卷 28, 编号 2 (2020)

研究现实性。糖蛋白- P（Pgp，ABCB1）是一种参与药物药代动力学和肿瘤细胞化疗耐药发展的转运蛋白。

目的：目的：研究黄体酮对体外培养的人小肠上皮细胞模型中Pgp活性的影响。

材料与方法：对Caco-2细胞系进行了研究。在特殊的Transwell体系中，通过非索非那定转运评价Pgp的活性。高效液相色谱法测定非索非那定的浓度。采用免疫酶测定法测定Pgp的含量。我们进行了四个系列的实验：对照组细胞在不添加任何物质的清洁运输介质中孵育；预孵育3天，10 mcmol / L浓度利福平对Pgp活性及合成的影响（诱导控制）；孕酮在1、10和100 mol / L预潜伏30分钟时对Pgp活性的影响；孕酮在1、10、100 mcmol / L预潜伏3天后对Pgp活性及合成的影响。

结果：黄体酮与细胞潜伏30 分钟时，浓度为1和10的黄体酮对Pgp的活性没有显著影响，但浓度为100的黄体酮会降低转运蛋白的活性。

将Caco-2细胞与黄体酮浓度分别为1，10和100微米的水杨酸潜伏3天后，Pgp的活性没有变化。与对照指标相比，孕酮在潜伏3天后，浓度为100微米的孕酮可显著提高肠上皮细胞Pgp的合成，提高114.3%，但在剩余的使用浓度（1和10微米）中效果不显著。

结论：体外实验中，在Caco-2细胞系细胞中，孕激素浓度为100微米时，对Pgp活性有直接抑制作用，但在潜伏3天后，孕酮增加了转运蛋白的合成，使其抑制活性减弱。

目的：分析了药物介导性心动过缓（DMB）作为一个医学和社会问题的相关性，其主要规律及确定了该问题的进一步研究必要性。

材料与方法：注册研究2017年1月1日至2018年6月3日（18个月）在Regional Clinical Cardiology Dispensary梁赞地区国家预算机构进行。纳入标准：1）在服用至少一种具有心动过缓作用（BCA）的药物制剂（MP）的同时出现心动过缓律失常综合征；2）签署知情同意书。在对登记在案的患者进行诊断或治疗时，没有进行额外的干预。

结果：18个月后，191例患者住院（年龄为77.0[69.0;82.0]岁，26.7%男生）在所有因用药过量而住院的病人中，有52.6%的人被证实患有药物性心动过缓。在分析期间，由于过量使用心脏病药物（1.7倍，p <0.001），特别是心动过缓作用药物（1.8倍，p <0.001），住院人数有所增加。药物引起的心动过缓的主要临床表现：降低心率（< 50次/分钟—80.0%，< 40次/分钟—51.1%）、窦房结（30.4%）和房室的（1型—8.2%，2型—10.4%，3型—14.1%）封锁，晕厥（32.6%），心脏停顿> 3秒（7.4%）。94.8%的患者住院接受紧急护理，40.7%在麻醉科接受复苏；17.8%的病例需要植入起搏器；医院死亡率为5.2%。超过半数（54.5%）的住院患者服用2种以上的药物具有心动过缓的作用，15.7%的患者服用3种以上的药物，3.14%的患者服用4种以上的药物（单一疗法和联合用药）受体阻滞剂—68.4%，抗心律失常药物—38.9%，地高辛—25.8%，非二氢吡啶钙拮抗剂—10.5%，l1-咪唑啉受体激动剂—9.5%，其他心动过缓药物—7.4%。为分析药物性心动过缓的原因，我们收集了135例患者的临床资料（年龄为77.0岁[69.0;82.0]，20.7%男生），其能准确说出有心动过缓作用的药物的剂量。其中，有14.1%的病例记录了绝对超过推荐剂量的情况，有85.9%的病例记录了几种具有心慢效应的药物的效应总和/增强情况，每种药物都以治疗剂量服用。

结论。该研究证实了药物性心动过缓问题的高度医学和社会意义，这需要实际医生、药理学家和临床药理学家以及医疗保健组织者的关注，并继续其研究。

目的：在使用有机硒进行标准药物治疗和膳食校正的背景下，评价Q-心肌梗塞患者不同病程时期、心率变异性指标、血液生化及流变学特征的关系。

材料与方法：对90例诊断为急性冠状动脉综合征、节段抬高、结果为Q-心肌梗死的患者（平均年龄为58.3±1.4岁，其中男生71例，女生19例）进行了开放的比较临床研究。患者被分成两组：对照组接受标准治疗，主要的治疗—另外，一种富含有机硒的饮食产品。在Q型心肌梗死的急性期、亚急性期和瘢痕期，采用Varicard 2.51复合材料对动态心脏间隔进行登记和数学分析，并对血液生化指标、硒状态和血液流变学特性进行评价。

结果：在住院治疗阶段，主组患者的心率下降（从68.8±1.7次降至64.0±1.3次/分；p < 0.05）。一开始，两组的SDNN水平均在临界值（25.0±1.3毫秒）内，压力指数（SI）比正常值高出数倍（1356.2±390.6标准单位），观察结束时，两组均未达到正常值。在整个治疗过程中，两组的变异系数（CV）均低于正常值，但动态上有轻微上升趋势。对照组心脏隔动态范围（HF）曲线谱的功率增加近2倍（p <0.05）。通过对血液生化指标、血清凝血和硒水平与心律数学分析的各个参数的相关性分析，发现它们在水平和方向上存在着不同的联系。

结论。使用富含硒的膳食产品，积极影响机体的滋养功能，结合标准疗法，可降低适应机制的张力，增加机体的适应潜力，有助于改善预后，降低风险。

Taking into account the peculiarities of the blood supply to the liver and the structure of its parenchyma, and, as a result, considerable difficulties in providing reliable hemostasis without additional traumatization, a surgeon needs to be careful when performing a surgical manipulation. Despite a large number of modern methods for stopping parenchymal bleeding, many practi-tioners give preference to classic methods of hemostasis, including ligation of bleeding vessels in the bulk of the organ using specialized sutures. One of the most serious complications of the use of suture material is cutting of organ tissue, which leads to enhanced bleeding and expansion of the area of damage. At the moment, the tactics of choosing suture material for surgical procedures is empirical. In this context, the aim of this study was to assess the physico-mechanical properties of suture material regarding its structure, and to develop a criterion for choosing surgical sutures for surgical procedures. For the study, the liver was removed out of corpses of males of 35 to 40 years of age, after which separate sections of 7.5×7×4 cm in size were obtained from it. Then a wound 3 cm long and 2 cm deep was made. The wound was sutured with a simple interrupted suture without tightening, but with application of one simple half-node. For suturing, catgut, twisted capron and polyglycolide thread were used. Attention was paid to the maximal force applied at the moment of cutting (Fmax) and the degree of pulling the thread at the moment of cutting (Lu). The analysis of the data was based on comparison of Fmax and Lu parameters. This method permits to refuse from the empirical approach to the choice of suture material for operations on the liver, and to develop a criterion for choosing surgical sutures.

Aim. Comparative analysis of the effectiveness of pharmacological correction of intrauterine growth restriction syndrome (IGRS) by monotherapy with diosmin and dipiridamol.

Materials and Methods. Retrospective and prospective examination of 80 pregnant women with singleton pregnancy with gestational age from 28 to 36 weeks with confirmed diagnosis of IGRS of 1 or 2 degree asymmetric form was conducted. 75.0% Of pregnant women that participated in the study, were of the average reproductive age (23-29 years of age). The share of young first-time-mother in I group was 10.0%, in II group – 15.0%, the share of age first-time-mothers was 17.5 and 10.0%, respectively. Extended history taking and history analysis, general clinical and obstetric-gynecological examination were conducted, laboratory and ultrasound methods were used. Newborns were evaluated on Apgar scale at birth and in 5 minutes. In the early neonatal period, inborn and transient pathological syndromes were evaluated.

Results. In patients receiving diosmin (n=40), reduction  of the resistance index of the right and left uterine arteries  to 0.440±0.004 and 0.460±0.004, respectively,  and of the umbilical artery to 0.56±0.02 was achieved, that is lower than in the group of patients taking dipiridamol (n=40). A positive influence of diosmin on the intrauterine condition of the fetus was found that was manifested by its increased compensatory capacities for adaptation  to chronic hypoxia in reliably higher percent of cases as compared to dipiridamol. After pharmacological correction, a tendency to normalization of the main parameters of the system of hemostasis was found in higher percent in women taking diosmin. This, in turn, produced a favorable influence on the volume of blood loss in physiological deliveries. Thus, in I group the average amount of blood loss was 180±15 ml, while in II group it was 265±15 ml (р<0.05). However, in operative delivery no such differences were obtained. In I group immediately after deliveries 10.0% of newborns were transferred to the resuscitation and intensive care unit, in II group transfer to resuscitation department was required in 37.5% of infants (<0.05). All the rest of children immediately after birth in the satisfactory condition were placed to one ward with mother, and they did not require resuscitation measures. 

Conclusion. Increase in the compensatory capacities of the fetus was shown in the conditions of chronic intrauterine hypoxia in a reliably higher percent of cases after pharmacological correction with diosmin. This, in turn, produced a favorable influence on perinatal outcomes, birth of children with a higher parameters of mass and height and health index.

Aim. Generalization of literature and proprietary data on genetic-physiological and evolutionary processes occurring in human populations in environmentally neglected industrial cities.

In the review information is given about damage to the genetic apparatus of cells of a human organism under influence of unfavorable environmental factors and disadaptations of different
genesis. To denote the totality of alterations induced by the given exposure, a new term is introduced – ‘genetics of disadaptations’. The information of mutagenic factors of the environment of industrial cities associated with growth of oncological diseases and of malformations resulting from chromosomal aberrations in cells is generalized. The problem of genetic burden of human populations
in environmentally neglected territories and of the influence of disadaptive factors on this process is discussed. Information of the ecological situation and morbidity of the population in Cherepovets industrial city is given. A role of disadaptations in genetic-evolutionary processes occurring in
human populations is shown. The cause of different manifestations of disadaptation in the population is stated to be divergence of traits. A hypothesis is proposed and evidences are given in favor of the existence of natural selection for a disadaptive trait in human populations. It is suggested that being accumulated in a human organism, disadaptive disorders may be transmitted to the next
generations reducing vital ability of organisms and inducing different diseases.

Conclusion. Within the topic, examples of different prophylactic measures for improving the health of the population of industrial cities are given to prevent unfavorable alterations of human genome under the influence of unfavorable ecological and related disadaptive factors.