Selective Intestinal Decontamination as a Method for Preventing Infectious Complications (Review).

Infectious complications are the most common cause of death in patients with severe burns. To date, there is no generally accepted method for preventing such complications in burn injury. One of the possible prevention options is selective intestinal decontamination (SID). This method is based on the enteral administration of non-absorbable antimicrobial agents. The preventive effect of SID involves inhibition of intestinal microflora translocation through the mucous membranes, inasmuch as studies demonstrate that endogenous opportunistic microorganisms are a common cause of infectious complications in various critical conditions. The SID method was originally developed in the Netherlands for patients suffering from mechanical injury. Antimicrobial drugs were selected based on their high activity in relation to the main endogenous opportunistic pathogens and minimal activity against normal intestinal microflora components. The combination of polymyxin (B or E), tobramycin, and amphotericin B with intravenous cefotaxime was chosen as the first SID regimen. Other regimens were proposed afterwards, and the application field of the method was expanded. In particular, it became the method of choice for prevention of infectious complications in patients with severe burn injury. Clinical studies demonstrate efficacy of some SID regimens for preventing infectious complications in patients with thermal injury. Concomitant administration of SID and systemic preventive antibiotics and addition of oropharyngeal decontamination increases the method efficacy. SID is generally well-tolerated, but some studies show an increased risk of diarrhea with this preventive option. In addition, SID increases the risk of developing antibiotic resistance like any other antibiotic regimens.

Synthesis and Antiplatelet and Anticoagulant Activity of Thietane-Containing 2-(5-Bromo-2,4-Dihydro-3-Oxo-1,2,4-Triazolyl-4)Acetate Salts.

Sulfone II was synthesized via oxidation of ethyl 2-[5-bromo-2,4-dihydro-3-oxo-2-(thietanyl-3)-1,2,4-triazolyl- 4]acetate (I) by H2O2. Hydrolysis of esters I and II synthesized 2-[5-bromo-2,4-dihydro- 3-oxo-2-(thietanyl-3)-1,2,4-triazolyl-4]- and 2-[5-bromo-2,4-dihydro-3-oxo-2-(1,1-dioxothietanyl-3)-1,2,4- triazolyl-4]acetic acids III and IV, respectively.Water-soluble salts V and VI were prepared by reacting acids III and IV with alkali-metal hydroxides and amines. The structures of the synthesized compounds were confirmed IR and NMR spectroscopic data. The antiplatelet and anticoagulant activity of the synthesized compounds was studied in vitro based on predictions of the PASS computer program. Compounds III and VIb, which showed the absence of predicted toxic risks and were superior to the reference drug in the collagen-induced aggregation test, had the most pronounced antiplatelet activity (comparable to that of acetylsalicylic acid) in the ADP-induced aggregation test. The anticoagulant activity of the compounds was significantly inferior to that of heparin sodium. All synthesized compounds satisfied Lipinski's rule-of-5.

[Criterion assessment system of the actual level of expertise of dental professionals practicing implant dentistry]. / Kriterial'naia sistema otsenki real'nykh kompetentsii vrachei-stomatologov, zanimaiushchikhsia dental'noi implantologiei. Rezul'taty analiza 43 portfolio molodykh vrachei-stomatologov.

The aim of the study was to develop criterion assessment system of the actual level of expertise of dental professionals practicing Implant dentistry. The study comprised fifteen dental experts aged from 35 to 47 years with the average 15 years clinical experience. For evaluation of the clinical portfolio of the dentists we developed 10 reference points and to ensure unification of the assessment approach we organised consensus methodical conference for our expert group. Scores were applied by parity of reasoning with point-rating system applied in continuing education programs of Medical University. Assessment of 43 clinical portfolios with short term and long term results of implant supported restorations was performed. Treatment was provided with the use of Nobel Biocare implants and prosthodontic rehabilitation was achieved with the use of CAD/CAM 'Procera' technology. The study showed that dentists who practice implant dentistry from 1 to 7 years have good manual skills and clinical expertise sufficient for achieving positive treatment outcome. At the same time in general their actual diagnostic skills are not sufficient, they misapply additional diagnostic methods, do not perform risk analysis of potential clinical complications that leads to shifting responsibilities on the patients in case of complications emergence. Methods of Computer Assisted Design are widely popular during all stages of rehabilitation (diagnostic, surgical stent, final prosthesis framework). Actual level of expertise of dental professionals doesn't depend on sex distribution. Males and females who practice implant dentistry have similar levels of clinical expertise.

[The association between physical inactivity and other behavioural risk factors of the development of chronic non-communicative diseases among the students]. / Assotsiatsiya gipodinamii i drugikh povedencheskikh faktorov riska razvitiya khronicheskikh neinfektsionnykh zabolevanii u studentov.

AIM: The objective of the present study was to evaluate the possible association between the physical inactivity and other behavioural risk factors of the development of chronic non- communicable diseases among the young persons. MATERIAL AND METHODS: A total of 216 1-2 grade students at the mean age of 18.8±1.3 years including 136 women and 80 men educated at A.I. Evdokimov Moscow State Medical Stomatological University, Ministry of Health of the Russian Federation, were recruited for the examination. RESULTS: The participants in the study were found to be at high risk of developing chronic non-communicable diseases associated with their behavioral patterns, such as smoking and delivery (37.5% among the young men and 42.6% among the women). The bioimpedance observations revealed the augmentation of the body fat weight, the reduction of muscle mass, and the impairment of basal metabolism under the influence of hypodynamia that was also responsible for the change of homeostasis parameters revealed based on the results of the complete blood cell count. The sex-specific differences and those associated with physical activity were apparent in the prevalence of selected risk factors. The majority of the men characterized by the normal level of physical activity show the lowest occurrence of nutrition-related risk factors. However, it is the girls having no signs of hypodynamia that most frequently tend to calculate the nutritional value of their diet and follow the healthy meal strategies. The girls exhibiting the signs of physical inactivity present with the enlarged hip circumference whereas the hypodynamic men tend to show the enlarged waist circumference. The present study has demonstrated that nutritional motivation of the students depends on the level of their physical activity and smoking habits. Low physical activity appears to be responsible for the changes in the body composition and affects the parameters of homeostasis determined from the complete blood cell count. At the same time, the physical exercises are known to either prevent or slow down the development of many chronic non-communicable diseases including cardiovascular disorders. This observation opens up the prospects for the prevention of such pathology by involving the students exhibiting the low level of physical activity in the physiotherapeutic programs. On the other hand, sports activities may contribute to socialization of the students by erasing the boundaries between those «fit¼ and «unfit¼ for such behaviour. Taken together, these considerations emphasize the necessity of the specialized programs for the students with the low level of physical activity and hypodynamia. CONCLUSION: The present study has demonstrated the signs of hypodynamia in 37.5 and 43.6% of the young men and women respectively.

[Physico-chemical and biophysical factors of post-injection aggression of the drug solutions in infiltrated tissues and methods of necrosis prevention].

Ultrasonic visualization of infiltration of the soft tissues increases precision of injection of drug solutions to the appointment place. It's proved that water for injection and 0,25% solution of novocainum can be used as antidote of hyperosmotic solutions and 5% solution of Natrii citrate is offered as antidote to calcium preparations. Fastly injection of these drugs infiltration caused by error injection of connective tissues by antidotes of hyperosmotic solutions and calcii preparation prevent post-injection necrosis.

[Individual prospects of control over process of transfer of solid and liquid drugs inside the stomach]. / Individual'nye vozmozhnosti upravleniia protsessom fizicheskogo peremeshcheniia tverdykh i zhidkikh lekarstvennykh form vnutri zheludka.

It was discovered that patients with stomach ulcers take anti-ulcer drugs while standing, sitting, lying, or moving in the space. The overwhelming majority of them take drugs while sitting and keep the same position almost without any motion during one hour.

[Pharmacologic possibility of limiting the energy-dependent accumulation of calcium by mitochondria of the ischemic myocardium]. / Farmakologicheskaia vozmozhnost' ogranicheniia énergozavisimoi akkumuliatsii kal'tsiia mitokhondriiami ishemizirovannogo miokarda.

In experiments with total ischemia of the isolated rat heart it was found that a preliminary administration of preparations with malonate-like action to the animals exerts, unlike isoptin, cold-like effect on the time-course of calcium levels in mitochondria of the ischemic myocardium and limits the process of accumulation and release of calcium by organelles.

[Pharmacologic and cold therapy in severe chronic ischemia of the lower extremities]. / Farmakokholodovaia terapiia pri tiazheloi khronicheskoi ishemii nizhnikh konechnostei.

It was demonstrated experimentally and in the clinic that pharmacocoid therapy applied before, during, and after operation produces a protective anti-ischemic and spasmolytic effect, prevents of reduces the intensity of reperfusion disorders, and allows the viability of the limb involved in severe chronic ischemia to be appraised.

[Local hypothermia in the treatment of acute arterial occlusion of the extremities]. / Mestnaia gipotermiia v lechenii ostroi neprokhodimosti arterii konechnosti.

An experimental and clinical investigation of the possibility to use local hypothermia of the extremity in the complex treatment of its acute ischemia was performed. It was established that the local hypothermia could considerably improve tissue viability in the process of the extremity ischemia at the expense of spasmolytic, hypocoagulative, anesthetic effects and inhibition of metabolism. A conclusion is made that the local hypothermia should be used in the clinic for the improvement of results of treatment of patients with acute arterial obstruction of the lower extremities complicated by severe ischemia.

[Effect of local hyper- and hypothermia on hemodynamics and viability of the ischemic intestine]. / Vliianie lokal'noi giper- i gipotermii na gemodinamiku i zhiznesposobnost' ishemizirovannoi kishki.

Chronic experiments in animals have shown that local hyperthermia aggravates sequellae of the intestine ischemia. It has been established that hypothermia has a favourable effect on the development and outcomes of the ischemic process in the bowel.

[Improved blood flow in the organs and the prevention of thrombus formation with cold]. / Uluchshenie krovotoka v organakh i predotvrashchenie tromboobrazovaniia s pomoshch'iu kholoda.

It has been established that tissue cooling to 15-20 degrees C brings about a short-term spasm of smooth muscles of the intestine, peripheral vessels and of the visceral vessels, replaced by an appreciable spasmolytic effect at the 5th-8th minute of hypothermia. The maximal hyperemia develops by the 15th-20th minute of the cooling and persists over the whole period of the cooling. It is assumed that inhibition of oxidative phosphorylation in the mitochondria of the smooth muscles underlies the spasmolytic action of cold. In addition, cold produces a marked hypocoagulation effect.

[Possible mechanism of action of isoquinoline and phenothiazine derivatives, nitrites and nitrates on myocardial oxygen consumption]. / Vozmozhnyi mekhanizm deistviia proizvodnykh izokhinolina, fenotiazina, nitritov i nitratov na potreblenie miokardom kisloroda.

It has been demonstrated in experiments with isolated pieces of the rat myocardium that papaverine, Nospa, nonachlazine, etmozine, nitroglycerin and sodium nitrite are capable to reduce the rate of oxygen consumption by the myocardium at the expense of variation in mitochondrial respiration according to the malonate-like action.

[Biochemical basis for the spasmolytic effect of isoquinoline and phenothiazine derivatives]. / Biokhimicheskaia osnova spazmoliticheskogo éffekta proizvodnykh izokhinolina i fenotiazina.

Experiments with isolated ring-like strips of pig heart veins and arteries and those with rat small intestinal strips made in the presence of hyperpotassium contracture have demonstrated that spasmolytic activity of papaverine, nospa, nonachlazine, and ethmozine is a consequence of the reduced respiratory intensity and phosphorylation in smooth muscle mitochondria. No changes in the anaerobic glycolysis rate have been found after drug administrations.

[Effect of hypothermia and anti-angina preparations with malonate-like action on myocardial glycolysis and oxidative phosphorylation]. / O vliianii gipotermii i antianginal'nykh preparatov s malonatpodobnym deistviem na glikoliz i okislitel'noe fosforilirovanie miokarda.

It has been discovered that hypothermia under 20 degrees C produces no effect on the reactions of anaerobic glycolysis and lactate level in the rat and dog myocardium during ischemia and anoxia. At the same time hypothermia reduces 8-10-fold the rate of free and conjugated mitochondrial respiration, which is similar to the malonate-like action of a number of antianginal drugs. Based on the fact that hypothermia protects the tissues from ischemic lesions it is concluded that inhibition of mitochondrial respiration with the drugs having a malonate-like action or with other mechanisms is to also protect the myocardium at early times of acute ischemia.