Analysis of the infant traffic injuries peculiarities of according to the trauma mechanism and optimization of the emergency care principles

The article analyzes the injuries in children received as a result of traffic accidents, depending on the injury mechanism. For those children, who were in the car, predominantly local injuries of the MSS were noted with a smaller number of associated injuries. For those children, who were hit by a car, severe polyfocal injuries of MSS with damage to internal organs were noted. The principles of providing qualified and specialized emergency medicine to the children with combined injuries are described, that improve the efficiency and adequacy of all treatment-diagnostic measures and their qualified implementation.

Achievements of the Clinic of Traumatology and Orthopedics of Moscow State Medical and Dentistry University named after A. I. Evdokimov in treatment of complications and consequences of fractures of long bones of extremities

The work is devoted to improving the effectiveness of treatment of patients with complications and consequences of fractures of the long bones of the extremities by improving and developing new surgical techniques aimed at early individual social and household rehabilitation due to the maximally complete and rapid restoration of the integrity and functions of the damaged segment. Reconstructive operations were performed in 285 patients with delayed fracture consolidation, incorrectly fused fractures, false joints, and false joints with chronic osteomyelitis. The analysis of the applied treatment methods effectiveness from the viewpoint of optimizing the treatment process allowed us to develop an algorithm for the surgical treatment of patients with complications and consequences of fractures of the long bones of the extremities. The use of the proposed algorithm in surgical treatment maximally eliminates possible errors and increases the treatment effectiveness.

50th anniversary of the Department of Traumatology, Orthopedics and Disaster Medicine of A.I. Yevdokimov Moscow State University of Medicine and Dentistry

The purpose — to sum up the results of the work of the Department of Traumatology, Orthopedics and Disaster Medicine for 50 years. Material and methods. A detailed analysis was carried out of the stages of the Department development since its creation in 1971. The contribution of Professors Yu.V. Golyakhovskiy, A.S. Imamaliev, V.I. Zorya, N.V. Yarygin is highlighted. The achievements of the staff in scientific, educational, pedagogical and medical work over the past years are discussed. Results. Today, the overall bed fund of the Traumatology and Orthopedics bases of the Department is 300 beds. Only in 2019-2020, according to the results of studies conducted in clinics, 155 scientific articles and theses were published, 92 reports were made, two patents for inventions were obtained. Two textbooks, two training manuals on traumatology and orthopedics, and two monographs were published. The 4th and the 5th International Pirogov Forums were organized, with the leading Russian and foreign specialists as speakers. Conclusion. The Professors of the Department of Traumatology, Orthopedics and Disaster Medicine are highly qualified specialists, renowned in the sphere of Traumatology, Orthopedics and Disaster Medicine. The collective of the Department of Traumatology, Orthopedics and Disaster Medicine, relying on the previous experience and traditions, is energetic and confident on its anniversary.

On the clinical significance of HDL cholesterol at the present stage

The leading death cause in the world is diseases of the cardiovascular system, with CHD as the leader in the structure of cardiovascular diseases. The cause of this disease is atherosclerosis. One of the possible causes of atherosclerosis is an increase in LDL-C and a decrease in HDL-C in the blood. Many epidemiological studies have reliably shown that HDL cholesterol reduces the risk of developing cardiovascular diseases. Data from recent studies cast doubt on this data. The review briefly describes the current understanding of the effect of HDL-C high levels on morbidity and mortality, lists the new approaches to assessing the role and function of these particles, presents the results of clinical studies of drugs that affect their concentration in blood plasma and the probable causes leading to an increase of the HDL-Cin content in the blood.

Problems of surgical treatment of the anterior pelvic ring chronic injuries

A surgical treatment of the joints of the pelvic ring, especially the pubic joint is a separate and complex problem. When using standard plates, which are applied in the treatment of patients with fresh injuries to stabilize old injuries of the pelvic ring, problems arise with fatigue fracture of plates, destabilization of the metal structure and the need for repeated surgical interventions. Therefore, in the case of old injuries, during surgical treatment, it is necessary to use other tactical approaches to fixing pelvic injuries and to search for adapted structures for such cases. The purpose — to study the features of fixation of old injuries of the pelvic ring and to determine the results of different methods of the anterior pelvis fixation in old cases. Materials and methods. A retrospective analysis of the performed surgical treatment was carried out. In 2000-2015, in the first department of National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov, 117 patients underwent surgical treatment of old injuries of the anterior pelvic ring under our supervision using standard reconstructive plates applied in the surgical treatment of new injuries of the pelvic ring. Results. Of the 65 patients who underwent fixation of an old injury of the anterior semiring with AO reconstructive plates and AO pelvic plates, installed in a standard manner as in new injuries, 12 patients (10,2%) experienced migration or fracture of structures within 2 to 6 months from the operation. In 52 patients, fixation of the anterior section with two AO plates was applied, one of which was located in a standard way along the upper edge of the pubic bones, the second was implanted additionally along the anterior surface of the pelvic ring perpendicular to the first one. In this group, migration and destabilization of the structures was observed in 7 patients (13,4%) within a period from 2 weeks to 2 months from the date of the operation. Conclusion. The analysis of the study results suggests that surgical treatment of old injuries of the anterior pelvic ring requires a special approach to the choice of the surgical fixation method, which differs from the treatment of new injuries. Over time, in the absence of treatment for injuries and ruptures of the pelvic ring, cicatricial-fibrous adhesions of the pelvic ring occur, which does not always ensure the stability of the pelvic ring, but leads to rigid post-traumatic deformity of the pelvis. Taking into account the cases of destabilization in groups 1 — 10,2% and 2 — 13,4%, as well as the assessment of the long-term results according to the Majeed scale, the use of standard methods for fixing the anterior pelvic semiring can be considered ineffective in old pelvic injuries.

Modern view on the features of varicella in children and the possibility of specific prevention

The literature review presents modern information about the peculiarities of the epidemiology and course of chickenpox in children and clarifies the reasons for complicated course of the disease. The modern aspects of pathogenesis are described, starting with the characteristics of the varicella zoster virus structure, the features of its interaction with the macroorganism, the nature of the immune response, which is one of the important factors of an unfavorable course of the disease. The clinical variety of chickenpox complications is reflected, including damage to various organs and systems, primarily the nervous, endocrine systems and the skin. Convincing data on chickenpox as a serious infectious disease are presented. The article provides up-to-date information on the possibilities of specific prevention of chickenpox in children. The presence of a normative-legal basis for chickenpox prevention, as well as the chickenpox vaccine approved for use from 12 months of age, its inclusion in the National Vaccination Schedule for epidemiological indications, the high immunogenicity of the vaccine, its safety and efficacy, make one confident in the existence of a real mechanism of influence on morbidity, which is confirmed by the global experience.

Application of melatonin for prevention and treatment of circadian rhythm disorders

The article presents data from the Russian and foreign literature of the properties of melatonin, its role in the vital activity of the body and the regulation of circadian rhythms. The features of using the drug in desynchronosis, the optimal dosage and time of administration, as well as the possibility of its use in combination with non-pharmacological treatment methods are discussed. These methods include dosed light exposure and exercise. Additionally, new studies are considered, indicating the beneficial effect of melatonin and its agonists on the immune, cardiovascular, endocrine and nervous systems. Based on the collected data, it is asserted that melatonin can significantly accelerate the process of adaptation to a new time zone without the development of side effects. Therefore, this drug is the most effective and safe treatment for desynchronosis. It is also important to note that the study of the multifaceted effects of melatonin on body functions opens up great prospects in the treatment of many diseases.

Chronic stress and brain-derived neurotrophic factor

The article discusses the influence of stress on the development of nervous tissue, in particular, on the synthesis of neurotrophins (by the example of the brain-derived neurotrophic factor (BDNF), as the most studied class representative). The biological functions of BDNF are discussed as well as its influence on neuroplasticity and the mechanisms by which the protection of neurons is carried out. The article covers the relationship of the stress-implementing system (hypothalamic-pituitary-adrenal axis) and its main active agent (cortisol) with the BDNF synthesis system at its various levels: from the inhibition of mRNA formation to the mechanisms of postsynaptic signal transmission. Information is also provided on changes of BDNF levels due to the maternal deprivation. Epigenetic changes under the influence of glucocorticoids are also reported. However, it is not only glucocorticoids that alter the functioning of the neurotrophin system. The article provides examples of the reverse effect, enabling to consider neurotrophins as a substance with an anti-stress function. In conclusion, the authors give examples of activities that, according to research, can stimulate the synthesis of neurotrophic factor in the brain.

Clinical case of recurrent vomiting in a child: diagnostic search from functional gastrointestinal disorders to piloid astrocytoma

The urgency of the problem of recurrent vomiting in children is due not only to the high prevalence of this syndrome, but also to a wide range of reasons for its development. The article presents a clinical case of observation of a child with recurrent vomiting syndrome. It shows the dynamics of the disease, the importance of identifying such «anxiety symptom» as the nutritional status violation. In this case, the cause of vomiting of central genesis was not immediately taken into account, although differential diagnosis presupposes an integrated approach, and doctors' oncological alertness should be constantly preserved even in pediatrics.

Markers of steroid resistance of the primary nephrotic syndrome in children

The global task of the recent decade is to search for clinical and laboratory markers accurately showing a patient’s reaction to steroid therapy and other immunosuppressive drugs. It is important the applied methods and tests to be non-invasive and simple to use. The article considers various biomarkers used to verify the type of nephrotic syndrome depending on the sensitivity to steroid therapy. Besides the common markers, which are used in clinical practice or have shown a significant result, the work highlights the molecular- genetic markers of resistance to steroid therapy, which are of special clinical importance today. Also, the article presents authors’ own results in diagnosing the steroid resistance of the primary nephrotic syndrome.