Аuthors: R. A. Moskalenko
Calprotectin has two calcium-binding proteins S100A8 (calgranulin A) and S100A9 (calgranulin B), which belong to the family of S100 proteins. These proteins are involved in intracellular signaling, affecting on the level of Ca2+ and as Ca2+ -buffer proteins. S100 proteins are involved in many cellular processes, such as cell cycle regulation, cell growth, differentiation and chemotaxis.
Today, metabolic disorders with S100 protein family are associated with development and progress of such pathologies as cardiomyopathy, atherosclerosis, neurodegenerative diseases, connective tissue diseases. Besides calprotectins take part in inflammation, reports about their antimicrobial activity, regulatory activity against cells, which are involved in immune reactions, carcinogenesis, development of amyloid-associated diseases are accumulated.
The aim is to analyze the data of scientific literature to establish the role of proteins calgranulins A and B and their complex (calprotectin) in the development of pathological biomineralization of soft tissues in human body.
Calprotectin is expressed by granulocytes, monocytes and macrophages in early stages of differentiation. For example, proteins S100A8 and S100A9 take up 45% of all cytoplasmic proteins in neutrophils, and in monocytes – only about 1% of protein cytoplasm. Also calprotectins expression was described in fibroblasts and endothelial cells, activated mature macrophages, osteoblasts and keratinocytes.
The main part of cytokino- and chemokino-like calprotectin activity is caused by its conection with RAGE receptors (receptor of advanced glycation and end products) and TLR4 (toll-like receptor 4) that trigger signaling pathways, which contribute to calcification in the vascular system, prostate, regulate cytoskeleton structure through polymerization of tubulin and more.
Calgranulin A (S100A8) and calgranulin B (S100A9) alone and as part of calprotectins complex are extremely interesting objects for stud-ing their possible role in the pathological process of biomineralization. In addition to chemokine and cytokine activity and influence on different specific receptors, these molecules have important constitutive feature: the binding of calcium and some other two valence ions. The combination of proteins S100A8 and S100A9 with biomineralization in such pathological processes as inflammation, tumor growth and atherosclerosis, says abot their obvious correlation.
Calprotectin-dependent endothelial damage may be a critical element in vascular morphogenesis biomineralization during chronic inflammation, atherosclerosis and cancer.
During analysis of the literature a concentration-dependent effect of S100A8/S100A9 on tumor cells is revealed: calprotectin and its components contribute to tumor growth and spread at low concentrations, at high concentrations – cause apoptosis of neoplastic cells. Besides, calprotectin affect directly tumor cells through interaction with TLR4, which are expressed in them and they are endogenous receptors for S100A8/S100A9.
The number of calgranulin A and B increases at the early stages of complicated atherosclerosis while the development of biomineralization. S100A8 and S100A9 in atherosclerotic plaque may significantly affect the redox and calcium-dependent processes of atherosclerosis pathogenesis and its chronic complications, including abnormal biomineralization. Numerous properties of calgranulin S100A8/S100A9 and its components can be a point of the promising new drugs and finding new biomarkers of disease.
Keywords: calprotectin, biomineralization, calgranulin A, calgranulin B, atherosclerosis.
Аuthors: E. Ts. Yasynska, Zh. A. Revenko
Using clinical and statistical analysis for patients with coronary heart disease (CHD), we selected patients with and without signs of arrhythmias and conduction of the heart. We also highlighted their risk factors and, based on these findings, developed a system of predicting the diseases. To identify patients with CHD risk factors of violations of rhythm and conductivity of heart was used prospective and retrospective surveillance methods. Based on the data regarding risk factors and anti-risk using the methods of Wald and Bayes developed a diagnostic prognostic table (map) in the form of predictive coefficients (PC) this informative weight of each trait.
Keywords: violations of rhythm and conductivity of heart, cardiovascular disease, system of prediction, risk and anti-risk factors, the prevalence of disorders of rhythm and conduction of the heart, prognostic indices, the methods of Wald and Bayes, informative weight of each trait, the observations map, the mathematical tools.
Аuthors: Ye. L. Mikhalyuk, S. N. Malakhova, M. V. Didenko
Introduction. An important feature of sports medicine, unique to the athletes is the dynamics of the functional state of the body from the preparatory period to the competition; the athlete is in a state of good "fitness level".
The purpose was to study and compare HRV, central hemodynamics and PWC170 at athletes sprint qualification of the III-rd discharge to IMS obtained in the preparatory and competitive periods of training process.
Materials and methods of examination. A total of 35 runners who specialize in running at a distance of 100–200 m, the qualification of the III-rd discharge to IMS. The study of HRV and central hemodynamics was performed by the standard technique on the diagnostic complex "Cardio +”. Physical performance was measured on a bicycle ergometer with the calculation of submaximal test PWC170.
Results and discussion. General data on a group of sprinters athletes (n = 35) show that in the competitive compared to the preparatory period has been some strengthening of parasympathetic effects ANS transformation eukinetic in hypokinetic TC, lack of individuals with hyperkinetic TC significant increase PWC170/kg 11.22 % and IFS. Separate analysis of the athletes has demonstrated similar shifts in the competitive period with some advantages of high-class athletes. The correlations show that increasing PWC170/kg and the IFS is a decrease to CI values characteristic hypokinetic TC, while the high-class athletes, in addition to a decrease in before the values characteristic of the prevalence of parasympathetic ANS. Increased PWC170/kg and IFS helped to improve athletic performance and enhance their skills in the competitive period.
Conclusions. In competitive period compared to the preparatory period, in athletes-sprinters (n = 35), there has been some strengthening of parasympathetic effects ANS transformation eukinetic in hypokinetic TC and a significant increasing PWC170/kg to 11.22 %.
At high-class athletes (n = 26) in the competitive period occurred similar to that in the general group, shifts from the HRV and central hemodynamics, and a significant increased PWC170/kg to 10.24 %.
Athletes qualification of II–III discharge (n = 9) in the competitive period decreased parasympathetic ANS influences, prevalence athletes with eukinetic TC and the lack athletes with hyperkinetic TC and significant increase PWC170/kg to 11.93 %. PWC170/kg to 11.93 %.
As the physical performance of athletes to a reduction in the CI values corresponding hypokinetic TC, while the high-class athletes, in addition to reduced CI values characteristic of prevalence parasympathetic ANS.
Increase PWC170/kg and functional state in the competitive period helped to improve athletic performance and improve the skills of athletes.
Keywords: athletes of high class and low-skill, preparation and competition period, heart rate variability, central hemodynamics, physical performance, correlation.
Аuthors: R. M. Mykolayenko, D. G. Sumtsov, G. O. Sumtsov
A comparative analysis of the results of treatment of 4012 patients with various surgical, gynecological and urological pathologies was performed. Operated age of the patients is from 18 to 88 years. 1085 patients underwent endoscopic technique intervention and 454 patients experienced simultaneous operations. There was performed cholecystectomy in 243 (49.0 %) of 496 patients that underwent simultaneous operations and 83 (16.7 %) patients were with gynecological pathology. Only 76 (15.3 %) of the group were operated simultaneously on cholecystectomy and gynecological operation by video endoscopic method, but the majority (297 or 59.9 %) of patients were operated by means of an open surgical method, as the main problem in them was plastic hernia. 123 (24.8 %) patients were operated by means of an open surgical method only. Such simultaneous operations are possible and safe only after a thorough selection and preparedness of patients. Postoperative mortality was 0.02 % on 4012 operated patients; complications developed in 1.4 % of patients. There were no significant difference in the course of post operation period and frequency of complications after ordinary and simultaneous operations. The average hospital stay after laparoscopic operations was 2.6 days.
To select patients for simultaneous operations it is necessary to examine the gallbladder and cholecystic ducts before gynecological intervention; in case of surgical pathology in women the organs of small pelvis should be investigated. For wider application of simultaneous operations departments of operative gynecology should be placed in the surgical hospitals.
Keywords: laparoscopic and simultaneous operations, indications, advantages, complications.
Аuthors: S. V. Vrublevskaya, G. A. Milko
According to the Ministry of Health of Ukraine (2013) there are 43 930 children with asthma registered only in Ukraine. The most numerous are the regions with unfavorable ecological situation: Donetsk, Zaporіzhzhya, Dnipropetrovsk, Kharkov and Kyiv regions. The increase of allergic diseases requires further study of its formation mechanisms and improvement of complex primary prevention.
Objective. To investigate the cause and spectrum of allergens in infants of Zaporіzhzhya region compared with data of Ukraine and Europe sources and to adapt complex methods of prevention in infants with risk of development of allergic reactions for Zaporіzhzhya region.
Materials and methods. We investigated the features of the mechanism of response in 623 children aged 0–3 years in a large industrial region (Zaporizhzhya, Odesa, Kherson regions) with clinical manifestations of cutaneous allergic symptoms. The level of specific IgE and IgG4 were determined by ELISA using analyzer "Immulyte 2000" and a set of reagents firm «Siemens» (Germany)." The data obtained were processed by mathematical statistics in Statistica for Windows.
Results. Among 623 infants with clinical manifestations of allergic reactions only 239 (38.36 %) had IgE-dependent type allergic reactions in infants. Among 323 (51.84 %) of infants the total and specific IgE, eosinophil cationic protein were within the age norm. It was found that among children with clinical manifestations of atopic diseases of the skin maximum hypersensibilization to food allergens was mainly due to chicken egg protein (34.48 %) and cow's milk (25 %) – in children younger than 2 years. It is lower in children after 3 years of life. Maximum exposure to inhaled allergens hypersensibilization is significantly increasing to 3 years mainly to epidermal allergens pets and household allergens (29 %).
Keywords: іnfants, hypersensitivity, allergens, IgE, IgG4.
Аuthors: V. V. Bezuglaya
Despite the successes of sports cardiology, the scientific ideas of pathologic athletic heart are in a crisis state now in the domestic (Ukrainian) athletic-medical schools. This can be explained, on the one hand, by a growth in the frequencies of cardiac pathology and cardiac death in sport and, on the other hand, by the insufficient development of the scientific conception of pathologic athletic heart. The results of analysis of literature data testify to the necessity to distinguish the specific sports pathology of cardiovascular system. This is caused not only by the statistically high part of cardiac pathology in the general structure of illness and lethality in sport, but also by a number of specific features of the course of cardiac pathology in sportsmen. In other words, the separation of pathologic athletic heart as an individual nosologic unity is extremely urgent. The rejection of such pathology would mislead practicing cardiologists, who are forced to restrict themselves by the framework of generally accepted nosologies and sometimes to consider a clear pathology of sportsman’s heart as its physiological state. The slight development of the scientific conception of pathologic athletic heart hampers the study of the pathogenesis of diseases and the development of diagnostic criteria and therapeutic and prophylactic measures, which obviously does not favor a decrease in the morbidity of cardiovascular system and in the number of sudden cardiac deaths in sport.
Unfortunately, there exists no commonly accepted single term now for the definition of sports pathology of myocardium. In our opinion, in order to define the pathology of athletic heart, it is more expedient to use the words “cardiomyopathy due to physical overstress”, since this term indicates, first of all, the secondary character of damages of myocardium that arise at the noncorrespondence of the intensity and the volume of physical loads to the functional possibilities and the state of health of athletes. The clarification of etiopathogenous mechanisms of development of cardiomyopathy will favor the solution of one of the basic problems of applied sports medicine, namely, the treatment of a pathologic state of heart. Most researchers consider namely the physical overstress as the main reason for the appearance of myocardium's pathology in sportsmen. The data obtained for the last years allow us to assert that the physical loads are not the single reason, but a starting factor favoring the development of endogenous extracardiac disturbances, which favor the activation of pathologic processes in myocardium against the metabolism intensification background.
A specific feature of the pathology of a cardiovascular system in skilled sportsmen consists in that the dysfunction of myocardium mostly has no symptoms or is revealed only by a decrease in the resistance to physical loads. The real existence of cardiomyopathy in sportsmen is supported by distinctive changes in electrocardiograms. The ECG-equivalent of the given pathologic state in sportsmen is considered to be a violation of the processes of repolarization (a special attention should be paid to a horizontal displacement of the segment ST below the isoline by 1.0 mm with the transition to a negative wave T), as well as the presence of clinically significant disturbances of the rhythm of heart. It is very important that the majority of tragic events in sport is caused by namely a fatal arrhythmia.
In a number of cases, the cardiomyopathy due to a physical overstress can be manifested in a pathologic rearrangement of athletic hearts, which does not correspond to the directivity of the training process. First of all, this is related to the hypertrophy of myocardium, which is considered by most researchers as the necessary condition of the adaptation of sportsman’s heart. The hypertrophy of myocardium can be regarded as a version of physiological athletic heart, but only in the case where the myocardium thickness for the left ventricle is at most 12–13 mm in men and 11 mm in women. At the same time, the specific contribution of the myocardium hypertrophy to the general pattern of sudden deaths of sportsmen (with regard for the reasons concerning no heart) is already as high as 33 %. This is an indisputable proof of that the myocardium hypertrophy (of any etiology) is the direct reason for sudden deaths of sportsmen.
The results of analysis of the literature data indicate that the development of a myocardium hypertrophy in sportsmen ensures, to a certain extent, an enhancement of the functional possibilities of heart as a hemodynamical pump. At the same time, the disturbances arising in this case in the humoral regulation of the metabolism of myocardium, as well as changes in its blood supply and the intracardiac hemodynamics, not only decrease the efficiency of compensatory reactions, but lead to that the hypertrophy of myocardium on the subsequent stages of its development becomes a heavy factor for the activity of heart.
Keywords: athletic heart, cardiomyopathy, physical stress, hypertrophy, sudden cardiac death.
Аuthors: L. V. Gerasimenko, V. V. Khaziev
Introduction. Graves' disease in 60% of cases is followed by osteopenic bone disorders. Women are affected more than men. Moreover, bone disorders most often occur in women under the age of menopause. In Ukraine medical treatment (thyreostatic) or surgical treatment is most often used for treatment of Graves' disease.
Purpose. To determine the most effective methods of treatment for diffuse toxic goiter with correction of osteopenic complications in the women of different age – reproductive and menopausal.
Materials and methods. The patients with thypoid disorders were investigated – 36 of reproductive age and 29 menopausal, as well as healthy individuals (12 and 5, correspondingly). The examination included: ultrasound determination of the thyroid gland volume, mineral bone tissue density evaluation by dual-energy X-ray absorptiometry with reference criteria T- and Z-score calculation, and measurement of thyroid hormones and TSH with thyroid hormone immunoassay methods. Then, the patients were prescribed different treatments. All patients were administered Vitamin D3 and Calcium supplements for prevention. After that, two different age groups were given "Alpha-D3-Тeva" – medication for reproductive age; "Bonviva" (bisphosphonates group), "Bivalos" (Strontium ranelate) – for menopausal age. The preparations were taken for 12 months with a break for one month every 3 months of intake.
Results. Two other different age groups were treated surgically. It has been demonstrated that the surgical method of treatment of diffuse toxic goiter combined with anti-osteopenia medications leads to a more effective increase of the bone tissue mineral density values than medication method in attainment of euthyroid condition at the background of anti-osteopenia medications in both age groups of patients.
Keywords: reproductive age, menopause, osteopenia, osteoporosis, thyroid hormones, bone tissue density, medication treatment, surgical treatment.
Аuthors: A. V. Sokhan
Introduction. Previous studies have indicated that the brain-specific astroglial protein GFAP is a biomarker candidate indicative of astroglial damage in patients with CNS deseases.It is proved that the increase in GFAP content in CSF indicates destruction of glial cells and breach the blood-brain barrier function. At the same time, diagnostic and prognostic significance GFAP changes in CSF of patients with acute neuroinfections not well understood, practically no data on GFAP levels in CSF of patients with acute bacterial meningitis.
Purpose. The aim of study was to evaluate the diagnostic and prognostic role of GFAP level in CSF of patients with pneumococcal meningitis in the course of the disease.
MaterialsandMethods. In patients with acute pneumococcal meningitis were identified GFAP levels in the CSF on admission and after 10–12 days of treatment. As a comparison group were examined 12 patients with respiratory infection and meningism. GFAP levels in the CSF of patients were determined by sandwich ELISA method using the "BioVendor" company test system, Czech Republic. 26 cases of acute pneumococcal meningitis were analyzed. Among them, 7 (26.92 %) showed disease of moderate severity, in 19 (73.08 %) – severe course. In 5 (19.23 %) patients, the disease ended lethally. Severity was mainly due to the development of cerebral edema, an infectious- toxic shock, neurological symptoms.
Discussion. It is shown that levels of glial fibrillary acidic protein in the acute period of the disease was significantly increased, depending on the severity of the disease. This indicator can be used to evaluate the severity and prognosis of the disease.
Keywords: pneumococcal meningitis, glial fibrillary acidic protein, CSF.
Аuthors: A. O. Bieliaiev
Introduction. Migraine is a common disease that affects the working age people, has physical, psychological and socio-economic consequences. Transcranial magnetic stimulation is a noninvasive and painless method of influence on the human nervous system. Quality of life is an important tool for monitoring health status of patient and different components of the health.
Purpose. To examine effectiveness of the treatment of migraine by high-frequency transcranial magnetic stimulation by determining quality of life.
Materials and methods. The study involved 30 patients with migraine who received high-frequency transcranial magnetic stimulation. Given the different data from the literature on the effectiveness of the different areas of the cerebral cortex, all patients were divided into two groups, depending on the area of stimulation: the dorsolateral prefrontal cortex and the motor cortex of the left hemisphere.
Results. After using TMS in patients with migraine biggest changes were vital activity (68.8 % in both groups), general health (58.4 % and 60 %, respectively). Also, significant changes were the role of emotional problems (50 %), role functioning (49.5 % and 53.3 %) and pain intensity (47.8 % and 46.1 %). Changes of physical and mental components also point to a significant improvement of the quality of life in both groups.
Conclusion. It is proved that usage of transcranial magnetic stimulation significantly improves the quality of life in patients with migraine, regardless of zone stimulation.
Keywords: migraine, transcranial magnetic stimulation, quality of life.
Аuthors: L. Z. Vons
The aim of our study was to investigate changes in quality of life of patients depending on the stage of chronic kidney disease (CKD), to assess the correlation and study the factors that affect the progression of CKD and affect the quality of life of patients. We studied impact of psychological and somatic disorders in patients with CKD secondary to diabetes type 2 in these components of quality of life. We studied gender features causing diabetes.
Materials and Methods. We observed a group of 120 patients with diabetes mellitus type 2, and DN of I–V stages and chronic kidney disease of I–V stages. Among the patients studied, 59 (49 %) were men and 61 (51 %) were women. Average age was 59.2 ± 0.9 years, mean duration of diabetes constituted 11.8 ± 0.7 years, mean duration of diabetic nephropathy – 2.5 ± 0.3 years, the average length of CKD – 2.7 ± 0.3. The average weight was 84.0 ± 1.3 kg. Stage CKD was defined by GFR determined by the formula CKD-EPI.
We established diagnosis by classification of diseases of the urinary system, which was adopted in 2005 by The II National Congress Nephrology, stage DN – according to the classification Mogensen C.E. in 1983. We used general clinical examination methods (serum creatinine and serum glucose, glycosylated hemoglobin, blood pressure measurements); quality of life using a questionnaire quality of life SF-36 .
The data were subjected to statistical research processing, used for this application package statistica (StartSoft USA, v.12). We used the method of nonparametric statistics: Pearson’s Chi-sguare test to determine the causes of diabetes in men and women; ANOVA using Fisher’s F-criteria to test the null hypothesis; Spearman rank correlation to determine the presence and strength of communication between the studied parameters. Statistically significant difference: p ˂ 0.05.
All patients were divided into 5 groups according to the stage of CKD. The first group included 26 patients with CKD stage I, the second group – 27 people with CKD stage II, the third group – 15 people with CKD stage III, the fourth group accordingly – 17 patients with CKD stage IV, and the fifth group – 35 people with CKD stage V.
Discussion. Positive correlation was found between age and stage of CKD patients, weight, duration of diabetes, duration of NAM, blood pressure. Inverse correlation was found between CKD and GFR, and fasting glucose levels and some indicators of quality of life: physical functioning (PF); Role-Physical (R p); pain (P); vitality (VT); emotional functioning (RE); psychological health (MH). But we did not find the correlation between CKD and general health (GH) and social functioning (SF).
During the investigation it was found that one of the causes of diabetes is stress, but there are also some gender features. Men have got problems related to work, while women – family problems.
In the patients, who have got progression of CKD, life quality is worse. Our data suggests that the correction of weight, blood pressure control and adequate treatment of hypertension have got not only positive effect on the progression of CKD, but also improves life quality in our patients.
Keywords: thyroid cancer, biomineralization, immunohistochemistry, markers, apoptosis, osteopontin.
Аuthors: I. N. Nikitina, A. B. Sukhariev, A. V. Boichuk, S. A. Smijan
Data collected in the obstetric hospital. The aim of the present study was to assess the peculiarities of adaptation of the newborn twins, depending on the type of zygosity. The peculiarities of neonatal adaptation 94 twins were studied. We studied obstetric history, course of pregnancy, delivery, the fetuses and during neonatal adaptation of the newborn. The state of the fetoplacental complex was carried out in 10–13, 16–22, 28–34 weeks of pregnancy. It is proved that the adaptation of newborns with multiple pregnancy depends on the type of placentation. It is established that monozygotic twins is a risk factor disadaptation syndromes. Children with monozygotic with twins in comparison with dizygotic have a higher incidence of respiratory distress syndrome and a greater tendency to jaundice, hemorrhagic syndrome, impaired hemolymphodrainage second and third degrees of severity. Physical development of twins also is determined by the type of zygosity. In the group monozygotic twins often have more severe variants of intrauterine growth retardation. The high frequency of asphyxia on a background of immaturity that leads to the development disadaptation syndromes in these children, the most frequent of which are hypoxic-ischemic lesion of the Central nervous system, disorders of thermoregulation and gastrointestinal reactions. The results of these studies allow us to recommend the type definition zygosity during pregnancy to develop medical tactics and prognosis. Further research and prevention of complications in multiple pregnancies allows developing a system of preventive measures to reduce perinatal morbidity and mortality. Recommendations made as a result of this study can be implemented in obstetric clinic. Further research is needed to determine further development of newborns.
Keywords: multiple pregnancy, neonatal adaptation, zygosity, fetal growth retardation.
Аuthors: I. D. Duzhiy, S. M. Kobyletskyi, S. V. Kharchenko
Background. Today a personified approach may penetrate in a daily transfusion practice. Every patient with upper gastrointestinal bleeding should have a clear and individually selected indication for transfusion therapy.
Objective – to develop indications for the first erythrocyte transfusion for patients with upper gastrointestinal bleedings of different origin.
Materials and methods. A total of 10 patients with acute with upper gastrointestinal bleeding were studied in Sumy Regional Clinical Hospital and Sumy State University. The polymerase chain reaction method for ESR1/rs2234693 gene polymorphism of patients and the post hoc analysis were implemented.
Results. A new transfusion scheme was presented. The first erythrocyte transfusion was indicated to compensate ulcer and variceal bleedings, if diagnostics of haemostasis control, cardiovascular history and genotyping information were appropriately fixed and considered.
Conclusion. The first erythrocyte transfusion under the haemoglobinemia between ≤ 70 and 100 g/L may be individually effective when the clinical decision-making process for transfusion indication includes genotyping assessment. This strategy should be assessed in a future clinical trial.
Keywords: bleeding, transfusion, erythrocyte, gene polymorphism.
Аuthors: V. V. Shimko, I. A. Pustoviy, M. M. Kuprienko
Topicality. Acute appendicitis occurs in 60–70 % of urgent surgery cases. Postoperative complications amount is 4–15 %, but mortality is at level of 0.1–10 %. Despite the advanced operations technology and a significant number of antibiotics that can be used during surgical treatment of destructive appendicitis forms, it doesn’t work to improve treatment results during last decade.
Materials and methods. It was researched about 48 results of acute destructive appendicitis surgical treatment using lymphotropic antibacterial therapy and retrospectively analyzed the same number of patients in whom cases the antibiotic therapy was carried out according to the standard method.
The results and discussion. The developed method of lymphotropic antibacterial therapy allows to prevent septic complications of ileocecal area in cases of main group patients. Among operated patients using standard antibiotic of therapy the iliac area infiltration occurred in 3 (6.3 %) cases, postoperative wound infiltrate – 8 (10.7 %), which confirms the possibility of regional lymph system readjustment.
Prospects for further research. To continue accumulation of clinical material and to examine the effectiveness of lymphotropic antibacterial therapy during acute appendicitis complications, including the appendiceal infiltrate.
Keywords: appendicitis, complications, antibiotic therapy.
Аuthors: Yu. V. Melekhovets, V. V. Leonov, O. K. Melekhovets, L. M. Skubyra
Introduction. The study highlights the issues sonographic evaluation of the vascular wall changes after endogenous laser coagulation (EVLT) of the lower extremities with a laser source with wavelength of 1470 nm, 989 nm and 445 nm.
Purpose. The aim of this study was the sonographic evaluation of the dynamics of vascular changes by using different EVLT sources and modes.
Materials and Methods. 142 patients with varicose disease S2-5sErAsPr divided into three groups depending on the mode EVLT using 940-nm, 1470-nm и 445-nm diode lasers. A duplex sonography (combination of the traditional ultrasound with colour and spectral Doppler) was performed to evaluate degree of reflux in junction of the common femoral vein with the great saphenous vein, make an assessment of the local haemodynamics, vein wall characteristic etc.
Results and discussion. Preoperative mapping and postoperative sonographic monitoring carried out on the basic criteria (the state of the vascular wall, assessment of the vein diameter, presence and duration of reflux, lack of vein compression sensor) on the 7-th and 28 day, 8-th and 12-th week, 6-th months and 1 year after EVLT. The main sonographic characteristic of the vein obliteration are: gradual obliteration with a progressive decrease in diameter, following by the complete disappearance of the vessel due to fibrosis. The final step is converting into hyperechoic fibrous cord.
Discussion. Rate of the complete vessel obliteration achievement is one of the most important prognostic markers of relapse prevention. The blood flow absence and vascular obliteration after EVLT with a wavelength of 1470 nm, 989 nm and 445 nm is determined after 1.5 month. Formation of fibrous cord in the same period and the lack of sonographic signs of direct damage to the vascular wall are revealed only when using EVLT 1470 nm.
Keywords: varicose veins, laser coagulation, EVLT, sonography.
Аuthors: N. I. Chekalina
Introduction. The prevalence of autoimmune thyroiditis in Ukraine, which is the most common cause of hypothyroidism, in the past 10 years has increased by 68 %. Endothelial dysfunction formed under conditions of inflammation, today is regarded as the main pathogenic factor in atherosclerosis — morphological bases of coronary heart disease.
Purpose: To investigate the indicators of endothelial dysfunction in patients with autoimmune thyroiditis in combination with coronary heart disease.
Materials and methods. The study involved 75 people of both sexes aged 48 to 72 years: 55 patients with coronary heart disease (angina stable, II FC) were included to the group of comparison, 20 persons (study group) had additionally autoimmune thyroiditis, euthyroidism, 5 of which had subclinical hypothyroidism previously treated by L-thyroxine. 15 volunteers made up a group of healthy individuals. All participants in the study identified the blood circulating endothelial microparticles by identifying specific surface membrane molecules using monoclonal antibodies against the antigens CD32 and CD40 with cytofluometry. Like an additional marker that causes damage to the endothelium, blood level of tumour necrosis factor α by enzyme immunoassay was measured. Statistical analysis was performed using non-parametric test of Wilkokson for pairs data, correlations examined using nonparametric method of Spearman.
Results: The contents of microparticles CD32+CD40+ in peripheral blood were significantly higher in patients of study group than in patients of comparison group. This demonstrates the high level of endothelial dysfunction in chronic autoimmune inflammation. The number of microparticles CD32+CD40+ in patients of both groups was significantly higher than in healthy individuals. In cases of combination of coronary heart disease and autoimmune thyroiditis the level of tumour necrosis factor α was significantly higher than in the comparison group. We have identified a strong correlation between the number of circulating endothelial microparticles CD32+CD40+ and content of tumour necrosis factor α in peripheral blood. The sensitivity and specificity for the said pair of indices as markers of endothelial dysfunction was calculated.
Discussion. In cases of combination of autoimmune thyroiditis with coronary heart disease found significantly more pronounced signs of endothelial dysfunction than patients only with coronary heart disease, due to the influence of immune inflammation. Determination of the number of circulating endothelial microparticles by antigenic markers of endothelial activation CD32+CD40+ in combination with a tumor necrosis factor α in blood is highly informative method of verification of endothelial dysfunction in patients with autoimmune thyroiditis.
Keywords: endothelial dysfunction, autoimmune thyroiditis, coronary heart disease, circulating endothelial microparticles, systemic inflammation.
Аuthors: P. P. Bidzilya
Introduction. The body mass index (BMI) is a significant prognostic factor in patients with cardiovascular system diseases and in particular with CHF. According to the Framingham Study in subjects with increased BMI there was increased risk of developing CHF, 5 % in men, and 7 % in women for each unit of BMI. Though, that obesity is an important risk factor of diabetes mellitus type 2 and cardiovascular diseases, a high BMI may be associated with reduced mortality and better prognosis in CHF. This phenomenon is known as the "obesity paradox" or "reverse epidemiology". Violation of lipid metabolism is the most important pathogenetic links the development of atherosclerosis, coronary artery disease (CAD) and as a result CHF of ischemic genesis. In recent years an increasing number of works in which it is proved that in the conditions CHF it is the lower levels of lipid profile is associated with worse prognosis and low patient survival.
Thus, given the polarity of opinion regarding the "obesity paradox" and "lipids paradox" in CHF on the background of overweight and obesity, a small number of works which have studied the changes in lipid metabolism depending on the degree of excess weight, the chosen direction of research is timely and relevant.
Purpose. To study the changes of lipid metabolism in chronic CHF, depending on the degree of excess weight.
Materials and methods. The study included 211 patients with CHF I–III functional class on the background of normal, overweight and abdominal obesity of I–III degree. According to the objectives of the study, patients with CHF were divided into 5 groups depending on BMI. Group I included 26 patients with BMI 18.5–24.9 kg/m2 (normal weight). Group II included 67 patients with BMI 25–29.9 kg/m2 (overweight). Group III consisted of 59 subjects with BMI 30–34.9 kg/m2 (obesity of I degree). Group IV included 37 patients with BMI 35–39.9 kg/m2 (obesity of II degree). In the V group were 22 patients with BMI > 40 kg/m2 (obesity of III degree). The patients underwent general clinical and biochemical blood tests. Statistical processing of obtained data was performed using license program package Statistica (version 6.0).
Results. It was revealed that changes in lipid metabolism in CHF depending on degree of excess weight are characterized by increased levels of atherogenic and anti-atherogenic indices decrease simultaneously with the distribution of violations in patients with concomitant obesity.
Conclusion. Features of changes of lipid metabolism in CHF depending on the degree of excess weight were demonstrated.
Keywords: lipid metabolism, chronic heart failure, body mass index.
Аuthors: S. V. Popov, S. I. Bokova, D. V. Tetyura, A. A. Bilan, A. V. Tverezovsky, N. I. Kora
The severity of acute respiratory infections in children during the first 3–6 months of life and the development of complications may be due to the peculiarities of the immune system, its development after birth. Of particular influence on these processes, have particular power, in particular the presence and duration of breastfeeding. The objective was to study the features of the immune response of peripheral blood in conjunction with the duration of breast-feeding.
The study involved 60 children aged 1 to 3 years, who was being treated in the infectious department of children's hospital with a diagnosis of acute respiratory disease. They were divided according to age into 3 groups: 1 group included 20 children aged up to one year, 2 group – 20 children from year to 2 years and 3 group – 20 children aged 2 to 3 years. We analyzed the basic changes of the blood and the relationship between the absence / presence of breast-feeding for at least the first 6 months of life and gave the characteristics of the analysis of the deviations.
The results of blood tests showed some of basic changes of hematological indicators. It was found that the incidence of inflammatory changes and increases of toxicity grow with the age of the child and connected with a decrease in the frequency of breastfeeding. Feeding breast milk to the age of a year increases the probability of the improvements of the immune response in the form of higher levels mainly of neutrophils.
Keywords: acute respiratory infections, the immune system, breast-feeding.
Аuthors: I. G. Mudrenko, О. О. Potapov, D. D. Sotnikov, D. Y. Sviridenko, V. S. Yurchenko
We studied regularities of burnout syndrome formation in three groups of medical workers: psychiatrists, internship doctors and hospital nurses of psychiatric establishments. The aim of the study is determination of syndrome manifestation depending on work experience on the position and gender in separate groups of respondents. The study was carried out according to Maslach Burnout Inventory, the value of three scales “Emotional exhaustion”, “Depersonalization”, “Reduction of professional achievements” was figured out. The total amount of respondents – 62 medical workers.
According to results of given data processing we determined that the hospital nurses have high level of all indices on a scale: “Emotional exhaustion”, “Depersonalization”, “Reduction of professional achievements”. The doctors show the average degree of depersonalization manifestation and reduction of professional achievements, in psychiatrists the high degree of emotional exhaustion is formed during professional activity. We established some regularity according to which we concluded that the work experience of paramedical worker immediately in contact with the mentally ill up to 10 years is maximal as for mental health preservation and prevention of emotional exhaustion. Henceforth, the signs of emotional and mental exhaustion are rapidly formed (p < 0,001). In psychiatrists and somatic practitioners such a tendency is absent, the work experience doesn’t influence on emotional exhaustion formation. Indices dynamics of depersonalization in medical workers didn’t reveal dependence on work experience. The signs of emotional non-responsiveness, indifference, formal fulfillment of duties without personal involvement and empathy are formed and acquire high degree in paramedical workers, and average one in doctors in some years after immediate contact with mentally ill patients and then keeps at the same level. Gender analysis showed that women in the result of chronic stress and overwork are more prone to reduction of professional achievements than men (p < 0.05).
Keywords: emotional burnout, emotional exhaustion, depersonalization, reduction of professional achievements, psychiatrists, doctors of somatic profile, nurses.
Аuthors: T. Kaminska, E. Mukvich, L. Pinchuk
Introduction. Increased load school programs, forming long "school stress" lead to violations of the processes of memory, attention to stu-dents in need of periodic application not only preventive (prophylactic) and reconstruction and (medical) events.
Objective: to assess the effectiveness of herbal adaptogen extract of Ginkgo Biloba in the processes of mental performance, memory, think-ing ability to activate speed and increase the level of information pro-cesses in the high school age students. Material and methods. The study was conducted in 3 main groups of children and in 3 groups of comparison. Before and after the treatment a clinical examination of children by a neurologist and an ophthalmologist was carried out, dyna-mometry, measured blood pressure, heart rate were measured. Mental performance (stability, focus, precision and productivity) was deter-mined by tables of Anfimov. To evaluate the process of information processing we studied short and meaningful short-term visual memory. The nature and dynamics of vegetative changes measured in points for by AM Wayne.
Results. According to the parents and teachers children who received Ginkgo Biloba extract regularly for 3 months become calmer, less excit-ed and annoyed. The normalization of cortico-subcortical connections under the influence of treatment may be indicated by normalization of sleep. After the treatment pain of long bones disappeared that could be associated with the normalization of the microcirculation in the extremi-ties, as well as nosebleeds. The positive dynamics of existing symptoms in children surveyed contributed to the rapid decrease in body asthenia, fatigue and improvement of general condition, improved short-term visual memory.
Conclusions. After a course of treatment in children of all groups productivity and accuracy of the task significantly increased. Activation mental capacity occurred in all groups of children, regardless of their sex.
Keywords: Ginkgo Biloba extract, mental capacity, students.
Аuthors: T. B. Oleshko, D. Yu. Svyrydenko, V. Yu. Garbuzova
Introduction. Smoking is one of the main risk factors of cardiovascular diseases, including stroke. According to various studies the risk of blood stroke of smokers increases by 2–4 times, with the greatest risk for developing of ischemic atherothrombotic stroke (IAS). Smoking contributes to the development of atherosclerosis, arterial blood pressure increase and small cerebral vessel constriction as a result the cerebral blood supply becomes bad. One of the most priority field is to identify candidate genes involved in the pathogenic mechanisms of disease in patients with various risk factors, including smokers. That such is the gene endothelin-1, a powerful endogenous vasoconstrictor and a marker of endothelial dysfunction. It is known that smoking adversely affects the metabolism of the vascular wall.
Purpose. To study the distribution of allelic variants on gene polymorphism Lys198Asn endothelin-1 in patients with IAS in smokers and people who do not smoke.
Materials and Methods. For analysis venous blood of 170 patients with IAS (42.4 % women and 57.6 % men) aged 40 to 85 years (average age – 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). Lys198Asn (rs5370) polymorphism of EDN-1 gene was determined by polymerase chain reaction, followed by restriction fragment length analysis of the allocation of them by electrophoresis in agarose gel. Statistical analysis was performed by using the software package SPSS-17. The value of P < 0.05 was considered as significant. Pathogenetic variant of stroke was determined according to the TOAST criteria. Ischemic stroke character was determined with the help of history and clinical information of the disease given by CT brain study.
Results. Among the persons who do not smoke there was no significant association between polymorphisms studied and the development of ischemic atherothrombotic stroke (P = 0.081). The difference frequencies of different variants of Lys198Asn polymorphism in patients that smoke who suffer from ischemic atherothrombotic stroke and patients of the control group is close to accurate (P = 0.052). Having used logistic regression method, the following results were received. Individuals Asn/Asn genotype carriers, who do not smoke revealed increased risk of ischemic atherothrombotic stroke by 3.4 times (P = 0.041; OR = 3.379). However, the risk of stroke of smokers was not statistically significant.
Conclusion. In persons who do not smoke and are Asn/Asn genotype carriers the risk of ischemic atherothrombotic stroke development is higher than in 3.4 times in comparison with homozygotes for the major allele.
Keywords: endothelin-1, gene polymorphism, ischemic stroke, smoking.
Аuthors: A. V. Rieznik, R. A. Moskalenko, A. M. Romanjuk
Introduction.Thyroid cancer (TC) is the most frequent malignant tumor of the endocrine system, which besides has a relatively indolent course. The increasing incidence of thyroid cancer is mainly due to papillary thyroid cancer (PTC).
The aim is immunohistochemical studies of tissue of papillary thyroid cancer in conditions of presence and absence of biomineralization phenomena.
Materials and methods. 30 samples of PTC with signs of biomineralization and 30 samples without PTC biomineralization were examined. All PTC patients with signs of pathological biomineralization were joined in I (first) group (30 people). Patients who had PTC without signs of mineralization were included to the II (second) group (30 people). Immunohistochemical studies of protein expression of Ki-67, p53, bax, bcl-2, osteopontin (OPN), matrix metalloproteinase 1 (MMP1), and vascular endothelial growth factor (VEGF) were conducted in PTC tissue of both groups.
Data processing was carried out with the help of applied statistical methods, using Microsoft Excel 2010 with the addition AtteStat 12.0.5. The research results were checked for normal distribution by Shapiro-Wilky test. Evaluation of statistical significance of results difference between groups of samples was performed using nonparametric Mann-Whitney test and parametric t-Student test. The results were considered statistically significant at the probability of 95 % (p < 0.05).
Results. The difference between the results of immunohistochemical studies of bax expression (p < 0.001), OPN (p < 0.001) and VEGF (p < 0.05) in groups of PTC samples with the presence and absence of biomineralization may indicate their participation in pathological biomineralization processes under the conditions of this pathology.
It was found out that the presence of biomineralization is combined with significantly higher levels of expression of bax in thyroid tissue of malignant tumor (p < 0.001). High expression of bax protein and low expression of its antagonist bcl-2 indicate the strengthening of apoptosis in tumor cells.
The presence of pathological biomineralization leads to significantly higher levels of expression of protein OPN (p < 0.001) in the PTC tissue. It is known that osteopontin is an acidic phosphoprotein that is expressed in mineralized tissues and inhibits hydroxyapatite formation by binding to the surface of the crystals. We can assume that hyperproduction of osteopontin in tumor cells is a factor counteracting PTC biomineralization.
There have been exceeded endothelial growth factor expression in the group of PTC samples with calcification in comparison with PTC group without it (p < 0.05). Since VEGF protein is responsible for restoring oxygen to tissues in the situation of insufficient blood circulation, it may indicate a higher level of hypoxia in the mineralized PTC tissues.
In general, assessing the impact of biomineralization on the course of PTC it can be said about its promotion to protective forces of the body, which is to enhance apoptosis in the tumor and to limit the spread and growth of tumors mechanically.
Keywords: thyroid cancer, biomineralization, immunohistochemistry, markers, apoptosis, osteopontin.