[Changes in subfoveal choroidal thickness in myopic children who wear bifocal soft contact lenses]. / Izmenenie tolshchiny khorioidei u detei s miopiei na fone nosheniya bifokal'nykh myagkikh kontaktnykh linz.

PURPOSE: To study the changes in subfoveal choroidal thickness in children with progressive myopia who have been wearing bifocal soft contact lenses (BSCL) with an ADD power of +4.0 D for 3 months. MATERIAL AND METHODS: The study included 40 patients (80 eyes) with progressive myopia of low and moderate degrees. The main group consisted of 23 patients aged 10.04±1.5 years with an average myopia of -3.06±1.17 D, they were examined before and 3 months after vision correction with bifocal soft contact lenses Prima BIO Bi-focal («OkVision Retail¼, Russia). The control group consisted of 17 patients (34 eyes) aged 9.29±0.92 years with an average myopia of -3.05±1.5 D using single vision spectacle lenses. Cycloplegic refraction, choroidal thickness and axial length were measured in all patients before and after 3 months. Choroidal thickness was measured using the semi-automatic method on the optical coherent tomography system RS-3000 Advance 2 («Nidek¼, Japan). Axial length was measured using the optical biometer IOL Master 500 («Carl Zeiss¼, Germany). RESULTS: In the main group, subfoveolar choroidal thickness increased on average by 15.3±24.3 µm after 3 months of wearing BSCL, and in the control group it decreased on average by 9.03±28.65 µm. Comparison of changes in choroidal thickness between the main and the control groups revealed a significant difference (p<0.001). Increase in axial length of the eye in the main group was significantly less than in the control group (0.005±0.08 mm vs 0.07±0.06 mm; p<0.001). A strong negative correlation was found between changes in the axial length and subfoveolar choroidal thickness in the main group (r= -0.67), but no similar relationship was found in the control group (r= -0.13). CONCLUSION: Subfoveolar choroidal thickness increases in children wearing bifocal soft contact lenses for myopia correction.

Antihistamines Modulate Functional Activity of Macrophages.

We compared the effects of the first-, second- and third-generation antihistamines in different doses on enzyme activity and cytokine production by macrophages and their death using an in vitro model. It was found that decreasing the dose led to an increase in the number of viable cells; after contact with second-generation antihistamines (loratadine, desloratadine), apoptosis of macrophages predominated. A dose-dependent increase in activity of ATPase and 5'-AMP with less pronounced effect of second-generation drugs was revealed. It was shown that under the influence of drugs, macrophages do not produce IL-1ß, but actively synthesize TNFα and IL-10, which indicates the immunomodulatory properties of these drugs.

[Bilateral occlusion of retinal vessels in Waldenstrom's disease (a case study)]. / Dvustoronniaia okkliuziia retinal'nykh sosudov pri bolezni Val'denstrema (klinicheskoe nabliudenie).

The article describes a clinical case of bilateral occlusion of retinal vessels in a patient with Waldenstrom's disease - a rare lymphoplasmocytic tumor of the bone marrow characterized by a complex of syndromes, among which the syndrome of blood hyperviscosity dominates. Comprehensive clinical, instrumental and laboratory examinations revealed that besides the syndrome of blood hyperviscosity the patient also had loci of cerebral ischemia (according to magnetic resonance imaging), ocular hypoperfusion with severe deficiency of retinal and choroidal blood flow (according to Doppler methods) indicating the presence of ocular ischemic syndrome. Since bilateral occlusion of retinal vessels without concomitant vascular and/or systemic pathology is rare, patients with such diagnosis should be referred to a hematologist.

Effect of Hypotensive Drugs on Dynamics of Nitroxide-Producing Renal Function in Rats with Nephrogenic Hypertension.

An original model of nephrogenic hypertension in rats was used for histochemical mapping of NADPH diaphorase (NO synthase) in various renal segments to examine the effect of hypotensive drugs furosemide, bendazol, and clonidine on the time course of nitroxide production in the kidneys. In various nephron segments, these drugs modulated NO synthesis in different ways. Clonidine induced a stable up-regulation of NO synthesis, which can maintain active vasodilation and gradually diminish the rennin production. Bendazol also enhanced NO synthase activity in renal glomeruli and collecting tubules, but this effect was less pronounced and short lasting. During the first week after injection of bendazol, insignificant elevation of NO synthase activity was observed in the proximal nephron segments. Furosemide exerted the least effect on NO production in kidneys.

[Systemic Antimicrobials Consumption and Expenditures in Departments of Surgery of Multi-Profile Hospitals in the Russian Federation and the Republic of Belarus: Results of Multicentre Pharmacoepidemiological Study].

The results of the systemic antimicrobials (AM) consumption and expenditures assessment in the departments of surgery of multi-profile hospitals in different regions of the Russian Federation and the Republic of Belarus in 2009-2010 based on retrospective collection and analysis of the data from the hospital expenditure notes using ATC/DDD methodology are presented. The average AM consumption and expenditure rates in the above mentioned departments varied from 24.9 DDD/100 bed-days to 61.7 DDD/100 bed-days depending on the department profile, with beta-lactams (cephalosporins and penicillins) share in the consumption being as high as 70-90%, followed by fluoroquinolones and aminoglycosides. Only 55-70% of the consumed AM belonged to the drugs of choice, whereas the improper AM consumption and expenditure rates amounted up to 10-18%. The study outputs can be used for the budget allocation and AM distribution improvement in the departments of surgery, as well as for the development and efficacy control of the local antimicrobial stewardship programs.

Do classroom ventilation rates in California elementary schools influence standardized test scores? Results from a prospective study.

Limited evidence has associated lower ventilation rates (VRs) in schools with reduced student learning or achievement. We analyzed longitudinal data collected over two school years from 150 classrooms in 28 schools within three California school districts. We estimated daily classroom VRs from real-time indoor carbon dioxide measured by web-connected sensors. School districts provided individual-level scores on standard tests in Math and English, and classroom-level demographic data. Analyses assessing learning effects used two VR metrics: average VRs for 30 days prior to tests, and proportion of prior daily VRs above specified thresholds during the year. We estimated relationships between scores and VR metrics in multivariate models with generalized estimating equations. All school districts had median school-year VRs below the California VR standard. Most models showed some positive associations of VRs with test scores; however, estimates varied in magnitude and few 95% confidence intervals excluded the null. Combined-district models estimated statistically significant increases of 0.6 points (P = 0.01) on English tests for each 10% increase in prior 30-day VRs. Estimated increases in Math were of similar magnitude but not statistically significant. Findings suggest potential small positive associations between classroom VRs and learning.

Evaluation of the indoor air quality minimum ventilation rate procedure for use in California retail buildings.

This research assesses benefits of adding to California Title-24 ventilation rate (VR) standards a performance-based option, similar to the American Society of Heating, Refrigerating, and Air Conditioning Engineers 'Indoor Air Quality Procedure' (IAQP) for retail spaces. Ventilation rates and concentrations of contaminants of concern (CoC) were measured in 13 stores. Mass balance models were used to estimate 'IAQP-based' VRs that would maintain concentrations of all CoCs below health- or odor-based reference concentration limits. An intervention study in a 'big box' store assessed how the current VR, the Title 24-prescribed VR, and the IAQP-based VR (0.24, 0.69, and 1.51 air changes per hour) influenced measured IAQ and perceived of IAQ. Neither current VRs nor Title 24-prescribed VRs would maintain all CoCs below reference limits in 12 of 13 stores. In the big box store, the IAQP-based VR kept all CoCs below limits. More than 80% of subjects reported acceptable air quality at all three VRs. In 11 of 13 buildings, saving energy through lower VRs while maintaining acceptable IAQ would require source reduction or gas-phase air cleaning for CoCs. In only one of the 13 retail stores surveyed, application of the IAQP would have allowed reduced VRs without additional contaminant-reduction strategies.

[Clinical and molecular genetic analysis of hereditary optic neuropathies].

DNA samples of 50 patients with optic neuropathy (ON) associated with congenital cataract were studied to find 3 major mt-DNA mutations (m.11778G>A, m.3460G>A, m.14484T>C), mutations in "hot" regions of OPA 1 gene (exons 8, 14, 15, 16, 18, 27, 28) and in the entire coding sequence of OPA3 gene for molecular genetic confirmation of diagnosis of hereditary Leber and autosomal dominant ON. Primary mutations of mtDNA responsible for hereditary Leber ON were found in 16 patients (32%). Pathogenic mutations of OPAl gene (c.869G>A and c. 2850delT) were identified in 2 patients (4%), these mutations were not found in the literature. OPA3 gene mutations were not revealed.

Association of classroom ventilation with reduced illness absence: a prospective study in California elementary schools.

Limited evidence associates inadequate classroom ventilation rates (VRs) with increased illness absence (IA). We investigated relationships between VRs and IA in California elementary schools over two school years in 162 3rd-5th-grade classrooms in 28 schools in three school districts: South Coast (SC), Bay Area (BA), and Central Valley (CV). We estimated relationships between daily IA and VR (estimated from two year daily real-time carbon dioxide in each classroom) in zero-inflated negative binomial models. We also compared IA benefits and energy costs of increased VRs. All school districts had median VRs below the 7.1 l/s-person California standard. For each additional 1 l/s-person of VR, IA was reduced significantly (p<0.05) in models for combined districts (-1.6%) and for SC (-1.2%), and nonsignificantly for districts providing less data: BA (-1.5%) and CV (-1.0%). Assuming associations were causal and generalizable, increasing classroom VRs from the California average (4 l/s-person) to the State standard would decrease IA by 3.4%, increase attendance-linked funding to schools by $33 million annually, and increase costs by only $4 million. Further increasing VRs would provide additional benefits. These findings, while requiring confirmation, suggest that increasing classroom VRs above the State standard would substantially decrease illness absence and produce economic benefits.

[The value of autofluorescence imaging in diagnosis of retinal diseases].

Results of fundus autofluorescence imaging using confocal scanning laser ophthalmoscope HRA II ("Heidelberg Engeneering", Heidelberg, Germany) are presented. 106 patients with various retinal and optic nerve conditions were examined. The following conditions were diagnosed using autofluorescence imaging: early stage of age-related macular degeneration, macular hard and soft drusen, signs of retinitis pigmentosa, senile macular hole, central serous chorioretinopathy and optic disc drusen.

[Relationship of changes in visual functions and optic disk in patients with glaucoma concurrent with myopia].

Forty-nine myopic patients (70 eyes) aged 2 to 12 years (mean 7 +/- 4.2 years) with primary open-angle glaucoma (POAG) were examined. In patients with glaucoma concurrent with myopia, enlarged peripapillary retinal atrophy is one of the first signs of a progressive process, long optical axis in particular. Reduced visual functions were detectable in fewer cases than were changes in the optic disk and peripapillary retina. The most sensitive methods are in the following order: distant contrast discrimination (DCD), critical flicker fusion frequency (CFFF), Bjerrum's zones, statitic perimetry with a blue object on the Friedman analyzer, automatic static permentry on the Peritest, isoptoperimetry. In patients with POAG and in the majority of POAG concurrent with myopia with an anteroposterior axis (APA) of < 25 mm, excavation was shown to progress depthward and/or widthway with simultaneous narrowing of the neuroretinal rim. In patients with POAG concurrent with myopia at an APA of > 25 mm, peripapillary atrophy initially increased (usually in the temporal quadrant), excavation also widthway in the temporal direction. It is evident from the foregoing that increased peripapillary atrophy may be considered to be a marker of progression of the glaucomatous process in patients with myopia.

[Multicentre study of comparative efficacy of meropenem and combined regimens for empirical antibacterial therapy of severe nosocomial infections: results of clinical and pharmacoeconomic analysis].

Adequacy and effectiveness of empirical antibacterial therapy of severe nosocomial infections with meropenem vs. combined regimens of antibacterial therapy were investigated and the ratio of the cost and effectiveness of the compared regimens was evaluated. A prospective, randomized, open, comparative study of two initiative regimens of empirical antibacterial therapy of severe nosocomial infections was performed: meropenem in a daily dose of 1.5-3 g and the standard regimen with the use of betalactams and fluoroquinolones in combination with aminoglycosides and/or metronidazole. Patients with recorded diagnosis of nosocomial pneumonia (including the ventilator-associated one) or abdominal infection with the signs of severe sepsis and severity of APACHE II > 14 were enrolled. The patients were stratified into 2 groups subject to the disease severity, i.e. APACHE II 15-20 and APACHE II 21-25. One hundred thirty five out of 166 patients with recorded nosocomial infection were included into the final estimate of the therapy adequacy and effectiveness (Protocol Analysis): 62 patients were treated with meropenem and in the treatment of 73 patients the standard antibacterial therapy was used. In the group of the patients treated with meropenem there were stated significantly higher clinical effectiveness (recovery in 80.6% of the patients vs. the control of 46.6%, p < 0.01) and pathogen eradication (89.6 and 48.1% respectively, p < 0.01). The difference in the clinical and bacteriological effectiveness of meropenem and the standard therapy was more evident in the subgroups of more severe patients (APACHE > 20). With the use of meropenem the probability of recovery from nosocomial infection was significantly higher (RR 1.73-1.94, p < 0.001) vs. the control. Meropenem provided significantly higher eradication of the pathogens: P. aeruginosa (88 and 40% respectively, p = 0.007), E. coli (100 and 46.7%, p = 0.003), Acinetobacter spp. (90.9 and 40%, p = 0.02). The antibacterial therapy with the use of meropenem was assessed as adequate in 51 out of 56 patients (91.1%), that was 3 times as frequent as with the use of the standard antibacterial therapy (33.9%). The cost-effectiveness coefficient with the use of meropenem was 2.2 times lower vs. the control. Therefore, the empirical therapy of severe nosocomial infections with meropenem proved to be more adequate and from the economic viewpoint more advantageous vs. the standard combined regimens of antibacterial therapy, that was evident from significantly higher clinical and bacteriological efficacy of the treatment and decrease of the terms of the patients hospitalization in intensive care units (on the average by 5 days).

[The test for nitric oxide metabolites in exhaled air condensate as a method of assessing NO-reactivity of the airways in patients with bronchial asthma]. / Opredelenie metabolitov oksida azota v kondensate vydykhaemogo vozdukh kak sposob otsenki NO-reaktivnosti dykhatel'nykh putei u bol'nykh bronkhial'noi astmoi.

AIM: To estimate airways NO-reactivity in response to their stimulation with fenoterol in different clinical forms of bronchial asthma (BA). MATERIAL AND METHODS: The study included 73 patients with BA: mild disease was in 21, moderate--in 24 and severe--in 28 patients. Severe BA patients were divided into two subgroups: with a stable course (n = 15) and unstable course (n = 13). NO-producing function of the airways was estimated by concentration of stable NO-metabolites (mNO)(NO2, NO3) in exhaled air condensate. RESULTS: Spontaneous NO-producing activity of the airways increases and reaches maximum in severe unstable asthma. Fenoterol-stimulated NO-production was minimal in mild BA while the most significant augmentation of mNO was observed in unstable BA. Basal level of mNO and velocity parameters of external respiration function correlated. CONCLUSION: Estimation of NO-reactivity of the airways in the test with fenoterol with calculation of the index of airways NO-reactivity provides additional information about respiratory system condition in BA patients which may be used in clinical pulmonology.

[Significance of nitric oxide function in development of cardiac hypertrophy under condition of experimental renal hypertension]. / Znachenie oksida azota v razvitii gipertrofii serdtsa v usloviiakh éksperimental'noi pochechnoi gipertenzii.

The development of cardiac hypertrophy was studied under condition of experimental renal hypertension on the rat. The number of cardiac nitric oxide synthase (NOS)-positive neurones increased simultaneously with the increase in NOS-activity in these neurones. A connection was found between the development of cardiac hypertrophy and the activity of NOS in cardiomiocytes. The involvement of NO in the development cardiac hypertrophy as auto- and paracrine regulator is supposed.

[Nitric oxide formation by chromaffinocytes of respiratory system and its importance for catecholamine exocytosis]. / Obrazovanie okisi azota khromaffinotsitami organov dykhaniia i ee znachenie dlia ékzotsitoza katekholaminov.

Chromaffinocytes (both single and within paraganglia) located in larynx, trachea, extrapulmonary bronchi and lungs possess NADPH-diaphorase/NO-synthase activity. Chromaffinocytes and paraganglia are anatomically associated with the vagus, autonomous ganglia and the walls of small blood vessels. NO-synthase agonists, acethylcholine and Ca ionophore A23217, after intrapleural injection increase the enzyme activity, that is accompanied with the decrease of luminescence intensity and a reduction of monoamine content in cell cytoplasm. It is concluded that NO is involved in the mechanism of catecholamine release.

[Inducible nitric oxide synthase in rat lungs in experimental bronchial asthma and its status in administering drugs with adrenergic action]. / Indutsibel'naia nitrooksidsintaza v legkikh krys s éksperimental'noi bronkhial'noi astmoi i ee sostoianie pri vvedenii preparatov adrenergicheskogo deistviia.

The state of inducible NO-synthase (iNOs) in the rat lung with experimental model of bronchial asthma (BA) was studied after administrating short-acting beta 2-agonist fenoterol, long-acting beta 2-agonist salmeterol, and adrenoblocker propranolol. Administrated beta 2-agonists were observed to result in reducing iNOs activity in the rats with BA, while propranolol intensified iNOs expression.