The review is devoted to the 100-year history of the Institute of Maternal and Infant Health, renamed for the Institute of Pediatrics of the USSR Academy of Medical Sciences and then for the Scientific Center for Children’s Health of the Russian Academy of Medical Sciences. The regularities of the formation of the state system of maternity and infancy care, the peculiarities of the reorganization of the Institute in various historical periods, the contribution of the Institute’s scientists to the development of domestic Pediatrics and the formation of the system of child health care are traced. The Institute of Pediatrics is shown to be the leading pediatric institution in the country, capable of caring for children’s health, creating new generations of pediatricians and determining the future of Pediatrics. The uniqueness of the country’s leading Institute of Pediatrics is the harmonious combination of the age-old tradition of fundamental and applied research in the field of child health care with the provision of multidisciplinary high-tech medical management for children patients, and the training of scientific and medical personnel.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The author declares no conflict of interest.

Received: September 16, 2022
Accepted: September 20, 2022
Published: October 31, 2022

The review is devoted to the 100-year history of the Institute of Pediatrics, mainly there are analyzed the activities of scientific laboratories and departments, the peculiarities of their reorganization in various historical periods, the contribution of scientists to the development of domestic pediatric science and established patterns essential for the formation of the national system of child health care.  The scientific achievements of the scientists of the Institute of Pediatrics were established to be noted by the Grants Committee under the President of the Russian Federation. On a competitive basis, the Institute of Pediatrics of the Russian Academy of Medical Sciences is recognized as a leading scientific school, and its director, Academician M.Ya. Studenikin, as a the leader of the pediatric scientific school. Currently, the Institute of Pediatrics is the largest pediatric institution of the National Medical Research Center for Children’s Health of the Ministry of Health of Russia, has significant scientific potential, is able to ensure the children’s health care and create new generations of pediatricians on a modern scientific basis.

Contribution:
Fisenko A.P. — study conception and design of the study;
Smirnov I.E. — drafting of the manuscript;
Fisenko A.P. — critical revision.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: September 08, 2022
Accepted: September 20, 2022
Published: October 31, 2022

Introduction. The effectiveness of the use of TNF inhibitors in patients with inflammatory bowel diseases (IBD) has been shown. 20–40% of patients are known to fail to respond to received therapy, and 10–30% of patients experience a loss of effect by the year of therapy. Objective is to evaluate the information content of therapeutic drug monitoring (TDM) for effective treatment with TNF blockers (infliximab — IFX, adalimumab — ADA) in IBD children.

Materials and methods. There were examined seventy four children on IFX therapy including 66 children on ADA therapy. The age of the children ranged from 3.4 to 18 years. Residual levels of IHF and ADA were determined using a lateral flow immunoassay. Statistical data processing was performed using the Statistica 10.0, SPSS 16 software. Differences between groups were assessed using the nonparametric Mann–Whitney U test.

Results. IFX levels (less than 3 µg/ml) were detected in 64% of cases, ADA (less than 5 µg/ml) in 21% of cases. The residual level of IFX and ADA in remission significantly exceeded the level of drugs in groups of children in exacerbation. An inverse relationship was observed between the residual level of IFX (r = –0.68, p = 0.000) and ADA (r = –0.31, p = 0.000) and the number of days after drug administration. Anti-IFX antibodies were found in 27.3% in the exacerbation group and in 5.8% in remission (p < 0.001). Antibodies to ADA in children with IBD were found in 4 patients with a low concentration of the drug (2.57 ± 0.45 µg/ml) in the serum in a state of exacerbation. In patients on anti-TNF therapy, empirical dose selection revealed a residual level lower than in children in whom dose adjustment was carried out taking into account the residual concentration of drugs.

Conclusion. The use of TDM TNF blockers in combination with the determination of antibodies to drugs can significantly increase the effectiveness of therapy in IBD children.

Contribution:
Radygina T.V., Illarionov A.S., Petrichuk S.V. — research concept and design of the study;
Radygina T.V., Illarionov A.S., Petrichuk S.V., Kuptsova D.G., Potapov A.S., Anushenko A.O., Kurbatova O.V. — collection and processing of material;
Radygina T.V. — text writing;
Potapov A.S., Fisenko A.P. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Ethics approval. The study protocol was approved by the local ethics committee. The patients’ parents gave written voluntary informed consent to participate in the study. 

Acknowledgment. The study was carried out on state assignment of the Ministry of Health of Russia, number АААА-А19-119013090093-2.

Conflict of interest. The authors declare no conflict of interest.

Received: September 16, 2022
Accepted: September 20, 2022
Published: October 31, 2022

A unique clinical case of a combination of malformations of the anterior abdominal wall (omphalocele of large size) and malformation of the lymphatic system (congenital chyloperitoneum) is presented. Each of these defects can lead to a fatal outcome, and the combination of them has greatly increased the risk of developing an unfavourable outcome. The use of immunosuppressive therapy with Sirolimus used for the first time during the newborn period made it possible to completely stop the chyloperitoneum. This clinical example shows that in the treatment of surgical patients with multiple congenital malformations, a multidisciplinary approach and observation is necessary for timely response to the patient’s condition.

Contribution:
Gurskaya A.S. — concept and design;
Nakovkin O.N., Akhmedova D.M., Karnuta I.V., Shchukina A.A., Petrova N.V., Skvortsova V.A., Sulavko M.A., Ekimovskaya E.V. — collection and processing of the material;
Gurskaya A.S., Sulavko M.A. — writing the text;
Fisenko A.P. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: August 24, 2022
Accepted: September 20, 2022
Published: October 31, 2022

Aim of the study: to study the role and possibilities of magnetic resonance imaging (MRI) in the diagnosis of injuries of ligaments and soft tissues of the cervical spine in emergency care.

Materials and methods. MRI was performed in fifty two children with trauma of the cervical spine, in 1 of them with contrast enhancement. Boys predominated — 33 (63.5%), girls were 19 (36.5%). The age of the patients varied from 3 to 17 years, the mean age was 14 ± 1.4 years. The study was carried out on a Phillips Achieva dStream 3T scanner. The study protocol includes MR-myelography in sagittal and coronary projections, T2WI sagittal projection in PS STIR, T2WI SE, T1WI SE, DTI, axial projection of T2WI SE or T2*WI GRE.

Results. Trauma of cervical spine was combined in 46% (n = 24) of all 52 cases, and in 54% (n = 28) it was isolated. During the clinical and neurological examination according to the ASIA impairment scale, there were 13 (25%) children with grade A, 3 (5.8%) with grade B, 9 (17.3%) with grade C, 4 (7.7%) with degree D and 23 (44.2%) with grade E. Spinal cord injuries in the form of hematomyelia were detected in 13 (25%) children, contusion and swelling of the spinal cord — in 15 children (29%). According to MRI results, 4 (7.7%) had a traumatic hernia with a decrease in disc height, 15 (28.8%) had secondary stenosis of the spinal canal at the time of the study, 28 (53.8%) had spinal cord compression and changes in the MR signal, 5 (9.6%) had epi- and subdural hematomas, 45 (86.5%) had vertebral fractures.

Conclusion. MRI, as a method more sensitive than other imaging modalities in the diagnosis of soft tissue and spinal cord injuries, allows radiologist directly assessing the condition of spine soft tissues and, therefore, is critical in the evaluation of a patient with ligament injury and instability. Recognition of soft tissue injuries affects patient management and outcome.

Contribution of authors:
Bozhko O.V., Akhadov T.A., Melnikov I.A. — research concept and design;
Meshcheryakov S.V., Melnikov I.A., Semenova N.A., Dmitrenko D.M. — conducting research;
Bozhko O.V., Dmitrenko D.M. — collection and analysis of data;
Ublinskiy M.V., Manzhurtsev A.V., Khusainova D.N. — statistical analysis;
Bozhko O.V., Akhadov T.A. — writing text;
Ublinskiy M.V. — editing.
All co-authors — approval of the final version of the article and responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: September 07, 2022
Accepted: September 20, 2022
Published: October 31, 2022

Introduction. Spinal cord injury, like any severe injury, triggers a cascade of metabolic reactions leading to an increased demand for macronutrients. Untimely correction of nutritional losses leads to significant weight loss in the patient, and as a result, to an increase in the number of alimentary-dependent complications.

Materials and methods. The study included fifty spinal cord injury (SCI) children, aged of 7–18 years admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in Moscow within the first month after injury. All patients from the moment of admission and over the next 6 months had a dynamic monitoring of their nutritional status. It included examination of anthropometric and laboratory parameters, and examination of the state of component composition of plegic limbs using MR scanning on a high-field (1.5 T) Toshiba MR tomograph.

Results. The screening performed has revealed a risk of nutritional deficiency in all SCI patients. The findings were obtained indicating that in the majority of children of this category significant malnutrition had developed by the first month after the injury. Subsequently, it caused tissue imbalance in muscles of the plegic limbs. The timely correction of nutritional losses with special mixtures and standard diet products has stabilized the progressive weight loss and prevented complications associated with insufficient alimentation.

Conclusion. A regular comprehensive assessment of nutritional status is the basis for determining adequate nutritional support and diet for SCI children.

Contribution:
Ponina I.V. — concept and design of the study;
Ponina I.V., Novosyolova I.N., Popova O.V. — collection and processing of material;
Lukyanov V.A. — statistical processing of the material;
Ponina I.V., Novosyolova I.N. — writing text;
Akhadov T.A., Bozhko O.V. — analysis of MRI results;
Novosyolova I.N. — editing;
Valiullina S.A. — general management of the study, editing, conclusion of the manuscript for publication.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study was supported by a grant from the Government of Moscow «Diffuse-tensor imaging (DTT) and functional magnetic resonance imaging (fMRI) of the spinal cord in clinical practice (normal and spinal cord injury») (project No. 2112-9) and «System of integrated rehabilitation of children with acute traumatic injuries based on an organizational model using innovative medical convergent technologies» (project No. 2412-9).

Conflict of interest. The authors declare no conflict of interest. 

Received: September 05, 2022
Accepted: September 20, 2022
Published: October 31, 2022

Aim is to develop a comprehensive program of restorative treatment of posture disorders in children against the background of connective tissue dysplasia. 

Materials and methods. Ninety children aged from 4 to 17 years were under observation. Of these, 60 patients with connective tissue dysplasia (CTD) were divided into an experimental group (30 children) and a comparison group (30 children). These CTD children were under medical supervision from 2010 to 2020. The reference group consisted of 30 conditionally healthy children of the same age. All children were comprehensively examined. All СTD patients during the entire period of dispensary observation underwent comprehensive restorative treatment using methods of physical therapy, swimming and teaching patients at the educational school “Posture Correction” for children. The data obtained were processed statistically.

Results. Characteristic signs of hereditary disorders of connective tissue development were revealed in all CTD children. An increase in the concentration of oxyproline in the blood serum and an increase in urinary excretion of oxyproline and calcium were found. After 5 years from the start of rehabilitation measures, there was an increase in endurance of the back muscles, a minimum number of pathological manifestations, including arthritis, arthralgic syndromes, coccygodynia. Ten years later, at the age of 14 years, the children of the experimental group formed a good posture, a well-off muscular corset and a minimal number of complications. Patients of the comparison group during the observation process more often complained of a feeling of fatigue, prolonged, incurable pain in the thoracic and lumbar spine, weak muscle corset.

Conclusion. If CTD signs are detected in children, long-term dispensary observation should be carried out in outpatient conditions with the inclusion of a set of exercises of physical therapy and other rehabilitation measures. With the initial CTD manifestations on the part of the spine, children should be recommended to use a back support or a semi-rigid corset for the duration of increased loads, lessons, and long training sessions.

Contribution:
Metalnikov A.I. — concept and design of the study, collection and processing of material, writing the text, statistical processing of the material;
Ten Yu.V., Strozenko L.A. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: August 25, 2022
Accepted: September 20, 2022
Published: Octoder 31, 2022

The article presents an overview of current trends in the approach to the treatment of patients with short bowel syndrome (SBS), including the example of pediatric patients in the Tyumen region. SBC is an extremely rare nosological form in the practice of a clinician and, as a rule, patients with such a diagnosis require a multidisciplinary approach. The most common manifestations of the disease are symptoms of malabsorption: dumping syndrome, progressive weight loss, deficiency of macro- and micronutrients, other manifestations of dyspepsia and abdominal pain. Attention is drawn to the fact that the number and intensity of symptoms varies significantly among patients. The traditional tactic for treating such patients includes the need for lifelong parenteral nutrition or, as a necessary measure, intestinal transplantation. Rehabilitation measures in SBS children should take into account the requirements for correcting impaired absorption and restoring normal trophic status; relief of diarrhea, prevention and treatment of dysbiosis; control and correction of general digestive disorders. We found that the analogue of glucagon-like peptide 2 (GLP-2) — teduglutide — makes it possible to reduce the amount of parenteral nutrition, infusion time, and also achieve a complete transition to enteral autonomy. The method of treatment with Teduglutide is the most promising for patients of this category.

Contribution:
Tropina E.P., Zmanovskaya V.A. — concept and design of the study;
Tropina E.P. — collection and processing of the material;
Zmanovskaya V.A. — statistical processing;
Tropina E.P. — writing the text;
Zmanovskaya V.A. — edi­ting.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: September 12, 2022
Accepted: September 20, 2022
Published: October 31, 2022

The article presents current literature data from English-language (search made in PubMed) and Russian-language (search made in eLibrary) sources about the method for measurement of the lung diffusing capacity for carbon monoxide in children with cystic fibrosis (CF). This review presents the general characteristics of this test in children and adults with various diseases, and also describes the conflicting results of studies using this method in CF patients of various ages and disease severity. The expediency, the informativeness, and difficulties of evaluation and interpretation of the test’s results, depending on the age and course of the disease of patients, are discussed. The author concludes that further research of interpretation of indicators determined during the test of the lung diffusing capacity for carbon monoxide, such as the transfer factor, alveolar volume, and their ratio in CF children is necessary.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The author declares no conflict of interest.

Received: August 24, 2022
Accepted: September 20, 2022
Published: October 31, 2022

Electronic nicotine dosing systems, commonly known as electronic cigarettes or vapes, have quickly become the most common tobacco products used by teenagers and young people, largely due to the marketing and advertising of the companies that produce them. The appearance of nicotine-free vapes is a new round in the production of electronic cigarettes. Due to the widespread opinion about the harmlessness of such vapes, they are increasingly being used by children and adolescents. The review describes the composition of vaping aerosols, provides data from scientific research on their impact on human health. The danger of smoking both nicotine and nicotine-free vapes is shown. However, given the relative short duration of the use of electronic cigarettes, there are many both purely medical and legal questions. All these issues require further research, which continues all over the world. The authors recommend being wary of this habit and the newfangled hobby of teenagers and young people, applying knowledge about the dangers of vaping in everyday practice, which will indirectly help children and adolescents avoid the path of nicotine addiction, protecting the health of the younger generation.

Contribution:
Galitskaya M.G., Makarova S.G. — concept and design of the study;
Galitskaya M.G. — collection and processing of the material, writing the text;
Makarova S.G., Fisenko A.P. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all its parts. 

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: August 24, 2022
Accepted: September 20, 2022
Published: October 31, 2022

The review discusses the content of the concept of health in scientific and philosophical discourse. Taking into account the correlation of the subjects of clinical, preventive and social medicine, the historical stages of studying the problem of the health of the person (individual) and public health are briefly described. The content of the concept of health is revealed in accordance with the concept of B.G. Yudin in three dimensions: as a fact, norm and value. A methodological analysis of the definition of health in the WHO Constitution is given. The issue of legal correctness of Part 1 of Art. 27 of the Federal Law “On the Fundamentals of Protecting the Health of Citizens”. The problems of the philosophy of health are covered in the context of bioethics, the relevance of ethical control and health care is emphasized. The review defines the guidelines for the coverage of some problems of the philosophy of health in teaching in the system of domestic medical education.

Contribution:
Ivanyushkin A.Ya., Ivanyushkin I.A. — concept and design of the study;
Ivanyushkin I.A., Smirnov I.E., Lyausch L.B. — collection and processing of the material;
Ivanyushkin A.Ya., Ivanyushkin I.A. — writing of the text;
Smirnov I.E. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: September 08, 2022
Accepted: September 20, 2022
Published: October 31, 2022

Introduction. In pediatric practice, one may encounter various volumetric formations of the stomach, both benign and malignant. The verification and localization of the neoplasma is the most difficult issue in everyday work. Most often, benign tumors are represented by a rounded submucosal formation, covered with an intact mucous membrane. The most common formations that can be found in a child are leiomyomas.

Objective is to present the first experience of endoscopic submucosal dissection and enucleation of the choristoma in a child.

Clinical observation. The girl was admitted for inpatient treatment with complaints of prolonged (2 years) abdominal syndrome and mass formation of the antrum of the stomach. According to CT data, a voluminous soft tissue formation 8 × 7 × 12 mm in size was revealed in the antrum of the stomach, which does not accumulate a contrast agent. When performing esophagogastroduodenoscopy and endosonography, a submucosal formation of the prepyloric stomach was visualized, with dimensions of 7 × 10 mm. The macroscopic picture of the tumor corresponded to gastric leiomyoma. However, given the clinical picture, it was impossible to exclude the chorous stomach. Thus, the diagnosis was formulated: volumetric formation of the stomach. Leiomyoma? Choristoma? In the course of further treatment, surgical treatment was performed, in the amount of submucosal enucleation of the formation. According to the morphological study, the remote formation corresponded to the ectopic pancreatic tissue.

Conclusion. Choristoma does not always have a “classic” appearance with retraction in the center, and the clinical picture is of great importance in the verification of neoplasma. Endoscopic submucosal removal of gastric choristoma is a minimally invasive and effective method of surgical treatment that can be used in children.

Contribution:
Lokhmatov M.M., Solodinina E.N., Dyakonova E.Yu. — the concept and design of the study;
Korolev G.A., Budkina T.N., Oldakovskiy V.I., Tupylenko A.V., Efremenkov A.M. — collection and processing of material, writing the text, editing the text.
Аll co-authors — аpproval of the final version of the article, responsibility for the integrity of all parts of the article. 

The study protocol was approved by the local ethics committee. The patients’ parents gave written voluntary informed consent to participate in the study.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: August 19, 2022
Accepted: September 20, 2022
Published: October 31, 2022