ФГБНУ «Центральный научно-исследовательский институт туберкулеза», Москва, РоссияЦель: исследование эффективности профилактики возникновения медиастинальной грыжи (МСГ) и эффективности коррекции имевшейся до операции МСГ путем пластики переднего средостения (ППС) во время проведения пневмонэктомии (ПЭ)� Материалы и методы. Результаты ПЭ у 30 пациентов (22 мужчины и 8 женщин, возраст от 20 до 56 лет) с фиброзно-кавернозным туберку-лезом легких с множественной/широкой лекарственной устойчивостью возбудителя� В 1-й группе -17 пациентов, которым проведена ПЭ с ППС, из них у 10 (58,8%) пациентов до операции не было МСГ, а у 7 (41,2%) пациентов уже была МСГ малого объема� Во 2-й группе -13 пациентов, у которых ПЭ не сопровождалась ППС� Результаты. При ПЭ МСГ не формируется: у 82,4% (95%-ный ДИ 59,0-93,8%) пациентов, если выполняется ППС, и у 7,7% (95%-ный ДИ 1,4-33,3%) пациентов, если пластика не используется, p < 0,01� Проведение ППС во время ПЭ устранило имевшуюся до операции МСГ малого размера у 71,4% (95%-ный ДИ 35,9-91,8%) пациентов, вы-полнив коррекционную функцию� После ПЭ по поводу фиброзно-кавернозного туберкулеза риск формирования МСГ у пациентов, не имевших ее до операции, при выполнении пластики средостения составляет 10,0% (95%-ный ДИ 1,8-40,4%), у имевших МСГ -28,6% (95%-ный ДИ 8,2-64,1%)� При неиспользовании ППС риск составляет 90,0% (95%-ный ДИ 59,6-98,2%)� Ключевые слова: хирургия туберкулеза, осложнения пневмонэктомии, медиастинальная грыжа, пластика переднего средостения ANTERIOR MEDIASTINAL PLASTICS DURING PNEUMONECTOMY AS PREVENTION AND TREATMENT OF A MEDIASTINAL HERNIA IN FIBROUS CAVERNOUS PULMONARY TUBERCULOSIS PATIENTS M. А. BАGIROV, E. V. KRАSNIKOVА, А. E. ERGESHOVА, O. V. LOVАCHEVА, N. L. KАRPINА, R. А. PENАGI Central Research Institute of Tuberculosis, Moscow, RussiaThe objective is to study the efficiency of prevention of a mediastinal hernia and efficiency of its treatment through anterior mediastinal plastics performed during pneumonectomy� Subjects and Methods� Results of pneumonectomies in 30 patients (22 men and 8 women at the age varying from 20 to 56 years old) with fibrous cavernous pulmonary tuberculosis with multiple or extensive drug resistance� Group 1 included 17 patients who had pneumonectomy with anterior mediastinal plastics, of them 10 (58�8%) had no mediastinal hernia and 7 (41�2%) patients had a minor one� Group 2 included 13 patients who had pneumonectomy without anterior mediastinal plastics� Results. When pneumonectomy was performed, no mediastinal hernia developed in 82�4% (95% CI 59�0-93�8%) of patients who had anterior mediastinal plastics and in 7�7% (95% CI 1�4-33�3%) of patients with no plastics, p < 0�01� Anterior mediastinal plastics performed during pneumonectomy repaired a minor mediastinal hernia in 71�4% (95% CI 35�9-91�8%) of patients� After pneumonectomy with anterior mediastinal plastics due to fibrous cavernous tuberculosis, the risk of mediastinal hernia made 10�0% (95% CI 1�8-40�4%) in the patients who had no hernia before surgery, while in the patie...
The spread of drug-resistant forms of TB dictates the need for surgical treatment in the complex of anti-tuberculosis measures in Russia. Most often, surgical intervention is performed in the case of pulmonary tuberculoma or fibrotic cavitary tuberculosis (FCT). This study is devoted to the search for biomarkers that characterize the course of disease in surgical TB patients. It is assumed that such biomarkers will help the surgeon decide on the timing of the planned operation. A number of serum microRNAs, potential regulators of inflammation and fibrosis in TB, selected on the basis of PCR-Array analysis, were considered as biomarkers. Quantitative real time polymerase chain reaction and receiver operating curves (ROC) were used to verify Array data and to estimate the ability of microRNAs (miRNAs) to discriminate between healthy controls, tuberculoma patients, and FCT patients. The study showed that miR-155, miR-191 and miR-223 were differentially expressed in serum of tuberculoma with “decay” and tuberculoma without “decay” patients. Another combination (miR-26a, miR-191, miR-222 and miR-320) forms a set to differentiate between tuberculoma with “decay” and FCT. Patients with tuberculoma without “decay” diagnosis differ from those with FCT in serum expression of miR-26a, miR-155, miR-191, miR-222 and miR-223. Further investigations are required to evaluate these sets on a larger population so as to set cut-off values that could be applied in laboratory diagnosis.
In 2015, more than 10% of tuberculosis (TB)-related deaths were attributable to M. tuberculosis with multiple drug-resistance (MDR-TB) and extensively drug-resistance (XDR-TB) (WHO 2016). In combination with insufficient commitment to the treatment regimen, the genetic heterogeneity and clonality of the patient's M. tuberculosis, as well as the poor permeability of the tuberculosis granuloma for the drug, can lead to monotherapy, despite the use of several drugs, which further promotes the spread of MDR and XDR-TB. Of particular concern is the rapid spread of resistance to newly introduced into clinical practice second-line drugs, intended for the treatment of MDR-TB — delamanid and bedaquiline. Thus, the spread of drug resistance to chemotherapy, along with the limited possibilities of chemotherapy in patients with MDR-TB and XDR-TB, dictate the need to supplement canonical chemotherapy with TB treatment methods directed at the host. MicroRNAs (miRs) are short sequences of single-stranded RNA that control up to 60% of genes encoding protein synthesis at a post-transcriptional level. Accumulating data points to the essential role of miRs in fine tuning the host response to infection, primarily by modulating the expression of proteins involved in the reactions of innate and adaptive immune responses. Despite the fact that the established functions of miRs activity are intracellular, a number of studies have discovered highly stable extracellular miRs circulating in blood. Currently, the possibility of using these molecules as biomarkers is being actively investigated. Chronic TB inflammation is characterized by parallel or step-bystep development of regulatory and pro-inflammatory processes that affect the severity and outcome of the disease. Both pro- and anti-inflammatory effects are elements of the bacterial strategy in the struggle for survival in the host organism. In this review we discuss the role of miRs as markers of tuberculosis infection, the nature and prognosis of the course of the disease, the involvement of miRs in the regulation of the innate and adaptive immunity in tuberculosis infection, and the perspectives for clinical usage of miRs as means for diagnosis and treatment of tuberculosis.
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