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ASSOSIATION BETWEEN ENDOTHELIAL NITRIC OXIDE SYNTHASE GENE POLIMORPHISMS AND RISK OF CORONARY ARTERY DISEASE (REVIEW)

Authors: Prystupa L.N., Pogorielova O.S.

Pages: 375-386

Abstract


The article analyzed Ukrainian and foreign research on the impact study T-786С, G894T, 4a /b polymorphisms of  the eNOS gene on the risk of coronary artery disease (CAD) among representatives of different populations. The role of T-786C polimorphism of the eNOS gene was proven in the development of CAD among Japanese, Ukrainian, Italian population, and in the past it is associated with multivessel disease.

G894T polymorphism of the  eNOS gene  is associated with high risk of CAD, ischemic stroke in Italian, Turkish, Asian populations.  In the Russian population this polymorphism assotiated with restenosis of stents. The 4a/4b polymorphism of the eNOS gene has significant influence on risk of CAD in Turkish, Japanese, Korean, African-American, Iranian and Russian populations.  Japanese population has gender specificity of the association. Conflicting data obtained in separate studies of the influence of T-786C polymorphism  of the eNOS gene in the Turkish population. There was no association   4a /4b polymorphism of the eNOS gene in men Slovenia’s men and in Finland. Wasn’t  identify association of G894T polymorphism of the eNOS gene in Korean population. Wasn’t detected association  of genotypes 4a/4b, G894T, T-786S of the eNOS gene polymorphisms with risk of CAD in white Australians.

Due to the existence of common pathogenetic mechanisms, involving NO, polymorphism eNOS gene presence may increases the risk of developing COPD. So perspective is study of  polymorphisms  eNOS gene in patients with COPD and CAD of Ukrainian population. Investigate their role as candidate genes can help to predict and prevent the appearance of comorbid disorders.

Key words: chronic obstructive pulmonary disease, coronary artery disease, endothelial nitric oxide synthase gene polymorphism.

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JUSTIFICATION OF THE MANAGEMENT MODEL OF MEDICAL CARE TO PATIENTS WITH OPTIC ATROPHY

Authors: Vasiuta V.A.

Pages: 387-392

Abstract


Introduction. The number of patients with visual impairment in the world is growing steadily. Despite significant advances in the development of ophthalmology, frequency and severity of the pathology of the vision as a whole does not tend to improve. Ophthalmology Service in Ukraine is in the process of reform. Unfortunately there are some problems in the system to provide eye care. Among the serious ophthalmic disabling diseases special place occupies optic nerve atrophy (ANA), which is associated with the severity of the disease, irreversible decline in visual functions, complexity of treatment, high levels of disability and reduce efficiency. This  disease is among the most serious lesions of neurovision system, the possibility of rehabilitation which at the present level of development of medicine remains limited. The system of care  needs improvement and effective management decisions. Purpose  of our study was to justify the management model of medical care to patients with ONA.

Materials and methods. The research methodology was based on a systems approach, the main methods are: the method of system analyzed for qualitative and quantitative analysis of problems in providing medical care to patients with ONA, descriptive modeling- the development of optimized management model of medical care patients with ONA. The study was based on the experience of providing care to patients with ONA in the department neuroophtalmology SI "Institute of Neurosurgery named after A.P. Romodanov NAMS of Ukraine ". We analyzed data from 4000 patients  with  ONA, which were sent for further diagnosis and treatment strategy from medical institutions of all levels  (primary, secondary and tertiary).

Discussion. We proposed a model management system of medical care patients with ONA. This model has the following elements: organizational, legal, structural and functional, resource economy and takes into account the socio-economic conditions of the region. The basis of organizational and legal integration element is the principle diagnostic and treatment process for optimal interaction between physicians related specialties. For referrals to physicians related specialties offered to give an advisory opinion stating the reason for consultation (for example, "to avoid neurological etiological factor", tumors of the brain, demyelinating process, etc. ". After consulting the patient necessarily returned to the doctor who sent him to counseling that recorded in patients' records. Among the organizational and legal aspects, to ensure the management system of medical care ONA should highlight the availability of legislative support at national and regional level. Structural - functional element is to determine the optimal network of medical facilities to ensure the continuity of diagnostic and therapeutic process in patients with ONA, the organization and the feasibility study structural and functional model of neuroophtalmological rooms, planning of eye care. Resource - the economic aspect in the management system of medical care to patients with ONA on the background of insufficient funding should be based on the principle of optimization of intensive eye care in this patients. Socio - environmental conditions (health region's population, socio-demographic structure, level and way of life, environmental conditions of the region, economic development of the region) may act as risk factors for eye disease, and potential factors in resource and organizational and functional maintenance neuroophtalmological assistance. Studies management model of medical care to patients with ONA, presented its basic elements, which will optimize the medical assistance given category of patients.

Keywords: Optic nerve, atrophy, management model.

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INTEGRAL KNOWLEDGE ASSESSMENT ON HIV INFECTION/AIDS IN MEDICAL STUDENTS

Authors: Piddubna A.I., Chemych M.D., Pavluk L.A., Rogal L.I.

Pages: 393-399

Abstract


The results of knowledge assessment on HIV/AIDS in medical students conducted by questionnaire were demonstrated. Responders are informed group on HIV infection and the level of knowledge in etiology, mechanisms and routes of transmission, diagnostics is sufficient, but we found unsatisfactory awareness of the actions in emergency situations with infected biological material. We determined that medical students, as future health care professionals, are loyal enough towards people living with HIV, but facts of stigma and discrimination of this category of patients was revealed.

Keywords: HIV infection, medical students, knowledge assessment.

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THE BORRMANN TUMORS TYPES OF PATIENTS WHO UNDERWENT COMBINED SURGERY ON LOCALLY ADVANCED STOMACH CANCER

Authors: Oliynyk Yuriy Y.

Pages: 400-410

Abstract


Purpose - to determine the clinical significance of Bormann macroscopic types in patients with locally advanced gastric cancer (LAGC), that combined surgeries were performed.

Materials and methods. The study group consisted of 1114 patients, including 804 men and 310 women. All the patients underwent combined surgeries between 1962 and 2012. There were randomized 908 patients according to the criteria of Bormann classification into 4 types: Borrmann 1 (B1) - 285 (31,4%), the ratio of male/female was 216/69, Borrmann 2 (B2) - 269 (29,6%), 205/64, Borrmann 3 (B3) - 99 (10,9%), 67/32, Borrmann 4 (B4) - 255 (28,1%) 176/79. The SPSS 13.0 statistical package was used to perform all statistical analyses.Parameters affecting survival were calculated using Kaplan-Meier and Pearson’s χ2test. A statistically significant result was determined under the condition that p <0,05.

Results and discussion. At the body of the stomach were 186 (20.5%) morphological tumor types, 36 tumors (19.4%) revealed type B1, 46 (24,7%) - B2, 33 tumors (17,7%) - B3 and 71 tumor (38,2%) - B4. At the distal part of the stomach were 191 (21,0%) morphological tumor types, 79 (41.4%) revealed type B1, 64 (33,5%) - B2, 17 (8,9%) - B3, and 31 (16,2%) - B4. At the total lesion of the stomach were 54 (5,9%) morphological tumor types: 2 types of B1 (3,7%), 7 - B2 (12,9%), 3 - B3 (5,6%) and 42 - B4 (77,8%). At the proximal part of the stomach were 443 (48.8%) morphological tumor types, 160 tumors (41.4%) revealed type B1, 145 (33,5%) - B2, and 96 (16,2%) - B4. 191 patients underwent subtotal distal gastrectomy (SDG), 576 - total gastrectomy (TG) and 141 - subtotal proximal gastrectomy (SPG). Among them 285 (31,4%) surgical operations were executed at a type B1, just following: GE - 143 (50.2%), SDG - 79 (27, 7%) and SPG - 63 (22.1%). At a type B2 285 (31,4%) surgical operations were executed, just following: GE - 143 (50.2%), SDG - 79 (27, 7%) and SPG - 63 (22.1%). At a type B3 99 (10,9%) operations were executed, just following: GE - 77 (77.8%), SDG - 17 (17.2%), and SPG - 5 (5,1%). At a type B4 255 (28,1%) operations were executed, just following: GE – 207 (81,2%), SDG - 31 (12,1%) and SPG – 17 (6,7%). Mean life time of patients with a type B1 was46,42±5,19 months, B2 – 47,31±6,55 months, B3 – 37,03±9,88 months, і B4 – 20,36±3,04 mos. 3- and 5-year overall survival rate for a type B1 were respectively 32,76 ± 3,58% and 24,55 ± 3,33%; type B2 - 26,19 ± 3,35% and 20,26 ± 3,12% respectively; type B3 - 25,86 ± 5,75% and 18,01 ± 5,18% respectively and type B4 - 13,17 ± 2,73% and 8,67 ± 2,34% respectively. Differences between 3- and 5-year survival of patients with a type B1 and type B4, as well as B2 and B4 were statistically significant (p <0,001 and p <0,05, respectively).

Conclusion. Patients with LAGC and 1-2 Borrmann types have higher term of survival compared to Borrmann 4 type and negatively impact on the overall survival of patients, regardless of their sex and type of CS.

Keywords: locally advanced gastric cancer, Borrmann's types of tumors, combined surgical intervention.

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THE DELETION POLYMORPHISM OF THE GENES GSTM1AND GSTT1 UNDER EOSINOPHILIC AND NEUTROPHILIC PHENOTYPES OF BRONCHIAL ASTHMA IN CHILDRE

Authors: Koloskova O.K., Bilous T.M.

Pages: 411-415

Abstract


Purpose. To study the deletion polymorphism of the genes of glutathione-S-transferase (GSTM1 and GSTT1) in children with bronchial asthma (BA) under eosinophilic and neutrophilic types of airway inflammation.

Materials and Methods. It has been performed complex examination of 79 school-aged children with bronchial asthma, of whom in 46 patients (I-st clinical group) the eosinophilic type of bronchial inflammation was verified, but in 33 patients (II-nd clinical group) the neutrophilic airway inflammation was recognized. Determination of deletions in the genes GSTM1 and GSTT1 was provided by multiplex polymerase chain reaction using appropriate specific primers.

Results. In patients with the genotypes T1+M1del the severe course of BA more often occurred in children with the eosinophilic asthma phenotype than in neutrophilic asthma (61.5% vs. 42.9%).

AtthatinchildrenwiththeT1+M1delgenotypessuchclinicalsignsasmoreexpressivebronchiallabilityandassociatedallergicrhinitisweremorecommonforneutrophilicasthmaphenotype (33,0% and 71,4% correspondingly) ascomparedwithpatientswitheosinophilicasthma (13,8%; P<0,05 and 15,4%; P<0,05 correspondingly). In children with combination of the genotypes T1delM1+ and eosinophilic asthma phenotype the higher content of nitrogen monoxide metabolites in exhaled breath condensate (63,1 mmol/ml versus 44,4 mmol/ml; P<0,05) as well as the increase in the concentration of serum total IgE (905,8 IU/ml versus 578,6 IU/ml; P<0,05) have been determined in comparison with cases of neutrophilic asthma with the same deletion polymorphism of GSTM1.A verification of the genotype T1delM1+ in asthmatic patients with neutrophilic airway inflammation was associated with a severe course of the disease (50,0% vs. 37,5%; P<0,05) and concomitant allergic rhinitis (75,0% vs. 12,5%; P<0,05)ascomparedwithpatientswith combination of both eosinophilicasthma phenotype and the genotype T1delM1+.

Conclusions. Thus, in children with eosinophilic and neutrophilic asthma phenotypes in the presence of deletion polymorphism of GSTM1 and GSTT1 genes the certain clinical and laboratory features of the disease have been determined.

Keywords: bronchialasthma, children, glutathione-S-transferase.

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THE EFFECTIVENESS OF LIPID-LOWERING THERAPY IN PATIENT WITH HYPERTENSION ACCORDING THE C825T POLYMORPHISM OF Β3-SUBUNIT G-PROTEIN

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

Pages: 416-424

Abstract


High risk of cardiovascular deseases is associated with dyslipidemia.The most effective for  lipid lowering are statins. Previous studies have indicated the association between individual sensitivity to statins and polymorphisms of candidate genes that are predictors of atherosclerosis, dyslipidemia and coronary heart disease, one of that is a gene of  β3-subunit of G-protein (GNB3).

The aim this research was to analyze the effectiveness of lipid-lowering therapy in patients with arterial hypertension (AH) according the C825T polymorphism of GNB3.

In the study participated 62 patients with diagnosis of AH with dyslipidemia. To determine the level of lipid metabolism was performed on biochemical analyzer. The C825T polymorphism GNB3 was determinated by polymerase chain reaction and restriction digestion.

The study showed that after 4 weeks of atorvastatin observed decrease level of lipids, and after 12 weeks achieved target value of low density lipoprotein  in hypertensive patients with dyslipidemia. Carriers C/T and T/T genotypes had lower starting effectiveness dose of atorvastatin compared with carriers C/C genotype. Hypertensive patients with dyslipidemia carrier T allele (C/T and T/T genotypes) require higher doses purpose of atorvastatin compared with C allele carriers. For patients with C/C genotype appointment starting dose of atorvastatin is effective.

Keywords: dyslipidemia, polymorphism, gene β3-subunit of G-protein statins.

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MAIN INDICES OF BLOOD-BRAIN BARRIER DAMAGE AT ACUTE PHASE OF ISCHEMIC STROKE

Authors: Volodymyr Lychko, Volodymyr Malakhov

Pages: 425-429

Abstract


Introduction: An acute ischemic stroke causes expressed disruption of blood-brain barrier (BBB), which significantly affects prognosis. One of the indicators of the effect is the level of albumin in the cerebrospinal fluid (CSF).

The purpose of the study was to examine the level of albumin in the CSF in patients with ischemic stroke and to assess the role one as index of BBB dysfunction. In the study were involved 121 patients who had first incident of brain infarction (mean age was 64.4 ± 0.9 years) were comprehensively examined and the concentration of albumin in serum and CSF were determined.

The results of the study show level of albumin in CSF was clearly elevated in patients with increased severity of infarction. Under treatment, there was a general trend of increase in level of CSF albumin in patients of all groups, remarkably in those with severe condition.

Conclusion: The onset of brain infarction is characterize by significant functional changes of the BBB confirmed by a sharp increase in the level of CSF albumin (34.6 %) which directly correlated with the severity of patients. Dynamics of treatment have shown unfavorable prognostic signs due to increase in levels of albumin by 1.7 times observed in patients with severe condition.

Key words: albumin, cerebrospinal fluid, barrier, stroke, prognosis, dysfunction.

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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.

 

METABOLIC DISORDERS IN CHILDREN WITH DIABETES MELLITUS TYPE I AND DIABETIC NEPHROPATHY

Authors: Maidannyk Vitaliy, Burlaka Ievgeniia

Pages: 430-435

Abstract


Introduction. Diabetic nephropathy is the leading cause of death in patients with diabetes mellitus (DM). Two key mechanisms are involved in the development of diabetic nephropathy – advanced glycation and oxidative stress. Formation of diabetic nephropathy depends on the degree control of the diabetes, which is an indicator of the level of glycosylated hemoglobin (HbA1c).

Purpose: To investigate the level of metabolic disorders in children with DM type I and diabetic nephropathy.

Material and methods. The study involves 18 children with DM type I and diabetic nephropathy (aged 10 to 16 years). The affinity of hemoglobin to oxygen and lipid oxidation ratio were determined using spectrophotometric method.

Results. In the group of children with newly diagnosed DM type I a high rate of affinity of hemoglobin to oxygen as compared to the control group has been recorded. In the group of children with DM type I and developed diabetic nephropathy the level of the marker is significantly lower as compared to control group. Stage-dependent increase of the level of lipids oxidation coefficient depending on the efficacy of control of DM has been documented.

Discussion. We examined two components of pathogenesis and indicators of the persistent influence of glucose in diabetes mellitus – outcomes of the formation of advanced glycation products (HbA1c) and lipids oxidation coefficient. Further investigations of the advanced glycation products formation intermediates in secondary activation cascade of reactions, including the pathogenesis of progression of diabetic nephropathy is a promising direction to create schemes of prevention and treatment of diabetic kidney disease.

Keywords: diabetes mellitus type I, diabetic nephropathy, metabolic disorders

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FEATURES OF SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN PREGNANT IN ABSENCE OF EPIDEMIC INFLUENZA A H1N1

Authors: Pertseva T.O., Kireyeva T.V., Kravchenko N.K.

Pages: 436-442

Abstract


Introduction. Community acquired pneumonia (CAP) is one of the most dangerous respiratory diseases that complicates pregnancy. The epidemic of influenza virus type A H1N1 (2009–2010) stressed the importance of pneumonia in pregnant to society in every country.

Pregnant women make up about 2% of the general population. However, during the influenza epidemic of 2009–2010 their share among hospitalized patients was 7–10%, among persons that required treatment in the intensive care unit (ICU) – 6–9% and 10% of those who died. In consequence of increasing need of oxygen and changes in respiratory biomechanics pregnant with CAP are at high risk of development of acute respiratory failure. Thus, according to the California Pandemic (H1N1) Working Group, 22% of the total observed pregnant required hospitalization to ICU and respiratory support.

Prognostic scales, such as CURB-65, PORTorSMART-COP can help to objectify doctors’ clinical judgment about the place of treatment of patients with CAP (outpatient, hospital or ICU). Another way to evaluate risk of adverse outcomes in CAP patients is by monitoring the level of systemic inflammation with either routine markers, such as white blood cells (WBC) and C-reactive protein (C-RP) or advanced methods – defining marker of bacterial inflammation procalcitonin (PCT). However, there is not enough data on the use of above mentioned scales and changes in laboratory parameters in pregnant with CAP.

The aim of the study was to investigate features of community-acquired pneumonia in pregnant who were admitted to the ICU. Moreover, to assess factors of adverse outcomes, taking into account the severity of systemic inflammation.

Materials and methods. 23 pregnant that were hospitalized to ICU with diagnosis of CAP were included in the study. On admission (Visit 1) we estimated general condition (body temperature, respiratory rate (RR), saturation (Sp O2)), measured laboratory markers of inflammation (WBC, C¬RP, PCT), performed chest X-ray and scale SMRT-CO evaluation. On the 5-7th day of stay in the ICU (Visit 2) assessment of the dynamics of Sp O2 and laboratory parameters (WBC, S¬RP, PCT) were carried out.

According to the Sp O2 level that is marked as significant in SMRT-CO scale, we had divided pregnant into two subgroups. Subgroup A (Sp O2 93% or less) and subgroup B (Sp O2 94% or more). In both subgroups, we studied total score in SMRT-CO scale, and laboratory markers on visits 1 and 2.

Data analysis in subgroups showed that pregnant in subgroup B had no indication for treatment in ICU according to both the SMRT-CO points and the level of Sp O2 (96 ± 0,5%).

Analysis of the laboratory parameters showed that on Visit 1 both subgroups differed only in terms of C-RP, which was 30% higher in the subgroup A. Study detected no statistically significant changes in the level of WBC between visits, while levels of C-RP and PCT decreased significantly. Which indicates them as a more accurate tool to access the response to antibiotic therapy.

In subgroup A, we performed a factor analysis to estimate the factor loadings on data, which are generally used to estimate the severity of CAP in pregnant (Sp O2, SMRT-CO score, C-RP, PCT and gestational age). Analysis showed that significant load (greater than |0,7|) had the following factors: Sp O2 |0,88|, gestational age |0,9| and PCT level |0,82|. This suggests that these indicators can help to objectify severity of CAP in pregnant and make a decision on the need of ICU treatment.

Conclusions. We determined that 11 (47%) patients had no indications for admission to ICU according to both level of Sp O and SMRT-CO scale. Our data showed that the severity of CAP in pregnant can be estimated more completely by the levels of Sp O2 and PCT, considering the term of pregnancy.

Key words: pregnancy, pneumonia, SMRT-CO, procalcitonin.

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NEUROSURGICAL TREATMENT OF SACRAL TUMORS CAUSING A COMPRESSION OF NERVOUS STRUCTURES

Authors: Leshko M.M.,Slinko E.I., Potapov A.A.

Pages: 443-452

Abstract


Sacral tumors are rare and account for 1-7% of all spinal tumors. There are different histological types of tumors in the sacrum. Therapeutic strategy depends on the aggressiveness of the tumor, its biological nature and localization.The aim of this studyis development and introduction of neurosurgical interventions directed on removal of the sacral tumors, nervous structures decompression, and fixing of the spine.

We assessed and performed surgical treatment in 138 patients with sacral tumors operated in institute of neurosurgery in 2000 - 2015.The earliest symptom of sacral tumors is local pain in the sacrum. With tumor progression radicular syndrome occurs. We use computed tomography and MRI to confirm diagnosis and to assess spreading of the tumor for planning neurosurgical intervention.Among 138 patients assessed 60 had big tumors involving all sacral vertebrae (S1-S5), 48 - involving S1-S3 vertebrae, and 30 – involving only S3-S5 vertebrae.A change in the sacrum on plain radiographs is a late sign. Value of roots compression is confirmed by electroneuromyography.

Among 60 patients with big tumors of all sacral vertebrae (S1-S5) in 36 the tumors are totally removed, in the others - partially removed. Among 48 patients with a tumor of S1-S3 vertebrae total removing performed in 6 patients, partial removing - in 12. In all 30 patients with tumors of S3-S5 vertebrae we performed total removal of a tumor. Tumors removed as a whole block only in 24 patients with tumors affected S3-S5 vertebrae. In all other patients tumors removed by piecemeal fashion.In the 36 patients after tumor removal a fixation of spine and pelvis was performed.Among 69 patients surveyed in the remote period relapses are found out at 36.

We claim that surgical excision, especially removal as a whole block, is a preferred way in sacral tumors treatment. Unfortunately, removal as a whole block can be performed only for small sacral tumors.

Keywords: sacraltumors

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LEFT VENTRICLE DIASTOLIC DYSFUNCTION IN POSTMENOPAUSAL WOMEN WITH ESSENTIAL ARTERIAL HYPERTENSION

Authors: Malynovska O.Ya.

Pages: 453-460

Abstract


Purpose: To determine the characteristics of diastolic dysfunction of the left ventricular myocardium in women with arterial hypertension and menopausal syndrome, depending on the severity of menopause.

Materials and methods. The study enrolled 120 women suffering from hypertension, postmenopausal from 1 to 5 years. The main group consisted of 90 patients with climacteric syndrome. According to the severity of somatic-vegetative symptoms on a scale MRS patients were divided into three groups: the first (0-5 points); the second (6-8 points) and third (≥ 9 points). The control group consisted of 30 women with hypertension in postmenopausal women with no signs of menopausal syndrome.

It was determined that a significant decrease in enddiastolic volum and left ventricular (LV) ejection fraction, improving endsystolic volum of LV signs of LV hypertrophy in the second and third groups, reduction of peak amplitude E and the increase of the amplitude of the peak A in the group with more severe menopause. Formation of diastolic dysfunction in patients with severe menopause confirmed lower early diastolic velocity of the mitral annulus with the ratio E / EA, indicators IVRT and DT.

In the study of myocardial relaxation type disorders in patients of the first group and the control group was observed predominantly normal left ventricular diastolic relaxation and impaired relaxation. Patients of the second and third groups dominated impaired relaxation and pseudonormal type among patients of the third group met patients with diastolic dysfunction of restrictive type.

Thus, women with hypertension in early postmenopausal found an association with the severity of diastolic dysfunction severity of menopausal symptoms; the most prominent of diastolic relaxation of the left ventricle was observed in the groups with severe and moderate severity of menopausal symptoms; the main type of the observed diastolic dysfunction - impaired relaxation, but in some cases there is pseudonormal and restrictive types.

Keywords: essential arterial hypertension, left ventricle diastolic dysfunction, climacteric syndrome, transmitral blood flow. left ventricle hypertrophy.

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References

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INFLUENCE OF C677T POLYMORPHISM OF METHYLENETETRAHYDROFOLATE REDUCTASE GENE AT THE PLASMA HOMOCYSTEINE LEVEL IN PATIENTS WITH NONALCOHOLIC FATTY LEVER DISEASE AND WAYS OF ITS CORRECTION

Authors: Orlovskyi V.F., Kuchma N.G.

Pages: 461-467

Abstract


Introduction and Purpose.The purpose of the research was explore the plasma homocysteine levels in patients with nonalcoholic fatty liver disease, possibility of its correction of vitamin B12 and folic acid dependent on C677T polymorphism gene methylentetrahydrofolate reductase. Nonalcoholic fatty liver disease combined with diabetes mellitus 2 type, hypertension, dyslipidemia and obesity, they are the main components of the metabolic syndrome. That is predictive of cardiovascular diseases that impact and duration and quality of life.

Materials and  Methods. In a study of 53 patients participated with nonalcoholic fatty liver disease and 47 patients in the combination of diabetes mellitus 2 type. The control group included 40 healthy individuals. Patients  administered vitamin B12 and folic acid under the scheme during the month and of plasma homocysteine levels were determined before and after the treatment.

Results. The results of the study show that patient with minor allele T (C/T and T/T) before treatment of plasma homocysteine level was significantly higher than in major allele homozygous for (C/C) in patients in both groups. In patients with comorbid pathology of this index was higher compared to isolated  nonalcoholic fatty liver disease. After treatment received plasma homocysteine decrease in all studied groups of patients. In patients of both groups, homozygotes for the minor allele T (Т/Т) after treatment homocysteine is not decreased significantly as compared with the other genotypes (С/С and C/T). Consistent to earlier research the study supported the hypothesis that low MTHFR enzyme activity in these patients is not compensated by receiving folic acid and vitamin B12 in sufficient quantity. Therefore, patients with genotype T/T for C677T polymorphism of the gene MTHFR for correction hyperhomocysteinemia need additional doses drugs.

Conclusion. Involving to treat vitamin B12 and folic acid significantly reduced plasma homocysteine levels in patients with non alcoholic fatty liver disease. However, in patients minor allele T carriers effect of this treatment on the hyperhomocysteinemia was not significant, which prevented reach target levels of homocysteine in these patients.

Keywords: methylenetetrahydrofolate reductase (MTHFR), allelic polymorphism, homocysteine, nonalcoholic fatty liver disease, treatment of hyperhomocysteinemia.

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PREDICTORS OF ADVERSE CLINICAL COURSE AND CARDIOVASCULAR MORTALITY DURING HOSPITAL PERIOD OF ACUTE MYOCARDIAL INFARCTION AMONG FEMALE PATIENTS

Authors: Netyazhenko N.V.

Pages: 468-474

Abstract


Aim To identify predictors of adverse course and cardiovascular mortality during hospital period of acute myocardial infarction among female patients.

Materials and Methods. The study included 65 women with myocardial infarction (MI) with elevation segment ST. In order to find predictors of unfavorable development of MI combined end point (CEP) (acute left ventricular failure class III-IV and recurrence by T.Killip MI) and cardiovascular mortality was promoted single-factor analysis, options which were identified fairly significant, used in multivariate stepwise discriminant analysis with determination of the odds ratio (OR).

Results. Risk of  CET increased in women with MI and presence of following indicators of progress plasma coagulation hemostasis the concentration of soluble complexes fibrynmonomers > 4x10 g / l (OR 4.1), reduction of protein C normalized ratio <0.72 (OR 3.7 ), the duration activated partial thromboplastin time <50 c (3.0 HS) and thrombin time <22s (OR 4.4). The most influential parameter functional activity of platelets appeared extent of platelet aggregation induced by arachidonic acid> 3.3% (OR 5.1) and adenosine diphosphate> 4.1% (OR 2.2). Microalbuminuria (MAU) with albumin-creatynin ratio (ACR) from 3 to 30 mg / mol in 6 times increased risk of CEP (OR 6.6). In the course of development of complications of MI and impact indicators such as coronary artery disease duration <3 years (OR 1.8) and hypertension> 5 years (OR 1.6)). An adverse effect on course of MI had a duration of postmenopausal period (<5 years), which is up to 3.9 times increased the likelihood of CEP MI and cardiovascular mortality up to 7.1 times (p <0.05).

Conclusion: The results of indicators plasma coagulation and platelet hemostasis, MAU definition with ACR and a history, especially the duration of postmenopausal period have prognostic value and should be used to differentiate women with MI risk stratification for.

Key words: myocardial infarction, predictors, weather, woman.

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  2. Jackson E.A., Moscucci M., Smith D.E., Share D., Dixon S., Greenbaum A., Gurm H.S. The association of sex with outcomes among patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction in the contemporary era: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).American heart journal. 2011;161(1):106-112.
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  9. Yahagi K., Harry R. Davis, Arbustini E. et al. Sex differences in coronary artery disease: Pathological observations. Atherosclerosis.2015; Vol. 239.:260-267.

 

ENZYMATIC MARKERS OF RENAL LESIONS IN TERM NEWBORNS WITH PERINATAL PATHOLOGY

Authors: Babintseva A.G.

Pages: 475-485

Abstract


Introduction. Considering universality of hypoxic lesions of various systems of organs, morpho-functional immaturity of the body, absence of specific clinical manifestation of renal lesions in newborns and the necessity to use potentially nephrotoxic therapeutic means in sick newborns, the study of enzymuria and interrelations between separate components in general cohort of children with disturbed process of early postnatal adaptation is topical. It will enable furthere laboration of diagnostic-therapeutic algorithm of management of such children considering severity of perinatal pathology but not a separate nosologic unit.

Purpose: to detect activity of enzymes in the urine of newborns with perinatal pathology of various severity with the aim to find the depth of lesion of the structural-functional elements of the kidneys and localization of pathological process.

Materials and Methods.

A comprehensive clinical-paraclinical examination of 121 term newborns was conducted. The children were distributed according to the degree of severity of the processes of early neonatal adaptation. The first main group included 36 newborns with severe disorders of general condition (IA group), these condmain group – 48 children with disorders of adaptive processes of moderate severity (IB group). The control group included 37 healthy newborns (II group). The degree of severity of clinical-paraclinical signs of perinatal pathology was detected by means of neonatal scale of acute physiology (Score for Neonatal Acute Physiology Perinatal Extension – SNAP-PE). Exception criteria were gestation term less than 37 weeks, body weight less 2500 g, congenital defects of the urinary system.

Absolute activity of the following enzymes was examined: cholinesterase (ЕС 3.1.1.7), aspartate aminopeptidase (ЕС 2.6.1.1), alanine aminopeptidase (ЕС 2.6.1.2), alkalin phosphatase (3.1.3.1), lactate dehydrogenase (ЕС 1.1.1.27), gamma-glutamyltransferase (ЕС 2.3.2.2) of urine by means of biochemical methods as well as correlation of activity of these enzymes to the level of creatinine in urine.

Discussion. Term newbornswith clinical signs of perinatal pathology were indicated to constitute the high risk group concerning functional disorders of the urinary system, and traditional methods of their confirmation are of not high diagnostics value. Term children with intensification of the degree of severity of perinatal pathology show are liable increase of enzymatic activity (alkalin phosphatase, gamma-glutamyltransferase), cytosol (alanine aminopeptidase) and mitochondria (aspartate aminopeptidase, lactate dehydrogenase) which is indicative of deep lesions of the nephrothelial structure and requires a certain correction of therapeutic measures. At the same time, under conditions of perinatal pathology in term newborns the canalicular structures are mostly disturbed against the ground of a high risk of development of glomerular filter dysfunction, which under unfavourable conditions may result in the formation of terminal renal lesions – acute renal failure. Timely prognosis and diagnostics of functional disorders of the urinary system in general cohort of sick newborns in the first days of life considering classical criteria and activity of urinary enzymes will enable to prevent the formation of severe renal pathology, to decrease levels of morbidity and mortality of children of this group.

Keywords: newborn, enzymuria, cholinesterase, alkaline phosphatase, gamma-glutamyltransferase, aminopeptidases, lactate dehydrogenase.

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PROBLEMS OF SURGICAL TREATMENT PATIENTS OF PRIMARY CANCER OF THE FALLOPIAN TUBES

Authors: Sumtsov D. G., Sumtsov G. A., Giryavenko N.I.

Pages: 486-490

Abstract


Fifteen patients with cancer of the fallopian tubes were surgical treated and examined. The volume of operation was hysterectomy with oophorectomy, resection of the omentum and pelvic lymphadenectomy, including 4 with the removal of the common iliac lymph nodes and lower lumbar nodes. There   were 9 patients with stage I-II and 6 patients with III-IV stage CFT. Metastases in the lower iliac lymph nodes were histologically confirmed in 6 patients (40 ± 13% CI 16-68). Two of them were combined with metastases in the common iliac and lower lumbar lymph nodes. Radiation or chemoradiation therapy was given all the other.

Over 5years 9 women lived without recurrence and metastasis (60 ± 13% CI 32-84).7 women among of the group of patients who were hurt the first two stages lived over 5 years (88 ± 12% CI 47-100). 3 patients among of the 11 who had I-II stages CFT (27 ± 14% CI 7-65) were transferred to the stage IIIС after histological examination of lymph nodes. On this basis, about a third of CFT patients with minimal and intact primary sources already have lymph node metastases. Iargues lymphadenectomy in the surgical treatment of   CFT.

Keywords: primary cancer of the fallopian tubes, metastasis, surgical treatment

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EFFECT OF MILD HYPOTHERMIA ON THE ABILITY OF RAT BONE MARROW STROMAL CELLS TO FORM COLONIES IN VITRO

Authors: Malyshkina S.V., Poshelok D.M. Nikolchenko O.A., Vyshniakova I.V., Samoilova K.M.

Pages: 491-498

Abstract


Introduction. The study of the effect of hypothermia (decreased body temperature) on bone remodeling is one of the current problems in biology and medicine. Bone marrow contains stromal cells that are able to differentiate into оsteogenic direction, so there the number, structural and functional conditions are important for bone remodeling and osteoreparation. It is known that bone marrow stromal cells are extremely sensitive to unfavorable external and internal factors. The number of these cells and their ability to form cell colonies decreases with age and development of destructive changes in the bones. In the literature we have not found works in which the effect of mild hypothermia on bone marrow stromal cells would have been studied.

The purpose: to evaluate investigate in vitro the colony-forming ability of bone marrow stromal cells in rats of different ages after the mild hypothermia induced by cold exposure.

Materials and Methods. We studied the cytological indicators of the ability of bone marrow stromal cells to form colonies during the cultivation – the number and area of cell colonies, the morphological characteristics of the cultured cells. Experimental animals (10 rats) at the age of 6 and 24 months were kept in separate sections of the cold chamber at temperature −20°С for 5 days to 5 hours per day. Animals of the control groups (10 rats) were kept in the separate boxes at a room temperature (18-22 °C). Bone marrow was isolated from the rat femurs and tibias at 7 and 28 days after induced mild hypothermia. Euthanasia of animals was performed by the intraperitoneal administration of sodium thiopental (90 mg / kg). Bone marrow cells were seeded into plastic flasks (Falcon) based 1.5×106 cells per 1 cm2, and then cultured in a nutrient medium containing DMEM (Sigma), 2 mM L-glutamine, 20 % fetal calf serum and 100 U/ml penicillin and 100 mg/ml streptomycin. The nutrient medium was changed every three days up to 12 days of culture, then it was removed, and the cell cultures washed with PBS, fixed with May-Grunwald, stained with azure-eosin by Romanovsky. The cytological indicators were studied using light microscope OlympusCX41RF. The obtained digital values were processed by the methods of variation statistics. The differences between paired samples were evaluated by using Student t-test and considered statistically significant at P<0.05. Plan of the experimental study and its carrying out in accordance to the Law of Ukraine № 3447-IV «On protection of animals from cruelty» and European Convention for the protection of vertebrate animals used for experimental and other scientific purposes were approved by the positive decision of the local Committee on Bioethics (protocols No. 88, 30.05.2011, No. 131, 16.06.2014).

Results. In the cultures of bone marrow cells isolated from the bones of the young rats at 7 day after cold exposure the number and area of colonies are less as compared with the control, respectively, by 34.5 and 40.1 %. The cells with destructive changes (vacuolization of the cytoplasm, pyknosis of the nucleus) are identified on the periphery of the colonies. The colonies of the cells are no formed in the cultures of bone marrow cells of experimental old rats (the cells are arranged individually or in small clusters). In the cell cultures of control old rats the number and area of colonies are less than in the cell cultures of control young rats by 53.6 and 44.2 %, respectively. At 28 day after cold exposure the differences in the number and area of cell colonies between the experimental and control cultures of bone marrow cells both young and old rats are decreased compared with ones at 7 day. This suggests that the regenerative processes occur in the bone marrow of rats after mild hypothermia. At that, these processes are less active in old animals, so as at 28 day after cold exposure all cytological indicators remain the lowest in the cell cultures of experimental old rats.

Conclusion. The study showed that mild hypothermia induced in rats by cold exposure inhibits the proliferative activity of bone marrow stromal cells and their ability to form cell colonies in vitro. Negative effects of hypothermia are more expressed in the bone marrow cell culture of old animals.

Keywords: cell culture, bone marrow, cell colonies, hypothermia, rats.

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СOMPLEX INTIMA-MEDIA OF THE CAROTID ARTERIES, ELASTIC PROPERTIES OF THE VASCULAR AND THEIR PREDICTOR ABILITY IN PATIENTS WITH HYPERTENSIVE NEPHROPATHY

Authors: Fushtey I.M., Tokarenko О.О.

Pages: 499-507

Abstract


Introduction. Studying features of arterial stiffness and its predictor ability at an early stage of the hypertensive nephropathy (HN) is very important to deepen knowledge about pathogenetic development mechanisms of the latter. The aim was to study intima-media thickness (IMT) of carotid arteries in patients with HN, to study elastic properties of vascular elastic and muscular types identifying their interactions, and to analyze their predictor abilities concerning the HN.

Materials and  Methods. We examined two main groups of patients with essential hypertension (EH) stage II with second (n=31) and third (n=31) degree of increased blood pressure with early signs of nephropathy, and also three comparison groups, including patients with EH stage II with second (n=31) and third (n=31) degree of increased blood pressure with preserved renal function and practically healthy individuals (n=31). The ratio value of albumin/creatinine in urine 30 mg/d was seen as a marker of kidney disorder, the latter found by immuneturbidimetry method. Ultrasound examination of neck vessels was performed using sonographic сomplex Ultima Pro-30 with the help of a linear probe L5-10/40E. IMT measured in the distal common carotid arteries. For further analysis the average IMT value of left and right common carotid arteries was used. Increase of IMT was diagnosed with the value higher than 0,9 mm. To estimate the condition of elastic properties of the vascular wall a computerized rheographic complex REOCOM was used. Measurements of the pulse wave velocity (PWV) were performed on the aorta and the aorto-femoral segments.

Results. These data suggest that in patients with EH and HN significantly more pronounced remodeling of carotid arteries is observed, as well as a significant loss of elastic properties of blood vessels of elastic and muscular types. It was found that there exist correlation interrelations parameters of the elastic properties of blood vessels between themselves and with the IMT averages of left and right common carotid artery. ROC analysis revealed that the IMT average of the left and right common carotid artery, PWV on the aorta and average PWV on the left and right aorto-femoral segments can be used as predictors of HNoccurrence. Logistic regression revealed that among the latter the most qualitative and independent predictors are PWV on the aorta and IMT average of the left and right common carotid artery. And both an isolated use and as a part of the constructed model of logistic regression are possible.

Keywords: hypertensive nephropathy, thickness of the intima-media сomplex, pulse wave velocity, arterial stiffness.

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DYNAMICS OF ABILITIES TO MAINTAIN A BALANCE IN PATIENTS WITH HYPERTENSION, STROKE, INFLUENCED COMPLEX OF PHYSICAL REHABILITATION

Authors: Klapchuk V.V., Fetisova V.V., Alexandrova M.O.

Pages:508-513

Abstract


In this work has been shown that the initial indexes of abilities to maintain balance and of the functional state of the cardiovascular system of women 40-52 years old, who suffer from hypertension 2 st, stroke, were different from the norm. After a comprehensive physical rehabilitation in a sanatorium the results of tests on the maintaining of balance such as "standing on one leg in a pose of "swallows" , Romberg and Yarotsky tests, were significantly improved.  Between the levels of systolic and diastolic blood pressure and heart rate at the end of the course of physical rehabilitation had no statistically significant differences in the groups of patients examined. Program of physical rehabilitation, which contains segmental-reflex massage, passive and active exercises, physical exercises for relax of the paretic muscles, combined with breathing exercises and special exercises to maintain a balance has been recommended  to introduction. It's preferably to use as a starting position of sitting on a chair and lying with a raised body at the first half of the course, and at the second one - lying, sitting and standing. Designed complexes contain more exercises for the legs than for the arms, because during exercises for the muscles of the arms the blood pressure significantly  rises compared with exercises for the muscles of the legs. Exercises involving large muscle groups are dominating In the complex. They have a greater depressor effect than exercises for small muscle groups. Those patients who suffering from dizziness and impaired sustainability must get an elements of vestibular training (exercises to develop balance, with the changing the position of the head in space, ones  with the closed eyes etc.). It is proved that such program have an advantage over conventional restorative treatment, which includes the traditional gymnastics and classic massage.

Key words: maintaining balance, hypertension, physical rehabilitation.

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