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Humans and their health

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No 4 (2019)
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https://doi.org/10.21626/vestnik/2019-4

CLINICAL MEDICINE

5-13 520
Abstract

Objective. The aim of the study was to assess the information content of systemic homeokinesis shifts in relation to the clinic of cardiac syndrome against the background of the acute toxic effects of alcohol and toxic encephalopathy. 

Materials and methods. The study included 120 patients with the toxic effects of alcohol and encephalopathy in combination with alcoholic cardiomyopathy in half of the cases aged 40-55 years. The severity of alcoholic encephalopathy was characterized using a Rayton numerical sequence test. On the 1st day of hospitalization, echocardiography (EcoCG) and Holter cardiac rhythm monitoring were performed over a 24-hour period according to generally accepted methods. Systemic homeokinesis was evaluated using its one-parameter informational-entropic model, obtained on the basis of the analysis of the nonlinear dynamics of the cardiac rhythm. 

Results. Cardiac syndrome, of which was manifested by supraventricular extrasystole in 76%, was detected in 15% of patient without heart damage, but with the highest severity of encephalopathy. With cardiomyopathy, arrhythmia was present in all patients and ventricular extrasystole occurred 3.5 times more often. In 9% of cases, it was prognostically unfavorable. The analysis of the nonlinear dynamics of the entropy of the cardiac rhythm in both samples revealed that the integral value of the shifts of the criterion for the degree of randomness of its phase path reflects functional instability, which is significantly higher in individuals with cardiomyopathy and in cases with prognostically significant ventricular extrasystole. 

Conclusion. It was established that the presence of alcoholic cardiomyopathy against the background of the toxic effects of alcohol and encephalopathy is manifested by a significantly greater instability of systemic homeokinesis compared with the same urgent pathology, but without somatic heart damage. A quantitative assessment of the nonlinear dynamics of the entropy of cardiac rhythm in patients with a clinic of the toxic effects of alcohol, apparently, can be used as a marker for the possible development of complications, including prognostically unfavorable arrhythmias.

14-20 691
Abstract

In modern medicine, quite a lot of attention is paid to the problem of connective tissue dysplasia (CTD). One of the most common manifestations of CTD is primary mitral valve prolapse (MVP), characterized by a variety of cardiac and non-cardiac symptoms. Despite the abundance of data on the clinical picture of MVP, a number of questions remain poorly studied, including changes in peripheral blood, some aspects of which it was possible to study by assessing the phenomenon of endogenous autorosette formation. 

Objective. The aim of the study is to evaluate the severity and activity of the endogenous autorosette formation process in peripheral blood in connective tissue dysplasia. 

Materials and methods. A survey of 76 patients with MVP and CTD was performed to assess the phenomenon of endogenous autorosette formation in the peripheral blood in patients with CTD. All patients underwent capillary blood sampling. In blood smears (Romanowsky-Giemsa stain), the total number of leukocytes (L) was counted, the leukocyte formula was determined, rosette-forming cells were counted in percent per 100 L. 

Results. As a result of counting rosette-forming cells per 100 leukocytes, a striking increase in the number of autorosettes, especially with exocytic lysis of erythrocytes membranes, was found in the peripheral blood of the examined persons compared to healthy ones (p<0.001). In addition, the dependence of the intensity of endogenous rosette-forming on the degree of prolapse of the mitral valve cusps and on the combination of MVP with other heart anomalies was noted. 

Conclusion. The detected increase in the peripheral blood of autorosettes in patients with MVP complements the clinical picture and confirms the systematic nature of the pathology, and the predominance of neutrophilic autorosettes with exocytic lysis among the total number of autorosettes indicates a high activity of the process. The noted dependence of the intensity of endogenous rosette-forming on the degree of prolapse of the mitral valve cusps and on the combination of MVP with other heart anomalies reflects the severity of CTD.

21-30 597
Abstract

Objective: to conduct a comprehensive comparative assessment of the effectiveness of typical outpatient practice and active combined pharmacotherapy in patients with combined cardiovascular pathology. 

Materials and methods. The study included 100 patients with combined cardiovascular pathology: arterial hypertension, stable angina, chronic heart failure (CHF). The examination was carried out in 2 stages: 1) monitoring the effectiveness of pharmacotherapy carried out in a standard outpatient facility; 2) a change in the pharmacotherapy regimen in patients and, if needed, dose correction of the newly prescribed treatment regimen. Evaluation of the results was carried out on the basis of clinical, biochemical, and instrumental methods of examination, statistical analysis. 

Results. During the period of active intervention, in comparison with standard outpatient practice, a statistically significant improvement in the main clinical indicators was found, a significant decrease in the level of blood pressure(BP) (systolic (SBP) - 136.36 ± 9.23, diastolic (DBP) - 82.34 ± 6.95) and heart rate (66.42 ± 5.26). No negative changes in the biochemical analysis of blood were detected, and positive changes in the parameters of the daily BP and electrocardiography (ECG) monitoring were recorded. A more pronounced (p <0.05) positive effect of active intervention on the structural parameters of the left ventricle was established (left ventricular myocardial mass index (∆%) - 8.12 ± 0.96), parameters of life quality, level of anxiety and depression. 

Conclusion. The results of the study demonstrate the superiority of active management of patients with combined cardiac pathology, which is expressed in considerably more significant positive dynamics of hemodynamic parameters, regression of clinical indicators of the severity of heart failure and stable angina, structural characteristics of the left ventricle, parameters of arrhythmic activity of the heart, indicators of life quality, level of anxiety and depression.

31-38 555
Abstract

During the newborn period, the hemostatic system undergoes a number of changes that cause it to be less stable under any adverse effects. This is especially evident in premature and low-weight children by the time of gestation. One of the damaging factors that affects the hemostatic system is the infectious-inflammatory process. Modern integral methods of hemostasis assessment, such as thromboelastography and thrombodynamics, most fully reflect the state of the coagulation system. 

The purpose of this study was to study the features of hemostasis in non-surgical stages of necrotizing enterocolitis (NEC) in premature newborns. 

Materials and methods. A total of 86 children were examined in the neonatal period. The main group included 62 children with NEC, the control group included 24 newborns with perinatal CNS lesions. Children of both groups were comparable in gestational age and mass-growth indicators. In addition to the generally accepted methods of the hemostasis research, integral methods were used - thrombodynamics and thromboelastography. 

Results. Global methods for assessing hemostasis in newborns with NEC have revealed hypercoagulation and a tendency to thrombosis in more than 70% of children in the main group and only 10% of children in the control group. When analyzing only the indicators of the standard coagulogram, there were no significant differences in terms of hemostasis disorders in the compared groups.

39-48 577
Abstract
For the timely diagnosis and prevention of peripheral arterial diseases (PAD) at the early stages, a further study of their pathogenesis is necessary. Today, foreign literature offers an in-depth study of this problem with the search for genetic biomarkers for early screening of patients suffering from asymptomatic forms of PAD, as well as those predisposed to this pathology. With the help of genetic determinants, it is possible to identify key mechanisms involved in the pathogenesis of PAD, thereby determining treatment tactics for more effective treatment. In this article, we have reviewed the progress made in studies related to the genetics of peripheral artery disease (PAD). We have discussed the considerable role of genetic factors, the interaction of genes and the environment in developing and / or progressing PAD; the potential role of biomarkers in identifying patients at risk for PAD and for stratification of this risk, new approaches for identifying reliable biomarkers for PAD. The efforts made nowadays in the areas of inheritance, linkage analysis and candidate gene research have been described in detail. We have reviewed the current research on the genome association (GWAS) and epigenetic studies, the current problems and future directions of advanced research in the field of genetics of PAD.
49-55 567
Abstract

Objective: to evaluate the time change in blood clotting while using different application hemostatic materials in an in vitro experiment. 

Materials and methods. As materials of the research we used the following samples of haemostatic materials: control group (group No. 1), Tachocomb (No. 2), Gelita-Spon Standard (No. 3), Surgicel Fibrillar (No. 4), the samples of hemostatic sponges developed together with "Linteks LLC" (St. Petersburg, Russia) on a basis of sodium- carboxymethyl cellulose (Na-CMC) with various modifications: Na-CMC+ Tranexamic acid, pressed (No. 5), Na-CMC+ Tranexamic acid, not pressed (No. 6), Na-CMC pressed (No. 7), Na-CMC not pressed (No. 8). The time assessment of coagulation was carried out according to the technique developed by us. 

Results. During the research it was established that all groups of tested samples accelerated the process of blood clot formation to different degree that was confirmed by statistically significant differences (p≤0.05). The most effective samples were those of group N 6, which accelerated the clotting time 1.73 times as compared to the control group (p≤0.05). Group N 8 samples accelerated clot formation time by 14.1 seconds, indicating that they had the least efficacy of the test samples. 

Conclusion. The samples developed by the authors are not inferior in efficiency to the foreign analogues used in clinical practice, such as Tachocomb, Gelatina-Spon Standart, Surgicel Fibrillar. The most effectiveness was shown by the modified implants of group No. 6 (Na-CMC Tranexamic acid, unpressed). This combined agent forms a blood clot quite rapidly, which indicates the need for further comprehensive examination and, in the long run, active use of this implant in surgical practice to stop bleeding.

56-63 524
Abstract

Objective. The purpose of the research is to study the development factors of irritable bowel syndrome (IBS) in patients with colonic diverticulosis (CD). 

Materials and methods. A one-center observational prospective study was conducted in 185 patients with asymptomatic diverticulosis (group 1) and 178 patients without diverticula of the colon (group 2). All patients underwent colonoscopy and Heim test to identify the individual coping strategies. During a 5-year follow-up, IBS symptoms were reported according to Roman criteria IV. 

Results. Group1patients developed significantly more (p< 0.001) inflammatory changes in the colon mucosa according to the index of low-grade histological activity in sigmoid and descending colon (61% and 19%) as compared to group 2 patients (4% and 0%). The cumulative "survival" for IBS symptoms in patients without diverticula was higher than in patients with CD. IBS-symptoms were significantly more common in patients with CD and depended on the location of diverticulosis. 

Conclusion. Low-grade inflammation of the colon mucosa is an independent predictor of IBS-like symptoms. Nonadaptive coping strategies predominate in patients with IBS symptoms, regardless of the presence of CD.

64-71 813
Abstract
Congenital malformations of the respiratory system are rare non-chromosomal pathology (4.01-4.15‰). But, despite it, the questions of fetal surgery of these anomalies remain relevant, because, firstly, they are often combined with other malformations, and secondly, in complicated cases, the death of fetus or newborn can occur. This article describes the structure of lesions, diagnostic problems and intrauterine surgical treatment of congenital pulmonary airway malformation and bronchopulmonary sequestration complicated by massive pleural effusion. Laser ablation of the feeding artery and thoracoamniotic shunting are described in a comparative aspect as the principle, the most common in the world, methods of surgical treatment. Based on different studies, which were described and analised in this article, laser ablation is recognized as a modern, radical and highly effective method that provides a higher rate of live birth, surviving (about 100% versus to 59-68% during shunting), allows to increase the gestational age (up to 39.1 weeks), and reduces the rate of postnatal surgeries ( up to 18.2-20%), as well as the need for intensive care or oxygen support of newborns. Laser ablation in 91.7% of cases completely stops the blood supply to the lung lesion and in almost all described cases leads to its further necrosis and lysis in postnatal period of newborn’s life.

MEDICOBIOLOGICAL SCIENCES

72-82 526
Abstract

Objective. To develop the methods for pharmacological correction of immunometabolic disorders in tubal peritoneal infertility against the background of chronic infections and inflammatory process of the reproductive system. 

Materials and methods. 96 women were under observation with a confirmed diagnosis of secondary infertility of tubal peritoneal genesis against the background of chronic infections and inflammatory process of bacterial-viral etiology in remission. The parameters of the immune status, the intensity of lipid peroxidation processes and the state of the antioxidant system were revealed in the peripheral blood and cervical-vaginal washout. All women were equally divided into 4 groups depending on the pharmacological treatment methods: the 1st group received basic pharmacotherapy (BFT) after endoscopic surgery (antibacterial, antifungal, vitamin therapy). The 2nd-4th group, in addition to BFT, respectively received Hepone, Cycloferon or Lavomax within 30 days. 

Results. Within 24 hours following the diagnostic and treatment laparoscopy the endothelial dysfunction, «oxidative stress», and activation of lipid peroxidation processes were established at the systemic and local levels. BFT was not effective enough, after Hepon was administered 86.7% of laboratory parameters remained impaired, and the use of Cycloferon reduced their number to 71.1%. The most effective was the inclusion of Lavomax in BFT, since 60% of the laboratory parameters studied remained unchanged. 

Conclusion. Administration of Hepon, Cycloferon, and especially Lavomax while conducting BFT for tubal peritoneal infertility has shown their high efficiency in the correction of impaired parameters of the immune and metabolic status at the systemic and local levels.

83-89 615
Abstract

Objective. The aim was to study of the effect of ACTH6-9-PGP on the level of depression in rats in the forced swimming test compared to ACTH4-7-PGP. 

Materials and methods. The experiments were performed on 90 mature Wistar male rats weighing 250-300 g. Animals were divided into 9 groups (8 experimental and 1 control) with 10 animals each. A physiological solution of 0.9% sodium chloride, ACTH6-9-PGP and ACTH4-7-PGP peptides synthesized in the Institute of Molecular Genetics, Russian Academy of Sciences, were used in the work. Peptides were administered once intraperitoneally 15 minutes before testing: ACTH6-9-PGP at the doses of 0.5, 5, 50, 150 and 450 μg/kg, ACTH4-7-PGP at the doses of 50, 150 and 450 μg/kg. The depressive behavior of rats was evaluated using a non-burdened forced swimming test. 

Results. The intraperitoneal administration of ACTH6-9-PGP at a dose of 450 μg/kg helps to reduce the time of animals’ immobilization and passive swimming, as well as to increase the duration of their active swimming, which indicates the presence of the antidepressant effect of the peptide. At the same time, ACTH4-7-PGP at all doses used did not significantly affect the studied indicators of behavioral activity, and its effects were limited only by an increase in the time of passive swimming. 

Conclusion. Thus, it was found that ACTH6-9-PGP, in contrast to ACTH4-7-PGP, is able to have an antidepressant effect.

90-95 515
Abstract

Objective: a comparative analysis of the level of serum IgE, IL-17A in patients with acute spontaneous urticaria, and their consideration as predictors of progression to chronic forms. 

Materials and methods. The study group consisted of 48 patients with acute spontaneous urticaria, the control group consisted of 18 healthy donors. The study of IL-17A, IgE in serum was performed by ELISA. 

Results. Patients are divided into groups according to the level of serum IgE: I - 24 patients with a normal level (up to 100 IU/ml), II - 13 with a moderately elevated (100-500 IU/ml), III - 11 with a significantly high (over 500 IU/ml), in the control group - 22.19 ± 46.08 IU/ml. In patients I, the IgE content is comparable with the control (33.92 ± 27.46 IU/ml), II - 9.9 times (220.75 ± 135.1 IU/ml), III - 85. 4 times (1,894.28 ± 1,171.73 IU/ml) exceeded the control values. In patients I, IL-17A is 2 times higher than the control (45.16 ± 6.49 pg/ml, 23.05 ± 19.92 pg/ml, respectively), II is also 2 times higher (44.9 ± 4.32 pg/ml), III - exceeded 2.2 times (49.66 ± 3.98 pg/ml). A significant increase in IL-17A was revealed both in patients with normal serum IgE levels (p = 0.0044, p<0.05, Mann-Whitney U test = 45.5), and in patients with high (p = 0.0011, p<0.05, Uemp, Mann-Whitney U test = 26.0) and a significantly high level of this indicator (p = 0.0004, p<0.05, Mann-Whitney U test= 76.5). A significant correlation was revealed between the elevated serum IgE and IL-17A (R = 0.29, p = 0.045, p<0.05). 

Conclusion. The increased production of IL-17A in patients with acute spontaneous urticaria indicates its role in pathogenesis. A reliable correlation between elevated serum IgE and IL-17A suggests: a high level of serum IgE in acute urticaria reflects not only an IgE-mediated response, but also the possibility of developing a Th2 response under conditions of autoreactivity. Patients with high levels of serum IgE, IL-17A may be at risk of having the chronic disease.

96-103 723
Abstract

The relevance of this study is due to the high number of side effects caused by nonsteroidal anti-inflammatory drugs. Our previous studies consecrated anti-inflammatory, antipyretic and analgesic bioactivity of tetrahydropyridines and hexahydroquinolines, derivatives of α-cyanothioacetamide. 

Objective. The objective was to determine the acute oral toxicity in vivo of new tetrahydropyridine and hexahydroquinoline derivatives, derivatives of α-cyanothioacetamide, with laboratory codes ТD0364, ТD0353, ТD0351, CV036, CV125 and OC05184. 

Materials and methods. The study was conducted in accordance with the Interstate standard GOST 32644-2014 (OECD, Test No. 423:2001, IDT) on 63 white laboratory female rats weighing 180-220 g in autumn in a certified pharmaceutical laboratory. 

Results. The introduction of five prototypes of tetrahydropyridine and hexahydroquinoline derivatives in the maximum (2,000 mg/kg) dosage under laboratory codes ТD0364, ТD0353, ТD0351, CV036, CV125 was characterized by zero mortality. We have discovered no visible signs of neurotoxicity, ulcerogenic properties, and hepatotoxicity. Intragastric administration of the compound OC 05184 in a dose of 2,000 mg/kg caused death of all rats in the group within the first 12 hours; however, the introduction of the sample OC 05184 in the dosage of 300 mg/kg did not lead to death for 2 weeks. Moreover, there were no signs of toxicity from the first minute of intragastric administration. 

Conclusion. Five of the investigated tetrahydropyridine and hexahydroquinoline derivatives coded ТD0364, ТD0353, ТD0351, CV036 and CV125 belong to low toxic compounds (5th toxicity grade). The compound with the laboratory code 05184 OC belongs to the 4th toxicity class.

PHARMACEUTICAL SCIENCES

104-114 1028
Abstract

Onopordum acanthium L. and Carduus nutans L. belong to the tribe Cardueae, family Asteraceae, The similar macro features and nearest habitats provide the difficulties to differentiate each plant during collection. Onopordum acanthium is a medicinal plant using in the folk medicine. It is a potential anti-inflammatory and antitumor agent for preventive usage. 

Objective. The aim of this work is to found and describe macro- and micro features of these similar species of the tribe Cardueae. 

Materials and methods. In this research the samples of Onopordum acanthium and Carduus nutans collected during flowering and fruiting were used. The external features were described according to the XIV edition of the State Russian Pharmacopeia. Microanalysis was carried out with aerial parts and roots. The photos of micro preparations were taken. 

Results. These two species differ with respect to anatomy of leaves, stem wings, inflorescences. Micro analysis provide that Carduus nutans flower stalk has more ribs and densely tomentous; a stem of Onopordum acanthium has wings all over its surface; several bundles in the stem are offset and flipped to 90°; there are trichomes on both sides of leaves of Onopordum acanthium , also there are salt cells on the down side; the root medullary rays and first and secondary xylem are different; and phloem is pigmented in Onopordum acanthium. 

Conclusion. The results of this work may be used in the instruction of collection of medicinal raw material of Onopordum acanthium.



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ISSN 1998-5746 (Print)
ISSN 1998-5754 (Online)