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ROLE OF ENDOTHELIAL DYSFUNCTION IN PATHOGENESIS OF ISCHEMIC STROKE (REVIEW OF LITERATURE)

Authors: Oleshko T.B., Sotnikov D.D.

Pages: 165-173

Abstract


Ischemic stroke together with ischemic heart disease and oncopathology continues to hold leading position among causes of morbidity, mortality and invalidization of population both in Ukraine and in the whole world. Endothelial dysfunction is an early feature of a stroke. That is why knowing of mechanisms that are the basis of its development is very significant. The most important function of endothelium is vasomor tone regulation which is made by means of correlation between vasodilators and vasoconstrictors. During endothelial dysfunction the bioavailability of nitrogen oxide is decreased, thus vasodilatory effect of endothelium is violated. An important change is increasing of products and biological activity – endothelin-1. It performs its influence through activation of specific ETA and ETB-receptors. Effect of endothelin-1 is determined by localization of receptors and correlations between them. The basic action principle of endothelin-1 is increasing of internal cellular concentration of calcium. It causes strong contraction of unstriated muscles as well as coagulants activation.

Imbalance in factor system of endothelial vascular innervation evidences endothelium-dependent mechanisms of ischemic stroke pathogenesis.

Key words: ischemic stroke, endothelial dysfunction, nitrogen oxide, endothelin-1.

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PATHOGENIC ROLE OF THE MICROBAL PERSISTENCE OF DENTAL PLAQUE IN PERIODONTITIS DEVELOPMENT

Authors: Demkovych A.

Pages: 174-180

Abstract


This article presents the role of microbial factors in the development of inflammation in periodontal. The leading role in the formation of inflammation in the mouth belongs resistant obligate anaerobic and microaerophilic organisms. During invasion of bacteria produce compounds that reduce or completely block the activity of protective systems. Factors that induce prolonged inflammation and periodontal tissue destruction usually are attributed exo- and endotoxins by pathogenic bacteria, in particular Porphyromonas gingivalis, the number of which increases substantially in periodontal diseases, especially in fresh lesions. Identification of P. gingivalis indicates the progression risk of chronic inflammation in parodontum.

The aim of the work is to analyze the scientific literature data of the microbial etiology of periodontitis, for the development of the disease, a combination of these conditions: pathogenic bacteria in an amount sufficient to start the inflammatory process; living conditions in the mouth should contribute to the growth and reproduction of pathogenic organisms; in periodontal tissues should be absent microorganisms – bacteria parodontopatogenic antagonists; microorganisms have spatially localized so that they (or) their metabolic products could act directly on target cells; the human body must be sensitive to bacteria and their toxins. Gums have of features associated with the structure of this component periodontal mucosa. Found that in most places periodontal destruction and often occur P. gingivalis, A. actinomycetemcomitans, P. intermedia, T. forsythensis, E. corrodens, F. nucleatum. P. melanogenica, V. parvula, Peptostreptococcus micros and others. Inflammation in periodontal tissues and is caused by microbial dental plaque. It with the development of periodontitis found to increase the number P. gingivalis, P. intermedia and T. forsythensis more than 100 times. Pathogenicity factors of is endotoxin, phospholipase A, that violates the integrity of the membrane epithelial cells and hemagglutinin protease and contributing active introduction of microorganisms in the periodontal tissues and their rapid destruction. Deep penetration of microorganisms in the gum tissue leads to a high probability relapse after therapy. P. gingivalis is one of the major pathogens involved in periodontitis. Predominance in tissues Porphyromonas gingivalis is a poor prognostic sign in typical forms of periodontitis. Porphyromonas gingivalis – gramnegative anaerobic fixed coli, which belong to the family Porphyromonadaceae. The surface is covered with P. gingivalis fibrils. They are the most frequent, followed Aggregatibacter Actinomycetemcomitans, pathogens of chronic generalized periodontitis. Especially a lot of them can be found in fresh area destruction. They are most closely associated with chronic periodontitis from all the pathogens . Intracellular Porphyromonas gingivalis able to subdue the metabolism of cells that are directly relevant to the development of the disease. So, after the invasion of Porphyromonas gingivalis in gingival epitheliocytes is inhibited the secretion of interleukin-8 weakens periodontal natural protection. In the situation that created microorganism, loses signal the presence of bacteria and not sent white blood cells to destroy them. P. gingivalis may prevent migration polymorphonuclear leukocytes and through the epithelial barrier.

Key words: Periodontal, periodontal disease, Porphyromonas gingivalis, microbe, inflammation.

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THE STUDY OF HETEROCHTOMATIN IN NUCLEI OF BUCCAL EPITELIAL CELLS AFTER THE LOADING OF B.PERTUSSIS ANTIGEN, TAKEN IN DEFFERENT ULTRASOUND FREQUENCY

Authors: Isaenko O.Yu.

Pages: 181-187

Abstract


While carrying out series of experiments we supposed that mild receptor interaction between pertussis pathogen antigens and epithelial cells can effect the functional activity of the test-cells, have an impact on the nucleus chromatin structure that would help to use this method as an additional test for evaluating the harmfulness of pertussis vaccine candidate drugs.

The goal of this work was to study the influence of B.pertussis antigenic fractions on heterochromatin structure of interphase nuclei of buccal epithelium.

Obtaining the native antigen was carried out by ultrasound disintegration in different frequency ranges of Bordetella pertussis industrial strains № 267 and № 475: the low-frequency (frequency of 60 kHz, power of 5 W), medium-frequency (frequency of 130 kHz, power of 9 W), high-frequency (frequency 1,6 MHz, power of 3 W), followed by desintegrate centrifugation (18000g), filtration, concentration and fractionation of antigenic complex into separate fractions by gel - chromatography.

Assessment of the heterochromatin stability in the buccal epithelium of nuclei cells after adding each individual B.pertussis antigen was performed as follows. We got buccal epithelium from the inner surface of the healthy adult human cheek and placed it to the buffer solution. We added experimental preparations (1: 1 by volume) to epithelial cell suspension and physiological solution of sodium chloride to the control sample. We kept it for 4 hours, then made preparations on a slide and tinted with 2% orcein for 30-60 minutes. Under the light microscope we counted the number of heterochromatin granulas in 30 epithelial cell nuclei.

Evaluation of heterochromatin stability in interphase nuclei of buccal epithelium during applying pertussis antigen microbes extracted in different frequency ranges of ultrasound (low - 60 kHz, average - 130 kHz, high - 1.6 мHz) showed growth of figures in all experimental groups comparatively to control values. There was not found reliable difference in the amount of heterochromatin in the nuclei of buccal epithelium cells after adding purified antigens with molecular weight ≥ 1000 kDa and ~ 3.0 kDa between each other (all frequency ranges of ultrasound). Reliable increase in the number of heterochromatin comparatively to other fractions was seen after interaction of buccal epithelium with cell-free preparations of molecular weight ~ 8.1 kDa obtained in the medium frequency range of ultrasound (130 kHz). This method is sensitive to adding the antigen and can be used as an additional test for evaluating the harmfulness of candidate drugs of pertussis vaccine.

Key words: buccal epithelium, heterochromatin, antigens, Bordetella pertussis, аnimal.

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ULTRASONIC ECHO OF THYROID GLAND BIOMINERALIZATION

Authors: Rieznik A.V., Gapchenko A.V., Gapchenko V.V., Starkiv M.P., Moskalenko R.A.

Pages: 188-198

Abstract


Summary. Over the past decade the extraordinary spread of the thyroid gland (TG) was marked, which is associated with many factors, including the instrumental diagnostics improvement. For example, during physical examination of thyroid in 4-7% of healthy population thyroid nodes are found and at the same time ultrasonography (USG) estimates the cancer incidence among population at 17-27% level. Most thyroid nodular pathology is benign, but about 4-14% nodes have malignant nature.

The aim was to study the connection between ultrasonographic signs of calcification and morphological changes in thyroid tissue.

The study was conducted on 110 biopsies obtained during surgery on the thyroid proliferative disease, accompanied by pathological biomineralization (I group - 20 cases of mixed goiter (MG), the second group - 10 autoimmune thyroiditis (AIT) and diffuse toxic goiter (DTG) 20 - follicular adenoma (FA) 30 - follicular thyroid cancer (FTC) 30 - papillary thyroid cancer (PTC)), which were held at the Sumy Regional Clinical Oncology Center (SRCONC) and Sumy Regional Hospital (SRH). All patients were investigated by ultrasonography at the SRCONC, SRH and "Floris" medical centre before surgery.

For benign thyroid pathological processes accompanied with node formation (MG and FA), are characterized by arc- and annular calcification capsules (40% in each group) with the spread of pathological tissue mineralization (50% MG and 40% FA) and the formation of large preferably amorphous calcifications. A separate group of thyroid diseases can be identified by diffuse nature - DTG and AIT. For these diseases pattern of rough calcification or solitary structures with smooth edges (in total - 60%) are predominant. Microcalcifications represent a significant share of biomineralization manifestations during thyroiditis are.

Since the node formation during AIT and DTG are developing at a slower rate than other thyroid diseases (MG, tumors), identification of arc- annular facilities during ultrasound can be used for differential diagnosis of nodular thyroid pathology.

Malignant thyroid tumors also have their differences in a preferred embodiment calcification. For FTC formation of coarse calcifications with irregular polycyclic edges (70%) is preferrable. At the same time, PTC is characterized by the formation of microcalcificates (80%) which are identified as psammoma bodies (PT) during histological examination.

Pathological mineralization in thyroid has potentially great diagnostic value. Knowledge of morphology basis and genesis of the most common ultrasonographic pattern will help to improve the quality of thyroid disease differential diagnosis. Patients with calcification signs of thyroid should be carefully examined using an instrumental methods and fine needle aspiration biopsy followed by cytology.

Key words: thyroid gland, ultrasound examination, calcification, nodes, psammoma bodies, pathological biomineralization.

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SEX PECULIARITIES OF ALLELIC VARIANTS DISTRIBUTION OF N5,N10-METILENTETRAHIDROFOLAT-REDUCTASE (MTHFR) GENE BY A1298C POLYMORPHISM IN PATIENTS WITH ATHEROTHROMBOTIC ISCHEMIC STROKE

Authors: Matlay O.I., Garbuzova V.Yu.

Pages: 199-205

Abstract


Introduction. Every year statistics notes the increasing morbidity and mortality as the result of cardiovascular diseases such as stroke and myocardial infarction in the first line. Stroke depends on age, sex, region of residence, and varies from 150 - 200 cases per 100 000 of population. The most common cause of vascular brain tromboinclusive lesions is Atherothrombosis - generalized and progressing process that depends on the evolution of atherosclerotic changes in vessels. Principally the important role in the pathogenesis of atherosclerosis and its complications plays endothelial dysfunction. One of the causes of chronic endothelial damage may be negative effects of excess homocysteine. The key enzymes that affect the homocysteine level is N5,N10- metilentetrahidrofolatreductase (MTHFR), that encodes a gene MTHFR. One of clinically relevant polymorphisms MTHFR gene is A1298C (Glu429Ala, rs1801131). As the result of mutations a variant of the enzyme with a termolability threshold 55 ° C is produced, which has twice reduced activity.

Purpose. To analyse the communication polymorphism A1298C MTHFR gene with atherothrombotic ischemic stroke in two sexes of Ukrainian population.

Materials and Methods.

For analysis venous blood of 170 patients with atherothrombotic ischemic stroke (42,4 % women and 57,6 % men) aged 40 to 85 years (minimal - 64,7 ± 0,73 years) who were on the records in the outpatient department Sumy clinical Hospital № 5 was used. The control group consisted of 124 patients (36,3 % women and 63,7 % men), average age was 76,7 ± 0,93 years. The groups did not differ in the ratio of two sexes (P = 0,294 for the χ²-test), but the average age of the first group (76,7 ± 0,93 years) was significantly higher than that of the second one (P < 0,001). A1298C polymorphism was determined by polymerase chain reaction, followed by restriction fragment length analysis. The results have been statistically worked on by using the new Excel 2000. Statistical significance of differences was determined by χ² and t-test. Pathogenetic variant of stroke was determined according to the criteria TOAST. Ischemic stroke character was determined with the help of history and clinical information of the disease given by CT brain study.

Results. Genotyping of patients with atherothrombotic ischemic stroke and the comparison of the data with the results of restriction analysis in the control group made it possible to reveal that patients with atherothrombotic ischemic stroke ratio of homozygotes for the major allele (A/A), heterozygotes (A/C) and homozygotes for the minor allele (C/C) is 42,3 %, 37,1 % and 20,6 %, while in the control group - respectively 46,0 %, 44,3 %, 9,7 %. The differences in the distribution of the frequency of these genotypes between the group of patients with atherothrombotic ischemic stroke and control groups were statistically true (P = 0,039). The Ratio of options of the same polymorphism in women and men with atherothrombotic ischemic stroke and without this disease showed the following - Women had the distribution – A/A - 47,0%, A/C - 36,8%, C/C - 18,0% (in the control group, respectively 46,7 %, 40,0 %, 13,3 %; P = 0,744, respectively among men – 38,8 %, 38,8 %, 22,4 % (45,6 %, 46,8 %, 7,6 %; P = 0,027).

Conclusion. So, in Ukraine, namely in the Sumy region, іn men, the carrier C/C variant of the MTHFR gene polymorphism A1298C on the studied risk of atherothrombotic ischemic stroke is 3.5 times higher than the media A/A variant.

Key words: metilentetrahidrofolatreductase (MTHFR), allelic polymorphism, ischemic stroke, sex.

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MORPHMETRIC CHARACTERISTICS OF THE ORBIT INADULTS ACCORDING THE SEX FEATURES

Authors: Dubina S.A., Yabluchansky M.I.

Pages: 206-213

Abstract


Introduction. As in statistics of traumatism there are sexual distinctions, the assessment of sexual dimorphism in morphometric indicators of an orbit is an important prerequisite for planning of surgical reconstructive operations, implantations of orbital structures.

Purpose. Research objective is to assess morphometric indicators of an orbit of adults by sexes and to prove presence or absence of differences between them for receiving a morphometric standard of norm for each sex.

Materials and methods. Research was conducted with use of СT-scans of 96 people age from 21 to 74 years (48,6 ± 3,2 years) without pathologies of a craniofacial zone in their consent in Donetsk diagnostic center. According to Martin R. (1957), Alekseiev V. (1964), Chan L. L. et al. (2009), Gayvoronsky I. (2012), Ji Y. et al. (2010) approaches length of walls of an orbit, width and height of an entrance to the orbit, its depth, a slope angle of an entrance to the orbit as well as an angle between medial and lateral walls were measured. Verification of the obtained data on a normality was made with use of criterion χ2. Statistical data processing included an assessment of parameters of descriptive statistics and the correlation analysis. The assessment of distinctions between means of each indicator was carried out with use of Student's t-criterion. The correlation analysis was carried out on the basis of calculation of Pearson's coefficient of correlation, the subsequent assessment of the statistical reliability of obtained coefficients and calculation of confidence intervals of their average values.

Discussion. As a result of the analysis of the obtained data about means of morphometric indicators and their confidence intervals it is found out that individual variability of linear indicators at men and women has similarity and coincides with the main characteristics of a joint selection. At the same time, variability of angular indicators is different: man's selection has impact on stabilization of variability of an angle between medial and lateral walls and adds variability to an indicator of an angle of entry to an orbit in the general selection; influence of a female selection is opposite. Correlation between morphometric indicators in male and female series is weak and difference between coefficients of correlation is statistically insignificant. Lack of statistically reliable differences between average linear and angular values of orbits in male and female selections allows to use received data as authentically interchangeable as well as to take as a morphometric standard of their norm data of the general selection regardless of sex.

Keywords: orbit, morphometry, adults, sexual dimorphism.

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  14. Kalamanova, M.V., Shut, V.V., Stepanenko, V.V. [Facial bone structures  according to a craniomtery, a telex-ray analysis and a computer and magnetic and resonant tomography] Materialy ХХХVI yubileynoy itogovoy konferentsii molodyih uchenyih Moskovskogo gosudarstvennogo mediko-stomatologicheskogo universiteta [Proceedings of ХХХVI final conference of young scientists of Moscow state medico-stomatologic university]. – Moscow: MSMSU. – p. 36.

 

INHALATION VERSUS TOTAL INTRAVENOUS ANAESTHESIA DURING CESAREAN SECTION: DOES THE ANESTHETIC TECHNIQUE INFLUENCE SERUM LEVELS OF PROINFLAMATORY AND ANTIINFLAMMATORY CYTOKINES

Authors: Volkov O.О.

Pages: 214-222

Abstract


Introduction. The great number of works confirms a working hypothesis, that neuroinflammation has impact on development of the postoperative cognitive dysfunctions. The surgery duration and anaesthesia duration influence the postoperative cognitive dysfunctions was proven on animal models. This effect correlates with the changes of proinflammatory cytokines.

The goal of this study was to investigate influence of the anesthetic technique (inhalation versus total intravenous anaesthesia) for cesarean section on parturients’ plasma levels of proinflammatory (IL-6 and TNF-alpha) and antiinflammatory (IL-10) cytokines after surgery.

Materials and methods

Having agreed with local ethics committee and obtained informed consent, 64 pregnants (at 37-42 weeks gestation, who delivered by the caesarian section) were examined. The women were divided into two groups depending on maintenance of anaesthesia. For 1st group (n=30) was prescripted inhalation anaesthesia (IA). 2nd group (n=34) received total intravenous anaesthesia (TIVA). Criteria of exception were: age to 18 and 45 more than, term of pregnancy to 36 weeks, severe preeclamsia or eclampsia, decompensated extragenital pathology, diabetes mellitus, psychical diseases, signs of bacterial or viral infection, mycoses, abandonment of woman from participating in the research at any of it stages, use ketamine in an anaesthetic manual. Inhalation anaesthesia: induction - thiopental sodium (5 mgs/kg), maintenance - sevofluran 1,3 vol.%, in fresh gas flow 1,5 L/min. Relaxation – suxcinilcholinum (1-1,5 mgs/ kg). There were phentanyl (0,05 mgs/of ml - 4 mls) and diazepamum (10 mgs) after newborn extraction. Maintenance of analgesia is a phentanyl in a dose 0,05 mgs/of ml is a 1 ml having approaching of BIS by 60. ТIVА: induction - thiopental sodium (4 mgs/of kg), relaxation - suxcinilcholinum (1-1,5 mgs/of kg). Anaesthesia controlled by BISX Module, BIS™ Covidient, USA in both groups. The cytokines concentration was determined by the method of IFA analysis. We used on the kits of reagents JSC "Vector-Best" А- 8756 for TNFα with the range of measureable concentrations: 0-250 pg/ml. For IL - 6 was used on the kit of reagents Human IL-6 ELISA kit Diaclone (France) with the range of measureable concentrations: 0-200 pg/ml. The blood samples for analyses were taken: upon admission to the obstetrical department (P1), 24hours after the surgery (P2), on the 5-7th day after the surgery (P3).

Parameters of regional norm for IL-6 and TNFα were measured for 15 unpregnant healthy women in age 25-40. The blood samples for analyses were taken on an empty stomach at 9-11 a.m. The Normal val-ue for IL-6 was 1,40±0,15 pg/ml (range 0,92-1,67 pg/ml, σ=0,34). For TNFα a level of normal values was 9,37±1,07 pg/ml (range 4,50-12,7 pg/ml, σ=3,17).

Results and Discussion.

The study shows that the features of cytokine profile of pregnant at 37-42 weeks gestation are conditioned by the reliable increasing of levels both IL-6 and IL-10, but IL-6 level significantly dominates. However level of proinflammatory TNFα is reliable decreased. The cytokine profile after a caesarian section for pregnant at 37-42 weeks gestation is reliable correlated to the anesthetic technique.

After inhalation anaesthesia with sevofluran, as well as at TIVA level of proinflammatory IL-6 has a pike rising in 24 postoperative hours, with a progressive decreasing by 5-7 day after surgery. Moreover IL-6 increasing in 24 hours after cesarean section at TIVA is more expressed and one decreasing by 5-7 day considerably less than at inhalation anaesthesia. In addition inhalation anaesthesia does not influence on the level of proinflammatory TNFα after surgery, while TIVA keep on decreasing initially low level of TNFα. TIVA does not influence the level of antiinflammatory IL-10 in a postoperative period, while after inhalation anaesthesia it normalization starts already from the first day after cesarean section. 

As a result inhalation anaesthesia assists to cytokine profile normalization by 5-7 day after caesarean section.

Keywords: sevofluran, general anaesthesia, caesarian section, cytokines.

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INDICATORS MEDIUM-WEIGHT MOLECULES AS A CRITERION FOR OBJECTIVE EVALUATION OF THE QUALITY OF LIFE IN PATIENTS WITH ACUTE MYELOID LEUKEMIA

Authors: Anoshina M.J., Goryainova N.V., Kubarova V.O., Basova O.V.

Pages: 223-230

Abstract


The aim of the work was to determine the parameters of medium-weight molecules (MWM) in patients with acute myeloid leukemia (AML) in the onset of the disease and after induction chemotherapy. The object of the study was the blood serum of 36 patients with AML in first acute period between the ages of 25 to 74 years, which were observed in the department of diseases of the blood SI "IHT NAMSU." Content in the serum was determined by measuring the MWM at a wavelength of 254 nm acid-soluble fraction MWM254, which indicates the level of intense proteolytic intermediates having a molecular weight of 1000D to 2000D and a wavelength of 280 nm acid-soluble fraction MSM280  resulting from the accumulation of biologically active substances with a molecular weight of 2000D to 5000D. However, the light absorbance at 254 nm and 280 nm is not fully display elevated levels of biologically active oligopeptides, which cause discoordination metabolic processes in the body. Therefore, the range was increased and the measurement was performed at a wavelength of 238 nm, 254 nm, 260 nm and 280 nm with the calculation of peptide / nucleotide coefficients and aromaticity (K238/260 and K238/280, respectively). Also determined the distribution ratio of K 280/254. It is proved that in patients with AML at the onset of the disease is worsening endogenous intoxication by raising three of the four acid-soluble fractions of MWM. Correlation analysis of the data showed that the onset of the disease indicators MWM have a close relationship with some of the main prognostic factors and biochemical markers of liver function and kidney. Research and data correlation analysis suggests the appropriateness and legality of the use of indicators MWM as an objective criterion for assessing the quality of life of patients with AML.

Keywords: acute myeloid leukemia, endogenous intoxication, medium-weight molecules, the quality of life.

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DEPENDENCE OF THE INTENSITY OF AUTOIMMUNE HEMOLYSIS FROM LEVEL OF EXPRESSION OF COMPLEMENT REGULATORY PROTEINS CD55 AND CD59 ON RED CELLS (ORIGINAL RESEARCHES)

Authors: Myronenko G.А.

Pages: 231-240

Abstract


Introduction. All the erythrocytes (RBCs) immune destruction mechanisms involve in varying degrees components of the complement system, which perform cytotoxical and opsonizational function. Research studies of the system complement CD55 (dissociation decay factor – DAF), CD59 (membrane inhibitor of reactive lysis – MIRL) proteins-regulators expression under autoimmune hemolytic anemia (AIHA) were only started to conduct in last few years. Under the same antibody parameters clinical course sharpness which depends on red blood cells destruction speed often differs, so the individual features of the complement system activation regulatory mechanisms may affect the process of RBCs destruction in cases of patients with AIHA. By the time the number of observations is still very small and does not allow making definite conclusions on the role of CD55 and CD59 in the cytolysis pathogenesis with these diseases, particularly, with AIHA.

Purpose. The purpose of current research study is to evaluate the role of RBCs CD55, CD59 expression in autoimmune hemolytic process progression.

Materials and methods. 29 patients with AIHA with different serological variants of the disease (with warm, cold agglutinins and a mixed variant) and 25 healthy people of control group were evaluated. The data of 11 patients with intense hemolysis (acute course, hemolytic crisis) and 14 people with moderate hemolysis (chronic out of crisis) were collected. We used the flow laser cytometric analysis (direct immunofluorescence test with MCA). Data collection was performed at the FACScan (Becton Dickinson, USA) flow laser cytofluorometer operated by Lysis II, and data analysis was performed using WinMDI 2.6. (Josef Trotter, Scripps Institute, La-Jolla, CA) program.

Discussion. The results of the research study shows abnormal decrease of the expression of complement regulatory proteins CD55/CD59 on erythrocyte membrane observed in 65 % of patients. This decrease didn’t depend on serological variants of autoimmune antibodies. Patients with AIHA acute course and haemolytic crisis showed significantly lower CD55 expression on RBCs in comparison with patients with the chronic course out of crisis (р < 0,05). Positive correlation between the mean fluorescence intensities of the expression of CD55 and the level of haemoglobin (rs=0,372; р < 0,05) as well as erythrocytes quantity was established (rs=0,399, р < 0,05). This correlation generally indicates the importance of this indicator for the progression of anemia.Thus the definition of the proportion of antigens carrier erythrocytes CD55, CD59, and the level of expression of these regulatory proteins allows us to distinguish a new pathogenetic factors of autoimmune hemolysis which may be promising diagnostic indicators of the severity and efficiency of AIHA treatment.

Keywords: CD55 (decay аccelerating factor – DAF), CD59 (membrane inhibitor of reactive lysis – MIRL), autoimmune haemolytic anemia, haemolytic crisis, erythrocytes, complement.

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CLINICAL-NEUROLOGICAL ASPECTS, PATHOGENETIC MECHANISMS OR NEUROAMINOACIDS AND TAU PROTEIN (Τ-5) PARTICIPATION IN NEUROTRANSMITTER AND AXONAL DAMAGE AND NEURODEGENERATION

Authors: Y.V. Lekomtseva

Pages: 241-247

Abstract


Introduction: Today, many researches have suggested complex pathogenic metabolic mechanisms of neurodegenerative diseases. Neuroaminoacids and glial cells are very important in mechanisms of seizure precipitation or recurrence as seizures can activate microglia and astrocytes to release a number of neurotoxic mediators and neurotransmitters, and contribute to neuronal hyperexcitability in epilepsy or development of chronic inflammatory processes other neurological disease especially multiple sclerosis. Tau protein is a neuronal microtubule-associated protein; a novel class of phosphor-proteins that appears to function in the formation and maintenance of axon by influencing microtubule organization. Axonally-derived tau is essentially involved into neurotoxic degenerative mechanisms: aggregation of its specific sets into filamentous inclusions is feature of intraneuronal, glial fibrillar lesions in Alzheimer disease and Parkinson disease.

Purpose: Study purpose was to perform neuroaminoacids serum levels: glutamate, aspartate, γ-aminobutyric acid (GABA) in conjunction with the marker of axonal damage – serum tau protein in patients with the different types of drug-resistant partial epilepsy, dyscirculation encephalopathy, remitting type of multiple sclerosis, and Parkinson's disease.

Materials and methods: Patients with the different clinical course of pharmacoresistant partial epilepsy (n=126), patients with the relapse of remitting course of multiple sclerosis (n=27), Parkinson disease (n=31), and patients with chronic dyscirculation encephalopathy (n=82) were investigated for basic serum level of glutamate, aspartate, γ-aminobutyric acid (GABA) measured by spectrophotometer method and pathological tau protein measured by Immunofluorescent method using Sigma reagent.

Discussion: These data showed that drug-resistant partial epilepsy had the most significant changes of neuroaminoacids serum data associated with high serum level of glutamate and low level of braking neuroaminoacids, particular, γ-aminobutyric acid compare to controls that could suggest about non effectiveness of braking pathogenesis mechanisms in such patient group. These results showed the prominent role of tau protein as a marker of axonal damage: patients with the relapse of multiple sclerosis had the highest serum tau level; patients with Parkinson disease had serum tau protein level increased but not so significantly. This study show the necessarily of future investigations of axonal markers serum levels compare with biochemical correlations to reveal their prediction role in the pathogenesis of neurodegeneration.

Key words: glutamate, aspartate, γ-aminobutyric acid, tau protein, neurodegeneration.

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A QUINQUENNIAL POPULATION-BASED STUDY OF PATIENTS WITH GASTRODUODENAL ULCER DISEASE AND ULCER BLEEDING IN SUMY REGION AND UKRAINE

Authors: Duzhiy I.D., Bratushka V.O., Dubnitskiy V.Yu., Kharchenko S.V.

Pages: 248-257

Abstract


Introduction: The bleeding is still the most frequent complication of the ulcer disease. An etiological relationship between these diseases may be very logical but not always, because it depends on many factors of the nature of ulcer process and its causes, for example, clinico-epidemiological ones. The purpose of the study was to present a clinico-epidemiological description and to search interrelations between the demographic rates, the incidence and the prevalence of the ulcer disease of the stomach and the duodenum, and hospital admission episodes statistics on ulcer bleedings in Ukraine and Sumy region.

Materials and methods: The authors analyzed data collection for a five-year period from 2009 to 2013, using the official statistical annual indicators like the resident population, the incidence and the prevalence of the ulcer disease of the stomach and the duodenum, and the rate of hospital admission episodes on ulcer bleedings. The analysis included two calculations for Spearman rank correlation(ρ) and linear Bravais-Pearson correlation(r).

Results: For Ukraine, it was estimated a significant correlation between the incidence and the prevalence of the ulcer disease(p=0,016, r=0,9433; р<0,0001, ρ=1); between the prevalence and the resident population(p=0,02, r=0,9343; р<0,0001, ρ=1); between the incidence and the resident population(р=0,0003, r=0,9957; р<0,0001, ρ=1). For Sumy region, a statistical significant Bravais-Pearson correlation was in case of hospital admission episodes on ulcer bleedings and of the resident population(p=0,0482, r=0,8813; р=0,16, ρ=0,7). Spearman rank correlation was significant for the prevalence of the ulcer disease and the resident population of the region(p=0,058, r=0,86; р<0,001, ρ=1).

Conclusions: The issue of demographic decrease of the Ukraine’s population does influence on the incidence and the prevalence of the ulcer disease, but it does not influence on hospital admission episodes with ulcer bleedings. On the country’s level, it appears an increasing trend of hospital admission episodes of ulcer bleedings. However, on the example of Sumy region, it should be noted that these trends are different, namely, it received a lack of correlation between the population’s decrease and the incidence of the ulcer disease or hospital admission episodes on ulcer bleedings. Moreover, Sumy region demonstrates a trend of decrease of hospital admission episodes on ulcer bleedings.

Keywords: gastroduodenal disease, ulcer bleeding, epidemiology, population

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EPIDURAL PHARMACOTHERAPY IN THE DIAGNOSIS AND TREATMENT OF PAIN SYNDROMES AFTER MICRODISCECTOMY IN THE LUMBAR SPINE

Authors: Khyzhnjak M.V.

Pages: 258-273

Abstract


Herniated disc — is the most common cause of spinal cord compression. Previous studies have indicated that pain recurrence after lumbar microdiscectomy occured in 5–19% cases. Repeated operations are performed in average in 7% cases. The choice of treatment tactics depends on accuracy of diagnosis of herniated disc or adhesive epidurit on operated level, pathogenesis factors and associated periods of osteoarthritis clinical flow. For diagnosis and treatment of pain relapse in different periods after surgery epidural pharmacotherapy was used. The purpose of the study was to estimate the possibility of epidural pharmacotherapy in diagnostics and treatment of recurrent radicular pain syndrome after lumbar microdiscectomy.

Materials and methods. The study was based on the results of a comprehensive examination and treatment of 28 patients with recurrent radicular pain after lumbar microdiscectomy. There were 17 (60.7%) men and 11 (39.3%) women aged from 31 to 60 years. Disease duration was (32±0.25) months in average. Research methods: clinical and neurological; neuroimaging (CT and MRI); statistic analysis. Radicular pain intensity in the lumbar spine, the degree of orthopedic disorders, motor and sensory disorders were evaluated. Moderate or mild orthopedic disorders were observed in 10 (36%) patients. Most often lumbar lordosis flattening was marked, limited mobility of lumbosacral spine, posture and gait changes and various autonomic disorder as marbling, dry and flaky skin, pasty lower extremities, regional hyperhidrosis. The duration of epidural pharmacotherapy — 1 day. The quality of life of patients after surgery, effectiveness of epidural pharmacotherapy, pain intensity were determined by the relevant scales: Oswestry and Roland – Morris index, and Visual Analogue Scale.

Discussion. The effectiveness of epidural pharmacotherapy in patients with recurrent neurological pain after lumbar microdiscectomy was assessed immediately after surgery and for the next 20 days. In 26 (92.9%) cases there was a significant improvement: pain intensity decreasing and functional activity increasing. In 2 (7.1%) patients we observed pain recurrence that required reoperation. Epidural pharmacotherapy is a highly effective method for pain syndromes treatment in patients after lumbar microdiscectomy.

Key words: herniated discs, microdiscectomy, pain, recurrence, epidural pharmacotherapy.

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FEATURES OF METABOLIC DISORDERS AND DEGESTIGS IN PATIENTS WITH CHRONIC PANCREATITIS WITH LIVER CIROSIS OF ALCOHOL ETHIOLOGY (ORIGINAL RESEARCH)

Authors: Mischuk V.G., Skoropad K.M.

Pages: 264-270

Abstract


Alcohol abuse is the most common cause of chronic pancreatitis in Western countries, the disease is characterized by progressive damage of the pancreas which finally leads to a significant infringement of exo- and endocrine functions. In the pathogenesis of chronic pancreatitis distinguish direct toxic effects of alcohol and indirectly through pathologically modified digestive organs, including the liver. On the other hand, in alcoholic liver cirrhosis  often develop metabolic failure and dysregulation of energy metabolism, metabolism of carbohydrates, aminoacids, serum protein and coagulation factors synthesis, ammonia neutralization, biosynthesis of lipids and lipoproteins, bile acids occurs.

The purpose of research was to study the state exocrine pancreatic function, protein synthetic function of the liver and trofolohichnyy status in patients with chronic pancreatitis combined with alcoholic cirrhosis class A, B by Chald-Pugh.

It was examined 49 patients: 15 – with chronic alcoholic pancreatitis, 15 - with alcoholic cirrhosis class A, B by Chald-Pugh and 19 - with a combination of both diseases. Alcoholic etiology of diseases was based on medical history, previous medical records, including narcologists surveillance, questionnaires CAGE, MAST, scales Le Go. Anthropometric indicators scatological analysis, determining the activity of elastase and chymotrypsin in stool was carried out and the levels of total protein, prothrombin, cholinesterase were determined.

The study showed that the combination of these diseases occurred fairly significant disorder of exocrine pancreatic function that manifestated as a diarrhea, flatulence, steatorrhea, a more pronounced decrease in activity of chymotrypsin and elastase in the faeces. In particular, the chymotrypsin activity in feces of patients suffering from combined alcoholic liver disease and chronic alcoholic pancreatitis was 3.9 times lower compared with those of healthy people and elastase level was 1.8 times lower. Also, the comorbidity caused significantly decreased levels of total protein, albumin, cholinesterase. Somatometric indicators (shoulder circumference, thickness of subcutaneous fat folds, body mass index) were also reduced the most, in cases of combined alcohol-induced cirrhosis and pancreatitis compared with isolated chronic pancreatitis and cirrhosis.

Keywords:chronic alcoholic pancreatitis, alcoholic liver cirrhosis, exocrine pancreatic function, trophological status.

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BCL1 POLYMORPHISM OF GLUCOCORTICOIDS RECEPTOR GENE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Authors: Savchenko O. V.

Pages: 271-276

Abstract


Considering the availability of connection between Bcl1 polymorphism of glucocorticoids receptor (GR) and development of rheumatoid arthritis (RA) and absence of such data in Ukraine, the purpose of our investigation was the comparative studying genotype’s frequency by Bcl1 polymorphism of glucocorticoids receptor in among common population and in patients with RA.

Materials and methods of investigation.

161 patients with RA in ages above 40 and 96 almost healthy humans had been investigated. During work process used conventional investigations for diagnosis. Bcl1 (rs41423247) polymorphism of 2nd exon has been determined by the method of polymerase chain reaction with following analyze of the length of restriction fragments by Fleury I.et al with modifications (2003).

Results of investigation. Detected, that most spread is C allele. Among patients with RA more often meet homozygotes by G allele comparing with control group, what is statistically significant by χ2 Pirson’s criteria (p=0,03). Homozygotes by G allele have the risk of RA development in 2,7 times higher that homozygotes by C allele (p=0,01). Therefore, this investigation proved that genotype G/G by Bcl1 polymorphism of GR gene contributes to RA development.

Conclusion. Determined, that among patients with RA probably more often meet G/G genotype comparing with control group, and the risk of RA development in homozygotes by minor allele G in 2,7 times higher that homozygotes by C allele. Thereby, the investigation of genotype by Bcl1 polymorphism of GR gene is prospectively concerning of the risk oh RA occurrence in common population.

Key words: rheumatoid arthritis, Bcl1 polymorphism, glucocorticoids receptor.

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CORRELATION ANALYSIS OF ELECTROLYTES CONTENT IN BIOLOGICAL FLUIDS OF NEONATES WITH DISTURBANCE KIDNEY FUNCTION DUE TO ASPHYXIA

Authors: A.N. Loboda., V.E. Markevich

Pages: 277-286

Abstract


In-depth research of electrolytes content and balance in biological fluids of newborns with impaired renal function due to asphyxia will optimize their examination and treatment plan. The purpose of the work is analyse correlation between trace elements (sodium, potassium, calcium, magnesium) in serum, erythrocytes and urine of newborns with disturbance kidney function due to asphyxia.

The study involved 200 term infants with signs of kidney damage: 100 children who have suffered severe asphyxia, 100 children with moderate asphyxia. Comparison group consisted of 20 infants without asphyxia at birth. The content of electrolytes determined by emission photometry, relationship between the variables set using Spearman's rank correlation coefficient.

In newborns with disturbance kidney function due to asphyxia, especially severe, at 1-2 days of life found significant changes in the serum electrolytes’ correlation, particularly in pairs Na-Ca, K-Ca, K-Mg. The restoration of physiological balance in a pair Na-Ca did not occur until the end of the neonatal period. In erythrocytes revealed a significant decrease the strength of the relationship in pairs Na-Ca, K-Ca, K-Mg and change the sign of correlation in pairs Na-K, Na-Mg, which indicates a significant violation intracellular balance of trace elements. In the early neonatal period urine correlation disappeared in a pair Na-Ca and became weaker in pairs Na-Mg, K-Ca, K-Mg and Ca-Mg in both groups of children with nephropathy caused by asphyxia.

Urinary content of sodium, calcium and magnesium in the early neonatal period should be used as a noninvasive indicator for indirect estimation of serum and erythrocyte levels in children with disturbance kidney function due to asphyxia.

Keywords: asphyxia, kidney, electrolyte, correlation, biological fluids.

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References

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SERUM ALDOSTERONE, MMP-9 AND GLYCOSAMINOGLYCANS LEVELS IN PREDICTING CHANGES OF THE GEOMETRY OF LEFT VENTRICLE IN PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Authors: Dielievskaya V.Yu.

Pages: 287-292

Abstract


The study was aimed to evaluate the prognostic value of serum levels of glycosaminoglycans, aldosterone and MMP-9 in the changes of left ventricular myocardium geometry in patients with arterial hypertension (AH) combined with chronic obstructive pulmonary disease (COPD). We examined 75 patients (48 men and 27 women) with AH combined with COPD. Patients were divided into 2 groups: 1 group consisted of patients with AH and COPD  of II degree of bronchial obstruction (n = 37), 2 group – AH and COPD of III degree of bronchial obstruction (n = 38). Aldosterone and MMP-9 were determined by ELISA, the level of glycosaminoglycans – using resorcin method.While increasing of the degree of bronchial obstruction there was a gradual increase in the left ventricle parameters, progression of systolic dysfunction and increased left ventricular mass. In patients with AH and COPD III compared to patients with AH and COPD II there was marked increase in the levels of MMP-9 on 22,5%, chondroitin-6-sulfates –  on 5,7% and  decrease ща heparan sulphates / keratan sulfates on 15,7% (p <0,05). No significant differences in serum levels of aldosterone while progression of  bronchial obstruction was found. In order to predict the increase of end-diastolic volume and left ventricular mass in patients with AH and COPD we calculated multiple regression equations by stepwise regression analysis using MMP-9, aldosterone and fractions of glycosaminoglycans.

Keywords: chronic obstructive pulmonary disease, chondroitin sulfates, glycosaminoglycans, aldosterone, left ventricle hypertrophy, matrix metalloprotease 9.

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THE RELATIONSHIP BETWEEN LEVELS OF CYTOKINES AND IRON-CONTAINING PROTEINS IN THE SERUM OF CHILDREN PEREDELKINO AGE, PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA ASSOCIATED WITH IRON DEFICIENCY ANEMIA

Authors: Vasylyshyn Kh.I., Vysotsky I.Yu., Smiyan O.I.

Pages: 293-298

Abstract


The aim of the research was to study the content of interleukin (IL) 4 and 8, transferrin and ferritin and their interrelations in the serum of toddlers with community-acquired pneumonia (CAP) associated with iron deficiency anemia (IDA), in the acute period.

We examined 55 children (aged 1–3 years), who were hospitalized with CAP. The patients were divided into two groups. 23 children with CAP without iron deficiency composed group 1. 32 patients with CAP associated with mild iron-deficiency anemia entered group 2. Serum cytokines (IL-4 and IL-8), transferrin and ferritin concentrations were measured by the ELISA using the test-systems. The evaluations were conducted during acute period (on 1st–3nd day after hospitalization). At onset of disease IL-8 and IL-4 concentrations increased in group I and group II. The content of transferrin decreased and the level of ferritin increased in group I. The level of transferrin increased and the content of ferritin decreased in group II. In I group was set a negative correlation of medium strength ferritin/IL-4 (p < 0.01), transferin/IL-8 (p < 0.05) and positive correlation of medium strength ferritin/IL-8 (p < 0.05). In II group were found negative correlative relation of the average force between the concentrations of ferritin and IL-4 (p < 0.01), levels of ferritin and IL-8 (p < 0.01) and a positive correlative relationship between the content of transferrin and IL-4 (p < 0.01), IL-8 (p < 0.05).

Conclusion. The levels of cytokines and iron-containing proteins in the serum of children with CAP, are interrelated.

Key words: community-acquired pneumonia, interleukins, transferrin, ferritin.

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KLINICAL AND EPIDEMIOLOGICAL, LABORATORY AND MICROBIOLOGICAL ASPECTS OF MORDEN SALMONELLOSIS

Authors: Chemych О.М.

Pages: 299-308

Abstract


Introduction. The role of infectious diseases in the world remains high, despite the progress made in the fight against pathologies. Second place in the overall structure of infectious diseases occupy acute intestinal infection. Salmonellosis occupies an important place in the group.

Purpose. Determine the clinical, laboratory and epidemiological aspects of salmonellosis caused by S. enteritidis and S. typhimurium.

Materials and Methods. 140 patients with salmonellosis were examined. Patients were divided into 2 groups: group 1 - salmonellosis caused by S. typhimurium (31,0%); group 2 – caused by S. enteritidis (69,0%). Most of them are men (62,1%) aged by (43,61±1,49) years.

Clinical, laboratory and bacteriological examinations were held. Values of intoxication were calculated: leukocyte index (LI), hematological index (HI), leukocytes shift index (LSI) and lymphocytic index (Ilymph).

Discussion. The disease is caused by dominant strains of S. enteritidis (69,0%), S. typhimurium (31,0%). Hospitalization of patients occurs throughout the year, an increase occurs in May - August, and patients with salmonellosis caused by S. typhimurium - often in the period from July to September and rarely March - April. The main factors of transmission were bird eggs (40.8%), meat and fish products (40.8%), dairy products (36.8%). Prevalent symptoms are abdominal pain on palpation with localization in several sites simultaneously, but more often in the umbilical region, epigastric, in the right iliac region; 1st degree dehydration; liver enlargement (mainly salmonellosis caused by S. typhimurium); fever is more intense during the first day of the disease with a tendency to decrease on the second – third day. In the acute period of salmonellosis first level integral markers of the intoxication (fever, headache, dehydration, abdominal pain, etc.) indicate a pronounced intoxication syndrome. Also expressed syndrome intoxication is confirmed by integrative indicators of endogenous intoxication, which are significantly elevated in all patients (LI, HI, LSI), except for Ilymph which decreases (p <0.05-0.001). In the study of intestinal microbiocenosis in the acute period it has been discovered the decrease of the number of bifidobacteria, lactobacilli and Escherichia coli with an increase of other representatives of opportunistic flora, hemolysing Escherichia coli and fungi of the genus Candida (p <0.05-0.001). This indicates necessary of the combined regimen of probiotics.

Keywords: Salmonella, clinical epidemiology, endogenous intoxication, microbiocenosis.

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ALLOHERNIOPLASTY OF POSTOPERATIVE HERNIAS AND THE WAYS OF ITS IMPROVEMENT

Authors: Hryvenko S.H.

Pages: 309-316

Abstract


Introduction. The issue of surgical treatment of hernias remains with no solution at hand. In recent years, plasty with the local tissues has ultimately yielded its position to modern technologies with the use of synthetic meshes. There are many ways of mesh placement; however, the sublay retromuscular (SRM) method is considered the method of choice. Nevertheless, modification of some of the technical steps and approaches for these surgeries may contribute to its effectiveness.

Purpose. To develop and introduce an optimal technique of the surgeries for postoperative hernias by improving the methods of cutting and fixing of the mesh.

Materials and Methods. The study has been based on treatment results of 126 patients with postoperative hernias treated in hospitals of Simferopol, from 2004 to 2013. The patients were from 21 to 75 years old, females and males accounted for 74.6% and 25.4% respectively. They were divided into 3 groups, comparable in age, sex ratio, type of hernia, and surgical intervention performed. The study group included 42 patients who had the SRM technique performed with the proprietary method of cutting and fixing of the mesh. The two control groups included patients who were operated with the standard methods of mesh cutting and fixing for the SRM technique (42 patients) and onlay technique (42 patients). All patients got identical polypropylene meshes. The proprietary technique of mesh cutting and fixing was carried out as follows. A mesh was folded in two in width. With a pair of scissors, an equilateral 4-5 cm long triangle, at 70-80° angle and with the base to the outside, was cut on both sides in the middle of the mesh. The mesh was then fixed precisely in the middle with the ligatures that had been used to form the rear wall of the retromuscular space. Subsequently, the halves of the mesh straightened up in the retromuscular space and were fixed with simple interrupted stitches at the lateral borders. Efficiency of the performed surgeries was analyzed by assessing the following factors: the nature and duration of discharge in drains, presence of wound complications such as seromas, hematomas, infiltrates, suppuration of the surgical wounds, ligature fistulas, graft rejection, recurrent hernias, as well as duration of inpatient stay after the surgery.

Discussion. The best results have been obtained in the SRM technique patient groups. Yet, the use of the proprietary procedures for mesh cutting and fixing has shown a number of advantages, evidenced by fewer postoperative complications and a more favorable postoperative period compared with the standard SRM technique group. There seem to be two main reasons for that. First, the proposed cutting technique allows to use a mesh of a relatively smaller size while allowing a sterling restoration of the abdominal wall. Second, the proposed fixation method enables to "close" the hernial defect evenly on all sides. This explains the absence of recurrences in this clinical group.

Keywords: postoperative ventral hernia, mesh, treatment, complications.

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EPIDEMIOLOGICAL AND CLINICAL ASPECTS OF DIARRHEAGENIC EHSHERIHIOSIS TODAY

Authors: Malysh N.G., Chemych О.М., Gurіna S.V.

Pages: 317-325

Abstract


In order to establish modern epidemiological and clinical features of diarrhegenic escherichiosis in the north-eastern region of Ukraine, using epidemiological, clinical, statistical research methods, conducted a retrospective analysis of the incidence and clinical course, a modern etiological structure, identified risk factors.

The incidence of diarrhegenic escherichiosis ranges from 1.7 to 5.4 per 100 thousand of inhabitants, with moderate growth trend. In the etiological structure dominated by enteroinvasive Escherichia coli (p<0.05). The highest incidence rates are recorded in February, March, April, and August. Most often affects children between the ages of 1 to 4 years (p<0.05). The clinical course of diarrhegenic escherichiosis caused by different groups of pathogenic Escherichia, adults were not significantly different.

Frequency of isolation of pathogenic E. coli "decreed" and contact persons exceeds the incidence of respectively 10 and 40 times. The correlation between the frequency of isolation of pathogenic serovars of E. coli have examined prophylactically, contact persons and the identification of patients of diarrhegenic escherichiosis not set (respectively r = 0.33; mr= 0.29 and r = -0.49; mr = 0.43).

Statistically significant direct strong correlation (r=0.98; mr=0.1) between the incidence rate of children under 1 year and adults.

Harbinger of increasing incidence Enteroinvasive infection caused by E. coli is to increase the detection of samples of food products which do not comply with regulatory sanitary and bacteriological parameters (r = 0.58; mr=02).

Key words: diarrhegenic escherichiosis, enteroinvasive Escherichia coli, epidemiology, clinical features.

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THE INFLUENCE OF SEX FOR THE NEXT FORECASTS AND EFFECTIVENESS OF THROMBOLYTIC THERAPY IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST-SEGMENT ELEVATION

Authors: Netyazhenko N.V.

Pages: 326-332

Abstract


The aim to study and compare the results of pharmacological reperfusion and its influence on the course of acute coronary syndrome (ACS) in both sexes.

Materials and Methods

The study included 73 patients of comparable age, comorbidities, a history and treatment assigned and distributed the following groups: group I (n = 14 men, n = 14 women) - patients who conducted thrombolytic therapy to 4 hours from the beginning of symptoms and the group II (n = 20 males, n = 20 women) - patients who conducted thrombolytic therapy in term> 4 <6 hours from the start of the first symptom. After thrombolytic therapy for hospital period it was evaluated in patients develop fatal and non-fatal cardiovascular events: recurrence of pain, acute left ventricular failure (ALVF) class II-V by Killip, arrhythmias and conduction recurrence of MI, hemorrhage, mortality. The development of these events in patients regarded as a manifestation of adverse flow.

Results

Thrombolytic therapy (TLT) <4 hours of the first symptoms accompanied by an increased risk of bleeding is 5 times among women compared with men. Among men in the group of early TLT lethal consequence developed in 4 (22.6%), while among women had no place (all p <0.05). Gender differences were detected in the remote TLT group (> 4 <6 hours). Among women group I (TLT (<4 hours) compared with women group II (TLT> 4 <6 hours) was noted increase in the frequency of re-MI (p <0.05) and mortality (p <0,01).

Conclusions

1. Implementation of TLT in up to 4 hours of onset of symptoms of ACS with ST-segment elevation is associated with increased risk of bleeding is 5 times among women compared with men (p <0.05). Death among men was significantly higher than in women whith early pharmacological reperfusion (<4 hours), and occurred in 28.6% (p <0.05).

2. The risk of complications such as MI recurrence (p <0.05) and mortality (p <0,01) increased with time from onset of symptoms to start of thrombolysis only among women.
3. The effectiveness of thrombolysis among women and men with early (<4 hours) and remote thrombolytic therapy (> 4 <6 hours) were not significantly different.

Keywords: women, reperfusion, thrombolysis, myocardial infarction.

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References

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STATE OF HEART RATE VARIABILITY, CENTRAL HEMODYNAMICS AND PHYSICAL PERFORMANCE AT SHORT-DISTANCE RUNNERS

Authors: Mikhalyuk E.L., Malakhova S.N., Didenko M.V.

Pages: 333-340

Abstract


Introduction. Analysis of specific scientific and methodological literature shows that exercise performed with a high heart rate, make high demands to the cardiovascular system sprinters. They often cause exhaustion of the adaptive capacity of an athlete and state disadaptative. This may affect the vegetative providing heart rate, central hemodynamic parameters, as well as physical performance.

Purpose of work was to study the bioelectrical activity of the heart, heart rate variability (HRV), central hemodynamics and physical performance (PP) at short-distance runners qualifications of II-III level to the Honored Master of Sports (HMS).

Materials and Methods. At the beginning of the preparatory period conducted a comprehensive survey, which included determination of the electrocardiogram, heart rate variability, central hemodynamics and physical performance in the 51 th athlete who specialize in running at a distance of 100-200 m. For the analysis of vegetative cardiovascular regulation used mathematical methods of HRV. Central hemodynamics were studied by automated tetrapolar rheography. Determination of PP was performed by using a submaximal cycle ergometer test PWC170. The index of the functional state (IFC) was counted on a formula suggested and patented by us.

Results. The study showed that at short-distance runners are certain features of the ECG associated with specific sports activity, experience of training and competitive employment and therefore qualified athletes. Spectral analysis of HRV indices did not significant differences between compared groups short-distance runners. Established, that for short-distance runner qualifications of HMS characterized by the predominance of hypokinetic type of circulation (TC) and in decreasing athletic qualifications decreases the number of athletes with hypokinetic TK and increase of eukinetic and hyperkinetic TC. Comparison of the relative physical performance (PWC170/kg) showed that at runners of HMS this value was highest (p<0,05). At short-distance runners high qualifications IFC replied assessment below average, and at athletes qualifications of II-III level – low.

Discussion. Thus, at runners of high qualifications values parasympathetic link of vegetative nervous system in comparison with low qualifications. The relative size of physical performance and index of the functional state in high qualifications runners was significantly higher than in less qualified athletes. Correlation analysis of high-class runners showed a close interrelation, which indicates that the prevalence of parasympathetic link of vegetative nervous system accompanied by hypokinetic TC and large sizes of physical performance, unlike athletes

II-III-th level in which the correlation was not found relationship between the studied parameters.

Key words: short-distance runners, ECG, heart rate variability, central hemodynamics, physical performance, correlation.

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PROGNOSTIC MODEL OF PRIMARY END POINT IN PATIENTS WITH ARTERIAL HYPERTENSION ASSOCIATE WITH ISCHAEMIC HEART DISEASE TREATED BY CALCIUM CHANNEL BLOCKER

Authors: Malchevska T.

Pages: 341-347

Abstract


Introduction. Arterial hypertension and ischaemic heart disease play great role in cerebrovascular incidence that is why the prognostic mathemetic model of developing ischaemic stroke is very important.

Purpose. A small amount of information regarding the forecast primary endpoint of ischemic stroke (II) in patients with coronary lesions against long existing hypertension (AH) was the purpose of the study.

 Materials and methods. Statistical analysis of survey results of 300 patients with different forms of coronary heart disease (CHD) (200 patients with stable coronary artery disease and 100 patients with acute myocardial infarction (MI), 25 patients with ischemic stroke conducted using spreadsheet programs, statistical analysis with the calculation of odds ratio (OR) and 95% confidence interval (95% CI) using tables 2h2. Pry stable coronary artery disease with hypertension in treatment using calcium channel blockers (CCB) to achieve target levels of blood pressure and ease clinical symptoms of coronary artery disease.

Results and discussion. Through multivariate stepwise regression analysis of predictive modeling clinical course in patients with hypertension with coronary artery disease treated with CCB decided equally low on of the primary endpoint of ischemic stroke odds ratio of patients younger and older than 60 years. With the length of more than 10 years hypertension and angina pectoris available in history over 5 years OR for adverse events were the same. Obesity and hypercholesterolemia in patients receiving CCB half had less impact on the risk events compared with standard treatment. Patients with hypertensive crisis first debut with the development of ischemic stroke, which previously received CCB had less risk of future events by 50%. Repeated hypertensive crises only in those patients who did not receive systematic CCB was twice higher the risk of cerebral incidents. In patients with atrial fibrillation who received CCB risk of stroke was 60% lower, while the standard treatment increased by half a chance event.

Conclusion. So, mathematical modeling can predict the clinical situation further course of coronary artery disease and cardiac influenced non-cardiac factors and at different drug regimes, and thus stratify the risk of most adverse events.

Key words: coronary artery disease, hypertension, calcium channel blockers, risk stratification.

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THE CASE OF TOTAL SPINAL ANESTESIA IN BRACHIAL PLEXUS BLOC FROM SUPRACLAVICULAR AXESS BY KULENKAMPH

Authors: Redko S.I., Portianoy E.N., Azarenkov A.V.

Pages: 348-353

Abstract


At the present time, both in Ukraine and abroad increased interest in regional anesthesia for operations on the upper limbs. This is due to the creation of new local anesthetics, and new hard-ware-based methods of the nerves search.

Up to 80% operations on the upper limbs in Ukraine are performed using regional anesthesia. The brachial plexus block has a number of advantages before general anesthesia, however, may cause the major complications .This article describes a rare case, but perhaps the most dangerous complications of the brachial plexus block -total spinal anesthesia. At untimely and inadequate actions of this complication can very quickly lead to cardiac arrest. The purpose of this work is methodical elaboration an algorithm for diagnosis and emergency measures in the event of such complications, as well as its prevention.

Early diagnosis and timely and adequate treatment are essential in the treatment of total spi-nal block.

Activities that must be performed immediately:
1 - stop the introduction of anesthetic;
2 - ventilation via face mask with 100% oxygen with subsequent intubation in a short period of time. As a rule, it does not require an additional injection of anesthetics and muscle relaxants;
3 - correction of hypotension by introduction of vazopressors and intravenous infusion of crystal-loids and colloids;
4 – bradycardia correction by introduction cholinergic antagonists and β-agonists
Article describes possible ways of penetration of the anesthetic into the subarachnoid space, clinical features, urgent measures and tactics for the upcoming operation. Wider application of instrumental methods of search nerves using a neurostimulator and under ultrasound control will allow significantly reduce the likelihood of total spinal block when performing blockade of the brachial plexus.

Key words: complication, apnea, hypotension, interscalene, neurostimulator, intubation, ventilation.

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THE DISTRIBUTION OF ALLELIC VARIANTS T134967G POLYMORPHISM OF THE АNКН GENE IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH NORMAL BLOOD PRESSURE AND HYPERTENSION

Authors: Rozиmenko I.A., Garbuzova V. Yu., Ataman A.V., Obukhova O.A.

Pages: 354-359

Abstract


Introduction. Transmembrane protein ANKH inorganic pyrophosphate transport regulator (ANKH) is regulates transport of inorganic pyrophosphate (PPi) of the cells into the extracellular environment, thus by playing an important role inhibitor of ectopic calcification of the vascular wall. Protein is contains 7-12 multi-pass transmembrane domains, each of 20 amino acids long. Mutations in this gene have been associated with autosomal dominant craniometaphyseal dysplasia and calcium pyrophosphate dehydrates deposition disease. Persons with recessive mutation of the ANKH gene are suffering from progressive ankylosis with concomitant vascular calcification caused by violation of inorganic pyrophosphate transport. As the calcification of the atherosclerotic plaque is an unto ward prognostic factor of the acute coronary syndrome, the polymorphism of the ANKH gene can be associated with the disease progression.

Purpose. To establish the frequency of allelic variants of the ANKH gene for T134967G polymorphism in patients with acute coronary syndrome (ACS) in persons with normal blood pressure and hypertension.

Materials and Methods. We used venous blood of 118 patients with ACS (22% women and 78% men) aged 40 to 73 years (mean age 55,9±0,89 years) who was hospitalized in the cardiology department of Sumy City Clinical Hospital #1. The control group consisted of 110 patients. Definition of T134967G polymorphism (rs187483) of ANKH gene was performed using PCR with the following restriction fragment length analysis of the allocation of them by electrophoresis in agarose gel. Restriction Hin6I (HinP1I) was used for restriction analysis. Statistical analysis was performed by using the software package SPSS-17. Thus the significance of differences was determined by Pearson’s chi-squered test and Student’s t-test. The value of P < 0,05 was considered as significant.

Results. Genotyping of patients with ACS for T134967G polymorphism of the ANKH gene was allowed setting the frequency with which there are some variants of this gene in patients with normal values of blood pressure (BP) and hypertension. The distribution of allelic variants among patients with ACS with different values of blood pressure was not significantly different (P = 0,949).

In persons who have the T/T genotype in control group and in patients with ACS, the value of BP syst. (P = 0,623), BP diast. (P = 0,065), BP pulse (P = 0,265) and BP mean (P = 0,159) were not significantly different. Values of BP syst. (P = 0,839), BP diast. (P = 0,561), BP pulse (P = 0,407) and BP mean (P = 0,827) in carriers of minor allele (T/G+G/G) were not significantly different between controls and patients with ACS. Patients with ACS – homozygotes for the major allele (T/T) – had significantly higher blood pressure syst. (P <0,0001), BP diast. (P <0,0001), BP pulse (P = 0,0007) and BP mean (P <0,0001) than practically healthy persons.Values of BP syst. (P <0,0001), BP diast. (P = 0,0003), BP pulse (P = 0,0001) and BP mean (P <0,0001) in patients with ACS and genotype T/G+G/G for T134967G polymorphism of the ANKN gene were also significantly higher than in controls.

Conclusion. In patients with ACS, regardless of genotype (T/T or T/G+G/G) values of BP syst., BP diast., BP pulse and BP mean is significantly higher than in the control group.

Key words: ANKH inorganic pyrophosphate transport regulator, acute coronary syndrome, allelic polymorphism.

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STANDARD MEASUREMENT OF BONE STRENGTH IN ANIMALS OF DIFFERENT AGE AND 3-D MODELING

Authors: Bushtruk A.N.

Pages: 360-365

Abstract


The purpose of our experiment was to investigate the strength parameters of the different ages rat’s femur after applying of perforated defect and the creation of an experimental 3-D model. In the experiment were used 54 male rats of 3 ages - young, mature and old age. We performed perforated defect in the middle third of femur from medial surface under sterile condition. The rats were taken out of the experiment at 24 days after injury.

To study the strength properties femur with bone defect were isolated and ensile strength, flexural and compression were determine according to standard methods. To assess the accuracy of the experiment and to compare the experimental data with the calculated values, we performed calculations of bones for tension, compression and bending with sophisticated computational systems Pro/Engineer and Pro / Mechanica.

Using 3-D modeling allows visually evaluate the distribution of the load on the bone during the action of external loads of different directions, and identify weaknesses spots. With the help of the module Pro / Engineer is possible to calculate the tensile strength with a slight deviation from the experimental data. Biomechanical model of the femur, which is based on the actual parameters of the original data allow a high probability to calculate the parameters of bone strength in animals of different age.

Keywords. Femoral bone, strength parameters, 3-D modeling

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References

  1. Ara Nazarian, F. Araiza Arroyo, Rosso Tensile properties of rat femoral bone as functions of bone volume fraction, apparent density and volumetric bone mineral density.  Journal of Biomechanics. 2011442482–2488.
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Wanyura H., Kowalczyk P., Bossak M, Samolczyk-Wanyura D. Finite element method for analysis of stresses arising in the skull after external loading in cranio-orbital fractures. Neurologia i Neurochirurgia Polska. 2012; 46: 344-350.

 

PSYCHOLOGICAL FEATURES AND PSYCHONEUROTIC VIOLATIONS AT PATIENTS ON A WHITE PLAGUE

Authors: Valetskiy Yu.

Pages: 366-372

Abstract


The aim of the study was to examine the psychological characteristics and psychoneurotic disorders in patients with newly diagnosed pulmonary tuberculosis with effective, ineffective and missing treatment of the disease. To solve this problem were examined clinically, radiologically and by questionnaire patients with newly diagnosed pulmonary tuberculosis.

Diagnosis of tuberculosis led to the stress of the patients. Later there came to addictive disease and primary psychoneurotic disorders disappeared by improving the patient's condition and treatment. In patients with ineffective treatment they grew and changed with new ones. With the deterioration of patients, increased toxicity and clinical manifestations of growing anxiety, neurotic amplified and psychological disorders.

The authors identified four stages in the evolution of psychoneurotic disorders: stress and neurotic stage, mental adaptation stage, the stage of dynamic psychoneurotic disorders, phase of involution or strengthening psychoneurotic disorders. They depend on the course and results of treatment of TB patients.

We found 14 psycho types of responding to the diagnosis of tuberculosis or ineffective treatment: harmonious, melanholic, listless, euphoric, anozohnozic, anxious, aggressive, neurasthenic, sensitive, hypochondriac, erhopathic, paranoid, obsessive-phobic mixed.

In effectively treated patients dominated harmonious and euphoric type of perception of the disease. In previously treated ineffectively dominated neurasthenic, anxious, anozohnozic, melanholic, aggressive types of responses to the disease, while in untreated patients - anxious, hypochondriac, paranoid psychotypes.

These psycho response of TB patients can be used to customize their methods of correction.

Keywords: tuberculosis, treatment, psychological and psychoneurotic specialities.

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