Data on the analysis of changes in the content of antioxidants and pro-oxidants, as well as copper, zinc, iron, magnesium cations in the blood plasma and concentrations of these ions in erythrocytes in patients with chronic bronchopulmonary disease (CBPD) complicated by pulmonary arterial hypertension (PAH) are presented. 288 children with congenital malformations of bronchi and lungs and cystic fibrosis were examined. Patients were divided into 4 groups: 1. CBPD without both chronic pulmonary heart (CPH) and PAH (n = 110); 2. Children with both CBPD and PAH (n = 80); 3. Patients with CBPD and forming CPH (FCPH) against the background of PAH (n = 46); 4. Children with both CBPD and CPH (n = 52). Reference data were obtained in 20 conditionally healthy children. An increase in the concentrations of free intra-erythrocyte iron (Fein) in CBPD patients has been established. A significant increase in Fein, especially pronounced in group 1 patients and gradually decreasing in other patients, indicates to a progressive oxidative stress and the involvement of more and more free iron in it. A significant increase in the activity of hydroperoxides (HP) in CPHLS indicates to an increase in the levels of organic peroxides and compensation for a decrease in the activity of superoxide dismutase (SOD) and other antioxidants. In CPH patients, the ratio of anti- and pro-oxidants Zn/Cu and Znin/Cuin decreases compared to CBPD patients without CPH. The authors believe that in the complex treatment of CBPD in children it is necessary to provide the prescription of iron and zinc chelators to prevent the intensification of oxidative stress underlying the development of multiple organ failure in these forms of bronchopulmonary pathology

Recent studies indicate to the special importance of endothelial function (EF) in processes of the regulation of blood circulation. There are presented data on the influence of physical loads on changes in EF on the basis of analysis of the changes of serum content of angiogenin, vascular endothelial growth factor, fibroblast growth factor, matrix metalloproteinase-9 and tissue inhibitor of MMP, thrombospondin and endothelin in young swimmers of various sports skill levels. During training activities and with gain in sports skill levels in young athletes there was found that a significant increment of the concentration of mentioned regulators may be a response to intense exercises indicating to active participation of endothelial vasculature of the growing body in a physiological mechanisms of adaptation to physical loads in children.

At some works, it has been shown there are signs of damage and endothelium dysfunction in patients with chronic viral hepatitis (CVH) and liver cirrhosis of viral etiology the severity of these conditions depends on the severity of the pathological process. Evaluation of the role of angiogenic factors and endothelial dysfunction in persistent of CVH in children and adolescents. 35 patients were examined: of which 11 with chronic hepatitis B (CHB) and 24 with chronic hepatitis C (CHC). The reference group consisted of 120 practically healthy persons of the corresponding age and sex. VEGF-A, angiotensin (ANG), soluble receptors of VEGF-A (sVEGF-R1 и sVEGF-R2) and trombomodulin (TM) have been investigated in serum by enzyme immunoassay using special kits (BCM Diagnostics, USA). Other endothelial dysfunction markers as von Willebrand factor (vWf) was determined in blood plasma by immunoturbidimetry (Siemens, Germany), plasminogen (PLG) was investigated due to extended coagulation. In children with CVH, regardless of etiology, the concentration of VEGF-A was significantly lower, and sVEGF-R2, sVEGF-R1 and TM was higher than in children without liver disease (p <0.001, p <0.05, p <0.01, p <0.001, respectively). The concentration of TM and the level of PLG activity in patients with CHC were slightly higher than in CHB. Decreased level of VEGF-A and increased expression of its soluble receptors indicate enhanced inhibition of angiogenesis in CVH, which may indicate the pathogenetic role of this phenomenon in the development of liver damage in CHC.

A total of 288 children with chronic inflammatory diseases of the lung (HIDL), including cystic fibrosis (CF), were examined comprehensively. Significant activation of neutrophilic elastase (NE) in the chronic pulmonary heart (CPH) and an increase in the activity of cathepsin G (according to the activation of anti-cathepsin-G) in CPH patients was established. An increase in the level of matrilysin - matrix metalloproteinase-7 (MMP-7) as the condition worsened was also found in patients with chronic leukemia; A significant increase in the content of MMP-7 is typical not so much for CPH patients, but for СF patients, in particular, during the formation of CPH in them. In СF patients, even without worsening the condition in the form of pulmonary arterial hypertension (PAH), the developing pulmonary heart (DPH) and CPH, the levels of MMP-7 were increased more significantly than in congenital lung malformations cases. In patients with pulmonary arterial hypertension (PAH) grade 1, the levels of IL-4 and IL-6 were 11.1 and 4.4 times higher than in controls, respectively. In PAH grade 2 children, the concentrations of IL-4 and IL-6 were 11.5 and 4.8 times higher than in controls. The dynamics of the content of endothelin-1 in the blood of patients was also characterized by an increase in its concentrations in HIDL patients by 4.5, 2.4 and 4.7 times, respectively, compared with the control. The content of nitric oxide in the blood of PAH patients was significantly lower than in the control and directly depended on the severity of PAH.

AIM:To study the changes in the key angiogenic factors VEGF-A and angiogenin (ANG) in children with different outcomes of combined injuries.MATERIAL AND METHODS:Contents of VEGF-A and ANG in blood serum were determined by enzyme immunoassay. The study included 40 patients, 21 boys and 19 girls. Patients were divided into 4 groups according to the outcome of injury: 1 - the recovery or mild residual symptoms; 2 - disabled; 3 - vegetable state; 4 - death. Patients were examined at different times after injury: 1-6 days, 7-11 days, 12-19 and 20-33 days.RESULTS AND CONCLUSION:In the first days after injury, the content of VEGF-A in patients of 1-3 groups was at the level of the reference group, moreover, in patients of the 3rd group it was close to the top edge. In group 4, the content of VEGF-A was maximal in the first days after injury and then gradually decreased to the point of death. In groups 1 and 3, the level of VEGF-A increased significantly starting from the 2nd week while in group 2 this indicator was slightly increased approaching later (up to 33 days of observation) to the upper values in the reference group. In the 3rd group, the content of VEGF-A reached the plateau on the 19th day after injury and was higher than the reference data, but lower than in patients of the 1st group. No correlation between the changes in ANG content at different times after combined injuries and outcome was found. There was a trend towards decreased levels of ANG, especially after 3-4 weeks after injury. The data obtained are important for the control over processes of vascular and tissue reparation after injury and for searching for effective ways of treatment of altered angiogenesis in such patients.

Often under the guise of «ordinary» Rickets are more severe kidney diseases, developing as a result of inherited or acquired, primary or secondary defects in the renal tubules. Incorrect diagnosis leads to an inadequate therapy, rapid progression of disease and renal failure. The article describes the main approaches to the diagnosis and treatment of disorders of tubular rachitis similar syndrome, presents a number of clinical cases in author's practice.Key words: tubulopathy, acidosis, electrolyte disorders, rickets, rickets-like syndrome, diagnostics, treatment, children.

Malnutrition is widely spread among infants with severe, especially chronic pathology. Effective treatment of the underlying disease is impossible without adequate diet therapy that includes clinical nutritive products with specially designed composition. Rational feeding positively influences metabolic processes and adds to body mass gain.Key words: malnutrition, hypotrophy, infants, special clinical nutrition, short-life proteins.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 119–125)

Malnutrition is widely spread among infants with severe, especially chronic pathology. Effective treatment of the underlying disease is impossible without adequate diet therapy that includes clinical nutritive products with specially designed composition. Rational feeding positively influences metabolic processes and adds to body mass gain. Key words: malnutrition, hypotrophy, infants, special clinical nutrition, short-life proteins. (Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 119–125 )

Often under the guise of «ordinary» Rickets are more severe kidney diseases, developing as a result of inherited or acquired, primary or secondary defects in the renal tubules. Incorrect diagnosis leads to an inadequate therapy, rapid progression of disease and renal failure. The article describes the main approaches to the diagnosis and treatment of disorders of tubular rachitis similar syndrome, presents a number of clinical cases in author's practice. Key words: tubulopathy, acidosis, electrolyte disorders, rickets, rickets-like syndrome, diagnostics, treatment, children.

The review highlighted problems of reorganization of myocardical contractile and cytoskeletal proteins in cardiomyopathy (CM). The role of the genetic factors coding contractile proteins, proteins of thin and thick filaments, and also extracellular matrix proteins in processes of formation and development of hypertrophic (HCM) and dilated (DCM) cardiomyopathy are analyzed. The mechanisms responsible for the changes in cardiac proteins on regulation involved into force generation, its transfer, recycling ATP, impairments in transmembranal signals, that finally lead to cardiac cell dysfunction determining various manifestations of CM are considered.

A study was conducted to assess the safety of non-ionic contrast media in paediatric nephrourology and their impact onto renal function and homeostasis, reflecting the risk of development of contrast-induced nephropathy. After contrast media use we observed elevation of cystatin C and endothelin, decrease of sodium fractional excretion and hypocoagulation were identified. The results obtained indicate that renal hypoperfusion with a consequent decrease of sodium fractional excretion and elevation of endothelin production may play a role in contrast-induced nephropathy. Increased serum cystatin C reflects adverse impact of contrast agents on renal function. Hypocoagulation effect requires that coagulation disorders must be excluded before use of contast media. Key words: children, contrast-induced nephropathy, renal function, cystatin C, endothelin, hemostasis. (Pediatric Pharmacology. – 2010; 7(2):78-82)

A study was conducted to assess the safety of non-ionic contrast media in paediatric nephrourology and their impact onto renal function and homeostasis, reflecting the risk of development of contrast-induced nephropathy. After contrast media use we observed elevation of cystatin C and endothelin, decrease of sodium fractional excretion and hypocoagulation were identified. The results obtained indicate that renal hypoperfusion with a consequent decrease of sodium fractional excretion and elevation of endothelin production may play a role in contrast-induced nephropathy. Increased serum cystatin C reflects adverse impact of contrast agents on renal function. Hypocoagulation effect requires that coagulation disorders must be excluded before use of contast media.Key words: children, contrast-induced nephropathy, renal function, cystatin C, endothelin, hemostasis. (Pediatric Pharmacology. – 2010; 7(2):78-82)

This article presents the results of a study of effectiveness and safety of ibandronic acid in 21 children with rheumatologic diseases and severe systemic osteoporosis. The treatment with ibandronic acid during 48 weeks provided statistically significant increase of mineral density of bones, decrease of pain intensity, lessening of serum concentration of bone resorption marker — C-terminal telopeptide. The development of repeated compressive fractures of vertebrae and bones of peripheral skeleton at the time of treatment with this medication was not detected. Key words: children, rheumatological diseases, osteoporosis, treatment, bifosfonates, ibandronic acid.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(1):116-121)

Search for and practical application of new medications to treat of osteoporosis is one of the critical issues in pediatric rheumatology. The article reviews the efficacy and safety of alendronic acid in 64 subjects with juvenile rheumatoid arthritis and systemic osteoporosis. It is demonstrated that alendronate-based therapy in weekly 1 mg/kg doses over 12 months facilitated reliably increased bonedensity, decreased intensity of pain syndrome, and lowered C-terminal telopeptide serum concentration, which indicates improved bone metabolism processes.Key words: juvenile rheumatoid arthritis, osteoporosis, children, treatment, bisphosphonates, alendronic acid. (Pediatric Pharmacology. – 2010; 7(1):48-54)

The article is devoted to an important section of the pediatric cardiology — dilated cardiomyopathy (DCMP). This is largely due to the spread of the given disease, its possible progress and tendency to the formation of the chronic heart failure (CHF). The progress in the research of the DCMP'accompanied CHF formation and development processes is the studies of the extracellular matrix status (EM), which is defined by the activity of the matrix metalloproteinases (MMP) and their tissue inhibitors (TIMMP). This article describes the complex clinical and biochemical studies of the serum MMP'1, MMP'2, MMP'9 and TIMMP'1 levels in children with DCMP at different stages of the illness course. MMP and their inhibitor concentration were defined by means of the enzyme'linked immunosorbent assay (ELISA). Based on the results from the morphofunctional studies and data of the biochemical analyses, the authors determined the importance of changes in the isomeric EM composition pertaining to the disturbances of the systolic and diastolic functions, as well as in heart remodeling for such children.Key words: chronic heart failure, dilated cardiomyopathy, extracellular matrix, matrix metalloproteinases, tissue inhibitors of the matrix metalloproteinases.

Shockwave lithotripsy implemented in the clinical practices in the 1980-s drastically altered the treatment approach for the urolithiasis and took a leading place in the therapy of this disease. The key task of the distant shockwave lithotripsy is to provide for the fast, reliable, safe and noninvasive kidney and renal duct litholysis. The article highlights the outcome of the shockwave lithotripsy application on Econolith 3000 for the treatment of 27 children. The results of the performed treatment indicated the high efficiency and low invasiveness of this method to eliminate the concrements, as well as the perspective of its use, including in the infants. Shockwave lithotripsy allows the specialists to abandon the traumatic surgeries. Key words: distant shockwave lithotripsy, urolithiasis, children.

Shockwave lithotripsy implemented in the clinical practices in the 1980-s drastically altered the treatment approach for the urolithiasis and took a leading place in the therapy of this disease. The key task of the distant shockwave lithotripsy is to provide for the fast, reliable, safe and noninvasive kidney and renal duct litholysis. The article highlights the outcome of the shockwave lithotripsy application on Econolith 3000 for the treatment of 27 children. The results of the performed treatment indicated the high efficiency and low invasiveness of this method to eliminate the concrements, as well as the perspective of its use, including in the infants. Shockwave lithotripsy allows the specialists to abandon the traumatic surgeries.Key words: distant shockwave lithotripsy, urolithiasis, children.

Restrictive cardiomyopathy (RCMP) is heart disorder with unclear etiology; it can be characterized as disease with disorder of diastolic myocardium function of left ventricle, conditioned by restriction. The chronic heart failure as a syndrome of RCMP can develop as a result of disbalance in system of complex biochemical, structural, and geometrical mechanisms of myocardium re-modeling. Extra cellular matrix play significant role in heart structure and geometry breaking. The destruction of heart is realized by matrix metalloproteinases (MMP). The activity of MMP, in its turn, is controlled by its tissue inhibitors. The present study analyzed the role of MMP in process of collagen’s synthesis and catabolism deregulation, myocardium fibrosis, change of heart chambers, and development of diastolic dysfunction in children with RCMP.Key words: children, chronic heart failure, restrictive cardiomyopathy, matrix metalloproteinases.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(5):36-39)