[Factors of the hemostasis system as biomarkers of severe course of acute viral infections]

The authors give literature review of hemostasis and immune system factors intraction as main biomarkers of a severe cause of viral infectious diseases. Pro-inflamatory cytokines as the main markers of inflammation, can serve both as biomarkers of the clinical severity of the infectious process and reflect the state of the hemostatic and fibrinolytic systems, since components of these systems are present in various structures of the central nervous system and affect the development of neurons and synaptic plasticity. An inverse correlation has been proven between the concentration of D-dimer and the oxygenation index, and the development of DIC is not associated with the presence of respiratory failure in patients with influenza type A, while the ferritin concentration directly reflects the severity of the disease. One of the markers of endothelial damage may be soluble thrombomodulin, which, however, is rarely used in routine clinical practice. Cytoflavin is a highly effective pathogenetic drug that affects various parts of the hemostasis system, has anti-ischemic, antioxidant, antihypoxic, immunocorrective effect, which is indicated for any generalized infectious disease since its debut.

A Comparative Study of Different Protocols for Isolation of Murine Neutrophils from Bone Marrow and Spleen

Neutrophils are considered as the main player in innate immunity. In the last few years, it has been shown that they are involved in different physiological conditions and diseases. However, progress in the field of neutrophil biology is relatively slow due to existing difficulties in neutrophil isolation and maintenance in culture. Here we compare four protocols based on density-gradient and immunomagnetic methods for isolation of murine neutrophils from bone marrow and spleen. Neutrophil isolation was performed using Ficoll 1.077/1.119 g/mL density gradient, Ficoll 1.083/1.090/1.110 g/mL density gradient and immunomagnetic method of negative and positive selection. The different protocols were compared with respect to sample purity, cell viability, yield, and cost. The functionality of isolated neutrophils was checked by NETosis analysis and neutrophil oxidative burst test. Obtained data revealed that given purity/yield/viability/cost ratio the protocol based on cell centrifugation on Ficoll 1.077/1.119 g/mL density gradient is recommended for isolation of neutrophils from bone marrow, whereas immunomagnetic method of positive selection using Dynabeads is recommended for isolation of splenic neutrophils.

The Effect of Cell-Free DNA from Blood Serum of Mice with Metastatic Melanoma on Enhancement of Oncogenic Properties of Melanoma Cells

Currently, a significant increase in the levels of circulating cell-free DNA (cfDNA) in the blood of patients is considered as a generally recognized marker of the development of oncological diseases. Although the tumor-associated cfDNA has been well studied, its biological functions remain unclear. In this work, we investigated the effect of cfDNA isolated from the blood serum of the mice with B16-F10 metastatic melanoma on the properties of the B16-F10 melanoma cells in vitro. It was found that the profile of cfDNA isolated from the blood serum of mice with melanoma differs significantly from the cfDNA isolated from the blood serum of healthy mice, and is similar to the genomic DNA of B16 cells with regards to abundance of oncogenes and mobile genetic elements (MGE). It was shown that the cfDNA of mice with melanoma penetrated into B16 cells, resulting in the increase in abundance of oncogenes and MGE fragments, and caused 5-fold increase of the mRNA level of the secreted DNase Dnase1l3 and a slight increase of the mRNA level of the Jun, Fos, Ras, and Myc oncogenes. cfDNA of the healthy mice caused increase of the mRNA level of intracellular regulatory DNase EndoG and 4-fold increase of the mRNA level of Fos and Ras oncogenes, which are well-known triggers of a large number of signal cascades, from apoptosis inhibition to increased tumor cell proliferation. Thus, it is obvious that the circulating cfDNA of tumor origin is able to penetrate into the cells and, despite the fact that no changes were found in the level of viability and migration activity of the tumor cells, cfDNA, even with a single exposure, can cause changes at the cellular level that increase oncogenicity of the recipient cells.

[Balloon dilation treatment of primary obstructive megaureter in children]

PURPOSE

Investigation of the results of ureteral stricture single balloon dilation in children with primary obstructive megaureter.

MATERIALS AND METHODS

Since 2012 to 2020 79 children (65 boys and 15 girls) with primary obstructive megaureter of II and III grades who had 92 affected ureters were operated on by method of ureteral stricture balloon dilation. Duration of postoperative stenting period was Me=68 [48; 91] days, bladder catheterization period - Me=15 [5; 61] days. Follow-up was from 1 to 10 years.

RESULTS

There were no intraoperative complications in the group of investigation. Pyelonephritis exacerbation in the early postoperative period occurred in 15 cases (18,98%). Control comprehensive examination revealed that urodynamics of 63 children (79,74%) tended to normalization what persisted in the future. There was no positive dynamics in 16 cases (20,25%). Vesico-ureteral reflux was revealed in 4 cases.

DISCUSSION

Assessment of impact of various predictors (passport, urodynamic, infectious, anatomic, operation and postoperative period characteristics) on the treatment results proved that the effectiveness of the procedure depends on the following factors: ureteral stricture length (M-U Test U=202,5 p=0,0002) and features of the stricture rapture during ballooning (Fisher exact p=0,0006). There was significant difference in results in the group of up to 10 mm inclusive stricture length and the longer stricture group (Fisher exact p=0,00001). High activity of pyelonephritis in postoperative period was the predictor of adverse outcome (Fisher exact p=0,00001).

CONCLUSION

Practically 80% of children with primary obstructive megaureter may be reliably cured by the method of ureteral stricture balloon dilation. The risk of intervention failure is greatly increased in case of the stricture length is more than 10 mm and technical difficulties of ballooning indicating a high resistance of the narrowed portion of the ureter to dilation.

[Herpesviruses and biomarkers in disseminated encephalomyelitis and multiple sclerosis in children (part II)]

Recently, the problem of demyelinating diseases in children is still very acute. This occurs, on the one hand, by high access and specificity of diagnostic methods and, on the other hand - by high morbidity of children different neuroinfectious diseases which can lead to demyelinating diseases. This literature review presents the currently available information on the autoantibodies and neurospecific protein role in the development of multiple sclerosis and acute disseminative encephalitis in children. The authors also describe their experience of complex etiopatogenic therapy and cytoflavin use that helps to reduce frequency and expression of demyelinating process and endothelium dysfunction in case of active herpesvirus infection.

[Herpesviruses and biomarkers in disseminated encephalomyelitis and multiple sclerosis in children]

The relevance of the study of demyelinating diseases is due to their increasing frequency in children, clarification of the role of infectious agents in their genesis, as well as the possibility of transformation of disseminated encephalomyelitis into multiple sclerosis. The literature review presents the currently available information on the causes of the development of demyelinating diseases, biomarkers of disseminated encephalomyelitis and multiple sclerosis, the causes of an unfavorable course and possible laboratory parameters indicating the transition from one disease to another, which can be used as prognostic factors. The authors also noted the experience of the authors on the importance of adequate etiopathogenetic therapy in changing the nature of the course of the disease, in particular, when confirming the relationship between the frequency of exacerbations of ADEM and MS with the activation of herpesvirus infections, courses of specific antiviral therapy are effective, as well as pathogenetic therapy aimed at correcting endothelial dysfunction using the drug cytoflavin.

Targeting Circulating SINEs and LINEs with DNase I Provides Metastases Inhibition in Experimental Tumor Models

Tumor-associated cell-free DNAs (cfDNAs) are found to play some important roles at different stages of tumor progression; they are involved in the transformation of normal cells and contribute to tumor migration and invasion. DNase I is considered a promising cancer cure, due to its ability to degrade cfDNAs. Previous studies using murine tumor models have proved the high anti-metastatic potential of DNase I. Later circulating cfDNAs, especially tandem repeats associated with short-interspersed nuclear elements (SINEs) and long-interspersed nuclear elements (LINEs), have been found to be the enzyme's main molecular targets. Here, using Lewis lung carcinoma, melanoma B16, and lymphosarcoma RLS₄₀ murine tumor models, we reveal that tumor progression is accompanied by an increase in the level of SINE and LINEs in the pool of circulating cfDNAs. Treatment with DNase I decreased in the number and area of metastases by factor 3-10, and the size of the primary tumor node by factor 1.5-2, which correlated with 5- to 10-fold decreasing SINEs and LINEs. We demonstrated that SINEs and LINEs from cfDNA of tumor-bearing mice are able to penetrate human cells. The results show that SINEs and LINEs could be important players in metastasis, and this allows them to be considered as attractive new targets for anticancer therapy.

Alteration of the exDNA profile in blood serum of LLC-bearing mice under the decrease of tumour invasion potential by bovine pancreatic DNase I treatment

Taking into account recently obtained data indicating the participation of circulating extracellular DNA (exDNA) in tumorigenesis, enzymes with deoxyribonucleic activity have again been considered as potential antitumour and antimetastatic drugs. Previously, using murine Lewis lung carcinoma and hepatocellular carcinoma A1 tumour models, we have shown the antimetastatic activity of bovine DNase I, which correlates with an increase of DNase activity and a decrease of exDNA concentration in the blood serum of tumour-bearing mice. In this work, using next-generation sequencing on the ABS SOLiD^™ 5.500 platform, we performed a search for molecular targets of DNase I by comparing the exDNA profiles of healthy animals, untreated animals with Lewis lung carcinoma (LLC) and those with LLC treated with DNase I. We found that upon DNase I treatment of LLC-bearing mice, together with inhibition of metastasis, a number of strong alterations in the patterns of exDNA were observed. The major differences in exDNA profiles between groups were: i) the level of GC-poor sequences increased during tumour development was reduced to that of healthy mice; ii) levels of sequences corresponding to tumour-associated genes Hmga2, Myc and Jun were reduced in the DNase I-treated group in comparison with non-treated mice; iii) 224 types of tandem repeat over-presented in untreated LLC-bearing mice were significantly reduced after DNase I treatment. The most important result obtained in the work is that DNase I decreased the level of B-subfamily repeats having homology to human ALU repeats, known as markers of carcinogenesis, to the level of healthy animals. Thus, the obtained data lead us to suppose that circulating exDNA plays a role in tumour dissemination, and alteration of multiple molecular targets in the bloodstream by DNase I reduces the invasive potential of tumours.

[The markers of damage of neurons and glia in cerebrospinal liquor under meningitis in children.]

The actuality of analysis of cerebrospinal fluid under meningitis in children is conditioned by severity of course of disease with development of residual aftermaths in part of patients. The appearance of proteins specific for neurons, astro- and oligodendroglia in liquor and blood serum can serve as a marker of severity of damage of cerebral parenchyma and as a predictor of development of neurological deficiency. The analysis was applied to samples of liquor obtained during diagnostic lumbar puncture in 44 children (33 with viral serous meningitis, 11 with bacterial purulent meningitis). The detection of protein S-100, glial fibrillar acid protein and and neuron-specific enolase was implemented using solid-phase immune enzyme technique. The maximal increasing of concentrations of protein S-100 and glial fibrillar acid protein was detected at initial stage of bacterial purulent meningitis with consequent decreasing of at the stage of re-convalescence. Under serous meningitis at acute stage maximal high proved to be average value of concentration of neuron-specific enolase with tendency to its increasing at the stage of re-convalescence. The multi-directional correlation relationships are established concerning levels of of neuron-specific enolase, glial fibrillar acid protein and protein S-100 with standard liquorologic indices and their direct mutual relationships. The variability of levels of neuron-specific proteins in liquor is established associated with clinical characteristics of course of meningitis in children that testifies possibility of their application for specifying involvement into pathological process of different brain structures and necessity of further studying of relationship of infection affection of brain with development of neurological aftermaths at the residual period.

[Pathogenetic mechanisms of demyelinating diseases of the central nervous system in children]

OBJECTIVE

To study cerebrospinal fluid and protein indices characterizing the permeability of the hematoencephalitic barrier and intrathecal immunoglobulin synthesis in children with different course and outcome of demyelinating diseases of the central nervous system.

MATERIAL AND METHODS

We examined 72 children with demyelinating diseases of the central nervous system and 16 children of a control group (without neuroinfections).

RESULTS

Differences in the concentration of myelin basic protein, immunoglobulin G, albumin and immunoglobulin indices in the cerebrospinal fluid were determined depending on acute, prolonged, chronic course of disseminated encephalitis and multiple sclerosis in children. The maximum value of the immunoglobulin index and the intrathecal immunoglobulin synthesis index was identified in multiple sclerosis. The correlations of cerebrospinal fluid indicators and protein factors in the acute period of demyelinating diseases and the formation of neurologic deficiency in the disease outcome were determined that can be used for prognostic purpose.

CONCLUSION

The alterations in the indices obtained in this study can be included in the algorithm of laboratory examination. The results prove the involvement of various mechanisms in the pathogenesis of demyelinating diseases of the central nervous system in children.

[The prognostic value of biochemical indicators under neonatal hepatitis of different etiology]

Recently, the share of children with verified neonatal hepatitis induced by genetic predisposition, malformations of biliary tracts, inborn infections with affection of hepatobiliary system increased. The comprehensive biochemical examination of 62 children aged from 1.5 months to 2 years old with diagnosis of neonatal hepatitis. The changes of standard indicators of cytolysis, cholestasis and protein metabolism were on average moderate in group with reliable increase of protein concentration of acute phase of inflammation. The peak changes of biochemical indicators during primary examination are revealed in group of children with malformations of hepatobiliary system conditioned by viruses of herpetic group and in the process of development of expressed fibrosis of liver up to first year of life. The detection of proteins of acute phase makes it possible to objectively evaluate the presence of prolonged inflammatory process in liver and to promote prognosis of course of neonatal hepatitis in children of early age and timely correction of therapy and improvement of outcomes of disease. The detection of C-reactive protein, alpha2-macroglobulin and alpha1-antitripsin is recommended to be included into algorithm of examination of children with neonatal hepatitis.

[Atrial fibrillation registered for the first time: characteristics of clinical course, treatment, prognosis]

To study the clinical presentation of the first episode of atrial fibrillation (AF), treatment tactics and its compliance with current recommendations, features of the further clinical course and prognosis in patients with AF we performed a retrospective study on data of Polyclinic No 1 of the General Management Department of the President of RF . We analyzed data from 58 patients (36 men, 22 women) from January 2009 to September 2011 inclusive. The first episode of AF was recorded in the age from 48 to 90 years (in 39.7% of patients - aged 80 to 90 years old), mostly had paroxysmal character (84.5%), in 82.1% of cases was accompanied by marked clinical symptoms: sense of disruption of the heart (50%), feeling short of breath (28.6%), weakness (17.9%). In 87% of cases clinical symptomatology required calls for medical emergencies. In 42.9% of cases uncontrolled hypertension was possible predisposing factor for developing AF. Paroxysmal AF moved to constant in 38.8% of patients during the period from 1 year to 18 years. Due to the high risk of thromboembolic complications (2 to 5 on a scale of CHADS2), after the detection AF warfarin was shown to 96.6% of patients, because of the high risk of bleeding in practice was appointed only 37.9%. Complications of therapy in the form of bleeding were 9.1%. Tactics of rhythm control by antiarrhythmic drugs I and III classes has remained in 36.7% of patients with paroxysmal AF. -adrenoblockers were constantly taken by 63.3% of the patients using antiarrhythmic drugs I and III classes for relief of arrhythmia during her recurrence (the strategy of "pill in pocket").

[The immunologic factors in cerebrospinal liquor under bacterial, fungous or parasitic neuro-infections: a literature review]

The prognosis of course and outcome of inflectional inflammatory diseases of central nervous system, indicators of inflammatory reaction and immune response in cerebrospinal liquor in patients has been investigated.

[Newly developed atrial fibrillation among patients under active observation by an outpatient clinic]

We carried out prospective cohort study of incidence of new cases of atrial fibrillation (AF) in a sample of Moscow population (patients under observation in our policlinic). Total incidence of AF between 2003 and 2009 was 7.7 per 1000 patient/years, it was higher among men than among women. Incidence of AF progressively increased with age reaching maximum in age group more or equal 85 years. Most frequent baseline disease in patients with first appearance of AF was hypertensive disease (71%). Ischemic heart disease diagnosed according to strict criteria (postinfarction cardiosclerosis, revascularization procedures) was registered in 20.1%, diabetes - in 15.7%, chronic heart failure - in 13%, valvular heart disease - in 5.6%, and history of acute ischemic stroke - in 2.5% of patients.

[Detection of risk factors and early manifestations of cardiovascular diseases during ambulatory examination of working age persons]

We have studied prevalence of risk factors (RF) of cardiovascular diseases (CVD) recorded for statistical purposes in subjects of able bodied age during 10 year period of observation in a policlinic as well as prevalence of early and/or oligosymptomatic CVD manifestations in 11762 subjects of working age with RF of CVD development according to results of complex noninvasive examination of cardiovascular system in ambulatory conditions during the period from 2000 to 2009 year. Numbers of men and women were 45.3 and 54.7%, respectively. The program of examination included analysis of ECG, echocardiography (EchoCG), ultrasound examination of brachiocephalic vessels, 24-hour Holter ECG monitoring, exercise test on treadmill. In 2006 and 2007 complex examination was supplemented with 24-hour monitoring of arterial pressure, stress EchoCG, noninvasive arteriography. Complex ambulatory examination of subjects of working age with FR of CVD development with the use of noninvasive methods of functional diagnostics allowed to diagnose in 56% of studied persons various early and/or oligosymptomatic CVD manifestations which often appeared in combination, including ischemic heart disease (in 15%), hypertensive disease- (in 42%), cerebral atherosclerosis - (in 23.5%).

[Minimization of endogenous intoxication syndrome by individual choice of drugs for therapy of chronic hepatitis]

The results of clinical and laboratory examination of 107 children suffering from chronic hepatitis B or C were analysed. The biochemical criteria of the endogenous intoxication were investigated. Specific blood tests with antiviral drugs were conducted before the treatment and individual therapy schemes were assigned according to the tests' results. The early and sustained virological response rates during the individual antiviral treatment of the children with chronic hepatitis C proved to be 70.83 and 62.5% respectively.

[Prevalence of atrial fibrillation among patients under observation by an outpatient clinic]

Prevalence of atrial fibrillation among patients attending our policlinic (2.44 and 3.78% in 2002 and 2009, respectively) was higher among men than among women and progressively increased with age achieving maximum in the group of patients aged more or equal 85 years. Paroxysmal and persistent forms were more frequent than permanent AF. Thromboembolic complications, heart failure and valvular heart disease were to a greater degree characteristic of permanent AF.

[Antiviral activity of immunomodulator Selank in experimental influenza infection]

The main objective of this study was to evaluate the antiviral properties of the glyproline Selank in both in vitro and in vivo against the influenza virus strain A/Aichi 2/68 (H3N2). The pronounced antiviral effect of the agent was detected in both systems. Selank added to the cell culture 24 hours before inoculation (a preventive use scheme) showed the highest efficiency, by completely suppressing viral reproduction. The in vivo studies also demonstrated that the highest survival of laboratory animals was observed when the agent was administered by the prevention scheme. The use of Selank in vivo induced the gene expression of interferon-alpha (IFN-alpha), without affecting that of interleukin (IL)-4, IL-10, or tumor necrosis factor-alpha (TNF-alpha). The findings suggest that the mechanism of the antiviral action of Selank may be due to its ability to modulate Th1/Th2/Treg cytokine equilibrium both directly and indirectly via the central nervous system. This is particularly promising if that the agent is synthesized on the basis of an endogenous peptide and that it has no negative effects is kept in mind.

[Clinical aspects of autologous blood donation in cardiosurgery]

The paper presents auto donation protocols and a procedure for autodonor plasmapheresis used in cardiosurgical patients, complications, and their preventive measures on the basis of an analysis of 308 autodonor plasmapheresis procedures performed at the Russian Surgery Research Center, Russian Academy of Medical Sciences, in 2007. The preoperative autoblood preservation safety concept envisaging the safety of autodonors during blood donation, the correct storage and issue of autocomponents, and the prevention of adverse reactions to blood exfusion in patients was introduced. The rate of the reactions was 6.4% of the total number of auto donations in cardiosurgical high-risk patients, moderate reaction being most common. The findings indicated that exfusion of 450 ml of blood without previous infusion of plasma substitutes was a cause of collaptoid reactions in 14 cases of the collapse-complicated procedures of autodonor plasmapheresis in cardiosurgical patients (in 70% of the total number of complications). No association was found between of the frequency and severity of complications and the nosological entity, age, and body mass index; however, a further retrospective analysis of 1500 fresh frozen autoblood preservation procedures that have recently made at the Russian Surgery Research Center, Russian Academy of Medical Sciences, is required to have statistically significant data.

[Risk factors prevalence of subclinical forms of cardiovascular diseases among subjects of working age]

The prevalence of preclinical forms of cardiovascular diseases diagnosed by EchoCG, Holter monitoring, functional test, ultrasound of extracranial arteries was analysed among practically healthy subjects at risk of CHD who underwent primary outpatient examination in 1986-1995 Another 172 persons at high risk of cardiovascular disorders were included in the "vascular run" program for short-term medical examination. It is shown that the frequency of pathological conditions diagnosed by the above methods increases in case of combined arterial hypertension and metabolic disturbances (dyslipidemia, excessive body mass, glucose intolerance). Prospective observations revealed high prognostic value of comprehensive assessment of the cardiovascular system. It is concluded that a program of primary evaluation of the cardiovascular system using functional diagnostic tests for the discovery of preclinical disorders in practically healthy subjects should be developed on an individual basis with regard for risk factors and their magnitude.

[Ways of reducing donor blood components during reconstructive surgery of the heart valves under extracorporeal circulation]

Blood loss and transfusion tactics were analyzed in 131 patients who had undergone correction of one, two, and three cardiac valves under general balanced anesthesia and extracorporeal circulation. The volume of intraoperative blood loss was 869+/-298 ml with the range of 700 to 2000 ml. Packed red cells (PRC) were transfused to 9% of patients; fresh frozen plasma (FFP) in 10%, PRC and FFP were transfused to 17% patients. Donor blood was not used in 63.5% of patients in order to save the patient's blood. It comprised the preoperative storage of autologous plasma in a quantity of 300-700 ml, the modified intraoperative reservation of autologous blood in a volume of 400-1200 ml, and, in 70% of patients, the use of washed autologous red blood cells. The hemostasis protocol included the use of epsilon-aminocapronic acid, aprotinin (trasilol) not more than 2,000,000 KUE, and packed platelets. For adequate heparin neutralization, after administration of the calculated dose of protamine, it was long administered in a dose of 25 mg/hour for 4-5 hours. The developed and introduced comprehensive program for the patient's blood maintenance and blood loss diminution made it possible to avoid transfusing PRC and FFP in more than 60% of patients with a blood loss volume of as high as 1500 ml; and to maintain adequate oxygen balance and hemostasis in the remaining patients.

[Outpatient diagnostics of the initial stage of essential hypertension]

The informative value of functional diagnostic methods in the revealing of the initial stage of essential hypertension (EH) in patients with high risk of cardiovascular complications (CVC) and type 2 diabetes mellitus (DM2) was studied. The subjects of the study were 186 men considering themselves practically healthy, with high risk of CVC according to SCORE scale. Mean age of the subjects was 47.9 +/- 0.87 years; persons with various metabolic disorders prevailed. The patients were divided into two groups according to body mass index (BMI): group 1 patients (n = 142) had a BMI of > or = 25 kg/m2 (29.16 +/- 0.49); group 2 (n = 46) patients had a BMI of < 25 kg/m2 (22.95 +/- 0.37). The patients underwent clinical and laboratory examination including the measurement of biochemical parameters of lipid, carbohydrate, and purine metabolism. ECG, EchoCG, and 24-hour blood pressure monitoring (BPM) were performed. Office BP levels, 24-hour BMP data, and signs of left ventricular hypertrophy (LVH) according to ECG and EchoCG were evaluated. The study found that in persons with excessive body weight stable 24-hour arterial hypertension with both systolic and diastolic BP increased prevailed, while in subjects with normal body weight systolic arterial hypertension prevailed. The use of milder LVH criteria (left ventricular myocardial mass index > 116 g/m2) increased the number of persons with stage 2 EH. The prevalence of the initial stage of EH according to 24-hour BPM (87.4%) is 2.8 times higher than that according to office BP measurement (31.3%).

[Laboratory evaluation of the severity of intoxication syndrome in children with bacterial infections]

For the laboratory evaluation of the severity of intoxication syndrome, the spectral characteristics of low and median molecular weight substances (LMMWS) were studied in the plasma and red blood cells of 129 children with bacterial infections, among whom there were 76 children with acute intestinal infections (Flexner's dysentery, Sonne dysentery, and salmonellosis) and 53 children with bacterial purulent meningitis of hemophilic and meningococcal etiology. In the acute period, all the examinees were found to have considerable qualitative and quantitative distinctions of blood spectrograms from the normal values. There was an association of the spectral characteristics of blood LMMWS with the nosological entity, etiology and stage of disease, and the severity of intoxication syndrome. The maximum distinctions from the normal values were detected in children with bacterial meningitis running with complicating the course of acute intestinal infection. There was an increase in the blood levels of LMMWS with the concomitant intercurrent diseases occurring, as compared with the smooth uncomplicated course of disease. The studies of the natural history of disease have indicated a gradual normalization of blood spectrograms; however, in bacterial meningitis, insignificant deviations preserved at the stage of convalescence. The spectral characteristics of plasma and red blood cell LMMWS are proposed to use for the objective appraisal of the severity of intoxication syndrome and the reserve detoxification capacities of blood in children with bacterial infections.

[Fatal and nonfatal cardiovascular complications in patients with essential hypertension (hypertensive disease) during follow-up for many years]

Fatal and nonfatal complications (stroke, myocardial infarction, chronic heart failure, sudden coronary death, chronic renal insufficiency) were registered during long term follow-up of 529 patients with hypertensive disease and results were analyzed retrospectively. Duration of ambulatory treatment in two thirds of patients exceeded 15 years. There were 243 deaths in 1993-1999. Mean age of those who died was 75 years. Main fatal complications were strokes and myocardial infarctions. Their rates were similar. Strokes comprised one third of all deaths irrespective of age. There were no significant differences between rates of ischemic and hemorrhagic strokes. Among causes of death proportion of sudden death was the highest in patients younger than 60 years while that of chronic heart failure rose with age. There were no cases of chronic renal failure. Atherosclerotic lesions in coronary and cerebral vessels were found at autopsies irrespective of cause of death.

[Endoscopic video-surgical treatment of children with cryptorchism]

Technical methods of laparoscopic orchiopexy were designed for patients with the abdominal form of cryptorchism. Results of the operations and substantiation of using the method are described. An evaluation of the effectiveness of the laparoscopic method of descending the testes was compared with that of a traditional operation using the inguinal access on the basis of an analysis of long-term results of the surgical treatment.

[Use of plasmapheresis in the treatment of drug-resistant cardiac arrhythmias]

AIM

To study the therapeutical efficiency of plasmapheresis (PA) in patients with drug-resistant cardiac arrhythmias (CA) and its mechanisms.

MATERIALS AND METHODS

Discrete PA sessions were carried out in 56 patients with drug-resistant CA: paroxysmal atrial arrhythmia (AA), ventricular and supraventricular premature contractions, supraventricular tachycardia of various etiology. Biochemical blood values, coagulographic parameters, lipid peroxidation (LPO), the spectrum of nonesterified fatty acids (NEFA), the level of medium-sized molecules were determined, ECG monitoring, EchoCG, and left ventricular radioisotope computed tomography were performed before and after a PA session.

RESULTS

PA was effective in 50% of cases. The duration of its effect averaged 3.0 (1.25-5.0) months. PA was more beneficial for patients with IHD, AA with normal left atrial dimensions, and hyperlipidemia. The duration of the effect was significantly higher when antiarrhythmic drug therapy was continued after PA. Due to PA, there were significant decreases in the blood concentrations of cholesterol, medium-sized molecules, malonic dialdehyde (MDA) and in the proportion of polyunsaturated NEFA. The antiarrhythmic effect was associated with the decreases in MDA and NEFA, with a tendency for a reduction in the rate of chemiluminescence.

CONCLUSION

PA may be used in the treatment of drug-resistant CA. The most significant mechanism of its antiarrhythmic activity is to recover sensitivity to antiarrhythmics. The intrinsic antiarrhythmic activity may be associated with its effect on NEFA metabolism and LPO; however, its mechanisms await further studies.

[Influence of posttransplantation plasmapheresis on results of transplantation of a cadaveric kidney]

Plasmapheresis was performed with "Haemonetics" (USA), PCS-Ultralite and MCS+ devices. During one procedure 1750-3550 ml of plasma were removed. Results were evaluated by the following parameters: diuresis within 24 hours after surgery, number of hemodialysis sessions after surgery, period of normalization of creatinine in blood. In patients of the study group oligoanuria was seen 4.5 times more rarely than in the control group, they needed less sessions of hemodialysis. Level of creatinine normalized earlier in the study group. Actually survival of patients with potent transplants was higher in the study group than in the controls. It is concluded that plasmapheresis has positive influence on the course of posttransplantation period.

[Chromatographic analysis of low molecular weight fraction of cerebrospinal fluid in children with acute neuroinfections]

Low molecular-weight (oligopeptide) fraction of the cerebrospinal fluid was analyzed by high-performance reversed phase liquid chromatography in 30 children with bacterial and viral neuroinfections. The incidence and height of chromathoraphic peaks in bacterial meningitis depended on the disease etiology, stage, and severity. Qualitative and quantitative composition of low molecular-weight fraction of the liquor varied in patients with viral neuroinfections, depending on the severity of the cerebral parenchyma involvement. Differences in chromatographic profiles in complicated and uneventful course of neuroinfections indicate a possible damaging, protective, or regulatory effect of the liquor peptides. These data focus the attention on the role of oligopeptides in the genesis of neuroinfectious process, significance of search for peptide markers, their further isolation, identification, and development of test systems available for clinical application.

[Diagnostic significance of the cerebrospinal fluid protein spectrum in bacterial and viral meningitis in children]

Protein spectrum of the cerebrospinal fluid (CSF) was studied by polyacrylamide gel disk electrophoresis in 119 children with bacterial and 17 with viral meningitis of different origin over the course of disease. Liquor proteinograms of patients were compared with those of 37 children without meningitis. Protein spectra of the CSF were shifted in the patients. These shifts can serve as differential diagnostic markers: types 1-2 and 2-2 haptoglobins and beta-lipoprotein appears in the blood during the acute period of disease. More pronounced and stubborn changes in the CSF protein spectrum in pneumococcal and hemophilic meningitis correlated with a more severe clinical course and formation of residual neurological consequences. Progress of dysproteinemic shifts in the protein spectrum of the CSF was characterized by a many-fold increase in the concentrations of high-molecular-weight proteins and decreased relative content of liquor-specific fractions, indicating sharp impairment of the blood-brain barrier permeability and formation of brain edema. Disk electrophoresis method is characterized by high resolution, informative value, requires low amounts of CSF for analysis, and is recommended as an accessory diagnostic test for infectious hospitals.

[The advantage of the laparoscopic method of examining patients with nonpalpable testes]

The authors compared the diagnostical value of traditional operations with the inguinal access and a new method using laparoscopy for treatment of patients with testis aplasia. The laparoscopic method of examination was found to be preferable since it allows the correct diagnosis to be made in 96% of children with cryptorchism.

[Unsolved questions of infectious endocarditis prophylaxis in outpatients practice]

AIM

To check practical feasibility of recommendations of prevention of infectious endocarditis (IE) and to provide more accurate figures on the occurrence of valvular lesions in working population.

MATERIALS AND METHODS

Subacute IE manifestations have been analysed in 10 patients of a general outpatient clinic. Echocardiograms of 6209 patients under 60 years of age were studied retrospectively.

RESULTS

In one-third of the patients IE developed in the presence of streptococcal and staphylococcal infection. In all the cases cardiac valve involvement was stated. In 4 cases changes in the valve were not accompanied my impairment of the valvular function. By echocardiography, valvular structure changes without valvular disease were detected 2.3 times more frequently that valvular disease. Difficulties presenting in outpatient IE prophylaxis are outlined.

CONCLUSION

Advances in IE prevention will be achieved if echo-CG becomes a mandatory examination in the program of working population check-up, if early diagnosis of streptococcal ENT infection is made, if physicians of different specialties work as a team.

[Contemporary quality control of inpatient care according to the survey]

A sociologic survey was carried out in one of the large multi-profile hospitals of St. Petersburg. A total of 220 questionnaires were distributed. The questionnaire included twenty signs by which the respondents assessed the quality of medical care and expressed their opinion on how it may be improved.

[Heart transplantation conducted at the All-Union Research Center of Surgery (the first clinical experience)]

The authors analyse experience in the first eight operations for orthotopic transplantation of the heart. Six patients were discharged from the clinic with good immediate results. Comparison of their own data with summarized results gained in other countries allowed the authors to define some specific problems which are of practical interest for clinics embarking on the clinical realization of the problem of heart transplantation.

[Mitral valve dysplasia as a cardiac surgery problem (a clinico-morphological comparison)]

Clinical appearance of mitral incompetence associated with mitral dysplasia (abnormal connective tissue structure in the cusps and chordae, with significant accumulation of acid mucopolysaccharides) is dependent on the extent of regurgitation, its pathogenetic mechanism (sudden or progressive), the presence of the prolapsing cusp syndrome, and attendant complications (endocarditis, chord abruption). Indications for surgery were marked regurgitation in 94% of patients, and septic endocarditis in 6%.

[Treatment of auricular fibrillation after correction of rheumatic heart disease under extracorporeal circulation]

Of 372 patients operated on for rheumatic valvular defects under extracorporeal circulation, 221 patients had chronic atrial fibrillation. In 41 patients, the duration of arrhythmia ranged from a few months to 2 years. Sinus rhythm was recovered in 22 patients, using quinidine and electric-impulse treatment, and 19 patients have maintained it continuously for many years. Factors contributing to stable and lasting sinus rhythm are an adequate correction of the defect, inactive rheumatic process, and the duration of atrial fibrillation not exceeding 1-2 years. The optimum time for sinus rhythm recovery is 2-6 months after surgery. Sinus rhythm recovery prior to surgical correction of the defect is not recommended.

[Role of mitral valve dysfunction in the development of cardiac insufficiency in postinfarct cardiosclerosis]

The clinical suggestion on the dysfunction of the mitral valve in 20 patients with post-infarction cardiosclerosis was confirmed by ventriculography (8 persons) and in autopsy (12 persons). The paper presents a clinical characteristics of the both groups of patients, the indices of the central hemodynamics, the end diastolic pressure in the left ventricle of the heart, coronaroangiography, as well as morphometric data of the examination of the hearts and of the extent of the scar lesions of the myocardium in patients who died of congestive cardiac insufficiency against the background of postinfarction cardiosclerosis combined with the papillary muscle affection.