Vol 69, No 11-12 (2014)

Objective: There are no any systemized studies of relationship between the coagulative haemostasis’ disorders and metabolic and cytokine status in patients with septic tuboovarial formations. The aim of the present work was to study the mechanisms of blood coagulation disorders and their relationships with changes of cytokine status and acute phase of inflammatory response in septic tubovarial formations in women. Methods: 32 patients with purulent tubovarial formations and 30 healthy women were examined. Results: Shortening of activated partial thromboplastin, prothrombin and thrombin clotting time, increasing the duration of XIIa-kallikrein-dependent fibrinolysis, as well as the elevation of paracoagulation products in blood plasma were observed. IL-1β (p =0.000023), TNF-α (р <0.001), C-reactive protein (р <0.001), haptoglobin (р <0.001) and fibrinogen (р <0.001) levels were higher in peripheral blood of patients in comparison with healthy women. Accumulation of lipid hydroperoxides (р <0.001) and malonic dialdehyde (р <0.001) occurred in the blood plasma of patients. Serum albumin (р <0.001) and transferring (р <0.001) levels were lesser in patients with purulent tuboovarial formations in comparison with healthy women. Conclusion: The obtained results showing an initiating role of cytokine and oxidative metabolic status changes in blood coagulation potential’s and fibrinolysis activity’s disorders developing. This biochemical signs may be used as objective criteria which may serve to determine the risk of thrombosis in case of acute inflammatory response in women with purulent tubovarial inflammation.

Objective: Our aim was to evaluate the characteristics of structural and functional changes of the heart in patients with chronic viral hepatitis. Methods: The study included 123 patients — 17 subjects with aviremiey after antiviral therapy (group 1), 38 patients with laboratory inactive hepatitis (group 2), 68 patients with biochemical active hepatitis (group 3). All patients had standard echocardiography, Doppler sonography and tissue Doppler echocardiography. Results: Patients with chronic viral hepatitis were revealed to develop changes in the geometry of the left ventricle (increase in the wall thickness). Patients with active hepatitis had increase in the left atrium, the right ventricle and indexed left ventricular mass of the heart. Significant morphological changes were not confirmed statistically in patients after «therapy». Pulmonary hypertension was revealed in 19% of cases, mitral valve prolapse was confirmed in 48%, with the detection rates being not dependent on hepatitis activity. Abnormal left ventricular remodeling was identified in 45% of patients, subjects with active hepatitis developed it more often. Dysfunction relaxation of both right and left ventricles depended on the activity of the inflammatory process in the liver. The condition partially persisted after antiviral treatment. Conclusion:
Specifics of the structural and functional changes of the heart in patients with chronic viral hepatitis is the development of left ventricular hypertrophy and in the presence of laboratory activity hepatitis — relative dilatation of the right heart and ventricular diastolic dysfunction of the heart. Carrying out specific antiviral therapy has a beneficial effect on cardiac hemodynamics parameters. Method of tissue Doppler echocardiography was efficient in evaluation of early disorders of diastolic function in patients with chronic viral hepatitis.

Objective: Dynamics and causes of infant and child mortality in the Russian Federation in post-Soviet period (1990–2012) under conditions of demographic policy implementation and healthcare system reforming are presented. Methods: Federal State Statistics Service's official statistics data (1990–2012) had been analyzed. The data was compared with similar rates of European Union countries. Results: It’s been revealed that infant mortality decreased (more than in 2 times) (from 17.4‰ to 8.6‰) through all its level indicators (early neonatal, neonatal, post-neonatal mortality) and due to almost all basic reasons (perinatal disorders, infectious diseases, respiratory diseases, congenital anomalies, accidents). Infant mortality rate in rural areas is higher (10.1‰ and 8.1‰), however, the gap between rates in rural regions and in cities is decreasing. In Russian Federation the infant mortality has regional distinctions, thus  Siberian and Far Eastern regions are the least advantaged areas. Mortality of children under 5 y.o. is declining (from 21.3‰ to 10.6‰), but its rate is still higher than in European Union countries (3.5‰). External factors occupy the top position as a death cause of infants and toddlers; the number of clinical cases with a diagnosis of malignant neoplasm increases. Conclusion: Thus, improving of the system of motherhood and childhood protection in the Russian Federation has resulted in significant reduction of infant and child mortality rate.

The analysis of the problem of chronic hepatitis C (CHC) in children. The data on the incidence of primary CHC child population on the territory of the Russian Federation and abroad. The problems of diagnosis of HCV-infection. Conducted a review of the risk of infection, highlight the possible routes of transmission are shown peculiarities of HCV-infected children, shows the frequency of chronic process. The state of the problem at the moment and evaluated further promise in the treatment of chronic hepatitis C in children.

In this review history, principles, technique and clinical applications of confocal laser endomicroscopy are briefly described. This technology allows to expand the diagnostic ability of traditional white light endoscopy and to assess effectiveness of therapeutic procedures in different gastrointestinal diseases. New experimental and clinical data in assessing small bowel barrier dysfunction as a predictor of relapse for inflammatory bowel disease is presented. Problems and perspectives regarding application of optical biopsy for gastrointestinal tract in pediatric practice are discussed.

Today approximately 70% of patients with Hodgkin lymphoma can be cured with the combined-modality therapy. Tumor burden, the importance of which was demonstrated at first 15 years ago, is a powerful prognostic factor. Data of literature of representations on predictive value of Hodgkin’s lymphoma tumor burden are shown in the article. The difficult immunological relations between tumor cells and reactive ones lead to development of the main symptoms. Nevertheless, the collective sign of tumor burden shows the greatest influence on survival and on probability of resistance, which relative risk can be predicted on this variable and treatment program. Patients with bulky disease need escalated therapy with high-dose chemotherapy. Integration into predictive models of the variable will change an expected contribution of clinical and laboratory parameters in the regression analyses constructed on patients with Hodgkin's lymphoma. Today the role of diagnostic functional methods, in particular a positron emission tomography, for metabolic active measurement which allows excluding a reactive component is considered.

Objective: Our aim was to determine the most common musculoskeletal diseases, depending on the type of sports and athletes’ age. Methods: The results of examination of 976 athletes aged 16 to 42 years (average age — 28,9±2,3) with musculoskeletal diseases were analyzed. Medical diagnostic procedures included clinical, laboratory, instrumental (radiography, magnetic resonance imaging, ultrasound) investigations and functional testing (goniometry, manual muscle testing). Results: Majority of patients were diagnosed to have diseases of the knee (17.9%) and ankle joints (11.3%), the heel bone (12.9%), Achilles tendon (10.2%), post-traumatic musculoskeletal diseases (16.2%), degenerative-dystrophic diseases of the spine (12.8%). In the young age group (16 to 20 years) post-traumatic disorders were most common. In the middle-age group (21 to 30 years) along with post-traumatic disorders diseases of the knee frequently occurred. For athletes over 30 years old, along with diseases of the knee spinal diseases were found to occur more than 2–3 times often compared with other age groups. Injuries which are more common for different types of sports were identified: acute traumas — competitive sports, diseases of the calcaneus — sports with running and jumping (athletics, volleyball, soccer), disease of ankle joints — sport with sharp change in movement direction (hockey, figure skating), disease of the knee — sports with high load of the knee joint (figure skating, gymnastics, volleyball, diseases of bones and joints of the upper extremity — tennis, disease of spine — weightlifting. Conclusion: pathological changes in the musculoskeletal system depend on the type of sports and the age of athletes. The combination of age and risk factors associated with type of sport increases the possibility of development of these diseases of the musculoskeletal system.

Objective: The aim of our clinical study was to evaluate the possibility of diagnosis of postrenal-transplantation complications in recipients using dynamic scintigraphy basing on temporary parameters standard zones of interest and medullary zone of renal transplantat comparing the results with the histological findings. Methods: We determined time of maximum and one-half maximal activity of radiopharmaceutical medication in renal transplantat, parenchyma and medullary zone the graft. According to pathological diagnosis, patients were categorized into three
groups: first — normals (n =32), second — acute rejection (n =43), third — chronic nephropathy (n =43). Results: In this study 118 patients aged 21–60 (38.4±9,8) years were included who underwent dynamic renal scintigraphy and biopsy renal transplantat. The time of maximum activity radiopharmaceuticals parenchyma the graft in patients in first group — 3.24±0.54 min, second — 6.61±3.28 min, third — 6.21±4.17 min (р <0,001). The time of maximum activity
radiopharmaceuticals medullary zone the graft in patients in first group — 3.95±0.95 min, second — 8.94±5.23 min (р <0,001), third — 7.29±4.16 min (р <0,01). The time of maximum activity radiopharmaceutical the whole graft in patients in first group — 3.87±0.62 min, second — 7.4±3.82
min (р <0,001), third — 8.03±4.28 min (р <0,01). The time one-half maximal activity radiopharmaceuticals parenchyma the graft in first group — 10.4±2.95 min, second — 37.09±3.89 min (р<0,001), third — 29.67±3.1 min (р<0,005). The time one-half maximal activity radiopharmaceuticals medullary zone the graft in first group — 11.71±5.93 min, second — 79.34±9.81 min (р <0,001), third — 29.67±3.95 min (р <0,005). The time one-half maximal activity radiopharmaceuticals the whole graft in first group — 12.31±3.91 min, second — 53.29±8.22 min, third — 52.71±7.86 min (р <0,001). Anderson–Bahadur distance: Т1/2
medullary zone the graft most significant between first and second groups patients (17.43), gives maximum index value at chronic nephropathy (-9.07), at differentiation between acute rejection and chronic nephropathy (8.48). Estimate of the area under the ROC indicate most informative time of maximum accumulation of the radiopharmaceutical of the whole graft (S_Roc=0,907) in acute rejection and Tmax parenchyma the renal transplantat (S_Roc=0,847) in patients with chronic nephropathy the graft. Sensitivity and specificity renal scintigraphy parameters of diagnosing on postrenal transplantation complications amounted 71.43–98.7% and 67.7–96.43% respectively. Conclusion: Renal scintigraphy is an additional test for early detection on postrenal transplantation complications and correct tactics conducting recipients. The parameters of kinetics of nephrotropic radiopharmaceuticals provide diagnosis of acute rejection and chronic nephropathy the graft. Inclusion of radionuclide diagnostics to monitor the state renal transplantat optimizes approach to biopsies graft.

Objective: Research purpose was to study phagocytic activity and a oxygen depended metabolism of blood neutrophils (NF) at patients with a renal cell carcinoma in dynamics — before operation and after surgical treatment. Methods: Patients with a locally invasive renal cell carcinoma (T₃N₀M₀) were put under observation before surgical treatment (n =84) and in 10 days after a radical nephrectomy (n =54) at the age of 45–55 years. The 56 conditionally healthy donors combine into the control group. Indicators of functional activity, the spontaneous and induced lyuminol- and lyutsigenindependent chemiluminescence (CHL) NF of peripheral blood was studied. Results: During the period before operation time of an exit to a maximum of spontaneous and stimulated lyuminol-dependent HL is slowed down (p <0.004 and p <0.006 respectively); indicators of the area of lyutsigenin-dependent HL NF of blood concerning indicators of control group are increased (p <0.001 for spontaneous, p <0.004 for the reaction induced by lyutsigenin). In 10 days after surgical treatment the quantity of active ingestion rate lowered (p <0.017 in the test with S. epidermidis, p <0.036 for test with latex); time of an exit to a maximum of spontaneous and stimulated lyuminol-dependent remains increased (p <0.006 and p <0.008 respectively) in comparison with indicators of healthy donors. The amount of an index of activation of lyuminol-dependent as in comparison with control (p <0.037), and relative to the period before operation increases (p <0.048). The area of spontaneous lyutsigenin-dependent HL NF of blood relative to indicators of control group is still increased (p <0.011), decrease in this parameter in comparison with amount of group before operation is however registered (p <0.004). Conclusion: At patients with renal cell carcinoma in 10 days after surgical treatment of NF of blood are characterized by the strengthened production of high-energy oxidizers and the reduced phagocytic activity that testifies to a functional and metabolic imbalance.

Consequent of investigation concerned with biological safety (BS) framework development in its broad interpretation, reflected in the Russian Federation State Acts, identified have been conceptual entity parameters of the up-to-date broad interpretation of BS, which have formed a part of the developed by the authors system for surveillance (prophylaxis, localization, indication, identification, and diagnostics) and control (prophylaxis, localization , and response/ elimination) over the emergency situations (ES) of biological (sanitary-epidemiological) character. The System functionality is activated through supplying the content with information data which are concerned with monitoring and control of specific internal and external threats in the sphere of BS provision fixed in the Supplement 2 of the IHR (2005), and with the previously characterized nomenclature of hazardous biological factors. The system is designed as a network-based research-and-practice tool for evaluation of the situation in the sphere of BS provision, as well as assessment of efficacy of management decision making as regards BS control and proper State policy implementation. Most of the system elements either directly or indirectly relate to the scope of activities conducted by Federal Service for Surveillance in the Sphere of Consumers Rights Protection and Human Welfare, being substantial argument for allocating coordination functions in the sphere of BS provision to this government agency and consistent with its function as the State Coordinator on IHR (2005). The data collected serve as materials to Draft Federal Law “Concerning biological safety provision of the population”.