Vol 100, No 6 (2019)

Aim. The study of the diagnostic value of KIM-1 and NGAL in urine and cystatin C in the blood plasma of low birth weight infants with ischemic nephropathy.

Methods. 150 newborns were divided into 3 groups: main group — 72 low birth weight infants with manifestations of ischemic nephropathy divided into three subgroups: group 1A — mild (n=36), 1B — moderate (n=20), 1C — severe (n=16); comparioson group — 28 low birth weight infants without the evidence of ischemic nephropathy; control group — 50 healthy newborns (20 full-term and 30 preterm).To assess the state of tubular epithelium of the kidneys, the levels of KIM-1 and NGAL were measured in the urine of neonates, to assess the state of glomerular filtration the level of сystatin C in the blood plasma was determined. Samples of blood and urine were collected twice, on days 1 to 3 and 7 to 10. Biomarker levels were determined by solid-phase enzyme immunoassay.

Results. In the main group on day 1 to 3 of life KIM-1 and NGAL in the urine were significantly elevated compared to the control group (p <0.001). On day 7 to 10 the level of KIM-1 in the urine in subgroup 1A decreased (0.98±0.09 ng/dl), while remaining significantly higher compared to the control group, and in subgroups 1B and 1C it increased to 1.24±0.10 and 1.36±0.12 ng/dl, respectively. On day 7 to 10 of life the concentration of NGAL in the urine of children of all three subgroups declined, remaining significantly high compared to the control values. Сoncentration of cystatin C was significantly high only in newborns of subgroup 1C (p <0.001).

Conclusion. Molecules of NGAL and KIM-1 are early markers of the renal ischemic injury in low birth weight infants who suffered perinatal hypoxia, and cystatin C cannot be considered an early predictor of renal damage in low birth weight infants with ischemic nephropathy as its level in the blood rises only in severe damage.

Aim. To study the long-term results of surgical treatment of patients with thyroid adenomas.

Methods. From 2004 to 2006, 667 patients with follicular adenomas of the thyroid gland, including 134 (20.1%) men and 533 (79.9%) women, were operated on in the surgical department №2 of city clinical hospital №11 of Ryazan. 3 groups of patients were defined: group 1 — operated on for solitary adenomas of the thyroid gland, 103 patients, hemithyreoidectomy performed; group 2 — operated on for multiple adenomas of the thyroid in both lobes, 101 patients, thyroidectomy performed; group 3 — 32 patients operated on for multiple adenomas of the thyroid in the same lobe, hemithyreoidectomy performed. Patients were examined 14 years after the surgery.

Results. Hypothyroidism was diagnosed in: group 1 — 18 (17.5%) patients, group 2 — 101 (100%), group 3 — 0. All patients with hypothyroidism were compensated with hormone replacement therapy. Permanent hypoparathyroidism was diagnosed only in group 2 — 8 (4.8%) patients. Unilateral laryngeal paralysis was found in group 1 in 1 (0.9%) patient, group 2 in 2 (1.9%) patients, group 3 contained no such patients. Recurrence (node more than 1 cm according to ultrasound) was observed in group 1 in 12 (11.7%) patients; fine-needle aspiration found colloidal nodes in 8 (7.8%) patients (Bethesda II), in 4 (3.9%) — follicular tumor (IV). Group 2 had no recurrences. In group 3 11 (34.3%) patients had recurrence; fine-needle aspiration found colloidal nodes in 1 (3.1%) patient (Bethesda II), in 10 (31.3%) — follicular tumor (Bethesda IV).

Conclusion. In solitary adenomas it is possible to perform organ-saving operations, which reduces the percentage of postoperative complications; in multiple adenomas, the optimal volume of surgery is thyroidectomy; when multiple adenomas are localized in one lobe, the chance of recurrence of the disease (31.3%) is high leading to re-surgery.

Aim. To study creatinine clearance, body mass index and to perform ROSE survey amomg patients with hypertension of different age groups at territorial internist's area.

Methods. The study involved 112 patients aged 40 to 75 years. Patients were divided into two groups according to the age: group 1 — 40 to 61 years, 55 people (15 men and 40 women), the average age 52.6±7.1 years; group 2 — 62 to 75 years, 57 people (15 men and 42 women), the average age 69.8±4.4 years. Creatinine clearance and body mass index were measured, and ROSE survey was conducted.

Results. In group 1 creatinine clearance <60 ml/min was in 5 (9%) subjects, in group 2 — in 20 (35%; p=0.002). In group 1 15 (27%) subjects had normal body mass, in group 2 — 5 (9%). In group 1 overweight was registered in 18 (33%) subjects, and in group 2 — in 24 (42%; p=0.407). Class I obesity in group 1 was found in 15 (27%) patients, in group 2 — in 16 (28%; p=0.907). Class II obesity in group 1 was noted in 5 (9%) patients, in group 2 — in 4 (7%; p=0.955). Class III obesity in group 1 was registered in 2 (4%) people and in 8 (14%) in group 2 (p=0.110). According to the results of ROSE questionnaire, signs of angina pectoris were found in 7 (13%) patients in group 1 and 17 (30%) in group 2 (p=0.048).

Conclusion. In the territorial internist's area the proportion of cases of overweight and obesity among patients of groups 1 and 2 with hypertension did not differ significantly (p >0.05); in patients from group 2 with hypertension creatinine clearance less than 60 ml/min was identified 3.9 times more often than in the younger age group (p=0.002); in patients of group 2 with hypertension were 2.3 times more likely to have angina, according to ROSE questionnaire than in group 1 (p=0.048).

The review deals with modern factors of the etiology and pathogenesis of autism, which is part of the autism spectrum disorder complex, approaches to the diagnosis and rehabilitation of patients, as well as social and humanitarian aspects of understanding this pathology as a phenomenon. Despite the fact that so far there is no single etiological concept of the development of autism, a sufficient amount of information has been accumulated that allows talking about genetic theory as one of the main causes of its occurrence. The functions of the main genes in which mutations can lead to the development of autism are examined in more detail, and its genomic architecture is established to be heterogeneous, that is, it is determined by polymorphism in several genes at once, and the disorder is aggravated when polymorphisms are combined with external risk factors. Some current aspects of the diagnosis of autism are outlined, including the main criteria — a persistent lack of social communication and social interactions, limited, repetitive forms of behavior, speech impairment. The main diagnostic questionnaires and rating scales used for the more accurate diagnosis and verification of autism spectrum disorders are presented. When considering the treatment and rehabilitation of patients with autism and other disorders of the autism spectrum, it was concluded that integrated approach including various methods of psychological, pedagogical and medical correction, as well as social adaptation and integration is the most effective. Studies in the social sciences are presented that examine autism spectrum disorders within the framework of social constructivism, the role of the social context in identifying and treating autism is shown, as well as the impact of medical discourse on stigmatization and discrimination of the autistic community. The approaches to the conceptualization of autism in the framework of the theory and movement of neurodiversification, representing autism as a form of biological diversity that requires a positive identity of autistic people and the recognition of their differences by society, are highlighted.

Omental malignant metastases are one of the challenging issues in oncology. The article provides a review of recent studies on the structure and functions of immune compartments of the greater omentum and their characteristic features that promote or inhibit tumor dissemination. The cellular composition of lymphoid nodules and milky spots is described, and functional and phenotypic properties of macrophages and lymphocytes are shown. Unique subpopulations of immunocompetent cells typical of this particular organ, as well as produced cytokines, are characterized. Particular attention is paid to the visceral adipose tissue surrounding immunocompetent cells and its effect on their functions. Analysis of the literature data has revealed a dual role, i.e. both protective and immunosuppressive one, of lymphoid structures of the greater omentum. The former is apparently associated mainly with a response to bacterial pathogens, while the latter is realized in cancer metastasis. The article focuses on immunological mechanisms that create local conditions for the growth and development of metastases, in particular, proinflammatory cytokines, chemokines, growth factors secreted by immune, tumor and mesothelial cells, and on the importance of the surrounding visceral adipose tissue for this process. The multidirectional prognostic significance of some local cellular and cytokine factors in cancer metastasis to the omentum and peritoneum is demonstrated. Possible approaches to treatment involving immunotherapy should be aimed at both elimination of tumor cells and overcoming the immunosuppressive environment. In this regard, reprogramming of macrophages, correction of hypoxic microenvironment, and the search for new control points seem promising.

Anemia is considered one of the manifistations of many neoplasms affecting the overall survival and reducing the quality of life of patients. The prevalence of anemia varies from 20 to 90% depending on the nosology, the stage of the disease, antitumor treatment. The pathogenesis of anemia in cancer patients is complex. Among pathogene­tic factors, such factors are distinguished as tumor infiltration of the bone marrow by malignant cells, inhibition of erythroid growth by cytokines of inflammation, decreased sensitivity of receptors to erythropoietin and its production, increased levels of hepcidin, defects of nutrition, increased deposition and sequestration of blood cells in the spleen, excessive bone fibrosis, hemorrhagic syndrome, antitumor therapy. The article presents the pathogenesis of anemia in oncological disease with a detailed description of the suppressive effect on hematopoiesis of a number of proinflammatory cytokines (interleukin-1β, interleukin-6, tumor necrosis factor-α, interferon-γ) produced by cells of the immune system. The mechanism of influence of cytokines on erythropoiesis, synthesis of erythropoietin as well as on the enhancement of hepcidin production in the body is presented in detail. The article also describes the mechanism of impairment of iron kinetics in the body in patients with cancer and subsequent development of functional deficiency. This review of the literature contains up-to-date information about the factors involved in the pathogenesis of anemia in cancer patients, understanding of which will allow the clinical physician to choose a rational way of pathogenetic or substitution correction of anemic syndrome, taking into account the personalized approach to treatment and prevention, especially in patients receiving surgical, chemotherapy, radiation treatment.

Aim. To study the problems of organizing vaccination of children in children's clinics to develop measures aimed at increasing the coverage of children with vaccination.

Methods. On the basis of 7 children's polyclinics in Saint Petersburg, an anonymous survey of 1724 mothers who had children aged 1 year was carried out by random sampling according to a specially developed form “Questionnaire for a mother of a child aged one year”. The representativeness of this sample was tested by professor A.M. Merkova's method, the error did not exceed 2.2%.

Results. 15.7% of children had violations of the vaccination status, 4.9% of them were not completely vaccinated. The main reason for refusal from vaccination in 89.8% of cases with partial vaccination and in 82.5% of cases with complete refusal was medical contraindications related to the child’s state of health. The most common causes of vaccination against individual childhood infections (partial vaccination) were the belief that there is no danger of infection with childhood infectious diseases (81.3%) and the fear of possible post-vaccination complications (69.7%). Parents completely refused vaccinations most often because of doubts about the quality of vaccines (74.4%) and fear of possible post-vaccination complications (66.7%). 69.5% of parents whose children were vaccinated in the first year of life did not receive complete information from the doctor about the vaccine and the disease that the child will be vaccinated with, as well as the possible consequences of immunization. In 76.6% of partially and completely vaccinated children, immunization was not organized in accordance with the guidelines. At the same time, in 49.1% of them, the health worker specified the information about the state of health after vaccination by phone call the day after immunization, and 1.7% of children had no follow-up after vaccination.

Conclusion. The organization of vaccine prophylaxis in children's clinics has a significant number of unresolved problems, which can lead to a further decrease in the coverage of children with vaccination against vaccine-controlled infections.

Aim. To study a number of epidemiological indicators of a breast cancer in the Udmurt Republic for their assessment and prediction of dynamics.

Methods. A retrospective analysis of data on a breast cancer of the population cancer register of the Udmurt Republic was performed in comparison with the corresponding statistics in the Russian Federation in 2017. For assessment of the received results the software BIOSTAT 4.3 was used. The forecast of epidemiological intensive indicators was calculated by methods of linear and polynomial trends.

Results. The ratio of breast cancer (17.8% in 2017) among the female population of the Republic was the highest among all malignant tumors. In 2017 the crude indicator of breast cancer morbidity equaled 69.80 per 100 000, and standardized one — 40.50 per 100 000. The standardized indicator of breast cancer incidence in Udmurtia was one of the lowest in Russia (77th rank place among 85 territorial entities). Crude mortality rate was 19.10 per 100 000, and standardized one — 10.00 per 100 000 (82nd rank place in the Russian Federation). The ratio of the patients actively revealed (among registered numbre) was 45.8% (the average Russian value, 38.7%). Early diagnostics of tumor was carried out in 71.6% of patients, stage 1 of the disease was revealed in 34.3% of cases (in the Russian Federation average data, 69.9% and 26.0%, respectively). Forecasting till 2022 shows a trend of further growth of detectability of malignant tumors of breast at early stages among female population in the Udmurt Republic. Lethality of patients during the first year from the moment of diagnosis was 5.4% (the average Russian indicator, 6.0%).

Conclusion. Morbidity and mortality rates of breast cancer in the Udmurt Republic in 2017 were lower than the average Russian indicators, and the statistical analysis does not show a negative trend till 2022.

Delayed post-hypoxic leukoencephalopathy is a clinical syndrome caused by a lesion of the white matter of the brain with an acute onset developing several days after emerging from coma. The reason of delayed post-hypoxic leukoencephalopathy is prolonged cerebral hypooxygenation, it often results from carbon monoxide poisoning, less often it is associated with acute brain hypoxia caused by respiratory failure, an overdose of opiates. The leading role in the clinical picture of delayed post-hypoxic leukoencephalopathy is played by the duration and severity of cerebral anoxia in the acute period of the disease. The period of temporary well-being of a patient with an episode of acute hypoxia lasts 2 to 40 days. Pathogenesis and pathophysiology have not been well studied. Its development after carbon monoxide poisoning is considered to be caused by direct myelinotoxic effect. It is essential to collect a detailed history for diagnosing a case, neurovisualization is an informative method for investigation. Magnetic resonance imaging may detect the signs that are pathognomonic for delayed post-hypoxic leukoencephalopathy, that is diffuse hyperintensity of the white matter of the cerebral hemispheres in T2-mode, symmetry of the damage of both cerebral hemispheres, damage of the subcortical gray matter — globus pallidus. The standards for the treatment of delayed post-hypoxic leukoencephalopathy have not been developed. The use of glucocorticoids has been described, perspective use of amantadine were shown in case of frontal-subcortical syndrome. There are recommendations on prescribing the following therapy for the patients with delayed post-hypoxic leukoencephalopathy: hyperbaric oxygenation, coenzyme Q10, vitamin E and group B. We present a clinical observation that demonstrates the complexity of the clinical picture of delayed post-hypoxic leukoencephalopathy, the difficulty of its diagnosis without taking into account information about previous carbon monoxide poisoning. The results of magnetic resonance imaging at the onset of the disease are considered to be of utmost interest. The clinical observation of the patient presented in the article allows us to make an assumption about pathogenesis and contributes to search for means aimed at preventing the development of delayed post-hypoxic leukoencephalopathy in people with acute carbon monoxide poisoning.

In developing science and society, the questions about the acceptability of the use of certain invented technologies arise more frequently. These issues require an unambiguous solution and monitoring of its implementation. One of the most pressing contemporary issues of biomedicine is the possibility of human cloning, the legal regulation of which has not been developed. The aim of the work is to analyze the existing ethical and legal framework of human cloning in the Russian Federation and to develop proposals for its improvement. The authors studied the materials published since the invention of cloning technology, such as speeches by leading scientists, scientific publications on this topic, the work of research groups (both in support of cloning and against it), as well as the results of sociological surveys of the population, legal acts of the Russian Federation, the experience of foreign states in the regulation of biotechnology. The lack of legal regulation of the process of human cloning in the territory of the Russian Federation was revealed. To supplement it, the following proposals are suggested: (1) clarification of terminology in legislative documents and legal consolidation of the concepts of therapeutic and reproductive cloning; (2) establishment of penalties for violation of prohibitions on the use of technology and definition of mechanisms for the enforcement of these penalties; (3) development of the direction of “somatic human rights” and, with a view to the future, consolidation of human clone rights. The authors believe that in the presence of legal regulation, the development of technology will not bring moral harm to humanity.

Почему важна точная диагностика РАС? Не диагностировать РАС у детей при их наличии (ложноотрицательный результат) — значит, допустить, что дети с РАС не получат раннего лечения, а семьи — своевременной поддержки и обучения. Неверная диагностика РАС (ложноположительный результат) может привести к стрессу в семье, ненужным исследованиям и вмешательствам, а также нагрузке на и без того ограниченные ресурсы.

Какова цель этого обзора? Выяснить, какой из часто используемых диагностических тестов (инструментов) является наиболее точным для диагностики РАС у детей дошкольного возраста. Кокрейновские исследователи рассмотрели 13 опубликованных статей, чтобы ответить на этот вопрос.

Расстройства аутистического спектра (РАС) — типы расстройств, характеризующиеся ограниченным и повторяющимся поведением, а также трудностями в социальном взаимодействии и коммуникации. Было предположено, что повышение уровня токсичных металлов в организме приводит к появлению более серьёзных симптомов РАС, и выведение этих тяжёлых металлов с помощью фармацевтических хелатирующих агентов (химических веществ, которые вводят в кровь, чтобы связать и удалить токсичные тяжёлые металлы из организма) может привести к уменьшению симптомов.