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MIXOID LIPOSARCOMA (LITERATURE REVIEW)

Аuthors: I. Vynnychenko,  Y. Moskalenko,  O. Vynnychenko

Pages: 461–468

Abstract

The incidence of liposarcom has a proportion from 10 to 35 % among all soft tissue sarcomas in the cancer structure. They are often located on the extremities (60 %) and in the retroperitoneal space (10–20 %). Liposarcoma is one of the most mysterious malignancies, which generates still a lot of questions.
The aim of the work is to perform literature analysis for establishment of the molecular mechanisms of liposarcomata onset and tactics of surgery, chemotherapy and radiation treatment of mixoid liposarcoma.
Mixoid liposarcoma is usually characterized by t (12; 16) translocation or, less commonly, by t (12; 22), that encodes transcription of the FUS-CHOP gene, which is represented by adipose tissue in 40 % of malignant tumors. Highly differentiated liposarcomata have a relatively simple karyotype, which includes mostly diploids, except for the chromosome with 12q amplification. Increase of differentiation is accompanied by the changes in the genotype and mostly by the 12q loci strengthening, including HDM2, CDK4 and other genes. HDM2, which is localized at 12q15, and CDK4, which is localized at 12q14.1, play an important role in the carcinogenesis, preventing tumor suppression genes.
Conception of ablastics, ideas about sheath and zone intervention are the basis of modern oncological surgery.
Adjuvant and neoadjuvant radiation therapy plays an important role in the treatment of patients with liposarcoma, in addition to the surgical method.
Ifosfamidum and doxorubicin are used as the first-line chemotherapy, gemcitabine, docetaxel and trabektedin – as second- and third-line therapy. Alternative therapeutic strategies involve the inhibition of heat shock protein 90 (Hsp90), using of cyclin-dependent kinase 4 (CDK4) inhibitors, CDK4 / 6 inhibitors, anti-IGF-1R antibodies, RG7112 inhibitors and MDM2 antagonists, antigen-specific vaccines based on NY-ESO-1.

Keywords: liposarcoma, molecular mechanisms, chemotherapy, radiotherapy.

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ENDOMETRIAL CANCER – COMPARATIVE RESULTS OF DIAGNOSTICS AND TREATMENT

Аuthors: D. G. Sumtsov,  G. A. Sumtsov

Pages: 469–477

Abstract

The results of diagnostics and treatment of 518 patients with newly diagnosed uterine body cancer were analyzed in Sumy region in 2008–2010. The patients had been treated according to the clinical protocol processing recommended by the Ministry of Health of Ukraine in 2007.
The results were compared with the results of 551 female patients with the same diagnosis established in the region in 2005–2007, when clinical protocols had not been used. Data on the results of diagnostics and treatment of uterine body cancer (UBC) in 2005–2007 were published in “Visnyk” No 2, a medical journal of Sumy State University, in 2011.
There was found no significant changes in the UBC incidence in the analyzed period. The age status of cases was nearly identical. In the early stages of the disease such modern methods of diagnosing UBC as CT, MRI and hysteroscopy with biopsy were actively introduced. Preoperational diagnostics was also implemented. The detection of UBC in the early stages (I and II stage) had actually remained at the same satisfactory level and was accordingly 91.6–90.3 ± 1.3 %. The proportion of UBC patients treated by combined radiation therapy method decreased from 19.4 ± 1.7 % to 17.7 ± 1.6 %.
Surgical activity increased from 76.6 ± 1.8 % to 81.2 ± 1.7 %, the proportion of expanded operations increased from 15.4 ± 1.8% to 23.3 ± 2.1 % and a number of patients receiving combination therapy increased from 48.2 ± 2.1 % to 52.5 ± 2.3 %, too. Overall 5-year survival of patients with all phases of UBC and after various methods of treatment remained unchanged at 74.2 ± 1.9 % (previously 73.5 ± 1.8 %). In our opinion, the failure of expected success in results is due to a significant reduction in the number of patients who received integrated treatment and insufficient proportion of expanded operations.
Keywords: uterine body cancer, clinical protocols, diagnostics, treatment.

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COGNITIVE AND PSYCHOEMOTIONAL DISTURBANCES IN PATIENTS WITH CHRONIC VIRAL HEPATITIS B AND C

Аuthors: M. D. Chemych, O. M. Chemych, D. A. Butenko, I. S. Chajka, N. I. Ilyina

Pages: 478–483

Abstract

The purpose of this research was to examine cognitive disorders and psycho-emotional changes in patients with chronic viral hepatitis B and C. To reach the result, 140 patients were examined, using he following neuropsychological tests: mini mental state examination test (MMSE), clock drawing test, geriatric depression scale (GDS), test of verbal associations, clinical dementia rating (CDR), Hamilton rating scale for depression. In addition, all patients were examined using standard clinical and laboratory methods.
Neuropsychological tests showed that patients with chronic viral hepatitis B and chronic viral hepatitis C had pretty similar results, indicating the presence of mild cognitive impairment. However, results of patients with chronic viral hepatitis C were a little better. Among the identified disturbances in emotional sphere disorders of mild and moderate degree prevailed.
Contrary to expectations, the results of clock drawing test indicated less percentage of disturbances, than other tests which were used in this research. It seems that this phenomenon is connected to low sensitivity of this test.
It was also found out that patients who received antiviral therapy had a significant deterioration of psychological state, including depressive disorders of mild and moderate severity. Such patients often complained of different sleep disturbances, memory impairment and poor concentration. In addition, patients who had a history of drug using experience, had worse results of neuropsychiatric tests.
Keywords: chronic viral hepatitis, cognitive disorders, psychological state, hepatic encephalopathy, depression..

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NEW NON-DRUG TECHNOLOGIES IN THE TREATMENT OF PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE WITH CONCOMITANT CARDIOVASCULAR DISEASE

Аuthors: I. B. Zabolotnaya

Pages: 484–492

Abstract

Introduction. NAFLD is one of the most common diffuse liver diseases among individuals older than 40 years. In recent studies it was established a high risk of coronary heart disease in patients with NAFLD. It is also known that in patients with coronary artery disease, NAFLD makes a significant contribution to the improvement of cardiovascular risk through a number of metabolic disorders such as dyslipidemia and insulin resistance. The developed algorithms for medical treatment of this disease do not always satisfy their results. Therefore, it is urgent to develop methods of treatment of NAFLD with comorbid coronary artery disease by the use of natural and preformed physical factors.
The purpose is to study the effectiveness of oral intake of aqueous solution from Poltava bischofite deposits in patients with nonalcoholic fatty liver disease with concomitant coronary heart disease of I-II functional class (FC).
Materials and Methods: 60 patients with NAFLD with comorbid coronary artery disease; anamnestic, clinical, biochemical and immunochemical methods, sonographic study of the digestive system, statistics.
Discussion. Course application of aqueous solution of bischofite improves the clinical course of the underlying disease (p < 0.05), concomitant diseases of the biliary tract (p < 0.02) and irritable bowel syndrome with constipation (p < 0.003), improves the functional state of the liver and blood lipid (p < 0.02), significantly reducing insulin resistance (p < 0.01), primarily due to reduction of hyperinsulinemia (p < 0.01).
Oral intake of bishofit contributes to the regulation of the circadian rhythm of heart rate by reducing the average heart rate, circadian heart rate index, number of minutes in tachycardia (p < 0.001), improvement in coronary blood flow (p < 0.05), implementation of anti-arrhythmic action in the form of reducing the number of supraventricular arrhythmias and their grades (p < 0.001), which is accompanied by a decrease in drug loading, and improves the quality of life of patients.
Conclusion. The studies show high efficacy of non-drug treatment, providing multidirectional and multifaceted impact on the patients with NAFLD and comorbid with coronary artery disease, which is accompanied by a decrease in drug loading, reduced cardiovascular risk and improves the quality of life of patients.
Keywords: non-alcoholic fatty liver disease, bishofit.

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STATE OF LIPID METABOLISM IN CHRONIC HEART FAILURE DUE TO DIFFERENT FORMS OF ISCHEMIC HEART DISEASE IN PATIENTS WITH EXCESS WEIGHT

Аuthors: P. P. Bidzilya

Pages: 493–499

Abstract

Introduction. Chronic heart failure (CHF) leads to morbidity and mortality worldwide, and ischemic heart disease (IHD) is an important factor that causes it, especially in combination with obesity and diabetes. Despite significant advances in modern pharmacological and interventional treatment, the survival rate of patients with IHD complicated with CHF remains very low, for 5 years after the onset of clinical signs of myocardial dysfunction is less than 50 %. Today it is known that in IHD there is an increase in total cholesterol (TC), triglycerides (TG), low density lipoproteins cholesterol (LDL-C) while reducing high density lipoprotein cholesterol (HDL-C), the degree of the revealed changes correlated with the severity and consequences of the disease. Researchers of the Framingham Study proved that dyslipidemia is a leading risk factor for development of CHF, however, significant positive correlation between cholesterol levels and overall mortality occurred in patients under 40 years, a weak age 50–70 years, and older 80 years were negative. As in various forms of IHD the higher the level of HDL-C is associated with better survival in patients with ischemic CHF. At the same time in patients with CHF low levels of atherogenic cholesterol fractions (TC, LDL-C, VLDL-C and TG) were predictors of adverse effects and lower survival, irrespective of the genesis of the disease, and the administration of statins was independently and significantly associated with high mortality.
Thus, the effect of different cholesterol levels on the prognosis of CHF with concomitant obesity is not fully understood, researches are conducted to determine feasibility, safety and efficacy of hypolipidaemic therapy in patients with clinically manifested form of the disease. Given that the main factors of CHF are isolated IHD or its combination with arterial hypertension, the presence of "High-cholesterol paradox" and "Obesity paradox", a small number of investigations in patients with different nosological forms of IHD, the chosen direction of research is relevant and timely.
Purpose. To study the state of lipid metabolism in CHF due to different forms of IHD in patients with excess weight.
Materials and methods. The study included 116 patients with CHF of I–III functional class due to different form of IHD on the background of normal, overweight and abdominal obesity of I–III degree. According to the objectives of the study and depending on nosological units of IHD, which caused the development of CHF, there were identified the following 3 groups: the I group included 58 patients with stable angina pectoris; the II group involved 63 studied with diffuse cardiosclerosis; the III group consisted of 45 patients with postinfarction cardiosclerosis. 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 is established that in CHF and excess weight among nosological forms of IHD maximum values of atherogenic lipids fractions are inherent in patients with postinfarction cardiosclerosis and lows in group of diffuse cardiosclerosis. Opposite changes occur with the content of the anti-atherogenic cholesterol. In patients with stable angina pectoris, the levels of atherogenic lipids which had significant differences occupy an intermediate position.
Conclusion. Features of state of lipid metabolism in CHF due to different forms of IHD in patients with excess weight were demonstrated.
Keywords: chronic ischemic heart failure, lipids metabolism, overweight, obesity.

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  9. Khan MR et al. (2013). Low-Density Lipoprotein Levels in Patients With Acute Heart Failure. Congest. Heart. Fail., 19, 85–91.
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  11. Voronkov LG. et al. (2013). Rekomendacii po diagnostike i lecheniyu khronicheskoj serdechnoj nedostatochnosti Asotsiatsii kardiolohov Ukraini ta Ukraintskoi asotsiatsii fakhivtsiv iz sertsevoi nedostatnosti (2012) [Guidelines for the diagnosis and treatment of chronic heart failure Association of cardiologists of Ukraine and the Ukrainian Association of specialists in heart failure (2012)]. Ukrainian cardiological journal, 1 (Add), 6–44.

PACKAGE OF MEASURES FOR MEDICAL AND SOCIAL REHABILITATION OF PATIENTS WITH PARANOID FORM OF SCHIZOPHRENIA AND SYMPTOMS OF DEPRESSION

Аuthors: K. S. Zhyvago

Pages: 500–507

Abstract

Introduction. The frequency of depressive symptoms of the patients with paranoid schizophrenia is about 7–75 % depending on the state of the disease. Recently, more attention is given to the aftermath of mental disorders, social re-adaptation, support of decent level of social functioning.
Purpose. The goal of the research was to develop a set of measures for medical and social rehabilitation of patients with paranoid schizophrenia who suffer from depressive symptoms, which was based on data from research of their social functioning and quality of life specificity.
Materials and Methods. We examined 82 patients with depressive symptoms and special characteristic of their social functioning and quality of life, comparing with a group of patients (47 persons) without symptoms of depression. In the future, patients with depressive symptoms were divided into basic (44 persons) and control groups (37 persons) in order to implement complex of rehabilitation developed by us (1 patient dropped out). For the study were used such methods: clinico-anamnestic, clinical, psychopathological, pathopsychological, socio-demographic and medical statistics. To study social functioning and quality of life the following scales were used: PANSS, CDSS, HDRS, HARS, PSP, a questionnaire for the assessment of social functioning and quality of life of the mentally ill people and WHOQOL for the mentally ill people. Groups did not differ for major demographic and patopsychological features.
Results. The most evident (p < 0,05) dysfunction was observed in such areas of social life: socially useful activities, relationships with family and self-service, characteristics of circle of contacts. Also, we noticed decreased ability to work and necessity to prevent aggressive tendencies in individual patients. By WHOQOL assessment we identified a low level of quality of life for this group of patients in general and in specific areas. Based on these results, we developed a set of activities of medical and social rehabilitation for patients with paranoid schizophrenia with symptoms of depression. Rehabilitation included: psychoeducational program for patients and their relatives; individual and group psychotherapeutic correction; formation of life skills; overcoming problems in interpersonal interaction; formation of social contacts and support as for existing problems (including overcoming problems in family relationships); organizing daily activities; career guidance. Work was performed both individually and in groups of patients and their relatives. The program was designed for 4–6 weeks for 3–5 sessions per week lasting up to 90 minutes. Areas of rehabilitation can be combined in different ways for to achieve the best results.
Discussion. The use of the proposed program allows to reduce the level of depression, improve social functioning and the quality of life of patients with depressive symptoms and paranoid schizophrenia.
Keywords: paranoid schizophrenia, depression, rehabilitation, social functioning, quality of life, the mentally ill
.

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References

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The frequency of depressive symptoms of the patients with paranoid schizophrenia is about 7–75 % depending on the state of the disease. Recently, more attention is given to the aftermath of mental disorders, social re-adaptation, support of decent level of social functioning.

Purpose. The goal of the research was to develop a set of measures for medical and social rehabilitation of patients with paranoid schizophrenia who suffer from depressive symptoms, which was based on data from research of their social functioning and quality of life specificity.

Materials and Methods. We examined 82 patients with depressive symptoms and special characteristic of their social functioning and quality of life, comparing with a group of patients (47 persons) without symptoms of depression. In the future, patients with depressive symptoms were divided into basic (44 persons) and control groups (37 persons) in order to implement complex of rehabilitation developed by us (1 patient dropped out). For the study were used such methods: clinico-anamnestic, clinical, psychopathological, pathopsychological, socio-demographic and medical statistics. To study social functioning and quality of life the following scales were used: PANSS, CDSS, HDRS, HARS, PSP, a questionnaire for the assessment of social functioning and quality of life of the mentally ill people and WHOQOL for the mentally ill people. Groups did not differ for major demographic and patopsychological features.

Results. The most evident (p < 0,05) dysfunction was observed in such areas of social life: socially useful activities, relationships with family and self-service, characteristics of circle of contacts. Also, we noticed decreased ability to work and necessity to prevent aggressive tendencies in individual patients. By WHOQOL assessment we identified a low level of quality of life for this group of patients in general and in specific areas. Based on these results, we developed a set of activities of medical and social rehabilitation for patients with paranoid schizophrenia with symptoms of depression. Rehabilitation included: psychoeducational program for patients and their relatives; individual and group psychotherapeutic correction; formation of life skills; overcoming problems in interpersonal interaction; formation of social contacts and support as for existing problems (including overcoming problems in family relationships); organizing daily activities; career guidance. Work was performed both individually and in groups of patients and their relatives. The program was designed for 4–6 weeks for 3–5 sessions per week lasting up to 90 minutes. Areas of rehabilitation can be combined in different ways for to achieve the best results.

Discussion. The use of the proposed program allows to reduce the level of depression, improve social functioning and the quality of life of patients with depressive symptoms and paranoid schizophrenia.

Keywords: paranoid schizophrenia, depression, rehabilitation, social functioning, quality of life, the mentally ill

PREDICTORS OF DEVELOPMENT OF NONALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH HYPOTHYROIDISM AT A YOUNG AGE

Аuthors: D. O. Zhaldak, O. K. Melekhovets, V. F. Orlovskyi

Pages: 508–514

Abstract

Introduction. Metabolic misbalance of hormones and pathogenic processes of hypothyroidism course the development of nonalcoholic fatty liver disease which is the major chronic disease of the liver and leads to cirrhosis and hepatocellular carcinoma. The purpose of the research was to estimate predictors of development of nonalcoholic fatty liver disease in patients with hypothyroidism at a young age.
Materials and methods. The study involved 63 patients with hypothyroidism who for the first time addressed a general practitione; etiological factor of the disease was not considered. The main criterion of group distribution was age of the patients and three groups were formed: 1st group – 18 patients aged 23 ± 5 years, 2nd group – 24 patients aged 37 ±7 years and 3rd group – 21 patients aged 52 ± 8 years. All patients were studied for blood lipid profile and blood chemistry. All patients had an ultrasound study of the thyroid gland and abdominal organs plus choleretic breakfast.
Results and discussion. The study found that 100 % of patients in 2nd and 3rd groups had manifestations of dyslipidemia, whereas at 1st group this criterion was found only in 44,4 % (8 patients). Signs of cytolysis were observed only in patients of 2nd group (3 patients – 4.7 % of the total number of investigated) and in patients of 3rd group (7 patients – 11 % of the total number of investigated). Increased level of GGT most of all was found in patients of 3rd group – 5 people (8 % of the total number of investigated). After ultrasound investigates we got the following results: 1st group – 100 % of all patients had dysmorphism of gallbladder and biliary dyskinesia on hypotonic type – bile ejection fraction averaged 20–30 %, including 3 patients (16 %) that had signs of fatty liver, degree I; patients of 2nd group had signs of chronic cholecystitis with symptoms of biliary dyskinesia on hypotonic type (bile ejection fraction averaged 30 %) – 13 patients, signs of fatty liver first degree – 5 patients, signs of fatty liver second degree – 4 patients, hepatosplenomegaly – 2 patients, 3 patients had sings of chronic calculous cholecystitis; patients of 3rd group had signs of fatty liver, degree I – 13 patients, fatty liver, degree II – 5 patients, 3 patient had chronic cholecystitis with symptoms of biliary dyskinesia of hypotonic type (bile ejection fraction was 20 %), hepatosplenomegaly – 5 patients and 5 patients had sings of chronic calculous cholecystitis.
Conclusions. Signs of biliary dyskinesia are diagnosed in patients with hypothyroidism at a young age, because of the low content of thyroid hormones in the blood. Without hormone replacement therapy and symptomatic treatment, signs of steatohepatosis develop and further it will cause nonalcoholic fatty liver disease. That's why biliary dyskinesia can be used as a predictor of nonalcoholic fatty liver disease in patients with hypothyroidism at a young age.
Keywords: nonalcoholic fatty liver disease, biliary dyskinesia, hypothyroidism, dyslipidemia, predictors.

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FEATURES OF CARDIOREMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION AND METABOLIC SYNDROME

Аuthors: V. N. Bondar, K. S. Chernyshova

Pages: 515–522

Abstract

Introduction. Left ventricular hypertrophy (LVH) is the most characteristic cardiac damage in arterial hypertension (AH) and substantially influences the course and prognosis. LVH is an independent risk factor for cardiovascular complications. Currently, however, the structural and functional features of cardiac remodeling in patients with arterial hypertension and concomitant metabolic syndrome (MS) have been insufficiently studied. The purpose of our research was to study the characteristics of cardioremodeling processes in patients with arterial hypertension in the presence and absence of metabolic syndrome.
We examined 128 patients with arterial hypertension and metabolic syndrome, who formed the basic group, and 112 hypertensive patients without MS, who formed the control group. Patients in both groups underwent echocardiography with assessment of basic indicators and types of LV remodeling. Assessment of left ventricular diastolic function was performed in pulsed mode doplerEchoCG. Statistical significance of differences was determined using T-test and Fisher’s criteria (φ).
The results obtained show more expressed signs of LVH by echocardiography data in the basic group compared to control (p < 0,01), the main indicators of LVH in hypertensive patients with metabolic syndrome were: interventricular septum thickness was (1.30 ± 0.01) cm, thickness of  left ventricular posterior wall  – (1.26 ± 0.01) cm,  left ventricular mass index – (144.3 ± 5.23) g/m2. These results are related to chronic increasing of blood pressure, hormonal and metabolic disorders in MS. In hypertensive patients with MS violations of left ventricular geometry were absent in 8 patients (6 %) compared with 15 patients in the control group (13 %) (φ = 1.72, p < 0.05). In patients of control group the incidence of concentric left ventricular hypertrophy (CLVH) was significantly higher compared to hypertensive patients with MS, 67 people (60 %) compared with 60 patients (47 %), respectively (φ = 1.85, p < 0.05). However, eccentric left ventricular hypertrophy (ELVH) significantly was more frequent in basic group compared with the control, 56 (44 %) and 19 (17 %) patients, respectively (φ = 4.25, p < 0.01). Concentric left ventricular remodeling most rarely encountered in both groups: 11 patients (10 %) versus 4 (3 %), respectively (φ = 2.09, p < 0.05). Arterial hypertension in combination with metabolic syndrome is accompanied by more expressed cardioremodeling processes. Violation of  LV geometry was significantly more frequent in arterial hypertension with metabolic syndrome. In the structure of violations both eccentric and concentric type of hypertrophy are equally often found. In addition, the presence of concomitant metabolic syndrome causes a more expressed diastolic dysfunction. Thus, the examination and treatment of hypertensive patients with MS should include the diagnostic, treatment and prevention of myocardial hypertrophy and diastolic dysfunction, because these cardioremodeling processes are independent risk factors for cardiovascular complications.
Keywords: arterial hypertension, metabolic syndrome, cardioremodeling, left ventricle, diastolic dysfunction.

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Left ventricular hypertrophy (LVH) is the most characteristic cardiac damage in arterial hypertension (AH) and substantially influences the course and prognosis. LVH is an independent risk factor for cardiovascular complications. Currently, however, the structural and functional features of cardiac remodeling in patients with arterial hypertension and concomitant metabolic syndrome (MS) have been insufficiently studied. The purpose of our research was to study the characteristics of cardioremodeling processes in patients with arterial hypertension in the presence and absence of metabolic syndrome.

We examined 128 patients with arterial hypertension and metabolic syndrome, who formed the basic group, and 112 hypertensive patients without MS, who formed the control group. Patients in both groups underwent echocardiography with assessment of basic indicators and types of LV remodeling. Assessment of left ventricular diastolic function was performed in pulsed mode doplerEchoCG. Statistical significance of differences was determined using T-test and Fisher’s criteria (φ).

The results obtained show more expressed signs of LVH by echocardiography data in the basic group compared to control (p < 0,01), the main indicators of LVH in hypertensive patients with metabolic syndrome were: interventricular septum thickness was (1.30 ± 0.01) cm, thickness of  left ventricular posterior wall  – (1.26 ± 0.01) cm,  left ventricular mass index – (144.3 ± 5.23) g/m2. These results are related to chronic increasing of blood pressure, hormonal and metabolic disorders in MS. In hypertensive patients with MS violations of left ventricular geometry were absent in 8 patients (6 %) compared with 15 patients in the control group (13 %) (φ = 1.72, p < 0.05). In patients of control group the incidence of concentric left ventricular hypertrophy (CLVH) was significantly higher compared to hypertensive patients with MS, 67 people (60 %) compared with 60 patients (47 %), respectively (φ = 1.85, p < 0.05). However, eccentric left ventricular hypertrophy (ELVH) significantly was more frequent in basic group compared with the control, 56 (44 %) and 19 (17 %) patients, respectively (φ = 4.25, p < 0.01). Concentric left ventricular remodeling most rarely encountered in both groups: 11 patients (10 %) versus 4 (3 %), respectively (φ = 2.09, p < 0.05). Arterial hypertension in combination with metabolic syndrome is accompanied by more expressed cardioremodeling processes. Violation of  LV geometry was significantly more frequent in arterial hypertension with metabolic syndrome. In the structure of violations both eccentric and concentric type of hypertrophy are equally often found. In addition, the presence of concomitant metabolic syndrome causes a more expressed diastolic dysfunction. Thus, the examination and treatment of hypertensive patients with MS should include the diagnostic, treatment and prevention of myocardial hypertrophy and diastolic dysfunction, because these cardioremodeling processes are independent risk factors for cardiovascular complications.

Keywords: arterial hypertension, metabolic syndrome, cardioremodeling, left ventricle, diastolic dysfunction

INFLUENCE OF DRY CARBON DIOXIDE BATHS AND INTERFERENCE THERAPY ON ENDOTHELIAL DYSFUNCTION IN COMPLEX TREATMENT OF PATIENTS WITH ISCHEMIC HEART DISEASE AND MICROVASCULAR ANGINA

Аuthors: E. O. Penina

Pages: 523529

Abstract

         

The efficiency of patients’ treatment in ischemic heart disease and microvascular angina, correction of endothelial function using both pharmacological and non-pharmacological therapies, remains relevant today. The purpose of the study was to investigate the effectiveness of modified drug therapy, dry carbon dioxide baths and interference therapy in the correction of endothelial dysfunction in patients with ischemic heart disease and microvascular angina.
We examined 160 patients with ischemic heart disease and microvascular angina, depending on methods of treatment were divided into 5 groups: group 1 – standard drug therapy, 2 group – modified drug therapy (amlodipine and L-arginine), group 3 – on the background of amlodipine and L-arginine the dry carbon dioxide baths (DCDB), group 4 – on the background of amlodipine and L-arginine the interference therapy (IT), group 5 – a combination of DCDB and IT. All patients underwent assessment of endothelial function before and after treatment. The significance of differences between groups was determined by T-test (P < 0.05).
During analyzing of endothelial dysfunction before and after treatment the greatest vasodilating effect was observed in groups which were additionally applied procedures of DCDB, especially the combination of DCDB and IT on the background of modified drug therapy (P1-3 ˂ 0,05), (P1-5 ˂ 0,05), (P2-3 ˂ 0,05), (P2-5 ˂ 0,05). The use of dry carbon dioxide baths, especially in combination with interference-therapy on the background of modified drug therapy allows to achieve the best results in correction of endothelial dysfunction as an important pathogenetic component in the development of microvascular angina.

Keywords: ischemic heart disease, microvascular angina, endothelial dysfunction, dry carbon dioxide baths, interference therapy.

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References

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THE SPECIES RANGE AND ANTIBIOTIC RESISTANCE OF THE NASAL-PHARYNGEAL MICROBIOTA IN CHILDREN WITH ACUTE RESPIRATORY VIRAL INFECTIONS

Аuthors: V. M. Holubnycha, Ye. V. Dmitrova, O. I. Smiyan, T. V. Ivakhnyuk, Zh. V. Khatynsʹka, O. I. Pereshyvaylo

Pages: 530536

Abstract

         

Objective: To investigate the species range and antibiotic resistance of the nasal-pharyngeal microbiota in children with acute respiratory viral infections.
Materials and methods: The investigation of the nasal-pharyngeal swab from 98 children with acute respiratory viral infections was conducted. Microbiological studies included PCR to establish the etiological structure of acute respiratory viral infections and classical bacteriological methods to determine bacterial and fungal component of the nasal-pharyngeal microflora. The sensitivity of isolated bacteria to antibiotics was determined by using disc-diffusion method.
Results: Species composition of respiratory viral infections pathogens consists of rhinoviruses (28.6 %), adenovirus (24.3 %), respiratory syncytial virus (8.6 %), parainfluenza virus types I and III (8.6%), metapneumovirus (4.3%), influenza viruses A and B (22.9 %), coronavirus (4.3 %). Concomitant bacterial and fungal microflora was represented mainly by staphylococci, streptococci, micrococci, Corynebacterium and fungi genus Candida. Opportunistic microorganisms dominated among the fungal-bacterial microflora component (52.3 % species). The simultaneous selection viruses and opportunistic microorganisms was noted in 17.7 ± 0.61 % of patients. Most strains (58.0 %) showed resistance to 2–3 antibiotics, 25.0 % strains were resistant to all antibiotics. Greatest number of selected microorganisms was susceptible to levofloxacin (65.9 %) and ciprofloxacin (69.3 %).
Conclusions: The dominant etiological agents in children with acute respiratory virus infections are rhinoviruses (28.6 %), adenoviruses (24.3 %) and influenza viruses B (14.3 %). Opportunistic microorganisms are isolated in 52.3 % of samples. Staphylococci (35.7 %) and streptococci (29.2 %) are dominant. Opportunistic pathogens are susceptible to levofloxacin (65.9 % strains) and ciprofloxacin (69.3 % strains).

Keywords: microbiota of the nose and throat, respiratory viruses, antibiotics, sensitivity.

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STRUCTURAL ALTERATION OF RATS' STOMACH FUNDUS UNDER CONDITION OF INTRACELLULAR DEHYDRATION OF THE BODY

Аuthors: V. I. Hula

Pages: 537545

Abstract

The research purpose was to study histomorphometrical parameters of the stomach fundus of white laboratory mature male rats under condition of sublethal intracellular dehydration.
The animals were divided into 2 groups. The 1st group which consisted of 7 rats was used as a control group. The 2nd group (7 rats) was experimental. The animals of experimental series received 1.2 % hypertonic sodium chloride solution and granulated feed. Sublethal intracellular dehydration degree was achieved on the 30th day of the experiment.
Under condition of sublethal intracellular dehydration of the body there was a considerable decrease in the average layer height of all the components of the stomach wall. The mucous layer disappeared from the surface of the mucous membrane and from the cytoplasm of the surface and neck mucous cells. There was revealed a thickness reduction of the surface epithelium and epithelium of the gastric pits, accompanied by severe degenerative changes and areas of its massive desquamation. The gastric pits smoothed and their depth decreased. In addition, the thinning of the mucous membrane was accompanied by a considerable reduction in the height of the gastric glands and increase in their density per 1 mm2. Destructive changes of the gastric glands were accompanied by hemorheological microcirculation disorders.
There was found a decrease in the total number of gland cells, their [glands’] degenerative changes and a reduction of the surface of cross-section of the cytoplasm which caused a major visual distension of lumen of the gastric glands. The most significant quantitative changes took place in neuroendocrine cells which indicates substantial damage of the stomach secretory function. There were no significant structural changes in muscular and serous membrane of the stomach except for reduction of their thickness.
Conclusion. Sublethal intracellular dehydration lead to a considerable decrease in the average layer height of all the components of the stomach wall and alteration of structure of the gastric glands and cells.
Keywords: stomach, fundal part, intracellular dehydration.

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ANALYSIS OF ASSOCIATION OF VITAMIN K EPOXIDE REDUCTASE COMPLEX SUBUNIT 1 (VKORC1) GENE HAPLOTYPES WITH ISCHEMIC ATHEROTHROMBOTIC STROKE

Аuthors: Ye. I. Dubovyk, V. Yu. Harbuzova,  A. V. Ataman

Pages: 546–554

Abstract

Introduction. Ischemic atherothrombotic stroke (IAS) is a multifactorial disease which development is determined by environmental and genetic factors. In recent years, a large number SNPs of various potential candidate-genes have been investigated to establish their association with IAS. However, haplotype analysis is considered more effective than single nucleotide polymorphism analysis to search for genetic determinants of widespread diseases or human features. Thus, the purpose of the present study was the conduction of a case-control study on representatives of the North-Eastern region of Ukraine in order to assess the possible association of vitamin K epoxide reductase complex subunit 1 (VKORC1) gene haplotypes with IAS.
Materials and methods. The study group included 170 unrelated Ukrainian patients with a mean age of 64.7 ± 0.73 years who had IAS. The control group consisted of 124 individuals with the absence of cardio-vascular pathologies. VKORC1 promoter G-1639A (rs9923231) and first intron C1173T (rs9934438) polymorphisms genotyping was performed using PCR-RFLP (polymerase chain reaction with following restriction fragment length polymorphism analysis) method. Most statistical analyses were performed using Statistical Package for Social Science software (SPSS, version 17.0, Chicago, IL, USA). Linkage disequilibrium (LD) and haplotype frequencies were analyzed by Arlequin (version 3.1, Bern, University of Berne, Switzerland). All statistical tests were two-sided, P <0.05 was considered significant.
Results. The data obtained in present work demonstrated that VKORC1 G-1639A but not C1173T polymorphism was associated with IAS in Ukrainian population. It has been shown that the risk for IAS in patients with A/A and G/A genotypes was higher than for individuals with G/G genotype (OR = 1.905; Р = 0.009). Haplotype analysis demonstrated, that -1639G/1173T and -1639A/1173C haplotypes frequencies in stroke subjects was significant higher than in matched control (OR = 3.813, P = 0.010 and OR = 2.189, P = 0.011, respectively). In contrast, -1639G/1173C haplotype frequency was higher in the control group (OR = 0.548, P < 0.001). Frequency of -1639A/1173T haplotype in both groups was similar (P = 0.218).
Conclusion. VKORC1 -1639G/1173T and -1639A/1173C haplotypes is related to increased risk for IAS, while -1639G/1173C is a protective factor for IAS in Ukrainian population.
Keywords: VKORC1, gene polymorphism, haplotype, ischemic stroke.

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COMPARATIVE EVALUATION OF THE MAIN HEMATOLOGICAL INDICES OF VENOUS AND CAPILLARY BLOOD FROM DONORS IN SAMPLES OBTAINED USING K2EDTA AND K3EDTA

Аuthors: S. M. Dmytruk, S. I. Kryvtsun, I. B.Batura, S. A. Dmytruk

Pages: 555–563

Abstract

Relevance of carrying out a comparative analysis of hematological parameters in venous and capillary blood samples which were obtained using K2EDTA and K3EDTA is based on the need to take into account possible differences in the standardisation of pre-analytical phase of laboratory research, validation of analytical methods, the choice of biological material for analysis, comparing the results of the laboratory studies performed using venous and capillary blood.
Comparative analysis included analysis of the number of white blood cells, red blood cells, platelets, hemoglobin and hematocrit value in samples of venous and capillary blood taken using K2EDTA or K3EDTA, and was investigated by an automatic hematology analyzer in whole blood analysis mode.
Capillary blood samples taken using K2EDTA or K3EDTA in comparison with venous blood samples established increasing number of leukocytes, lower level of hemoglobin, smaller value of hematocrit, smaller number of erythrocytes and platelets. These differences, with an exception to the composition of capillary blood, are due to: greater sensitivity of procedure of sampling capillary blood to the factors that affect the value of pre-analytical phase error and depend on the type, brand and state of aggregation of anticoagulant, which are used in test tubes. In the data analyzed it appears that K2EDTA is an anticoagulant of choice during the selection and preparation of capillary blood samples for hematology research procedures.
Keywords: white blood cells, red blood cells, platelets, hemoglobin, hematocrit, venous blood, capillary blood, EDTA.

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PATHOLOGICAL BIOMINERALIZATION IN HEART VALVES AFFECTED BY ATHEROSCLEROSIS

Аuthors: R. A. Moskalenko, A. M. Romanjuk, I.-M. S. Zakorko, A. M. Piddubnyi, D. O. Levchenko, V. M. Hetmanska

Pages: 564–571

Abstract

Due to the aging of Ukrainian population the prevalence of growing of atherosclerotic affection of heart valve structures is observed, it affects significantly the life quality and prognosis for patients. Pathological biomineralization of heart valves has an adverse prognostic value for the course of coronary heart disease and it is accompanied by increase of frequency of sudden coronary death.
The aim of the work is the morphological study of mineralized tissue of aortic and mitral heart valves, which were affected by atherosclerosis.
During the study we used macroscopic description, histology and histochemistry, scanning electron microscopy with X-ray difraction. Material of 49 section cases was investigated, in which 30 patients had the combination of aortic valve (AV) and mitral valve (MV) affection, 16 and 3 had isolated affection of only MV and AV, respectively.
The average age of death people with atherosclerotic affection of MV was 69.09 ± 1.34 years, with AV affection – 68.84 ± 1.54 years. MV affection was equal due to the gender (50 % men and 50 % women), in the case of AV affection women (54.6 %) dominated insignificantly.
During macroscopic study of heart valves it was found that biomineral deposits were located in the cusps or in the fibrous ring in the case of atherosclerotic valve affection. Histological examination shows that thickening of the fibrous layer and elastic fibers, focal deposition of lipids, myxomatous changes, edema were found in the affected valve components.
The presence of calcium compounds in the identified biominerals was confirmed by histochemical staining with alizarine red and due to the method of von Kossa.
Study of the specific mineral component in the tissue of various heart valves (HV) showed the following results. MV contained in average 17.35 ± 2.08 % of calcified substance, 18.84 ± 2.23 % of biominerals was found in AV (p > 0.46).
During SEM with X-ray microanalysis mineralized HV elements were detected as bright objects with white and gray color, in the form of blocks, lumps, small powdered particles, it didn’t depend on the localization – MV or AV. Biomineral part of leaves and fibrous ring was inlaid into the histological structure of valves and it is associated closely with connective tissue component of the organ. In some places delamination of connective tissue and elastic fibers was observed, in other locations biomineral tissue passed fluently into the surrounding stroma. X-ray diffraction of mineralized components of all HV locations shows a similar chemical composition, which is close to the ratio of calcium and phosphorus, most of which corresponded to hydroxyapatite.
Keywords: heart valves, hydroxypatite, morphological changes, atherosclerosis, biomineralization.

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CALCULATION OF ENDOGENOUS INTOXICATION AND IMMUNOREACTIVITY INDICATORS IN PATIENTS WITH ACUTE INTESTINAL INFECTION USING CREATED ANDROID-APPLICATION

Аuthors: O. M. Chemych, L. V. Moroz, O. B. Berest, O. D. Yarovyi, V. V. Davidenko, M. D. Chemych

Pages: 572–582

Abstract

         

Haematological and integral indicators of moderate course of salmonellosis and acute intestinal infections, caused by opportunistic microorganisms, were analysed. In different periods of the disease were estimated integrative indicators of endogenous intoxication and immunoreactivity. The results are compared with the haematological parameters of healthy individuals as the basis of our program for the mobile operating system Android.

Automatic calculate parameters of endogenous intoxication and immunoreactivity in patients with acute intestinal infections using programs created for mobile operating system Android helps the doctor without the use of equipment objectively and quickly determine degree of endogenous intoxication and the ability of the patient to an effective immune response. This facilitates the rapid adjustment of treatment strategy, prevention of unwanted consequences and a decision on further outpatient treatment and monitoring convalescents. In terms of health insurance, would allow the doctor to confirm compliance and test the effectiveness of treatment.

Keywords: mobile operating system Android, salmonellosis, acute intestinal infections, integrative indicators, endogenous intoxication.

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