[Hypertrophy of palatine tonsils - possible treatment approaches]. / Gipertrofiya nebnykh mindalin ­ vozmozhnye podkhody v lechenii.

OBJECTIVE: To evaluate the effectiveness of different approaches to the treatment of patients with hypertrophy of the palatine tonsils (HPT). MATERIAL AND METHODS: 90 children with HPT of II-III degree and 20 healthy children (group 1) aged from 3 to 7 years were included in the study. Children with HPT were divided into three groups: group 2 - children who underwent tonsillotomy (n=30), group 3 - children who underwent conservative treatment, including only topical use of Polyoxidonium (n=30), group 4 - children who underwent complex treatment (tonsillotomy with subsequent local use of Polyoxidonium), (n=30). The severity of nasal breathing disturbances on a visual analogue scale, the average number of acute respiratory viral infections 6 months before and after treatment, the level of gene expression of antimicrobial peptides before and after treatment, the degree of hypertrophy of the palatine tonsils and spleen with an assessment of the echostructure and determination of the spleen mass coefficient using Ultrasound were evaluated in the study. RESULTS: In children receiving only Polyoxidonium, there was a decrease in the severity of nasal breathing disorders, a decrease in the frequency of acute respiratory viral infections, an increase in the expression of antimicrobial peptide genes compared to the initial level of these indicators. Comprehensive treatment of children with HPT (group 4) showed a significant decrease in the severity of nasal breathing disorders, a decrease in the average number of acute respiratory infections within 6 months, an increase in the expression of antimicrobial peptide genes compared to children who underwent only tonsillotomy (group 2) or only conservative therapy (group 3). CONCLUSION: It is proved that the use of Polyoxidonium in the complex treatment of HPT is clinically effective and safe.

[Type 2 Diabetes Mellitus and Heart Failure: Innovative Possibilities for Management of Prognosis].

Type 2 diabetes mellitus (T2DM) has gone beyond the professional interests of one specialty. T2DM, cardiovascular (CV) diseases and chronic kidney disease, considered from the standpoint of a single cardio-reno-metabolic continuum, place a heavy economic burden on society. At the same time, the improvement of diagnostic methods and medical technologies led to distinct decrease in the frequency and mortality from a number of complications of T2DM, including myocardial infarction and stroke, but other states took their place. Thus, heart failure (HF) has taken the position of one of the most frequent complications with average prevalence of 24-40 % and significant predominance of HF with preserved ejection fraction (HFpEF). According to this paradigm, HFpEF is not a disease of diastolic dysfunction, but a systemic disease, the central element of which is impaired renal function. All this together has a potential value for choosing the optimal therapy. In recent years the results of specially designed studies assessing the CV-safety of antidiabetic drugs from the groups of dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like preptide-1 (GLP-1) receptor agonists and sodium - glucose co-transporter-2 (SGLT2) inhibitors have become known. These drugs, except for SGLT2 inhibitors, by their mechanism of action affecting insulin resistance and hyperglycemia, demonstrated neutral or negative result on the frequency of hospitalizations due to HF. The EMPA-REG OUTCOME study with SGLT2, which has a special insulin-independent mechanism of action, demonstrated not only the efficacy and CV-safety of the drug in the form of a decrease in CV mortality by 38 %, but also a decrease in hospitalizations for HF by 35 %. Further studies with SGLT2 inhibitors confirmed positive effect on HF, indicating a class effect of the drugs. The recently completed study DECLARE-TIMI 58 proved the advantages of using dapagliflozin for the primary and secondary prevention of HF. This review highlights the prevalence of HF in diabetes mellitus, a new concept of the pathophysiology of HF, the main groups of sugar-lowering drugs and their effect on CV outcomes, in particular on HF.

Diagnostic performance of a low dose triple rule-out CT angiography using SAFIRE in emergency department.

OBJECTIVES: To compare the diagnostic performance of "triple rule out" CT angiography (TRO-CTA) at 100kVp using sinogram affirmed iterative reconstruction (SAFIRE) with TRO-CTA at 120kVp using filtered back projection (FBP) in patients with acute chest pain. METHODS: Consecutive non-prepared patients from a single radiological emergency department, referred for acute chest pain evaluation with TRO-CTA, were randomly assigned to two different TRO-CTA protocols. Fifty patients (66% men; mean age, 66.6±19.0 [SD] years [range: 24-97years]) had TRO-CTA at 120kVp with FBP and 97 patients (67% men; mean age, 62.8±17.9 [SD] years [range: 24-93years]) had TRO-CTA at 100kVp with SAFIRE. Two radiologists reviewed the TRO-CTA images for pathologic findings and degree of diagnostic confidence. Image noise, vessel attenuation value, signal-to-noise and contrast-to-noise ratios in five main thoracic arteries were measured for objective and subjective analysis. RESULTS: A total of 147 patients (98 men, 49 women; mean age, 64.7±18.4 [SD] [range, 24-97years) were included with good diagnostic confidence and equivalent pathological findings between the two TRO-CTA protocols. Objective and subjective analysis were identical between protocols and radiologists, except for vessel attenuation in the ascending aorta (P=0.02) and image noise in the pulmonary trunk (P=0.04). The effective radiation dose decreased significantly by 34% in the low dose TRO-CTA using SAFIRE protocol (5.7±2.7 vs 8.6±6.1mSv; P=4.7×10-6). CONCLUSIONS: Low dose TRO-CTA protocol using SAFIRE allows a high confidence diagnostic level with the benefit of a 34% radiation dose decrease compared with a standard TRO-CTA protocol using FBP.

Ultra-low-dose chest CT with iterative reconstruction does not alter anatomical image quality.

PURPOSE: To evaluate the effect of dose reduction with iterative reconstruction (IR) on image quality of chest CT scan. MATERIALS AND METHODS: Eighteen human cadavers had chest CT with one reference CT protocol (RP-CT; 120kVp/200mAs) and two protocols with dose reduction: low-dose-CT (LD-CT; 120kVp/40mAs) and ultra-low-dose CT (ULD-CT; 120kVp/10mAs). Data were reconstructed with filter-back-projection (FBP) for RP-CT and with FBP and IR (sinogram affirmed iterative reconstruction [SAFIRE®]) algorithm for LD-CT and ULD-CT. Volume CT dose index (CTDIvol) were recorded. The signal-to-noise (SNR), contrast-to-noise (CNR) ratios of LD-CT and ULD-CT and quantitative parameters were compared to RP-CT. Two radiologists reviewed the CT examinations assessed independently the quality of anatomical structures and expressed a confidence level using a 2-point scale (50% and 95%). RESULTS: CTDIvol was 2.69 mGy for LD-CT (-80%; P<0.01) and 0.67 mGy for ULD-CT (-95%; P<0.01) as compared to 13.42 mGy for RP-CT. SNR and CNR were significantly decreased (P<0.01) for LD-CT and ULD-CT, but IR improved these values satisfactorily. No significant differences were observed for quantitative measurements. Radiologists rated excellent/good the RP-CT and LD-CT images, whereas good/fair the ULD-CT images. Confidence level for subjective anatomical analysis was 95% for all protocols. CONCLUSIONS: Dose reduction with a dose lower than 1 mGy, used in conjunction with IR allows performing chest CT examinations that provide a high quality of anatomical structures.

Dose reduction with iterative reconstruction: Optimization of CT protocols in clinical practice.

OBJECTIVES: To create an adaptable and global approach for optimizing MDCT protocols by evaluating the influence of acquisition parameters and Iterative Reconstruction (IR) on dose reduction and image quality. MATERIALS AND METHODS: MDCT acquisitions were performed on quality image phantom by varying kVp, mAs, and pitch for the same collimation. The raw data were reconstructed by FBP and Sinogram Affirmed Iterative Reconstruction (SAFIRE) with different reconstruction kernel and thickness. A total of 4032 combinations of parameters were obtained. Indices of quality image (image noise, NCT, CNR, SNR, NPS and MTF) were analyzed. We developed a software in order to facilitate the optimization between dose reduction and image quality. Its outcomes were verified on an adult anthropomorphic phantom. RESULTS: Dose reduction resulted in the increase of image noise and the decrease of SNR and CNR. The use of IR improved these indices for the same dose without affecting NCT and MTF. The image validation was performed by the anthropomorphic phantom. The software proposed combinations of parameters to reduce doses while keeping indices of the image quality adequate. We observed a CTDIvol reduction between -44% and -83% as compared to the French diagnostic reference levels (DRL) for different anatomical localization. CONCLUSION: The software developed in this study may help radiologists in selecting adequate combinations of parameters that allows to obtain an appropriate image with dose reduction.

[Direct human DNA damage by unfavorable environmental and climatic factors].

AIM: To study the impact of simulated climatic conditions of the 2010 summer in Moscow on the telomere repeats of chromosomes in human blood cells. MATERIALS AND METHODS: The climatic conditions of July-August 2010 in Moscow were simulated at the Medical Technical Complex, Institute of Biomedical Problems, Russian Academy of Sciences. The relative length of the telomeric repeats of blood cell chromosomes from 6 apparently healthy volunteers was measured by quantitative real-time polymerase chain reaction. RESULTS: These conditions were ascertained to lead to a statistically significant decline in the length of telomere repeats in the terminal portions of chromosomes by 15%. CONCLUSION: Environmental changes and abnormal temperature rises may result in oxidative stress accompanied by telomere shortening, which can be, in turn, a factor of premature aging.

[Tonocardin in complex treatment of diabetes mellitus concurrent with hypertension]. / Tonokardin v kompleksnom lechenii sakharnogo diabeta, sochetaiushchegosia s gipertoniei.

AIM: To examine the effect of the alpha 1-adrenoblocker tonocardin (doxazosin) on the course of arterial hypertension (AH) and on carbohydrate and lipid metabolism and insulin resistance in patients with type 2 diabetes mellitus (DM) concurrent with AH. MATERIALS AND METHODS: 18 patients with type 2 DM concurrent with AH, treated with tonocardin for at least 12 weeks were examined; the fasting glycemia, the levels of blood glycosylated hemoglobin, serum total cholesterol and triglycerides, and the degree of insulin resistance (intravenous insulin load or insulin tolerance test and the insulin resistance index estimated by the HOMA method) were determined. RESULTS: Tonocardin treatment lowered systolic BP (from 159 +/- 19.83 to 136.57 +/- 17.43 mm Hg; by 14.5%), diastolic BP (from 93.38 +/- 12.98 to 79.12 +/- 11.69 mm Hg; by 15.28%), fasting glycemia (from 9.32 +/- 1.61 to 7.05 +/- 1.51 mmole/l; by 24.36%), glycosylated hemoglobin Ai (from 9.63 +/- 1.86 to 8.59 +/- 0.98%; by 10.8%), total cholesterol (from 6.09 +/- 0.57 to 5.4 +/- 0.4 mmole/l; by 11.4%), triglycerides (from 2.11 +/- 0.57 to 1.88 +/- 0.52 mmole/l; by 11%), glycemia after 30-min insulin load (from 9.32 +/- 1.61 to 5.77 +/- 1.57; by 39% and from 7.05 +/- 1.51 to 4.2 +/- 1.25 mmole/l; by 44% at the beginning and end of the follow-up, respectively), insulin resistance index (from 9.87 +/- 2.45 to 6.57 +/- 1.99; by 33.5%). CONCLUSION: The findings suggest that tonocardin exerts an antihypertensive effect and positively affects carbohydrate and lipid metabolisms, and diminishes insulin resistance in patients with type 2 DM concurrent with AH.

[Status of phosphorus-calcium metabolism and secretion of calcium- regulating hormones in diabetic nephropathy]. / Sostoianie fosforno-kal'tsievogo obmena i sekretsiia kal'tsii- reguliruiushchikh gormonov pri diabeticheskoi nefropatii.

The studies performed by the authors led them to the conclusion that diabetic nephropathy aggravates derangement of phosphoric--calcium metabolism in patients with diabetes mellitus. Secondary hyperparathyroidism, as a result of negative calcium balance in decompensated diabetes mellitus and renal dysfunction, contributes to development of marked alterations of the osteoarticular system.