Experimental Model for the Study of Reparative Bone Regeneration in the Reconstruction of the Lower Jaw

An experimental in vivo model has been developed on the rabbit mandible to study reparative regeneration of alveolar bone after intercortical split osteotomy and the role of the periosteum in the process of reparative osteogenesis. The peculiarity of this model is fixation of the periosteum over the reconstruction zone, which allows preserving the bone block displaced during surgery and leads to the formation of an organotypic structure of the regenerate with cortical and spongy bone.

[Prevalence and risk factors of delirium in COVID-19]

OBJECTIVE

To assess the frequency and risk factors of delirium in patients hospitalized with COVID-19.

MATERIAL AND METHODS

Four hundred and forty patients admitted to the Infectious Diseases Hospital of the University Clinical Hospital No.3 of Sechenov University were included in the study. The Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Screening Questionnaire-7 (GAD-7), the Insomnia Severity Index (ISI), the Delirium severity rating scale (DRS-R-98) were administered.

RESULTS

Delirium was detected in 27.8% of patients. Significant risk factors were age (p=0.002), severity of respiratory failure (p=0.005), concomitant somatic disease (p=0.003), and respiratory therapy (p<0.001). There was an association between severe anxiety (p<0.001) and insomnia (p=0.07) observed at admission with the risk of developing delirium during the hospital stay.

CONCLUSION

The study reveals a high prevalence of delirium in patients with COVID-19. In order to prevent delirium and/or reduce the risk, early diagnosis and identification of preclinical forms are of particular importance.

[Soy protein as part of a low-protein diet is a new direction in cardio- and nephroprotection in patients with 3B-4 stages of chronic kidney disease: prospective, randomized, controlled clinical study]

BACKGROUND

It has been established that the use of a low-protein diet (LPD) in combination with ketoanalogues (KA) of essential amino acids can contribute to cardio- and nephroprotection in chronic kidney disease (CKD). Moreover, it has been shown that replacing part of the animal protein with soy protein (SP) in the diet contributed to more pronounced nephro- and cardioprotection in CKD, however, the data, available in the literature, are mainly represented by experimental studies.

AIM

To compare the effects of 2 types of diets on the main parameters of nephro- and cardioprotection in patients with CKD.

MATERIALS AND METHODS

We have conducted a prospective, randomized, controlled clinical study which included 85 patients with 3B4 stages of CKD, compliant to LPD (0.6 g of protein/kg body weight) + KA (1 tablet/5 kg body weight). 43 patients (Group 1) received LPD with replacing animal protein with soy (60% soy protein + 40% another vegetable proteins) + KA, and 42 patients (control group, Group 2) received LPD (60% animal protein + 40% vegetable protein) + KA, within 12 months.

RESULTS

The dietary substitution of animal protein with SP to a greater extent delayed the decrease in glomerular filtration rate (-5.9% vs -13.3%; p=0.048), the increase in left ventricular hypertrophy (+4.7% vs +12.3%; p=0.042), as well as the increase in central systolic blood pressure (+2.6% vs +13.0%; p=0.021), augmentation index (+7.6% vs +23.3%; p=0.010), slowed down the decrease in lean body mass in men (+0.9% vs -11.2%; p=0.017) and women (-1.8% vs -10.3%; p=0.024), increase in phosphorus (-10.3% vs +13.0%; p=0.029), cholesterol (-10.7% vs -3.4%; p=0.047) and urea (+6.3% vs +19.6%; p=0.035) serum levels.

CONCLUSION

The use of LPD with substitution of animal protein with soy protein + KA provides a more pronounced effect on nephro- and cardioprotection as well as maintenance of nutritional status, than conventional LPD + KA in patients with 3B4 stages of CKD.

[Rationale for the use of bioactive cements by in vitro simulation of accidental pulp opening]

OBJECTIVE

To study the features of reparative dentinogenesis when using biomaterials during accidental opening of the pulp in an experiment.

MATERIAL AND METHODS

In an experiment on 3 dwarf pigs of the Svetlogorsk breed a traumatic opening of the tooth cavity was carried out in 18 teeth (6 molars, 6 premolars, 6 incisors), then Biodentin (9 teeth) and Aurosil (9 teeth) were applied on the opened pulp horn. After 14, 30 and 60 days, dwarf pigs were euthanized, and jaw blocks taken. Histological examination of the teeth was carried out using the method of embedding in methyl methacrylate (OsteoBead, Sigma, USA). Thin sections of 35-50 microns were made from the samples and stained using the «Heavenly Trichrome» method. Documentation was carried out using a Leica DM100 microscope and an EC3 digital camera in reflected and transmitted light.

RESULTS

Histological examination of the thin sections of teeth stained according to the «Heavenly Trichrome» method revealed that 2 weeks after the pulp opening and applying of Aurosil and Biodentin, comparable processes occurred in the tooth cavity. Thus, the proliferation of odontoblasts was noted on the lateral surfaces of the chamber. New dentin layers and odontoblasts spread over the lower surface of the material with the formation of dentinal bridges by 4 weeks of observation in both groups. By week 12, there was a decrease in the proliferative activity of odontoblasts and dentin maturation in all cases. At the initial stages of the experiment, some pulp edema and moderate plethora were noted, which was no longer observed at 4 weeks. By 12 weeks, because of the proliferation of odontoblasts, the volume of the tooth cavity was reduced by a third. By the 6th month in the experiment, no significant changes in the structure of dentin and pulp were revealed.

CONCLUSION

According to morphological data the studied biomaterials (Aurosil and Biodentin) contribute to dentin regeneration equally.

[Organ changes found by postmortem examination in COVID-19 patients]

The postmortem study results presented in 20 sources of literature on 186 COVID-19 patients were analyzed. Pathological changes were noted in multiple organs, by involving predominantly the respiratory, circulatory, and excretory systems. The changes in the lungs were characterized by an increase in organ weight (59.3%), a dark red color of the parenchyma (47.4%), compaction of lung tissue (56%), and signs of lung congestion (37.3%). The histological characteristics found during postmortem lung tissue examination, which were indicative of diffuse alveolar damage, were proliferation of type II alveolocytes in 65.2% of cases, the appearance of hyaline membranes lining the alveoli in 64.4%, and interstitial edema in 54.2%. In the analyzed sources, 22% of cases were noticed to have severe thrombosis and pulmonary artery branch embolism that was associated with lower extremity deep vein thrombosis. In all the sources of literature, acute tubular necrosis, tubular luminal dilatation, and interstitial edema were detected in the kidneys.

Bilateral thalamic stroke in patient with patent foramen ovale and hereditary thrombophilia

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

Bilateral thalamic stroke in patient with patent foramen ovale and hereditary thrombophilia

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

[Regeneration of dental pulp tissue using pulpal autologous mesenchymal stem cells and platelet-rich plasma]

Regeneration of pulp and dentin could be important in operative dentistry as a method to save teeth. Currently cell population from dental pulp of deciduous and permanent teeth of humans and laboratory animals are isolated and characterized. The paper presents a study on pulp regeneration using autologous mesenchymal stromal cells from pulp of molars in combination with fibrin clot, transplanted in pulp chamber of miniature pigs after pulp removal. The results proved that transplantation of autologous multipotent stromal cells of dental pulp in combination with autologous platelet-rich plasma in pulp chamber of miniature pigs after pulp removal leads to pulp restoration and reparative dentinogenesis with dentinal bridge formation on the 30th day. However, the completion of regeneration also results in a decrease in the pulp chamber volume due to the neodentin bedding. Tissue regeneration of dental pulp by direct pulp capping in the absence of inflammatory processes is a promising direction of the use of cellular technologies.

[ISCHEMIA - the Largest Ever R andomized Study in Stable Coronary Artery Disease. Baseline Characteristics of Enrolled Patients in One Russian Site]

Indications for coronary revascularization in patients with stable coronary heart disease (CHD), presented in the current international guidelines are largely based on the clinical trials conducted sometimes more than 30 years ago. ISCHEMIA is the major multicenter international randomized trial intended to answer the question about the optimal treatment strategy in stable coronary artery disease at the present time.

PURPOSE

To analyze the most important baseline characteristics of patients enrolled in the ISCHEMIA study in one Russian site.

METHODS

The principal inclusion criteria are a positive stress test (in our center, exercise stress echocardiography) of at least moderate risk and obstructive coronary heart disease confirmed by coronary computed tomography angiography (CCTA). Main exclusion criteria are a significant stenosis of the left main coronary artery by CCTA, clinical progression/destabilization of the ischemic heart disease, angina of IV CCS class, left ventricular ejection fraction (EF) 80% - beta blockers, >80% - ACE inhibitors/ARBs. They are at well controlled resting heart rate (.

[Behçet's disease: Intracardiac thrombosis (a description of two cases and a review of literature)]

Behçet's disease (BD) is systemic vasculitis of unknown etiology, which is more common in the countries located along the Great Silk Road. The disease is diagnosed if a patient has 4 key diagnostic signs: aphthous stomatitis, genital sores, and eye and skin lesions. Vascular diseases referred to as minor criteria for BD are characterized by the formation of aneurysms and thrombosis, predominantly in the venous bed. In venous disorders, a blood clot can form in any vessel, including caval, cerebral, pulmonary, and other veins. The paper describes two clinical cases of BD with intracardiac thrombosis. In one case, a 24-year-old male patient with a documented diagnosis of BD, echocardiography revealed a left ventricular spontaneous echo contrast phenomenon that disappeared due to immunosuppressive therapy. The other case was a 34-year-old female patient, in whom the diagnosis was based on the international disease criteria: aphthous stomatitis, skin lesions (pseudopustulosis, erythema nodosum), and genital sores. Computed tomographic angiography showed a 3.7×2.2-cm mass (thrombus) in the right atrium. In addition, blood clots were present in the hepatic and inferior vena cava. No abnormalities in the coagulation system were found in both cases.

Thermoplasmonic Semitransparent Nanohole Electrodes

Nonradiative decay of plasmons in metallic nanostructures offers unique means for light-to-heat conversion at the nanoscale. Typical thermoplasmonic systems utilize discrete particles, while metal nanohole arrays were instead considered suitable as heat sinks to reduce heating effects. By contrast, we show for the first time that under uniform broadband illumination (e.g., the sun) ultrathin plasmonic nanohole arrays can be highly competitive plasmonic heaters and provide significantly higher temperatures than analogous nanodisk arrays. Our plasmonic nanohole arrays also heat significantly more than nonstructured metal films, while simultaneously providing superior light transmission. Besides being efficient light-driven heat sources, these thin perforated gold films can simultaneously be used as electrodes. We used this feature to develop "plasmonic thermistors" for electrical monitoring of plasmon-induced temperature changes. The nanohole arrays provided temperature changes up to 7.5 K by simulated sunlight, which is very high compared to previously reported plasmonic systems under similar conditions (solar illumination and ambient conditions). Both temperatures and heating profiles quantitatively agree with combined optical and thermal simulations. Finally, we demonstrate the use of a thermoplasmonic nanohole electrode to power the first hybrid plasmonic ionic thermoelectric device, resulting in strong solar-induced heat gradients and corresponding thermoelectric voltages.

[Hemodynamic Predictors of Clinical Deterioration in Patients With Pulmonary Arterial Hypertension Associated With Systemic Scleroderma]

OBJECTIVE

to elucidate hemodynamic predictors of clinical deterioration (CD) in patients with pulmonary arterial hypertension (PAH) associated with systemic scleroderma (SSD).

MATERIAL AND METHODS

We included into this study 48 patients with PAH-SSD consecutively admitted in 2004-2014. At inclusion all patients underwent right heart catheterization (RHC) and thereafter were under dynamic observation. CD deterioration was diagnosed in the presence of the following: >15% decline in 6-minute walk test distance; worsening of PAH functional class; intensification of symptoms of right ventricular failure; necessity in administration of parenteral diuretics. RHC was used for confirmation of CD. Relative risk (RR) of events was calculated for identification of significant predictors of CD. Cut points were determined with the help of construction of characteristic curves, statistical significance was estimated in Kaplan-Meier analysis.

RESULTS

During follow-up (duration 46 [23;91] months) 21 patients had 24 CDs confirmed by RHC. Calculation of RR identified a number of hemodynamic parameters related to CD development. ROC analysis confirmed significance of initial right atrial pressure (RAP) 6.5 mm Hg (95% confidence interval [CI] 0.59-0.89, sensitivity 71%, specificity 63%, p<0.004) and dynamics of pulmonary vascular resistance (PVR) -1.06 Wood units (95%CI 0.790.99; sensitivity 76%, specificity 80%, <0.0001). Kaplan-Meier analysis revealed significant differences in times to CD (median 31.5 and 10 months in patients with RAP <6.5 and more or equal 6.5 mm Hg, respectively, p=0.01; 37 and 17months in patients with PVR lowering >1.06 Wood units and no PVR lowering, respectively, p=0.009.

CONCLUSION

We identified prognostic levels of key hemodynamic predictors of CD in patients with SSD and PAH (RAP 6.5 mm Hg, PVR - 1. 06 Wood units) which can be used for individualization and optimization of therapy.

[The age-specific changes in the histological structure of the thyroid cartilage in the men]

The objective of the present study was to elucidate the morphological and morphometric characteristics of the human thyroid cartilage during different periods of life. The thyroid cartilages were harvested from 70 cadavers of the subjects of the masculine gender who had died at the age from 1 to 93 years from the non-violent causes and had neither injuries nor signs of pathological changes in the neck organs. The microscopic studies were carried out using the standard methods for the staining of the preparations with hematoxylin and eosin. The following parameters were evaluated: the area of the cartilaginous and bone tissues, the average area of the cartilaginous and bone tissues in the field of vision, the average width of the cartilaginous plate, the thickness of the cortical plate, the number of trabeculae, the average area and length of the trabeculae, the average, minimal, and maximum area of the trabeculae, the number of the young and mature chondrocytes, the width of the zones of the young and mature cartilage and their ratio, the area of the reticular-fibrous and adipose tissues and their ratio. In addition, we also determined mean values, standard deviations, correlation coefficients, and the significance of differences (p). The following characteristics exhibited the most significant correlation with the age: the average area of the bone (r=0.69) and cartilaginous (r=-0.63) tissues, adipose (r=0.67) and reticular fibrous (r=0.61) tissues, the average length of the trabeculae (r=0.7), the number of young chondrocytes in the field of vision (r=-0.789). It is concluded that the described correlations can be helpful in the practical forensic medical activities as the additional diagnostic criteria for the determination of the human age.

[COMPLEX IMMUNOGLOBULIN PREPARATION FOR THERAPY OF PERTUSSIS IN YOUNG CHILDREN]

AIM

Study the possibility of inclusion of complex immunoglobulin preparation (CIP) pos- sessing specific activity against pertussis exotoxins into complex therapy of pertussis infection in young children.

MATERIALS AND METHODS

-2 groups of children with.pertussis younger than 3 years were examined. The main group (50 individuals) received CIPper os - 1 dose 1 - 2 times per day for 5 days, comparison group (34 children) received only basic therapy. Evaluation of clinical effectiveness of CIP was carried out, the content of anti-pertussis class G antibodies and total IgE in patients were studied.

RESULTS

A good clinical effectiveness of the preparation was shown, as well as immune modulating activity against humoral immune response to pertussis infection.

CONCLUSION

The detected positive effect of CIP on pertussis -course in children has indicated a principally novel use of this per oral drug form.

Peculiarities of vitalization of grafts made of porous polytetrafluoroethylene in reconstruction of major veins (an experimental study)

Increased incidence of locally disseminated malignant neoplasms with invasion of major veins compels modern surgery to search for an optimal material for reconstruction of major veins. Presented herein are the results of an experimental study aimed at exploring patency and peculiarities of vitalization of grafts made of porous polytetrafluoroethylene (7th generation, 2010) manufactured by the Closed Joint Stock Company 'Research and Production Complex 'Ecoflon' (St. Petersburg, Russia) with an internal diameter measuring 4.0 mm and used for reconstruction of major veins and arteries with a follow up period up to 270 days. Vitalization of porous polytetrafluoroethylene grafts in the venous position is comparable to that in the arterial position, having similar patterns. Both in the arterial and venous position, vitalization of the graft proceeds at the expense of 'crawling' of the neointima from the anastomoses to the centre of the graft. To distinctive peculiarities of vitalization of grafts in the venous position belong statistically significantly larger thickness of the neointima in the venous position at all stages of the study, lack of statistically significant difference of the neointimal thickness near the edges and in the central part of the graft in the venous position at 270 days. Neither thromboses nor haemodynamically meaningful stenoses of the porous polytetrafluoroethylene grafts and anastomoses in the venous position, despite low velocity of blood flow and its laminar pattern, were observed at any terms of follow up. The obtained findings are indicative of the possibility and validity of using porous polytetrafluoroethylene grafts for reconstruction of major veins in clinical practice.

Surface Contamination of Some Materials of the Space Station ‘MIR’

About 60 samples of various materials exposed to low Earth orbit (LEO) conditions for 997 days on board the orbital space station ‘Mir’ were investigated. The aim was to determine the properties of the contamination layers formed during LEO exposition.

The following methods were used: optical and scanning electron microscopy, local x-ray microanalysis, secondary ion mass spectrometry in fast atom bombardment ionization mode, electron spectroscopy for chemical analysis, temperature programmed desorption mass spectrometry, x-ray phase analysis, spectral reflectance, solar absorbance and relative emittance measurements.

Two effects were observed for all samples: the formation of contamination deposits and the erosion of the substrate–original surface. The relative contribution of both effects changes depending on the sample type and on exposure conditions. The deposit thickness varies on the sample surface over a very wide range (at least five decimal orders of magnitude), changing from values exceeding 100 μm to values of less than 2 nm (possibly these regions do not contain any deposit at all).

The main element of contamination is silicon; the others are potassium and calcium. Evidence of a chemical reaction between the Teflon FEP substrate and the contamination was observed.

[Survival in pulmonary arterial hypertension, associated with connective tissue diseases, treated by sildenafil: results of the prospective study]

AIM

To investigate the effect of sildenafil on the survival of patients with pulmonary arterial hypertension (PAH) associated with connective tissue diseases (CTD), who have been followed up at the Rheumatology Expert Center.

SUBJECTS AND METHODS

A total of 16 patients (all women) with PAH associated with CTD, who had been admitted to the V. A. Nasonova Research Institute of Rheumatology in 2013-2015, were examined. PAH corresponded to Functional Class II in the majority of the patients. After the diagnosis was verified by catheterization of the right heart and pulmonary artery, all the patients received original sildenafil (a phosphodiesterase type 5 inhibitor, a potent vasodilator, the efficiency of which was proven in patients with PAH) at a dose of 20 mg thrice daily. Survival rates and time to clinical deterioration were estimated during a prospective follow-up).

RESULTS

Three-year survival rates were 94% in the study group and 25% in the group of historical control (p < 0.05). The time to clinical deterioration was associated with the duration of the follow-up and hemodynamic parameters (right atrial pressure and changes in vascular resistance within 4 months after therapy initiation).

CONCLUSION

The administration of sildenafil substantially improves survival in patients with PAH associated with CTD as compared with the historical control. The identification of poor prognostic factors in this cohort of patients and early diagnosis will favor the personification of therapy for the fatal manifestation of CTD.

[EXPERIENCE WITH THE USE OF EPTIFIBATIDE IN ACUTE CORONARY SYNDROME DURING CORONARY INTERVENTION IN PATIENTS OLDER AGE GROUP]

Acute coronary syndrome is the leading cause of death in patients older age group. Primary PCI is nearly uncontested revascularization method because of its efficacy in reperfusion achievement and less hemorrhagic complications compared to systemic thrombolytic therapy. Nevertheless, the age of the patients is a significant bleeding risk factor, sophisticating the choice and dosing antiplatelet and anticoagulant therapy during coronary angioplasty and stenting. Blocker 2b/3a receptor eptifibatide are used to avoids the development of ischemic complications and improves myocardial perfusion, but accompanied with bleeding risk during common infusion (12-18 hours). Combined intracoronary and intravenous infusion eptifibatide during only coronary intervention enhance procedure safety.

[THE DYNAMICS AND STRUCTURE OF INDICATORS OF SECONDARY DISABILITY DUE TO CEREBROVASCULAR DISEASES IN THE ELDERLY IN ST. PETERSBURG IN THE PERIOD 2005-2014]

The article presents data about secondary disability due to cerebrovascular diseases in the elderly based on results of examination in the Bureau of medical-social expertise of Saint Petersburg in the period from 2005 to 2014. Тhe analysis revealed a high proportion of the disabled elderly in the structure of disability due cerebrovascular diseases; and the growth of the share of people with disabilities elderly in the analyzed period.

Total phenol analysis of weakly supported water using a laccase-based microband biosensor

The monitoring of phenolic compounds in wastewaters in a simple manner is of great importance for environmental control. Here, a novel screen printed laccase-based microband array for in situ, total phenol estimation in wastewaters and for water quality monitoring without additional sample pre-treatment is presented. Numerical simulations using the finite element method were utilized for the characterization of micro-scale graphite electrodes. Anodization followed by covalent modification was used for the electrode functionalization with laccase. The functionalization efficiency and the electrochemical performance in direct and catechol-mediated oxygen reduction were studied at the microband laccase electrodes and compared with macro-scale electrode structures. The reduction of the dimensions of the enzyme biosensor, when used under optimized conditions, led to a significant improvement in its analytical characteristics. The elaborated microsensor showed fast responses towards catechol additions to tap water - a weakly supported medium - characterized by a linear range from 0.2 to 10 μM, a sensitivity of 1.35 ± 0.4 A M(-1) cm(-2) and a dynamic range up to 43 μM. This enhanced laccase-based microsensor was used for water quality monitoring and its performance for total phenol analysis of wastewater samples from different stages of the cleaning process was compared to a standard method.

[Clinical and hemodynamic characteristics and possibilities for therapy in patients with severe (functional class IV) pulmonary arterial hypertension associated with diffuse connective tissue diseases]

AIM

To study the clinical and hemodynamic characteristics of a group of patients with Functional Class (FC) IV pulmonary arterial hypertension (PAH) developing in the presence of diffuse connective tissue diseases (DCTD) and to evaluate the efficacy of intravenous iloprost.

SUBJECTS AND METHODS

The study enrolled 59 patients with PAN-DCTD, including 7 who had FC IV and 8 who developed this condition during a follow-up. The diagnosis of PAH was based on pulmonary artery catheterization findings. FC IV was diagnosed using the conventional New York Heart Association classification. All the patients received PAH-specific therapy (bosentan, sildenafil); the patients with FC IV had combined therapy; 4 patients were treated with intravenous iloprost calculated with reference to 0.5-2.5 ng/kg/min for 15 days. In addition to the patients with FC IV, 3 patients with unstable FC Ill were given iloprost. Besides targeted therapy, all the patients received standard treatment, including diuretics, and ionotropic therapy.

RESULTS

Evaluation of hemodynamics in patients with different FCs revealed the most important differences in right atrial pressure, cardiac output, cardiac index, and pulmonary vascular resistance. A linear relationship was seen between the level of this indicator and FC, the closest correlation being for hemodynamic parameters characterizing right ventricular systolic function. There were no changes in mean pulmonary artery pressure; only the patients with FC IV were found to have its slight elevation (from 52 ± 15 to 55 ± 11 mm Hg). Pulmonary artery wedge pressure remained unchanged regardless of FC. Intravenous iloprost was noted to have an obvious positive effect on both clinical and hemodynamic parameters. Catheterization verified improvement in 6 out of the 7 patients; no hemodynamic changes were found in 1 patient during 15-day therapy.

CONCLUSION

The patients with FC IV PAH-DCTD have clinical and hemodynamic features responsible for a fatal prognosis. The results of using intravenous iloprost in patients with decompensated PAH associated with scleroderma systematica convince to use its PAH-specific tablets in cases of verified clinical deterioration when taking its dosage form.

[Left and right ventricular diastolic dysfunction in patients with early rheumatoid arthritis before prescribing disease-modifying antirheumatic therapy]

AIM

To estimate the rate of diastolic dysfunction (DD) of the left and right ventricles (LV and RV) in patients with early rheumatoid arthritis (RA) before using disease-modifying antirheumatic drugs (DMARDs) therapy and to investigate its association with traditional risk factors (TRFs) for cardiovascular diseases (CVD) and inflammatory markers.

SUBJECTS AND METHODS

The investigation enrolled 74 patients with a valid diagnosis of RA, including 56 (74%) women (median age, 54 years; disease duration, 7 months); the patients who were seropositive for rheumatoid factor (RF) (87%) and/or anti-cyclic citrullinated peptide (anti-CCP) antibodies (100%) who had not been on DMARDs or glucocorticosteroids. TRFs for CVD and carotid artery atherosclerosis were assessed from duplex scanning data and echocardiography was performed in all the patients with early RA before starting the therapy. The ratio of the maximum blood flow velocity during early diastolic filling (E) to that during atrial systole (A) was used as a criterion for LVDD and RVDD. There were 3 types of impaired ventricular filling: 1) E/A <1; 2) E/A = 1-2; 3) E/A > 2.

RESULTS

LVDD and RVDD were detected in 35 (48%) and 17 (23%) patients, respectively. RVDD was recorded only in conjunction with LVDD. Among LVDD and RVDD, the former was prevalent. All the patients with early RA were divided into 3 groups: 1) patients with LVDD and RVDD; 2) those with LVDD; 3) those without ventricular DD. All the three groups were matched for the level of DAS28, anti-CCP antibodies, and RF. The incidence of arterial hypertension, dyslipidemia, and abdominal obesity was higher in the patients of Groups 1 and 2 than in those of Group 3. There was a progressive decrease in high-density lipoprotein (HDL) cholesterol concentrations and increases in triglyceride (TG) levels and atherogenic index from Group 3 to Group 1, with the concentrations of total cholesterol and low-density lipoprotein cholesterol being similar in the 3 groups. Coronary heart disease was recorded more frequently in Group 2 than in Group 3. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) proved to be also significantly higher in the patients with DD than in those without DD. Correlations were found between LV E/A and ESR, CRP, HDL cholesterol, TG, RV E/A and ESR, DAS28, TG.

CONCLUSION

The patients with early-stage RA were found to have high incidence rates of LVDD and RVDD, which is related to the high prevalence of CVD, the high spread of TRF for CVD, and the high activity of an inflammatory process.

[Impact of bosentan therapy on stress-induced pulmonary hypertension in patients with systemic sclerosis]

AIM

To describe hemodynamic and clinical changes in patients with elevated mean pulmonary artery pressure (MPAP) > 30 mm Hg during exercise and the impact of bosentan therapy on stress-induced pulmonary hypertension (SIPH).

SUBJECTS AND METHODS

The study included 19 patients with systemic sclerosis (SDS) in whom possible causes of pulmonary hypertension (PH) (lung and left heart injuries and thromboembolism) were excluded. All the patients underwent pulmonary artery catheterization at rest and during exercise. The hemodynamic (right atrial pressure (RAP), systolic and diastolic pressure, MPAP, pulmonary artery wedge pressure (PAWP), cardiac output (CO) by a thermodilution technique), clinical (demographic, immunological, and instrumental) parameters were analyzed and the risk of pulmonary arterial hypertension (PAH) was also calculated; 5 patients with SIPH received 16-week bosentan therapy according to the conventional regimen.

RESULTS

Ten of the 19 patients were at increased risk for PAH in accordance with the DETECT scale, but no signs of PH at resting catheterization were found in anybody. In 5 patients, MPAP, was in the range from 21 to 24 mm Hg; in 9 (47%) patients were found to have SIPH, a median MPAP of 35 (32; 41) mm Hg. Seven patients had no diagnostic changes during exercise; 3 patients could not perform an exercise test. There were correlations between MPAP and DETECT risk scores (p < 0.05). The patients with SIPH had significantly higher levels of resting MPAP and exercise pulmonary vascular resistance (PVR) and PAWP. The calculated DETECT risk was significantly higher in the SIPH group. The level of uric acid was also higher in the SIPH group (p < 0.05). There were no changes in NT-proBNP levels, telangiectasias and anti-centromere antibodies, and EchoCG and lung test results. During 16-week bosentan therapy, there was a significant decrease in MPAP and transpulmonary gradient during exercise, but PVR, MPAP/CO ratio and NT-proBNP levels tended to decrease.

CONCLUSION

In the patients with SDS, SIPH may be a stage of pulmonary vasculopathy that precedes the development of clinical PAH. The use of current PAH-specific drugs used at the preclinical stage of the disease may substantially improve lifetime prognosis in patients with SDS-associated PAH.

Modeling of charge transport in ion bipolar junction transistors

Spatiotemporal control of the complex chemical microenvironment is of great importance to many fields within life science. One way to facilitate such control is to construct delivery circuits, comprising arrays of dispensing outlets, for ions and charged biomolecules based on ionic transistors. This allows for addressability of ionic signals, which opens up for spatiotemporally controlled delivery in a highly complex manner. One class of ionic transistors, the ion bipolar junction transistors (IBJTs), is especially attractive for these applications because these transistors are functional at physiological conditions and have been employed to modulate the delivery of neurotransmitters to regulate signaling in neuronal cells. Further, the first integrated complementary ionic circuits were recently developed on the basis of these ionic transistors. However, a detailed understanding of the device physics of these transistors is still lacking and hampers further development of components and circuits. Here, we report on the modeling of IBJTs using Poisson's and Nernst-Planck equations and the finite element method. A two-dimensional model of the device is employed that successfully reproduces the main characteristics of the measurement data. On the basis of the detailed concentration and potential profiles provided by the model, the different modes of operation of the transistor are analyzed as well as the transitions between the different modes. The model correctly predicts the measured threshold voltage, which is explained in terms of membrane potentials. All in all, the results provide the basis for a detailed understanding of IBJT operation. This new knowledge is employed to discuss potential improvements of ion bipolar junction transistors in terms of miniaturization and device parameters.

[Early complications after surgery for middle- and lower-ampullar cancer: total mesorectumectomy or "blind" preparation of rectum?]

It was performed a comparative analysis of parameters of early postoperative period in 318 patients with middle- and lower-ampullar cancer of rectum who underwent total mesorectumectomy and "blind" preparation of rectum. All patients were divided into 2 groups. The main group included 202 patients after total mesorectumectomy. The control group included 116 patients after "blind" preparation of rectum. Statistically significant differences in frequency of laparotomy wounds suppuration, urinary tract dysfunction and postoperative mortality were revealed. These complications were diagnosed more frequent in case of "blind" preparation of rectum. In the main group laparotomy wounds suppuration depended on sex (p<0.001, r=0.65), in the control group - on surgeon's experience (p=0.006, r=0.58), localization of tumor (p<0.001, r= -0.87) and type of surgery (p<0.001, r= -0.76). Urinary tract dysfunction after total mesorectumectomy depended on patient's sex (p<0.001, r=-0.77), after "blind" preparation of rectum - sex (p=0.002, r= -0.39) and performing of preoperative radiation therapy (p<0.001, r=0.46). In the main group none of the analyzed variables effected on the postoperative mortality. In the control group age (p=0.006, r=0.48), intraoperative blood loss (p=0.002, r=0.55), anastomosis failure (p=0.01, r=0.61), postoperative bleeding (p<0.001, r=0.88), early adhesive intestinal obstruction (p=0.006, r=0.77) effected on the mortality. It is considered that total mesorectumectomy in comparison with "blind" preparation of rectum decreases frequency of postoperative complications and mortality.

[Bosentan: a considerable increase in the survival of patients with pulmonary hypertension associated with systemic rheumatic diseases]

AIM

To evaluate the short-term efficacy of the nonselective endothelin receptor antagonist bosentan in the treatment of pulmonary hypertension (PH) associated with diffuse connective tissue diseases (CTD), as well as its effect on survival in both monotherapy and in combination with other PH-specific agents.

SUBJECTS AND METHODS

The study included 20 CDT-associated PH patients who had been hospitalized in 2009-2013. All the patients had valid diagnoses of scleroderma systematica (SDS) (n = 18) or systemic lupus erythematosus (SLE) (n = 2). Bosentan was given in an initial dose of 62.5 mg/day twice for 4 weeks, then 125 mg/day twice.

RESULTS

Eighteen patents completed therapy at 16 weeks. One patient with Functional Class (FC) IV PH associated with SDS died after 10 weeks of treatment because of PH progression; bosentan was discontinued in another patient following 4 weeks because of the enhanced activity of transaminases. The patients who had completed the investigation showed a significant FC decrease (from 2.9 +/- 1.0 to 2.4 +/- 1.0 following 16 weeks; p = 0.03), an increase in 6-minute walking distance (from 298 +/- 140 to 375 +/- 94 m; p < 0.002), a significant reduction in mean pulmonary artery pressure (from 48.2 +/- 15.0 to 42.8 +/- 12.0 mm Hg; p = 0.002), and pulmonary vascular resistance (PVR) (from 819 +/- 539 to 529 +/- 220 din/sec/cm(-5); p = 0.003). Right atrial pressure fell from 9.8 +/- 7.0 to 8.8 +/- 7.0 mm Hg; however, the changes were insignificant. There was a significant rise in cardiac index from 2.64 +/- 0.95 to 3.26 +/- 0.75 l/min/m2 (p = 0.005) and a significant decrease in uric acid levels from 562 +/- 254 to 469 +/- 194 micromol/l (p = 0.006). Overall 1-, 3-, and 5-year survival rates in patients with PH in the presence of CTD from PH onset were 100, 93, and 72%, respectively, in their treatment with endothelin receptor antagonists and differed significantly from the historical control group (87, 30, and 4%, respectively) when PH-specific therapy was unavailable.

CONCLUSION

The survival of the bosentan-treated patients with SDS and PH becomes similar to that in the patients with classical SDS. Analysis of the findings revealed the association of survival with lower PVR at 16 weeks of bosentan therapy, which is indicative of the need for hemodynamic monitoring of therapeutic effectiveness.

[Clinical guidelines for the diagnosis and treatment of pulmonary hypertension]

Pulmonary hypertension (PH) is a group of diseases characterized by progressive increases in pulmonary vascular resistance and pulmonary artery pressure, which results in right ventricular heart failure and sudden death. Based on the current version of the guidelines for PH diagnosis and treatment, adopted by the experts of the European Society of Cardiology and the European Respiratory Society in 2009, and on the data of Russian and foreign clinical trials, the Russian experts elaborated clinical guidelines for PH in 2013. The latter consider the current classifications of PH, the specific features of its pathogenesis, and its diagnostic algorithm. The section dealing with drugs for maintenance therapy discusses data on the use of oral anticoagulants, diuretics, cardiac glycosides, and oxygen therapy. PH-specific therapy includes calcium antagonists, prostanoids, endothelin receptor antagonists, and phosphodiesterase type 5 inhibitors. Surgical procedures for PH involve atrial septostomy, thromboendartectomy, and lung or heart-lung transplantation. A treatment algorithm is proposed for PH patients. The current medicinal approaches using specific therapy agents and their combinations offer new promises for the effective treatment of patients with PH and improve its prognosis.

Adenoviral transduction of multipotent mesenchymal stromal cells from human adipose tissue with bone morphogenetic protein BMP-2 gene

We determined conditions for effective transduction of multipotent mesenchymal stromal cells from human adipose tissue with adenoviral constructs carrying the gene of human bone morphogenetic protein BMP-2. The peak of transgene transcription and BMP-2 protein secretion in the transduced cultures was observed on day 6 after infection. The maximum transcription of BMP-2 gene and genes of osteogenic markers (bone sialoprotein, osteopontin, and osteocalcin) was observed in the medium containing sodium β-glycerophosphate and ascorbic acid. Addition of D 3 vitamin did not enhance the expression of BMP-2 gene in transduced cells. The obtained cell cultures with high osteogenic potential can be used in bone tissue engineering.

[Plasminogen activator inhibitor type 1 gene polymorphism and thromboses in patients with antiphospholipid syndrome]

AIM

To estimate the prevalence of plasminogen activator inhibitor type 1 (PAI-1) gene polymorphism in patients with antiphospholipid syndrome (APS) and its implication in vascular disorders.

SUBJECTS AND METHODS

The investigation enrolled 138 patients: 103 with APS, including 47 with systemic lupus erythematosus (SLE) + APS and 56 with primary APS (PAPS), 15 with SLE without APS, 20 with idiopathic thrombosis (IT), a control group (30 apparently healthy individuals). Thrombosis at various sites was recorded in 91 (88%) of the 103 patients with APS. The authors analyzed both the presence of thrombotic events in all the groups and the number of cases of thrombosis in each patient. Antiphospholipid antibodies, such as lupus anticoagulant, anticardiolipin antibodies, and anti-beta2-glycoprotein type 1 antibodies, were studied in all the patients. To diagnose a genotype in patients by the code encoding for PAI-1, DNA isolated from peripheral blood by standard methods was used and further investigated by real-time polymerase chain reaction.

RESULTS

Out of 91 patients with APS and thrombosis, 27 (30%) had the 4G/4G genotype, which corresponded to homozygous mutation in the PAI-1 gene, 50 (55%) had the 4G/5G genotype (heterozygous mutation), and 14 (15%) had the 5G/5G (a normal genotype). The PAI-1 4G/5G genotype was present in 22 (70%) of 31 patients with SLE + APS and lower limb deep vein thrombosis versus 17 (470%) of 36 patients with PAPS (odds ratio (OR) 2.73; 95% confidence interval (CI), 0.89 to 8.59; p = 0.08) and in 9 (90%) of 10 patients with SLE + APS and pulmonary artery thromboembolism versus 8 (40%) of 20 patients with PAPS (OR 13,5; 95% CI, 1.23 to 344.98; p = 0.02). The incidence of thrombosis per 100 person-years was higher in the PAI-1 4G/4G and 4G/5G groups: 35.4 and 28.1 cases per 100 person-years, respectively. Thromboses were least often in the group of patients with the PAI-1 5G/5G genotype (18.6).

CONCLUSION

The prevalence of the PAI-1 5G/5G genotype in patients with APS and thrombosis was significantly lower than in those with SLE without APS or thrombosis. The 4G/5G polymorphism in APS in the presence of SLE was associated with venous thromboembolisms whereas in PAPS there was no relationship between the PAI-1 genotype, a history of thrombosis, and its localization.

Tissue engineering construct on the basis of multipotent stromal adipose tissue cells and Osteomatrix for regeneration of the bone tissue

We developed a new method of creation of tissue engineering constructs for regeneration of the bone tissue based on the principle of free distribution of cells in a fibrin clot within a scaffold. The tissue engineering construct includes multipotent stromal adipose tissue cells committed in osteogenic lineage, platelet-rich plasma, and resorbed material on the basis of xenogeneic bone collagen. The culture of bone progenitor cells was characterized by the main markers of osteoblastic differon. The material meets all requirements for materials intended for tissue engineering. An innovative high-technological tissue engineering product for clinical application is prepared.

[Anatomy typological and clinical parallels in case of disturbance of soft tissue formations of shoulder girdle]

The influence of anthropology on topographical anatomical structure peculiarities of soft tissue formations of shoulder girdle has been investigated. The dependence of anatomical structure and topography of muscles, ligaments, tendon sheaths, synovial bursae, rotator cuffs on patient's body constitution type has been examined. The influence of a somatotype on topical damage of soft tissue structures of shoulder girdle has been proved. The so-called "holes" or weak areas, joint capsules, places where ligaments attach to bones and cartilages, where vascular formations also take place have been revealed. It is in these areas that degenerative inflammatory process begins. First of all this process influences hemolymph circulation, then it results in disturbance in production and resorption of synovial fluid and causes destructive processes in ligaments, tendons and osteochondral tissue. Due to research the ability to conduct differential diagnosis has been determined, methods of modality treatment and prevention of periarticular tissue diseases have been optimized.

[A comparative evaluation of bone tissue formation by tissue scaffold and osteoplastic material «Bio-Oss» transplantation in the maxillary sinus floor]

The effectiveness of bone tissue formation by transplantation of tissue-engineering scaffold and frequently used osteoplastic material «Bio-Oss» combined construction in maxillary sinus floor was evaluated and marked differences in regeneration terms by this treatment mode were found out.

[Bone tissue restoration after tooth removal by means of tissue-engineering construction based on multipotent stromal adipose cells]

The paper contains clinical examples of tissue-engineering construction based on multipotent stromal adipose cells application for tooth socket healing. The method do not only prevents the bone tissue resorption but allows recreating its volume.

Morphological changes in paraurethral area after introduction of tissue engineering construct on the basis of adipose tissue stromal cells

We studied morphological changes in the paraurethral area of Wistar rats after introduction of tissue engineering constructs on the basis of multipotent mesenchymal stem cells and gelatin sponge. The tissue engineering construct containing autologous culture of the stromal fraction of the adipose tissue was most effective. After introduction of this construct we observed more rapid degradation of the construct matrix and more intensive formation of collagen fibers.

Study of the safety of transplantation of cultured autologous human chondroblasts

Study of tumorigenic activity of cultured human chondroblasts intended for autologous transplantations showed that subcutaneous injection of human chondroblast suspension in a dose of 10(7)cells/0.2 ml did not cause the development of tumors in C.B-17 SCID immunodeficient mice over 12 weeks. Subcutaneous formations of compact cartilaginous consistency persisted at the site of chondroblast transplantation in all animals; these formations gradually shrank. Subcutaneous injection of tumor cell suspension (A204 human embryonic sarcoma) to C.B-17 SCID mice under the same conditions caused 100% development of tumors (poorly differentiated sarcomas) by day 14.

[Ethiology, clinical characteristics, and nosological structure of acute nephritic syndrome by drafted servicemen]

On example of 110 compulsory-duty servicemen of Far Eastern military region, were studied etiological, provocative factors, peculiarities of nosological structure, clinic, clinical courses and outcomes in conditions of acute nephritic syndrome (ANS). Streptococcal infection took precedence of progress of ANS in conditions of acute glomerulonephritis (AGN) in 96.2% of cases, in conditions of chronic glomerulonephritis (CGN) - in 71.9% of cases. Veridical AGN is detected by 27 patients (24.54%), CGN - 39 patients (35.46%). To remaining 44 patients the diagnosis of AGN also was detected, but for a variety of reasons they were not examined for the second time after stick leave. Peculiarity of ANS among compulsory-duty servicemen is difficultness of determination of it's nosological belonging to AGN or CGN. It is dictated by speed of regression of clinical and laboratorial manifestations of ANS, by absence hyposthenuria in condition of CGN. In connection with this for detecting of right diagnosis and right decision of questions of expertise, it's supervised an increase of role of early nephrobiopsia and obligatory repeated examination by persons, survived ANS.

Clinical study of the efficiency of combined cell transplant on the basis of multipotent mesenchymal stromal adipose tissue cells in patients with pronounced deficit of the maxillary and mandibulary bone tissue

The use of synthetic osteoplastic materials not always provides the required amount of the bone tissue. Transplantation of tissue-engineering constructs containing osteogenic precursor cells can be an alternative high-technology implantation method. Here we present the results of a pilot clinical study demonstrating safety of this method, accelerated healing of the operation wound, formation of young bone tissue after transplantation, and the possibility of mounting implants after 3 months in case of sufficient amount of the bone for primary fixation.

Morphological changes in intervertabral disk tissues in a static asymmetrical compression model of degenerative dystrophic diseases of intervertabral disks

Morphological studies showed that the model of compression static asymmetric degenerative diseases of intervertebral disks in rats developed by us corresponds to degenerative diseases of the spine in humans. Three-month compression led to a significant reduction of the total disk height by 15.3% and a reduction in the content of notochondrial cells by 64.8%.

[Combined cell transplant based upon autologic multipotent stromal cells of adipose tissue use in patients with distinct deficit of bone tissue in maxillae region]

Use of synthetic osteoplastic materials not always leads to formation of the necessary bone tissue volume. The alternative high technological implantation material can become tissue engineering constructions containing osteogenic precursor cells. Clinical observation of sinus lifting with the use of tissue engineering construction demonstrates the efficacy, shortening the terms of operation wound healing, young bone tissue formation after transplantation and possibility to install implants already after 3 months if the amount of bone is sufficient for primary fixation.

[Effect of metformin on the clinical course of gout and insulin resistance]

The aim of this prospective study was to evaluate results of metformin (MF) therapy during 1 year of uric acid (UA) metabolism and the clinical course of gout with insulin resistance (IR). The study included 30 patients (28 men and 2 women) of mean age 51 yr and duration of he disease 4-11 yr. IR was diagnosed based on the HOMA index.

INCLUSION CRITERIA

the absence of anti-gout therapy, normal renal and hepatic function, abstinence. The patients were given 1500 mg MF/day. The measured parameters included anthropometric and clinical characteristics, 24 hour AP, plasma UA, glucose, insulin, urea, creatinine, ALT, AST, lipid spectrum at the first and subsequent visits. UA clearance and excreted UA fraction were calculated. UA level decreased from 569 +/- 109.5 to 442.8 +/-107.4 mcmol/l (p < 0.01) after 12 months of MF therapy. Normouricemia ( < 360 mcmol/l) was achieved in 11 patients. Fasting insulin level dropped by 35% (from 23.9 to 15.9 mcU/ml, p < 0.01), HOMA index from 6.5 to 3. 7(p < 0.01). Serum glucose, cholesterol, triglycerides, and LDL cholesterol decreased while HDL cholesterol increased. Parameters of renal UA regulation and anthropometry remained unaltered. MF therapy resulted in a decrease of serum UA, insulin, and the degree of IR. The hypouricemic effect of MF was unrelated to renal UA excretion, reduced AP and body weight. It is hypothesized that MF reduces production of UA in patients with gout due to inhibition of synthesis of free fatty acids.

[Relationship between the intima-media complex thickness, the risk factors of cardiovascular diseases, and the level of C-reactive protein in gouty patients]

AIM

To estimate a relationship between the intima-media thickness (TIM), cardiovascular risk (CVR) factors, and the level of C-reactive protein (CRP) in gouty patients.

SUBJECTS AND METHODS

Eighty-nine patients at an interattack interval were examined. The patients' mean age was 46.0 +/- 11.4 years; the duration of the disease was 5.2 (3.0; 8.9) years. The traditional CVR factors were analyzed. Carotid ultrasound scanning was performed to detect vascular atherosclerotic lesion. The serum CRP concentration was measured by a highly sensitive immunonefelometric assay.

RESULTS

According to the TIM, the patients were divided into 2 groups: 1) 37 patients with signs of carotid atherosclerotic lesion (TIM > or = 0.9 mm); 2) 52 patients with a TIM of less than 0.9 mm. The ages at the moment of examination and at the onset of the disease, the duration of the disease, as well as systolic blood pressure, and the risk of myocardial ischemia were greater in Group 1 than those in Group 2. In patients with atherosclerosis, the concentration of CRP was statistically significantly higher than that in patients without this condition.

CONCLUSION

By complementing the classical CVR factors, CRP may be a predictor of cardiovascular diseases and their complications in patients with gout at an interattack interval.

[Organizational problems of disaster victim identification in mass casualties as exemplified by Tu 154-M and Airbus A310 passenger plane crashes]

Managerial experience is described that was gained during the large-scale work on victim identification following mass casualties in the Tu 154-M and Airbus A310 passenger plane crashes. The authors emphasize the necessity to set up a specialized agency of constant readiness meeting modern requirements for the implementation of a system of measures for personality identification. This agency must incorporate relevant departments of the Ministries of Health, Defense, and Emergency Situations as well as investigative authorities and other organizations.

[Clinical significance of heart rate variability in patients with systemic lupus erythematosus]

AIM

To evaluate clinical significance of heart rate variability (HRV) in patients with systemic lupus erythematosus (SLE).

MATERIAL AND METHODS

HRV was investigated by means of time-domain analysis of 24 hour ambulatory ECG of 122 SLE patients under 55 years of age and 32 age-matched healthy controls. In addition to clinical manifestations and activity of SLE, we assessed the presence of basic conventional cardiovascular risk factors (hypertension, smoking, body mass index, dyslipidemia), performed common carotid duplex scanning with measurement of intima-medial thickness (IMT). Inflammatory markers (ESR, CRP, IL-6) were assessed in all the patients.

RESULTS

Significantly lower HRV and the trend to tachycardia were detected in SLE patients when compared to the control group. There was a significant positive correlation between HRV and a cumulative dose of cyclophosphamide, a high density lipoprotein cholesterol level, a negative correlation between HRV and cumulative dose of azathioprine, standard risk factors (hypertension, smoking, body mass index, triglyceride level), markers of inflammation (ESR, CRP, IL-6) and IMT.

CONCLUSION

Measurement of HRV in combination with routine cardiovascular risk factors and level of inflammatory markers can be used for identification of subjects at risk for faster progression of atherosclerosis in SLE patients.

[A correlation of the intensity of the gas discharge luminescence of the skin and the activity of succinate dehydrogenase in blood lymphocytes in different states of the body]

The integral area of gas discharge luminescence of the hand finger skin and the activity of succinate dehydrogenase in lymphocytes in blood smears from patients with food allergia and attendant hypertension has been measured. Succinate dehydrogenase in these patients was hyperactivated or inhibited as compared with healthy persons. At more substantial deviations of activity, a more clearly pronounced hypertension was observed. The area of luminescence of the skin in some patients was near the upper boundary of norm or was beyond its limits. A high degree of correlation (r = 0.85) between the two parameters has been revealed. At moderate and high succinate dehydrogenase activity, the parameters of gas-discharge visualization decreased; the inhibition of succinate dehydrogenase activity enhances, the gas-discharge visualization increases. This probably indicates the contribution to the irradiation from hand fingers of the superoxide formed in the respiratory chain of mitochondria in the region of coenzyme Q upon its incomplete reduction caused by the inhibition of succinate dehydrogenase.

[Endothelial dysfunction in scleroderma systematica: clinicopathogenetic correlations]

AIM

To evaluate disturbances of vascular tonicity regulation in scleroderma systematica (SS) patients using laser Doppler flowmetry (LDF) with calculation of amplitude-frequency blood flow fluctuations (variability) basing on the mathematical model wavelet-transformation.

MATERIAL AND METHODS

The trial included 101 patients with verified SS aged 21-60 years (mean 52.3 years, 97 females). In addition, 15 and 10 patients with primary and secondary Raynaud syndrome diagnosed by ACR criteria, respectively, entered the trial. The control group consisted of 20 healthy subjects. Cardiovascular patients were not included in the study. Microcirculation was investigated with laser analyzer of capillary circulation in the tip of left hand finger III and external surface of the left arm. Endothelial motor function was studied in the tests with reactive hyperemia and nitroglycerin.

RESULTS

SS patients were found to have a significantly higher variability and endothelial rhythm amplitude index in arm skin, reduced microcirculation, the variation index and high neurogenic tonicity in the hand finger tip. A direct correlation was found between severity and area of skin lesion (of the arm, in particular) and their amplitude of endothelial fluctuations (r = 0.38, p = 0.03) of circulation in the arm skin. Persistent correlations between skin count and LDF values were not registered. There was a significant regression of flow-dependent dilation of the brachial artery in SS patients independent of classic cardiovascular risk factors.

CONCLUSION

SS patients have defects in regulation of vascular tonicity both in microcirculation and middle-caliber arteries. Vasomotor activity of the middle-caliber vessels is low in the absence of conventional cardiovascular disease risk factors. LDF detects changes in local regulation in cardiovascular patients confirming the role of neuroendothelial disorders in its pathogenesis. The trend to systemic DE in cardiovascular patients is associated with both disease-mediated vascular lesions (ulcers of finger tips, pulmonary hypertension) and cardiovascular disease markers.

[Prospects for using combined three-dimensional injection of gel transplants with autologous and allogenic cell cultures in reproductive medicine]

A combined cellular transplant for injection has been designed, by using lowly differentiated stromal fat tissue cells obtained from Wistar rats and it preserved biological and physical properties after passing through a small-diameter injection needle (an insulin syringe). A morphological study of the results of its transplantation into paraurethral tissues in 28 female rats showed that the transplant cells, autologous ones in particular, activated the proliferation of local connective tissue cell populations and retained their viability and proliferative and synthetic activities up 20 days or more. At the end of the experiment (on days 27-35), marked focal connective tissue enlargement at the site of injection of both allo- and autografts results in the narrowing of the urethral lumen. The injection implantation of combined allo- and autografts opens up new avenues for the treatment of pathological processes of the reproductive and urinary tracts.