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CHITOSAN FOR MEDICAL APPLICATION (REVIEW)

Authors: Sukhodub L.F., Sukhodub L.B.

Pagesи: 143-152

Abstract

The short overview describes some natural polysaccharide chitosan (CS) applications in practical medicine, in particular tissue engineering. History of chitosan discovery, its synthesis, physicochemical and spectral (IR) data are presented. We described some CS-hydroxyapatite (HA) scaffolds and more complicated systems based on two biopolymers: CS and sodium alginate (ALG), which wereobtained in the Bionanocomposite laboratory of Sumy State University (Sumy, Ukraine). On the one hand, these polymers are the most perspective because they have bacteriostatic properties for a vast number of aerobic and anaerobic bacteria; high biocompatibility towards the connective tissue; low toxicity; an ability to improve regenerative processes during wounds healing; and degradation ability with the creation of chemotaxic activity towards fibroblasts and osteoblasts. On the other hand, formation of nanosized (25–75 nm) calcium deficient hydroxyapatite (cdHA) particles in the polymer scaffold approaches the derived material to the biogenic bone tissue, which can provide its more effective implantation. Also, an accent was made on antibacterial CS properties, including the complexes with metal ions, biopolymer systems for control drug delivery with a prolong action. Modern direction in chitosan studies – electroformation of chitosan fiber (“Nanospider” technology) is also discussed.

Key words: chitosan, tissue engineering, scaffolds, hydroxyapatite, nanocomposites, coatings.

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ADHESIVE AND PERSISTENT POTENTIAL OF THE OPPORTUNISTIC MICROORGANISMS ISOLATED FROM THE RESPIRATORY TRACT OF THE PATIENTS WITH ACUTE RESPIRATORY VIRAL INFECTION

Authors: Holubnycha V.M.Chemych M.D.

Pages: 153-159

Abstract

The purpose of the study was to evaluate the frequency of the opportunistic pathogens isolation from the upper respiratory tract and gastrointestinal tract of the patients with acute respiratory viral infection. In addition, our task was to examine the factors that could realize microbes’ pathogenic potential and their influence on clinical manifestation.

Clinical and laboratory examination of 42 patients with acute respiratory viral infection was conducted. The investigation of the micro-ecological violations character was conducted using bacteriological and immunological study of nasal swabs from patients with acute respiratory viral infection. Research of the anti-lysozyme and anti-interferon activity was carried out according to the method of deferred antagonism using commercial preparations of lysozyme and human leukocyte interferon. Adhesive potential of the microbes was conducted using of the O+/- human blood group. Statistical analysis of the results was performed by determination of the relative error values, Student coefficient, and Pearson correlation coefficient.

There were isolated and identified 207 strains of bacteria and fungi. Among microorganisms isolated from the respiratory tract the proportion of opportunistic pathogens was 63.0 %. Staphylococci (73.4%) were isolated most often, and the level of the respiratory tract contamination by these pathogens in patients with complicated and uncomplicated course was similar. Determination of persistent factors showed the depending of the clinical course on the staphylococci anti-lysozyme and anti-interferon activity level.

Staphylococci are the dominant members of the normal microflora in patients with acute respiratory viral infection. Presence of the anti-lysozyme and anti-interferon activity in the microorganisms has influence on the clinical features of viral infections in adults.

Key words: viral infection, anti-lysozyme, anti-interferon activity, staphylococci, complicated course.

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THE ONTOGENETIC PECULIARITIES OF EFFECTS OF XENOGENIC CEREBROSPINAL FLUID ON RATS' LUNGS AT PARENTERAL ADMINISTRATION

Authors: Shatov D.V., Pikalyuk V.S., Shalanin V.V., Shymkus T.S.

Pages: 160-167

Abstract

Introduction and purpose. The cerebrospinal fluid contains many biologically active substances, which have a broad influence on different points of application in the organism. We performed the research of the influence of cerebrospinal fluid on the rats’ lungs (in the connection with the studies, provided in our department and devoted to influence of xenogenic cerebrospinal fluid (XCSF) on the organism of rats). 

Materials and methods. The investigation was performed on 84 Wistar rats of both sexes, which were divided into the experimental and control groups. The experiment was performed on impuberal (group 1), puberal (group 2) and aged rats (group 3). The duration of the experiment was 7 (for the groups 1 and 2), 30 (for all groups) and 90 days (for the groups 2 and 3). The rats of the experimental group got XCSF at the dose 0.002 ml/g three times with the interval of 2 days (for 7-day experiment) or ten times (for 30- and 90-day experiments). The control group received 0.9 % NaCl using the same dosage schedule. After decapitation (made under the general anesthesia) the lungs of the rats were fixed in 10 % formaldehyde. The histological specimens were stained with hematoxylin-eosin and with van Gieson's stain. The microscopy was performed using the light microscope Olympus CX-41, the morphometry was performed using the program «DP Soft». During the investigation we counted the relative amount of the areas with normal parenchyma, emphysema, dystelectasises, haemorrhages; we also studied the collagen fibers. 

Discussion. The triple introduction of XCSF to the animals of the group 1 caused growth of the relative amount of normal parenchyma by 14.35 % (р < 0.001) at the expense of decrease of relative amount of emphysematous areas by 15.95 % (р < 0.001). For group 2 the triple introduction caused less evident changes in comparison with the group 1: emphysematous areas decreased by 13.73 % (р < 0.001) at the expense of increase of the relative amount of the areas with normal parenchyma by 5.07 % (р < 0.01) and dystelectatic areas by 9.23 % (р < 0.001). During the 30-day experiment at the rats of the groups 2 and 3 the areas of normal parenchyma decreased by 8.85 % (р < 0.001) and 12.22 % (р < 0.001) respectively, while the amount of the emphysematous areas increased by 10.45 % (р < 0.001) in the group 2 and by 9.71 (р < 0.001) in the group 3. On 90th day we pointed out the growth of the relative amount of the normal parenchyma by 20.93 % (р < 0.001) due to the decrease of the relative amount of the emphysematous areas by 9.35 % (р < 0.001) and of the dystelectatic areas by 11.59 % (р < 0.001) in the group 2. In the group 3 the same, but less evident changes were found: the amount of the normal parenchyma increased by 6.85 % (р < 0.01), while emphysematous areas decreased by 5.56 % (р < 0.05) and dystelectatic areas decreased by 1.23 %  (р < 0.01). Under the picrofuchsin staining we noticed the decrease of collagen’s content at the animals, who had received XCSF.

Key words: cerebrospinal fluid, ontogenesis, histological structure, parenchyma of lungs, collagen.

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EVALUATION OF THE RECEPTORS ESTROGEN, PROGESTERONE AND HER-2/NEU EXPRESSION IN THE BREAST CANCER TISSUE UNDER THE INFLUENCE OF TRACE ELEMENTS ON THE BODY

Authors: Romaniuk A.M., Lуndіn M.S., Moskalenko R.A., Zolotarova A.V.

Pages: 168-175

Abstract

 

The problem of breast cancer is being studied for a long time. Questions of reducing morbidity and mortality remain unresolved due to the lack of effective ways of primary prevention. As the etiological factors of breast cancer describe a huge number of reasons, including environmental factors. Some chemical substances in the environment show the estrogen-like activity in the study of biological systems. Unfortunately, relatively few researches were devoted to studying the influence of chemicals on the possibility of carcinogenesis, initiation and progression of breast cancer. We do not know how they affect the expression of important prognostic receptors. The purpose of the study was to examine the expression of receptors estrogen, progesterone and еpidermal growth factor in the tissue of malignant breast tumors under the of trace elements influence on the body. 

We determined the morbidity of breast cancer in Sumy region by the histological studies in women for the period from 2009 to 2013. The breast tumor tissue for the immunohistochemical study was divided into two groups. The group 1 (the breast cancer tissue of women who lived in environmentally contaminated region) included 26 cases; the group 2 (the breast cancer tissue of women who lived in the environmentally clean areas) – 17 cases. Immunohistochemical reaction occurred in two stages using rabbit antibodies. Evaluation of the expression of ER and PR was performed by the method DCAllred. Evaluation of HER-2/neu expression was performed according to the recommendations of American Pathologists Consensus and the Office of the Food and Drug USA. 

The results of the study confirmed that the morbidity of breast cancer in environmentally contaminated regions almost twice higher than the environmentally clean areas of Sumy region. In addition, we found the increase in expression of epidermal growth factor and the reduction in expression of steroid hormones in environmentally contaminated region. Consequently, іt proved the negative effect of trace elements on the course of breast cancer.  

Key words: morbidity, tumor, expression, receptors, metals, immunohistochemistry, trace elements. 

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  28. Amat SPenault-Llorca F, Cure H.Scarff-Bloom-Richardson (SBR) grading: a pleiotropic marker of chemosensitivity in invasive ductal breast carcinomas treated by neoadjuvant chemotherapy. International Journal of Oncology.2002;20(4):791–796.
  29. TaylorKMVichovaPJordanNHiscoxSZIP7-mediated intracellular zinc transport contributes to aberrant growth factor signaling in antihormone-resistant breast cancer cellsEndocrinology. 2008;149:4912–4920.

 

AN ASSOCIATION STUDY OF A1166C POLYMORPHISM OF THE AGTR1 GENE WITH CEREBRAL STROKE IN RUSSIAN POPULATION OF CENTRAL RUSSIA

Authors: Bushueva O.Yu., Stetskaya T.A., Vyalykh E.K., Ivanov V.P., Polonikov A.V.

Pages: 176-184

Abstract

 

Introduction. The renin-angiotensin system is a major regulator of blood pressure. The angiotensin II type 1 receptor (AGTR1) plays a key role in blood pressure control, and is implicated in the pathogenesis of cerebrovascular disease. Polymorphisms within the AGTR1 gene have been found to be associated with the risk cerebral stroke (CS) in some populations. However, the exact role of this gene polymorphism in genetic predisposition to cerebrovascular disease is unclear.

 

Purpose. The aim of thisstudy was to investigate the association of polymorphism A1166C (rs5186) of AGTR1 gene with the risk of cerebral stroke in hypertensive patients of Central Russia.

 

Materials and methods. The patients with CS and healthy controls were recruited at Kursk hospitals during periods 2007 and 2010, and also between 2012 and 2013. We studied DNA samples obtained from 830 subjects, including 454 CS patients and 276 sex- and age-matched healthy controls with normal blood pressure level. The diagnosis of CS in all cases was confirmed by magnetic resonance imaging investigation. The polymorphism A1166C of AGTR1 genewas genotyped by TaqMan allele discrimination assay.

Results and discussion. Comparative analysis showed a difference in allele and genotype frequencies of polymorphism A1166C of AGTR1 genebetween the case and control groups. The study suggests that the AGTR1 gene A1166C polymorphism is not associated with susceptibility to CS in population from Central Russian region. Analysis stratified by a gender did not reveal the associations of the AGTR1 gene A1166C polymorphism with the CS risk. Our results are in agreement with the studies performed in other Russian and African Americans populations regarding the polymorphismA1166C of the AGTR1 gene. It is not a susceptibility gene for cerebral stroke.

Key words: cerebral stroke, genetic predisposition, angiotensinogen gene, single nucleotide polymorphism, sexual dimorphism.

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FEATURES OF THE ULTRAMICROSCOPIC STRUCTURE OF THE PARATHYROID GLANDS IN MATURE RATS AFTER IMMUNOSUPPRESSION

Authors: Kashchenko S.A., Erokhina V.V. 

Pages: 185-192

Abstract

 

The structure of the parathyroid glands actively responds to the action of various exogenous factors, but information about morphological features of the structure of the organ during immune status changing is limited.The objective of the work was to study features of electron-microscopic structure of the rat parathyroid glands under immunosuppression caused by the administration of cyclophosphamide. 

The study was carried out on 24 male rats of reproductive age with initial body weight 180 ± 10 g. Maintenance and care of animals conducted in accordance with the norms of bioethics. The animals received an intramuscular injection of cyclophosphamide at a dose of 200 mg/kg. The animals were sacrificed on the 3rd and 30th day after the given injection. We studied the ultrastructure of the rats’ parathyroid glands in norm as well as after immunosuppression. 

The parenchyma of the parathyroid glands of intact animals consisted of two types of cells: chief cells and oxyphil cells. The ultrastructure of parathyroid chief cells and the mode of secretion were typical to other polypeptide-secreting endocrine cells. Those features correlated with the cells functional activity. The polyhedral, slightly eosinophilic chief cells were more numerous and formed irregular, anastomosing cords supported by delicate connective tissue. Oxyphils, which appeared after the first decade of life, were larger, more acidophilic cells that were irregularly distributed and occurred singly or in clumps. Using electron microscopy we detected that oxyphils were packed with mitochondria but, unlike chief cells, they lacked secretory vesicles; they are thought to be nonsecretory. Fat cells were also found in the parenchyma.The introduction of cyclophosphamide into the rat’s organism at high doses caused certain changes in the ultrastructure of the organ. We observed polymorphism of cell nuclei; reduction in the diameter of the vessels of the microcirculation; reduction in the number of secretory granules; increase in the number of lipid and colloid droplets in the cell cytoplasm on 3rd day. We noticed tendency to normalization of morphological structure of the organ after the administration of cyclophosphamide on the 30th day. 

Key words: parathyroid gland, rats, ultrastructure, parathyroid cell, cyclophosphamide.

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MOTOR AND COGNITIVE DISORDERS IN DYNAMICS OF PARKINSON’S SYNDROME TREATMENT

Authors: Lychko V.S., Gelih V.V.

Pages: 193-198

Abstract

 

The aim of the study was to improve the assessment of the dynamics of motor and cognitive deficits in patients with Parkinson's syndrome within 6 months on a background of an optimal antiparkinsonian therapy. We employed such methods as clinical neurological examination with a quantitative assessment of motor, cognitive, affective and psychotic disorders; analysis of medical records, and statistical analysis. The optimal antiparkinsonian therapy showed variation in the rate of disease progression, while about a quarter of the patients manifested rapid rate of progression of motor disorders. The deterioration of cognitive function was observed in 25 % of patients and in 12 % of patients with mild cognitive impairment during 6 months of developing dementia. Neurodynamic, regulatory and visual-spatial cognitive functions were affected most by negative dynamic in patients with Parkinson's syndrome. The antiparkinsonian therapy in 29.4 % of patients provoked psychotic violations, more often in patients with more severe visual-spatial and regulatory cognitive disabilities. We recommend using the test that had been involved in our work in order to improve the assessment of the dynamics in patients with Parkinson's syndrome. The highest rate of progression of motor function was marked in patients with mild cognitive impairment due to the relationship between cognitive and mental disorders. The qualitative feature of patients with severe cognitive impairment was predominant growth of motor disorders in axial sections.

Key words: cognitive impairment, Parkinson's disease, cyclodol, dementia, mental disorders.

vladlychko@ya.ru 

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DEFINITION AND IDENTIFICATION OF VIRAL DNA VIRUSES OF THE FAMILY HERPESVIRIDAE IN ORAL FLUID OF PATIENTS WITH INFLAMMATORY AND DYSTROPHIC-INFLAMMATORY PERIODONTAL DISEASE, ASSOCIATED WITH PERSISTENT HERPES VIRUS INFECTION

Authors: Volosovets T.N.

Pages: 199-208

Abstract

Introduction. Lesions of periodontal herpesvirus is a complex process and is carried out by direct viral infection and replication, or due to virus-induced changes in the immune system. The prevalence of dystrophic and inflammatory lesions parodonta in the population; the complexity in the implementation of prevention and treatment of disease, and the ambiguity in the interpretation of the basic pathogenetic mechanisms (interrelated inflammatory, immune and metabolic) makes this issue extremely important in medicine.

Our aim was to detect viral DNA viruses of the family Herpesviridae in oral fluid of patients with inflammatory and dystrophic-inflammatory periodontal disease, associated with persistent herpes virus infection.

Material and methods. PCR and ELISA was performed detection and identification of viral DNA viruses of the family Herpesviridae in oral fluid of patients with inflammatory and dystrophic-inflammatory periodontal disease, associated with persistent herpes virus infection. I examined 290 patients with inflammatory and dystrophic-inflammatory periodontal disease (catarrhal gingivitis, generalized periodontitis (CP) and the initial and degree) and, depending on the presence or absence of persistent HVI divided them into groups.

Within the study was conducted immunological study of 170 patients with pathology of periodontal tissues infected by viruses of the family Herpesviridae (Experimental (I) group).

Results. As a result of the survey it was found that 170 (52.79 %) patients had relatively persistent HVI of virus and made D (I) group. 42.21% of patients had persistent HVI available and made the comparison group (II).

Conclusions

    1. During the polymerase chain reaction (PCR) in oral fluid of 170 patients of the main group reproduction HVI was detected only in 38.82 % of subjects: the herpes simplex virus (HSV) 1 and 2 – in 26.46 % of patients;–; the cytomegalovirus (CMV ) – in 10.58 % of patients. With greatest frequency in oral fluid was observed reproduction HSV 1 and type 2.
    2. Evaluating the local immunity by ELISA, IgM class antibodies to HSV RR was found in ; on EBV – in 3.77% of patients; to CMV – in 3.53 % of individuals.
    3. IgG class antibodies to EBV were determined in 51.76 % of patients; to CMV – in 68.23 % of patients; to HSV 1 and 2 – in 88.23 % of patients.

Key words: salpingoophoritis, inflammation, adolescents, IL-1β gene 511C/T.

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EFFECT OF BUSPIRONE HYDROCHLORIDE ON DISPERSION OF VENTRICULAR REPOLARIZATION IN PATIENTS WITH ANXIETY-DEPRESSIVE DISORDERS AND CHRONIC HEART FAILURE OF ISCHEMIC ETIOLOGY

Authors: Khrystychenko M.A. 

Pages: 209-215

Abstract

 

The purpose of the study was to investigate the effect of buspirone hydrochloride on QT interval dispersion (ΔQT) in patients with chronic heart failure (CHF) of ischemic etiology with anxiety and depressive disorders (ADD).

 

142 patients (85 males, 57 females; mean age 66.4 ± 10.5) NYHA II-IV were randomized into the study. All patients were prescribed buspirone hydrochloride 10 mg t.i.d. due to anxiety and depressive disorders. All patients had II-III functional classes of angina; 86 of them (60.6 %) had history of myocardial infarction. Randomized patients received standard CHF and coronary heart disease therapy. Informed consents were signed before the study initiation. Exclusion criteria were history of mental disorders, significant impairment of cognitive functions, alcohol/drug abuse, other psychoactive drug intake, and severe concomitant pathology. 

According to the results of Hospital Anxiety and Depression Scale (HADS), Beck Depression Questionnaire and Spielberger Anxiety Scale all patients were divided into two groups: the 1st with ADD, the 2nd – without them. 

Initially and in 3 months of buspirone hydrochloride intake rest ECG was recorded in 12 standard leads, 50 mm/s and QT (ΔQT) and QTc (ΔQTс) dispersions were calculated by the standard technique (DQT = QTmax – QТmin, ΔQTc = QTc max – QTc min). 

Initially mean ΔQT and ΔQTc for patients of the group 1 were 58.5 ± 11.0 ms and 57.8 ± 10.4 ms, respectively, 32.0 ± 9.7 and 31.2 ± 8.6 ms for the group 2. At re-examination ΔQT had no statistically significant differences in comparison with initial data and between groups (462.3±74.1 msand 454.0 ±66.2 msforthe groups 1 and 2, respectively) (p > 0.05).

Buspirone hydrochloride treatment did not lead to increase of dispersion of ventricular repolarization in the patients with ischemic CHF.

Key words: anxiety-depressive disorders, chronic heart failure, dispersion of ventricular repolarization, buspirone hydrochloride.

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ASSESSMENT OF MYOCARDIAL INFARCTION RISK FACTORS IN AL-NAJAF CITY

Authors: Ibrahim Alwan Kadhim Al-Ashour

Pages: 216-223

Abstract

 

Myocardial infarction (MI) is the condition of irreversible necrosis of the heart muscle that is a result of prolonged ischemia. After World War II coronary heart disease (CHD) assumed epidemic proportions in western countries; nowadays, myocardial infarction is the leading cause of death in developed countries. Thus this study is conducted to establish a data base for the factors contributing the incidence of MI in Al-Najaf city. 

The aim was to assess the myocardial infarction risk factors and to find out the differences between the patient and control groups regarding their age, BMI, B. sugar, smoking, gender, and biochemical parameters. 

Materials and methods. A case-control study was carried out in Al-Najaf Health Directorate; Al-Sadder Medical City, and Al-Hakeem General Hospitals from December 20, 2012 to April 1, 2013. A non-probability (purposive sample) of 50 patients with acute myocardial infarction was selected as the patient group, and 50 healthy adults composed the control group. The data were collected using a semi-structured questionnaire, which consisted of two parts: (1) socio-demographic data form that contained 5 items; (2) anthropometric and laboratory tests form that contained 5 items. The data were described statistically and analyzed using the descriptive and inferential statistical analysis procedures. 

Results. The study results showed that there was a significant difference between the patient and control groups regarding their age, BMI, blood sugar; smoking, gender, cholesterol; triglycerides, high density lipoprotein, and low density lipoprotein. Exception was the family history for the study samples; the results showed that there was a non-significant difference between the patient and control groups. 

Conclusion and recommendations. Age and gender of patients are the common non-modifiable risk factors. While weight, blood sugar, smoking, lipid profile of patients are the common modifiable risk factors. The researchers recommend that further studies should involve more patients at the national level, which may make a massive change in health care services provided in order to decrease the effect of modifiable risk factors. Education programs for both health care members and community individuals should focus on decreasing the incidence of MI by reducing its modifiable risk factors.

Key words: ssessment, risk factors, myocardial infarction.

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MORPHOLOGICAL FEATURES OF FORMATION OF THE ENDOCRINE COMPONENT OF THE TESTIS OF RATS IN EARLY POSTNATAL ONTOGENESIS UNDER THE INFLUENCE OF SALTS OF HEAVY METALS

Authors: Romaniuk A.M., Moskalenko Yu.V.

Pages: 224-236

Abstract

The article presentsresults of the study of seminal gland tissue of 128 male rats of neonatal, lactation, infantile and juvenile age periods. Our aim was to investigate the morphological features of the formation of immature testicular endocrine system of rats in early postnatal ontogenesis under the influence of salts of heavy metals (HMS), and in terms of correction with L-carnitine.

The animals were divided into two groups: the control and experimental. The controls involved: a subgroup 1 – intact rats treated with distilled water; and a subgroup 2 – animals treated with L-carnitine in the form of syrup enterally at a dose of 50 mg/kg. The experimental group composed of: a subgroup 3 – rats exposed to НМS; and a subgroup 4 – animals affected by НМS with correction of L-carnitine. The experimental group got drinking water with the combined solution containing 1 mg/l of salts Cr (VI), 1 mg/l of salts Pb (II), 1 mg/l of salt Mn (II), 5 mg/l of salts Zn (II), 1 mg/l of salts Cu (II) and 10 mg/l of salts Fe (III). The rats of the subgroups, which underwent correction, got drinking water with a combination of heavy metal salts and L-carnitine enterally using a probe 1 time a day at a dose of 50 mg/l. Each group of animals consisted of 8 rats. The animals were weighed and scarified on the 5th, 15th, 30th and 60th day by decapitation under ether anesthesia. Obtained testis tissue was studied using histological, histochemical, immunohistochemical and morphometric methods.

It was found out that in the early postnatal ontogenesis in the testes of the controls occurred maturation and growth of functionally active Leydig cells, reduction in number of gland cells of low activity; and formation of cell clusters as islands and strands. Under influence of salts of heavy metals amount of functionally active Leydig cells increased, the differentiation of endocrine component speeded up. Correcting the influence of heavy metal salts with L-carnitine, we noticed that morphofunctional activity of gland cells compared with controls slightly increased, but remained lower than in rats which were exposed to HMS. During activation of Leydig cells, we observed intratubular inhibition of spermatogenic epithelium maturation. Morphofunctional activity of endocrine cells of the testes under the influence of heavy metals can be explained by different mechanisms: activation of cytochrome P450, functioning of testosterone in the body's stress responses and activation of Leydig cells by the mechanism of negative feedback with structural abnormalities of the hypothalamic-pituitary- gonadal axis. Increasing the morphofunctional activity of endocrine component of the testes under the influence of threshold concentrations of heavy metals can lead

to disruption of behavioral responses toward increasing aggressiveness of individuals, as evidenced by the literature. There is high crime rate in polluted regions of Ukraine, because there are excessive rate of heavy metal compounds. We can assume that ecological and biological factors may be important in the structure of the risks of crime.

Key words: testis, immature rat, Leydig cells, salts of heavy metals, early postnatal ontogenesis.

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CHARACTERISTICS OF CLINICAL CONDITION, INTRACARDIAC AND SYSTEMIC HEMODYNAMICS IN PATIENTS WITH STAGE II HYPERTENSION WITH SIGNS OF HYPERTENSIVE NEPHROPATHY

Authors: Pereviazkina M.V.

Pages: 237-245

Abstract

The interactions are observed between the cardiovascular and kidney continuum. Nephroangiosclerosis in patients with cardiovascular pathology is one of the main causes of chronic renal insufficiency (CRI). Cardiovascular diseases are the main cause of mortality in patients with terminal CRI, whereby the cardiovascular mortality in patients dialyzed continuously is several times higher than in general population. Some data suggest that the interaction between the cardiovascular and kidney continuum can be already observed at early stages of HTN. Therefore, an early marker for renal impairment, in particular microalbuminuria, is at present considered to be a cardiovascular risk factor.

The objective of this study was to investigate the microalbuminuria level and endothelial functionin patients with stage II hypertension.

182 patients with stage II hypertension (HTN) were examined. 40 patients with stage II HTN with no sign of other cardiovascular and renal diseases were studied as the control group. The key factor for selection was the absence of MAU in this group ofpatients. 

The cardiac and hemodynamics status, the left ventricular systolic and diastolic functions were assessed using the ULTIMA Pro-30 scanner. The renal ultrasound examination was carried out, albumin excretion in urine (MAU, mg/24 h) was determined by the immunoturbidimetric test using the Micral-Test II test kit (Roche Diagnostics GMBH, Germany), the levels of endothelin-I and NO were determined.

In patients with stage II hypertension in whom microalbuminuria was detected, the discrepancy between the indicators of the left ventricular systolic function as compared with the group of patients in whom albumin excretion was not been observed. The tendency toward deterioration is observed in the indicators showing the left ventricular diastolic function depending on the presence of microalbuminuria. During the study of systemic hemodynamics according to the arterial hypertension stage (as the disease progressed) and the presence of albumin excretion, there was observed a decrease in the indicators, such as systolic discharge, cardiac output, cardiac index and an increase in total peripheral vascular resistance what resulted in increase in workload on the left ventricle myocardium and decrease in its capacity. The obtained data demonstrate the need to determine the albumin level in patients with hypertension in order to slow down the progression of hypertensive nephropathy.

Key words: hypertensive illness, mikroal'buminuriya, early diagnostics, hemodynamics.

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GENETIC ASPECTS OF BETA1-BLOCKERS TREATMENT FOR PATIENTS WITH HYPERTENSION

Authors: Dudchenko I.O., Prystupa L.N.

Pages: 246-255

Abstract

Introduction. Analysis of scientific studies has revealed the relationship between the T393C polymorphism of GNAS1 gene and Arg389Gly of ADRβ1 gene, and effectiveness of treatment using β1-blockers. However, these results are controversial, which may be due to ethnicity of the studied groups. In Ukraine, the study of T393C polymorphism of GNAS1 gene and its impact on the effectiveness of antihypertensive therapy using β1-blockers were not carried out.

Our aim was to determine the impact T393C polymorphisms of gene GNAS1 and Arg389Gly of ADRβ1 gene on efficiency of treatment using β1-blockers for patients with hypertension.

Materials and methods. The study involved 70 patients with verified diagnosis of hypertension. At baseline, β1‑blockers were appointed for patients at doses: metoprolol – 12.5 mg/kg per day, carvedilol – 25 mg/kg per day, and bisoprolol – 5 mg/kg per day. Efficacy of treatment was determined after 2 weeks by measuring heart rate and blood pressure. Polymorphism of gene was determined by polymerase chain reaction followed by restriction fragment analysis. Statistical analysis of the data was performed using the SPSS Statistics 21.0 program.

Discussion. It is proved that determining of T393C polymorphisms of GNAS1 gene and Arg389Gly of ADRβ1 gene plays an important role for the treatment with β1-blockers, because:

    • in patients with T393T genotype of GNAS1 gene observed higher level of reduction of systolic blood pressure and heart rate, when the treatment by β1-blocker was used, than in patients with C393C genotype;
    • in patients with Arg389Arg and Arg389Gly genotypes of ADRβ1 gene the level of reduction of heart rate and systolic blood pressure, when the treatment by β1‑blocker was used, was higher than in patients with Gly389Gly genotype.
    • in case when T393C or C393C genotypes of GNAS1 gene and Gly389Gly of ADRβ1 gene are combined, application of β1-adrenergic blockers is ineffective, even with its dose adjustment.

Key words: β1-blockers, gene polymorphism, heart rate, blood pressure.

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