik, I. Udyanskaya, V. Grigorieva, I. I. Krasnyuk (jr.), T. Slonskaya, A.A. Zhukova
Objective. To compare spraying characteristics of two nasal sprays containing framycetin – Isofra and Tramicent Materials and methods. We used a silicone model of the nasal cavity (Koken Co. Ltd., Tokyo, Japan) to assess dose distribution of the drug inside the nose. Shadow photography was applied to analyze dynamic characteristics of spraying and the dispersed composition of spray particles. Results. Using a silicone model, we evaluated the dose distribution of the spray inside the nasal cavity. We compared dose distribution of two nasal sprays containing framycetin (Isofra and Tramicent) with full and half-full bottles. Shadow photography was applied to evaluate dynamic characteristics of these sprays, including total duration of spraying, duration of its individual phases, spraying angle, as well as dispersion characteristics, such as average particle size and particle size distributions. Conclusion. The experiments with a silicone nose model demonstrated that Isofra ensured a larger distribution area inside the nasal cavity compared to Terramycin, which suggests a better coverage of the nasal mucosa with Isofra. Comparison of dynamic spraying characteristics (including duration of spraying phases, spraying angle, and shape of the cone) between Isofra and Tramicent using shadow photography showed that Isofra ensured a more homogenous spraying coverage with fine particles. Comparison of the dispersion composition of the two sprays showed that most of the Isofra dose was sprayed with smaller drops than Tramicent, which indicates a better dispersion of Isofra. Our findings suggest that Isofra ensured high quality spraying and effective delivery of the medicine into the nasal cavity. Key words: framycetin, spray, silicone nose model, shadow photography, spray characteristics
目标。比较两种含异氟拉霉素鼻喷雾剂的雾化特性。我们使用硅胶鼻腔模型(日本东京Koken公司)来评估药物在鼻内的剂量分布。采用阴影摄影法对喷雾的动态特性和喷雾颗粒的分散组成进行了分析。结果。使用硅胶模型,我们评估了喷雾在鼻腔内的剂量分布。我们比较了两种含framycetin鼻喷雾剂(Isofra和Tramicent)在满瓶和半满瓶时的剂量分布。采用阴影摄影法评价喷雾的动态特性,包括总喷射时间、各阶段持续时间、喷射角度以及平均粒径和粒径分布等分散特性。结论。硅胶鼻模型实验表明,与Terramycin相比,Isofra在鼻腔内的分布面积更大,这表明Isofra对鼻黏膜的覆盖更好。采用阴影摄影法对Isofra和Tramicent的动态喷涂特性(包括喷涂阶段持续时间、喷涂角度和锥形)进行比较,结果表明,Isofra能保证更均匀的细颗粒喷涂覆盖。两种喷雾剂的分散成分比较表明,大部分剂量的异戊异黄酮喷雾剂的滴度比曲美森小,表明异戊异黄酮的分散效果更好。我们的研究结果表明,Isofra保证了高质量的喷雾和有效的药物进入鼻腔。关键词:框架霉素,喷雾,硅胶鼻模型,阴影摄影,喷雾特性
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引用次数: 0
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Voprosy Prakticheskoi Pediatrii
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