Vestnik Rossiiskoi Akademii Meditsinskikh Nauk最新文献

Background: Problems of optimization diagnosis methods and prognosis for lung cancer remain unsolved. Lung cancer occupied the leading positions among cancer diseases.

Aims: Establishing change patterns in the parameters of endogenous intoxication and lipid peroxidation in the saliva of patients with lung cancer depending on the histologic type of tumor.

Materials and methods: The case-control study enrolled 516 men, who were divided into 3 groups: main (lung cancer, n=256), comparison group (non-malignant lung diseases, n=60), and control group (relatively healthy, n=200). Questioning and biochemical saliva study were carried out to all participants. Patients of the main group and the comparison group were hospitalized for surgical treatment, after which underwent the histological verification of the diagnosis. We used the spectrophotometric methods of investigation of parameters of lipid peroxidation and endogenous intoxication. Between-group differences were evaluated by nonparametric tests.

Results: Malondialdehyde as a product of lipid peroxidation is a little informative result. For more information it is necessary to determine the individual fractions of middle toxins count distribution ratio 280/254 nm, as well as to take into account the level of conjugated diene, triene conjugates, and Schiff bases. The following changes are observed at the transition from the control group to the comparison group, and then to the main: increased levels of triene conjugates and Schiff bases, as well as malondialdehyde. At the same time we detected the reduction in the level of diene conjugates, which confirms the fact of the increase in the oxidative stress process associated with benign diseases and lung cancer. In addition, there is a decrease in the content of individual fractions of middle toxins, but 280/254 nm partition coefficient growth is observed.

Conclusions: The findings support the hypothesis of the association processes of lipid peroxidation and endogenous intoxication with the development of lung cancer. It confirmed the dependence of these parameters on the histological type of tumor, the presence / absence and the degree of prevalence of remote and regional metastasis.

Background: Analysis of publication activity in the field of biomedicine shows insignificant input of Russia in the world scientific product. This is largely due to the lack of incentives for researchers. Article describes stimulation of researchers in Russia, compares it with foreign models, formulates main shortcomings of support and stimulation of research in Russia and introduces the concept of effective contract.

Aims: Development of personnel motivation and stimulation of employees of scientific and research organizations in the field of health.

Materials and methods: As a successful experience the article describes the implementation of effective contract in Veltishev Research and Clinical Institute for Pediatrics where for years remuneration of researchers depended upon their positions without consideration of research results. Effective contract brought significant changes in the traditional system setting new performance and efficiency criteria. New evaluation system took into account publication activity, presentation activity, implementation of research results, raising scientific personnel, thesis work and income-generating activities.

Results: Introduction of effective contract already in the second year led to a rise in the number of foreign publications, publications in journals with impact factor of more than 2, the general increase in the number of articles in peer-reviewed journals with impact factor more than 0.3, the growth of the number of articles by 1 researcher, Hirsch index improving both by individual employees and the entire Institute, increase of grant activity and presentation activity at top-rated professional congresses. The growth of publication and presentation activities has been achieved at the reduction of research staff by 23%. From financial viewpoint effective contract resulted in the redistribution of resources in favour of more efficient researchers.

Conclusions: The introduction of effective contract and increase of requirements for scientific output did not cause resistance of staff, although demanded certain time for joint development of criteria by scientific community, as well as the development and implementation of soft for continuous assessment of research activity.

The opportunities and the most promising ways of using cellular technology in traumatic spinal cord injury are considered in this review. A large number of experimental and clinical studies with the use of different types of cells: embryonic stem cells, induced pluripotent stem cells, mesenchymal stem cells, Schwann cells, olfactory mucosa cells, and others – was conducted. The use of these types of cells in traumatic spinal cord injury treatment often demonstrated a positive therapeutic effect: the motor and sensory function recovery of the spinal cord. However, some types of cell preparations involve some methodological and ethical problems; some types of cell therapies are ineffective or give rise to side effects. These factors complicate the selection of optimal cell therapy for the traumatic spinal cord injury treatment. The most promising cells seem to be the cells of the olfactory mucosa. Getting the olfactory mucosa is considered to be a feasible and safe procedure for patients. The clinical application of the cells of the olfactory mucosa is effective in motor function recovery due to remyelination and axonal regeneration after spinal cord injury. These cells are tissue-specific and autologous since they can be obtained from a patient with spinal cord injury, and after cultivation, expansion, and directed differentiation they can be transplanted to the same patient. The presented benefits of olfactory mucosa cells open up the possibility for its clinical application in the cell therapy.

Unlabelled: BACKGRAUND. Treponemal tests based on the detection of antibodies against the Treponema pallidum antigens are the most specific methods for serological diagnosis of syphilis. Due to the inability to cultivate this bacterium in vitro, the most promising sources of antigens for diagnostics are recombinant proteins of T. pallidum. Evaluation of the analytical value of certain T. pallidum proteins is the approach to improve sensitivity, specificity, and reproducibility of syphilis serological tests, including possibilities of differential diagnosis of various forms of the disease.

Objective: The aim of the research was to evaluate the analytical values (sensitivity and specificity) of recombinant protein Tp0965 of T. pallidum as a candidate antigen for serological diagnosis of syphilis.

Methods: tp0965 gene was cloned into the expression vector pET28a and the construct was used for the transformation of E. coli BL-21 (DE3) cells and further expression and purification of the recombinant protein. The collected protein was used as T. pallidum antigen for serum analysis (ELISA) of groups of patients with various forms of syphilis (n=84) and the group of healthy donors (n = 25).

Results: High frequency of positive ELISA results was shown with serum of patients with syphilis, compared to the group of healthy donors. The sensitivity of serological reactions using recombinant protein Tp0965 was 98.8%, specificity--87.5%. The highest sensitivity (100%) was detected in the groups of patients with primary, secondary and early latent syphilis while in the group of patients with late latent syphilis it decreased to 95.2%.

Conclusions: We concluded that due to its specificity T. pallidum recombinant protein Tp0965 can be used as a novel perspective antigen for development of syphilis serological diagnostic assays (for primary and early latent forms).

Aim: Transanal endoscopic microsurgery (TEM) is a main treatment technique for rectal adenomas, but can also be used for selected malignant tumors. This study presents TEM experience.

Methods: The study enrolled patients with rectal adenomas, and selected adenocarcinomas. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic MRI.

Results: Three hundred and thirty patients [mean age of 61,4±10 (33–88)] underwent TEM. The mean size ± SD of tumors was 3.2±1.2 cm (0.6–10.0). Mean distance from anal verge was 6.7±2.6 cm (2.0–14.0). Preoperative biopsy revealed: adenoma ― 263/330 (79,7%), adenocarcinoma ― 67/330 (20,3%). The median operating time was 40 (15–220) min. Tumor-free margins were obtained in all operative specimens. In 5/330 (1.5%) cases tumors were fragmented. The morbidity rate was 19/330 (5.7%). Pathological investigation revealed: adenoma in 192/330 (58.1%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 138/330 (41.9%). Median follow-up lasted for 24 (1–57) months. Five patients (2.0%) with adenoma and four patients (5.2%) with adenocarcinoma had local recurrence.

Conclusion: Transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.

Background: Myokines are produced and released by muscle cells in response to muscular contractions. Endogenous Cushing syndrome (CS) and acromegaly cause significant changes in muscle tissue leading to atrophy or hypertrophy. However, there is no data whether these endocrine abnormalities influence myokine secretion.

Aims: To evaluate serum levels of myostatin, interleukin-6 (IL6) and irisin in patients with CS and acromegaly.

Materials and methods: Fasting serum samples were taken and stored in aliquot at ≤-20°C from consecutive subjects with clinically evident and biochemically confirmed active CS, acromegaly and healthy volunteers matched by age, sex and body mass index (BMI). Commercially available kits were used to assay serum myokine levels. Grip strength was measured by a dynamometer. Insulin-like growth factor-1 (IGF1) was measured by immunochemiluminescence assay (Liaison), twenty-four hours urine free cortisol (24hUFC) ― by immunochemiluminescence assay (Vitros ECi), salivary free cortisol ― by electrochemiluminescence assay (Cobas). One-way ANOVA was utilized to assess the difference between groups.

Results: We enrolled 88 subjects: 30 patients suffered from CS (group 1), 28 ― acromegaly (2) and 30 matched healthy controls (3) with no difference among the groups in sex, age and BMI (p=0.492, 0.062 and 0.174 respectively). Mean 24hUFC in subjects with CS and mean IGF1 in subjects with acromegaly were significantly higher as compared to other groups (p<0.001). Right-hand grip strength was lower in patients with CS as compared to both patients with acromegaly and healthy subjects (p=0.04). However, among these young adults we did not find statistically significant differences in measured myokines levels: irisin ― p=0.15; IL6 ― p=0.34; myostatin ― p=0.50. There was a significant correlation between myostatin and irisin in the whole group of people and in every separately analyzed subset of patients (p<0.001), but no correlation was found between any measured myokines and 24hUFC or IGF1.

Conclusions: Hypercortisolism or supraphysiological IGF1 levels do not significantly influence serum levels of myostatin, IL6 and irisin in young adults.

Article consists of literature review, authors experience of the application of neurovisualization and neurophysiological research methods to predict the recovery of consciousness in patients in vegetative state (VS). According to the literature data PET with FDG has higher sensitivity in the detection of signs of consciousness, then functional MRI (fMRI). The method fMRI allows assessing the functional activity of the brain in a state of rest and in response to stimulation with different modalities ― visual, auditory, etc (with the application of active and passive paradigm). A higher specificity in the detection of signs of consciousness have the methodology of fMRI with the active paradigm, at the same time, the absence of signs of consciousness according to the fMRI can not be charged as a basis for the conclusion of a poor prognosis in a particular patient. Neurophysiological tests (EEG, TMS, EP, etc) are more readily available and quite effective. Based on the literature analysis, the authors comes to the conclusion that neurovisualization and neurophysiological tests used in the prediction of the outcome of VS reflects the residual functional activity of different brain areas, in a context of diffuse brain damage, and the recovery of consciousness is usually combined with the restoring of the functional activity off the thalamocortical tracts, which activity, indirectly, is evaluated using these methods. In the authors' opinions, the main disadvantage in the interpretation of the is the lack of a common pathophysiological concept of the organization of brain functions in VS patients. The authors offer for the discussion their concept of stable pathological states of the brain, which is based on the works of Russian pathophysiologists.

Aim: To evaluate the influence of different methods of local treatment on tissue repair in patients with diabetic foot ulcers.

Materials and methods: We evaluated such clinical characteristics as wound size and local perfusion after using negative pressure wound therapy (NPWT), local collagen, and standard care in patients with diabetic foot ulcers. We observed 63 patients with neuropathic and neuroischemic forms of diabetic foot (without critical ischemia) after surgical debridement. After that 21 patients received NPWT, 21 local collagen treatment and 21 ― standard care.

Results: After using NPWT wound area and depth decreased in 19,8% and 42,8% (p<0.05), in group of collagen dressings in 26,4 and 30,4% (p<0.05). In control group those parameters were 17,0 и 16.6% respectively (p<0.05). There was found the significant increase of local perfusion according to oxygen monitoring in group of NPWT (p<0.05).

Conclusion: The received data showed that the intensity of lower limb tissue repair processes increases more significant after using NPWT and collagen dressings in comparison to standard care which is found according to wound size and tissue perfusion alterations.

Background: Antibiotic tolerance (AT) represents one of the causes of the phenomenon of antibiotic resistance that allows escape of non-replicating metabolically inert microorganisms (persisters) from any antibiotics attack because molecular targets of antibiotics are lacking thereby creating the potential for chronic infections.

Aims: Determine the heterogeneity of the strains of opportunistic pathogens E. coli and P. aeruginosa isolates from children with hematologic malignancies containing bacterial persisters that cause the AT phenomenon.

Methods: Children with hematological malignancies were divided into 2 groups according to the intensity of antibiotic treatment of infectious complications. Ciprofloxacin-induced persisters were quantitatively determined in the biological materials obtained from sick children.

Results: Within the clinical isolates of E. coli and P. aeruginosa, about a third of the strains belong to high-persisting. The numbers of persistent forms of bacteria did not correlate with a minimal inhibitory concentration values ciprofloxacin (r=0.148, n=25, p>0.05). Interestingly, higher level of formation of persistent E. coli and P. aeruginosa, is associated with higher frequencies of infection attacks, massive antibiotic use and unfavorable course of the disease in children.

Conclusions: Therefore, detecting the persistent forms of bacterial pathogens including those associated with the health-care associated infection, specifically, in immunocompromised patients, should be included into the contemporary algorithms of microbiological observation and monitoring of patients and intrahospital environment.

The article is a brief review of publications devoted to the problem of persistent dysphonia. The main cause of voice disorders is the scarring of the vocal folds resulting from trauma, surgical manipulation, inflammatory process. Treatment of cicatricial lesions of the vocal folds remains a challenge, as far as existing methods do not ensure the recovery of the ultrastructure of the vocal folds. The authors present modern data on the structure of the vocal folds at the cellular level. Considered pathologic processes occur in different stages of scarring. Applied technologies of phonosurgery and conservative treatment, their effectiveness and shortcomings are covered. Analysis of experimental research conducted in the world demonstrates the promise of using the methods of tissue engineering to treat scarring of the vocal folds and to restore the microstructure of the latter. Identified current issues remain unresolved, which leads to the need for further experimental and clinical studies in the treatment of this pathology.