CARDIOLOGY
Objective. To investigate the clinical significance of estimation of adaptive reaction using L.Gharkavi algorithm in young people with borderline or mild arterial hypertension (AH).
Design and methods. 53 adolescents (16-26 yrs, mean 19.3+/-0.4 yrs) with normal body mass index (BMI; 18.5 — 24.9 kg/m2) were included. Antropometrics and laboratory measurements of the participants were recorded. Heart rate variability in frequency domain has been obtained from 24-h polyfunctional outpatient Holter monitoring (ECG+BP+chestpletysmography; Incart, SPb, Russia).
Results. All types of adaptive reaction were randomly met in the study population except «stress reaction». 13 adolescents (24.5%) had a leukocyte distribution corresponding to «training reaction». 26.4% young men demonstrated «reaction of quiet activation», 28,3% — «reaction of increased activation» and 20,8% of adolescents had «hyper activation». Mean systolic BP in this group at night (124.0±3.6 mm Hg) was higher than in «hyper activation» group (116.8±2.2 mm Hg, P<0.05). Diastolic BP in «training group» in the awakening time was higher than in «hyper activation» group (76.0±2.0 vs 70.6±2.2 mm Hg, P=0,04). Night BP decline for DBP in «training» and «hyper activation» groups was 20,1% to be due to a tendency to excessive night decrease of DBP («over-dippers»). Adolescents with «training» reaction had higher power of LF band at night than in «quiet activation» group (P=0,04) and «hyper activation» ones (P=0,05). Direct significant correlation exist between VFL power in the day-time and tension of leukocytes count registered if its value is out normal range (r=0,357).
Conclusion. Clinical assessment of leukocyte percentage types may be informative in young men with mild AH.
The aim of the study was to identify genetically caused structural and functional features of the cardiovascular system in different groups of Navy and differentiate them from the influence of certain professional factors.
Materials and methods. We examined 76 naval officer, study group consisted of 33 divers, the control group — 43 professional Navy, not exposed to hyperbaric. It was used count, biochemical blood tests, ECG, bicycle ergometry, echocardiography, volume sphygmography, ECG monitoring to assess the state of their cardiovascular system. As a result, it has been allocated 176 quantitative indicators, which assessed changes depending on β1- and β2-adrenoceptor polymorphisms.
Results. T he incidence of β2- and β2-adrenoceptor polymorphisms did not differ between the study and control groups. Indicators of electrophysiological functioning of the heart, central and peripheral hemodynamics were not significantly different in carriers of different genotypes of β1- and β2-adrenoceptor polymorphisms. According to the group analysis of variance the significant association of haplotypes β1- and β2-adrenoceptor with unidirectional changes in the group of indicators characterizing the cardiovascular system was revealed.
Conclusion. Haplotypes β1- and β2-adrenoceptor were more significant in the identification due to changes in the cardiovascular system. For carriers of the gene β1- adrenoceptor the most favorable haplotype is Arg389Arg-Ser49Gly, which is associated with positive effects on the cardiovascular system, manifesting strengthening of parasympathetic regulation of the heart rate, reduction in stiffness of the arterial wall and prevention of myocardial remodeling. For carriers of the gene β2-adrenoceptor favorable haplotypes have been identified.
SURGERY
During the period 2013-2015 were analyzed the results of surgical treatment of 34 patients with valvular disease and with concomitant paroxysmal form of atrial fibrillation (PAF). T he Group I included 19 patients who in addition to the correction of acquired heart disease were performed with the procedure named «cut and sew» (MAZE III) of the left atrium (LA). T he Group II included 15 patients who had the modified surgical ablation of left atrial bipolar radiofrequency insulator (procedure MAZE IV). T he study revealed that the procedure MAZE III (LA) and modified methods MAZE IV (LA) showed almost the same level of high efficiency (frequency of maintaining sinus rhythm after 1 year was 100% and 93,3%, respectively) that was accompanied by a lack of cerebral embolic complications during the observation period. As the result the procedure MAZE III (LA) or MAZE IV (LA) in the modification must be discussed immediately among all patients with PAF while the correction of heart valve disease.
PAIN, CRITICAL CARE, AND ANESTHESIA
Background. Overt disseminated intravascular coagulation (DIC) is independent risk factor in sepsis. Hypercoagulability, present in pre-DIC state, is hardly detected by available screening tests. T hromboelastometry (TEM) and thrombin generation test (TG) showed contradictory results in sepsis.
Objectives. The aim of the study is to compare the screening potential of T EM, TG and local tests to detect hypercoagulability in sepsis.
Design and methods. TEM screening of septic patients revealed hypercoagulability in 21 cases. T G test were performed along with screening coagulation tests and physiological anticoagulants.
Results. There was no thrombin generation in 2 of 21 cases. Increased ETP and Peak revealed only in one case. T he degree of T M-modulated suppression of T G was abnormally low in 15 cases out of 19. Median ETP suppression was only 14% [8,8–24], Peak suppression was 8% [3,4–12,5]. T hus, T EM- identified hypercoagulability was confirmed by both T G and TM+TG tests only in 16 cases (84.2%). Dynamic T EM-criteria (CFT intem) highly correlated with ETP- and PTsuppression values.
Conclusion. Hypercoagulability during sepsis is often due to abnormality in PC pathway. TEM appears to be sensitive POC tool to detect hypercoagulability in sepsis.
Dysfunction of the gastrointestinal tract is an important factor of the development and progression of multiple organ failure. Hypoperfusion of the intestinal wall is the most significant factor of intestinal damage in critically ill patients. T his article presents the results of clinical and morphological studies of 9 patients of intensive care unit, died from multiple organ failure. In 5 patients the standard treatment was supplemented with enteral introducing of oxygen. T he proposed technique — insufflation of oxygen in the gastrointestinal tract — is a simple and safe way to prevent and correct gut insufficiency in critical illness.
PEDIATRICS
Assessment of the state of the cardiovascular system of children born with intrauterine growth restriction (IGR) compared to children without IGR in given in the article in the neonatal period dynamics. Children born with IGR in the early neonatal period decrease of the amplitude of the P-wave, atrioventricular conductivity acceleration, decrease of the amplitude of the Т -wave, mitral valve anterior cusp flexure in children born with IGR more often than in Diastoilic and systolic diametres of the left ventricle were decreased in children born with IGR, shortening fraction and ejection fraction of the left ventricle were increased compared to children born without IGR (lower than in healthy newborns). Stroke volume, cardiac output and thickness of the posterior wall of the left ventricle were decreased while thickness of the inter-ventricular septum was increased. T ransmittal bloodstream speed was characterized by a decrease in the E peak value and A peak value, which are comparable. Speed of transtricuspid bloodstream expressed by E peak was decreased, while A peak prevailed. T ransaortic bloodstream speed was also decreased. By the end of the neonatal period of life children born with IGR had more expressed sympathetic. Amplitude of P wave increased significantly. Acceleration of atriovantricular conduction persisted, increase of the amplitude of the T wave was registered alongside with decrease of the duration of the Т 1Т interval, shortening of the electrical systole and growth of myocardial metabolism disturbance. In spite of high adaptive and regenerative functions of the heart in newborns with IGR, disturbance of myocardial functions and vegetative regulation providing the basis for pathology are registered.
ДИАГНОСТИКА
Uterine artery embolization (UAE) is minimally invasive, less complicated and uterine-preserve procedure when compared to traditional surgical options. Magnetic resonance (MR) imaging is the preferred modality in gynecologic pathology visualization. MR imaging is more accurate than transvaginal ultrasound in evaluating number, size and structure of the fibroids as well as their vascularization (by means of contrast enhancement) on pre-UAE uterus. MRI was performed in 97 women (35-49 y.o.) with symptomatic leiomyoma. In 21 women accompanying pathology was found partially explaining their symptoms. T he exclusion criteria also included subserosal leiomyoma on the narrow stalk (in 3 women) and huge (more than 9 cm in diameter) leiomyomas (in 10 women). In one woman leiomyoma expulsion was registered. U AE was performed in 42 women of 62 that were recommended after MRI. In all women contrast enhanced MRI, was performed also in 1, 6 and 12 month after the procedure. Shrinkage of fibroids as well as the absence of their enhancement was registered, showing the success or the manipulation. T hus, enhanced MRI is essential in uterine artery embolization efficiency assessment, predicting treatment response and it’s complications.
In our study 97 metastatic liver lesions (48 patients) were examined using high field (1,5T) magnetic resonance system. During this investigation quantitative and qualitative analysis of the diffusion-weighted images were performed. All the metastatic foci are well-determined on raw diffusion-weighted images with factor b=50 s/mm2. Diffusion-weighted imaging allows visualization of metastases undetectable on conventional magnetic resonance images. High sensitivity of diffusion-weighted images in detection of abdominal lymph nodes has a great value as in staging of primary tumor as in assessment of therapy. It was shown that diffusion weighted imaging improves diagnostics of such lesions and should be included in the standard MR-protocol of studying these patients.
The breast cancer is on the first place among all the maligncies in women. Conventional non-invasive imaging isn’t able to develop the nature of lesion in all cases, especially in the women of fertile age with well-developed gland tissue. This article deals with analysis of magnetic resonance mammography data with dynamic contrast enhancement of 170 women age 23–75, with nodes in the mammary glands. 93 (54,7%) cases were cancers diagnosed, 64 (37,7%) — fibroadenomas, 9 (5,2%) — localized fibroadenomatosis, 4 (2,4%) — inflammatory mass. The algorithm of magnetic resonance mammography with dynamic contrast enhancement is described.
In our study 494 patients with recurrent lung, breast, gastrointestinal malignancies and lymphomas were examined using combined positron-emission and computed scanner. During this investigation patterns of metastases of different tumors were determined. It was shown that positron-emission and computed tomography can provide more effective determination of recurrent disease in patients with thoracic and gastrointestinal malignancies. Combined positron-emission and computed tomography must be used for monitoring these patients for opportune development of recurrences.
58 patients with neurological disorders were examined using magnetic resonance imaging. Vascular parkinsonism was revealed in 8 patients, possible progressive supranuclear paralysis — in 5 patients, idiopathic Parkinson disease without vascular encephalopathy — in 32 patients, idiopathic Parkinson disease with vascular complications — in 13 patients. Diagnostic algorithm which consists of clinical patient assessment, patient’s reaction on levodopa treatment, visual assessment of non-contrast magnetic resonance images with analyses of «middle encephalon/pons» ratio is suggested, which allows to increase accuracy of vascular parkinconism diagnostics and differentiate it from other extrapiramydal disorders with equal symptoms.
Comparative estimation of magnetic-resonance pelvimetry and external pelvimetry measurements in 182 pregnant women at the end of the III trimester was performed. Basing of the magnetic-resonance pelvimetry data frequency and structure of a narrow pelvis were defined, and radiological classification of the narrowed forms of pelvis was analysed and added. According to magnetic-resonance pelvimetry data the narrowed pelvis was revealed in 158 (86,7%) women and «latent» form of narrowed pelvis (I and II degree) with reduction of several of 8 sizes of midpelvis lesser than on 1–2 cm from normal was determined in 125 (68,8%). T rue narrow pelvis (narrowing of the pelvis distances more than on 2 cm from normal) was developed in 33 (18,1%) women. The normal pelvis was found in 10,3% women. When the narrowing of midpelvis distances did not exceed 1 cm from normal (n=61), only in 26,1% women some changes from the external sizes were found. When the narrowing of midpelvis distances did not exceed 2 cm from normal (n=64), the external sizes were changed only in 51,5%. The general detection of anatomically narrowed pelvis with external pelvimetry was 77,3%, normal — 60%, latent» form of narrowed pelvis — 30,7%.
Experimental studies
Background: Leading causative agents of the prosthetic joint infections are the gram-positive pathogens, namely S. aureus and S. epidermidis, one of the most commonly used antibiotics is vancomycin. Vancomycin is often added to osteogenesis materials for eradication of the causative agents of orthopedic infections. T he action mechanism of vancomycin is associated with inhibition of synthesis of the bacterial cell wall, however, the effect on the growth of cells that form bone is poorly studied.
Objective: T he investigation of the vancomycin effect on the bone explants growth in organotypic tissue culture.
Design and methods: Studies were performed on 1500 bone tissue explants of the 10- to 12- day- old chicken embryos. For the first time, the effect of the drug on the growth and proliferation of bone tissue explants was studied using the method of organotypic tissue culture, confocal laser scanning microscopy and determination of alkaline phosphatase activity by biochemical analysis.
Results: It was shown that at high concentrations (10-4 and 10-5 M) vancomycin is almost completely inhibits the growth of bone tissue explants. T rophotropic effect of the drug is found in concentrations of 10-10-10-13 M.
Conclusion: T he effect of vancomycin was dose-dependent. It was found the trophotropic properties of the vancomycin in concentrations of 10-10-10-13 M. T he data obtained from the results of analysis of alkaline phosphatase activity suggest that the stimulatory effect of vancomycin at concentrations 10-10-10-13M was based on activation of the growth process and osteoclast proliferation and osteoblast precursor cells.
Introduction. Autophagy is a process, whereby components of cell undergo degradation influenced by lysosomal enzymes leading to autophagosome formation. Nowadays, autophagy is considered as one of the application point in range of pharmological approaches, particularly, in inherited orphan diseases and also in aging, and heart failure. O bject of research and properties of examined cell culture have the essential meaning for methodological evaluation of autophagy. In this work, we present selection of optimal conditions for evaluation of autophagy progress in C2C12 cell line.
Methods. To select the optimal approach to evaluate autophagy progress, we tested flow cytometry, immunocytochemistry, and immunoblot (Western blot). T o choose the optimal conditions of cell membrane permeabilization performance various detergents, temperature conditions, time of cell fixation, and components of lysis buffer were compared.
Results. We report, that application of 0,025% digitonin is decisive condition to extract separate protein LC3 fractions (soluble and insoluble). Samples fixation and reduced time of washing are necessary for flow cytometry and allow to maintain optimal number of cells for analysis based on detergent application. We consider, that applying of cell transfection with constructs, carrying LC3, can lead to increase the required time of serum deprivation.
Conclusions. O ptimized protocols for evaluation of autophagy in C2C12 cells over detection of separate fractions of LC3 can be effectively used in investigation of fundamental molecular and cellular mechanisms of myopaties and cardiomyopaties development.
ISSN 2410-5155 (Online)