CLINICAL MEDICINE
The aim of the study was to determine the relationship between the effectiveness of treatment of patients with traumatic brain injury complicated by subdural hematoma and the localization of the hematoma.
Materials and methods. The medical documentation of 52 patients with traumatic brain injury (TBI) complicated by acute subdural hematoma with a volume of 60-100 cm3 was retrospectively analyzed. Patients were divided into 3 groups depending on the location of the hematoma: group I consisted of 21 patients (40%) with hematoma localization in the frontotemporal region, group II - 18 patients (35%) with hematoma localization in the parietal - temporal region, group III - 13 patients (25%) with hematoma localization in the frontotemporal - occipital region. When patients are discharged from the hospital, their condition indicators are calculated according to the Rankin scale.
Results. More often subdural hematomas were localized in the frontotemporal and parietal-temporal regions, less often in the frontotemporal-occipital region. The severity of the victims' condition, estimated at less than 10 points according to the Glasgow scale, prevailed in patients with TBI complicated by subdural hematoma localized in the frontal-parietal-occipital region. The volume of hematoma localized in the frontal-parietal-occipital region prevailed in comparison with the frontal-temporal and parietal-temporal regions (p<0.01). After completing treatment in a specialized department, the degree of independence and disability, less than 2 points according to the Rankin scale, was established in 31 (60%) of the 52 victims; of these, in 18 (35%) patients, the hematoma was localized in the frontotemporal region.
Conclusion. The results of surgical treatment of patients with TBI complicated by subdural hematoma with a volume of 60-100 cm3 are interrelated with its localization. The best indicators of treatment effectiveness were found in patients with subdural hematoma localized in the frontotemporal region. The least effective treatment was observed when the hematoma was localized in the frontal-parietal-occipital region.
Objective - to analyze the risk factors (RF) of noncommunicable diseases depending on the comorbidity index (CI) in hospitalized patients.
Materials and methods. A cross-sectional study was performed at the Altai Regional Hospital for War Veterans. 128 people were invited to take part in the study during the month in the therapeutic department, 100 people agreed (78.1% response). The average age is 77.9±8.3 years, 48% of women, 52% of men. A general clinical examination, RF analysis of noncommunicable diseases, psychosocial factors, Montreal Cognitive Function Scale (MoCA test), and an examination by a neurologist to detect encephalopathy were performed. Based on the Charlson CI data, patients were divided into 3 groups: group 1 - CI 1-2 points - 46%, group 2 - CI 3-4 points - 38%, group 3 - CI 5 and more points - 16%.
Results. Regardless of gender, CI 5 or more was more common than CI 1-2 by 16.8%; among men, CI 5 and more occurred more often than CI 3-4 by 17.8%; middle-aged persons were only in the group with CI 1-2. In patients with CI 5 or more, compared with patients with CI 1-2, there was a higher frequency of such RFs as obesity (by 29.9%, all persons with CI 5 or more had abdominal obesity), social isolation (by 29.7%), type D personality (by 36.5%), as well as cognitive impairment (by 28.5%) and encephalopathy (by 32.9%). Depression was found 26.1% more often in patients with CI 3-4 than in patients with CI 1-2.
Conclusion. Comorbidity is not a mandatory condition characteristic of an aging population, it is primarily the result of individual behavior. Therefore, the identification and correction of RF of noncommunicable diseases, especially in conditions of comorbidity, seems to be an urgent task, which determines the success of treatment in this category of patients.
MEDICOBIOLOGICAL SCIENCES
The purpose of the study was to assess the parameters of innate immunity in patients with essential arterial hypertension and to establish a relationship with the effectiveness of antihypertensive pharmacotherapy.
Materials and methods. The study included 48 patients with essential arterial hypertension stage II, arterial hypertension 2 degree and hypertrophy of the left ventricular myocardium, which were divided into 2 groups: the first group (25 patients) - these are patients whose blood pressure reached the target values, and the second group (23 patients) are patients whose blood pressure did not reach the target values against the background of antihypertensive therapy (perindopril - 5 mg/day and amlodipine - 5 mg/day) (group 2). Indicators of 18 healthy donors were used as a comparison group (control group).
Results. In patients with essential arterial hypertension of group 1, compared with the control group, the concentration of IL-1α, IL-6, IL-8, IL-10, IL-1 receptor antagonist, IL-2, C4- and C5a-components of the complement system and factor H is significantly higher and the level of C3 is lower-component of the complement system. In patients with essential arterial hypertension of group 2, more pronounced changes in the cytokine link of the immunity and the complement system were established before the start of antihypertensive therapy. After the antihypertensive therapy in patients with essential arterial hypertension of the 1st group in the blood plasma, the concentration of TNF, IL-1α, IL-8, IL-10, IL-1 receptor antagonist significantly decreased, but not to the values of the control group, and in patients of the 2nd group, the effectiveness of antihypertensive therapy in correcting parameters innate immunity was found to be less effective.
Conclusion. Revealing the participation of innate immunity indicators in the formation of arterial hypertension opens up new possibilities for the pathogenetic therapy of this disease and developing measures to prevent or level the damage to target organs.
Objective: to develop a classification of mandibular forms and to study typical features of the morphometric characteristics of this bone in adults.
Materials and methods. The study was conducted on 150 lower jaws of adults. To determine the shape of the lower jaw, four morphometric parameters were measured: angular width, projection length from the corners, branch height, smallest branch width, and three morphometric indexes were introduced: 1 - the long-length longitudinal index of the lower jaw; 2 - longitude latitudinal index of the body of the lower jaw; 3 - latitudinal-altitude index of the branches of the lower jaw. According to these indices, 9 groups of jaws with different shapes were identified. In these groups, the values of 35 morphometric parameters of the body and branches of the lower jaw were studied.
Results. It was found that statistically significant differences (p <0.05) between the groups of jaws, determined by the value of the altitude-longitude index of the lower jaw and the longitude-latitude index of the body of the lower jaw, exist between the same morphometric parameters: angular width, projection length from the corners and chin angle , and most of the morphometric parameters of the body and branches of the lower jaw do not statistically significantly differ between the extreme forms (dolicho- and brachi, lepto- and eurimandibular). There are statistically significant differences between the jaw groups, systematized by the latitude-altitude index of the branch of the lower jaw (p <0.05) for most of the studied indicators of the branch of the lower jaw: branch height, smallest branch width, notch width, notch angle, base of the coronoid process , the base of the condylar process, the distance from the front edge of the lower jaw branch to the opening of the lower jaw, the distance from the notch of the lower jaw to the opening of the lower jaw, the distance from the angle of the lower jaw to the opening of the lower jaw. It has been proved that in the lower jaws with a hypsiramimandibular form, the values of the smallest branch width, the base length of the coronoid and condylar processes, as well as the distance from the front edge of the branch to the opening of the lower jaw are significantly smaller, however, the values of the branch height, notch angle, notch width, notch distance the angle of the lower jaw to its opening is larger compared to the platyramimandibular form (p˂0.05).
Conclusion. The greatest number of differences in the value of morphometric parameters is observed during the systematization of the lower jaw according to the shape of its branch. This can be explained by the fact that it is under the direct influence of the masticatory muscles, performing not only supporting, protective, but also motor function.
Objective. The aim of the study is to investigate the correction of functional disorders in ADMA-like preeclampsia with derivatives of the peptide imitating erythropoietin α-helix B.
Materials and methods. The study was performed in 120 white female Wistar rats weighing 250-300 g. ADMA-like preeclampsia was used as experimental preeclampsia. To assess the effectiveness of the pharmacological agents used, blood pressure, microcirculation in the placenta, and proteinuria were recorded, the content of final NO metabolites in the blood plasma was determined, and the coefficient of endothelial dysfunction was calculated. 50 μg / kg polypeptides (P-αB3 and P-αB4) were used as pharmacological agents, obtained by attaching to the original 11-amino acid peptide PHBSP [PubChem CID: 91810664], which is the amino acid chain Pyr-Glu-Gln-Leu-Glu-Arg-Ala-Leu-Asn-Ser-Ser (QEQLERALNSS) of KGD group from different ends of the chain.
Results. The use of the studied derivatives of peptide imitating erythropoietin α-helix B with ADMA-like preeclampsia leads to a pronounced correction of disorders. The greatest effect was observed with the introduction of the peptide with the laboratory code P-αB4. A significant decrease in systolic and diastolic pressure was noted, respectively, improved microcirculation in the placenta, restoration of the NO-synthesizing function of the endothelium, and a decrease in proteinuria.
Conclusion. The results obtained indicate the prospect of further research on the effectiveness of short-chain derivatives of erythropoietin imitating its α-helix B for the correction of functional disorders in preeclampsia.
Objective. To study the osteoprotective activity of glucosamine sulfate, strontium chloride, and their combinations on a model of experimental osteoporosis in laboratory animals (OVX model) in comparison with the Strometta preparation and control (OVX without correction).
Materials and methods. The material for the study was female Wistar rats weighing 250 ± 30 g. To simulate osteoporosis, bilateral ovariectomy was performed. Microcirculation was evaluated by Doppler flowmetry. Digital X-ray densitometry was used to determine bone density. Using histological morphometry, the transverse size of the trabeculae of the spongy bone tissue was studied.
Results. In such parameters as bone density, microcirculation, and the average width of bone trabeculae, significant differences were established compared with the control (OVX without correction) for groups with correction of glucosamine sulfate, strontium chloride, and their combination, and thus their osteoprotective effect was confirmed.
Conclusion. In the future, glucosamine sulfate, strontium chloride, and their combination can be used for drug prevention of osteoporosis in the postmenopausal period. However, for the introduction of strontium chloride and its combination with glucosamine sulfate into clinical practice, it is necessary to conduct complete preclinical and clinical trials.
Objective. The aim was revealing gender differences in morphological and functional changes of lymphoid organs (thymus and spleen), changes of cytokine production and subpopulation composition of peripheral blood lymphocytes in Wistar rats of three age groups with endotoxemia.
Materials and methods. We used male and female Wistar rats of three age groups: newborns, prepubertal and sexually mature adult rats. A day after the injection of 15 mg/kg of O26:B6 E. coli lipopolysaccharide (LPS), the volume fraction of the functional zones of the thymus and spleen, the number of AnnexinV + apoptotically dying cells in the thymus, the relative and absolute number of lymphocyte subpopulations (CD3+CD4+, CD3+CD8a+, CD4+CD25+Foxp3+, CD3-CD45R+) in peripheral blood and ex vivo production of IL-2, IL-4, IFN-γ and TNF-α were estimated.
Results. Sex differences in the response of the immune system after the LPS injection in different age periods are expressed differently: in the neonatal period, there is immunosuppression in females (decrease in the ex vivo production of IL-2, TNF-α and IFN-γ), and there is activation of pro-inflammatory reactions in males (increase in ex vivo production of IL-2 and TNF-α). As compared with other age periods at prepubertal age, LPS-induced immunological disorders are more pronounced, and gender differences are minimal and related only to the number of T-regulatory and B-lymphocytes. In the adults, the LPS-induced immunosuppression is most pronounced in males - they have a decrease in the production of all the cytokines studied and a decrease in the number of cytotoxic and regulatory T-lymphocytes and B-cells.
Conclusion. Thus, in each of the studied age periods - newborn, prepubertal and adult, the sexual differences in the immune system reactions are expressed differently and, apparently, these differences are determined by the content of sex steroid hormones, the concentration of which varies with age.
Objective - to study the morphological features of platelets of newborns by using electron microscopy.
Materials and methods. Peripheral blood platelets of healthy newborns were studied by means of transmission electron microscopy (TEM) method. The sample included 50 healthy babies from the Clinical Perinatal Center of Saratov region born at a gestational age of 37-42 weeks with an assessment on the Apgar scale (1952) at the first minute of at least 7 points. After blood sampling, platelet-rich plasma (PRP) was obtained by centrifugation.
Results. As a result of the study, 3 forms of platelets were identified: 1. Inactive ones, rounded or more often oval-shaped, in which it is possible to see almost all intracellular structures being typical for platelets; 2. Activated forms that have long processes (pseudopods) and usually have no granules; 3. Transitional forms - apparently, platelets at the initial stages of activation: elements of their open tubular system are already expanding, and this leads to the appearance of vacuoles. However, they do not yet have a distinct rearrangement of the cytoskeleton, and, accordingly, long processes and a significant change in shape. Platelets of newborns are heterogeneous in morphofunctional state: most of them are represented by inactive forms 82(80-85)%, the smaller part includes activated 15(13-17)% and transitional forms 3(2-4)%. Platelet microparticles (PM) are platelet derivatives and are also variable in size and structure. They can be represented by simple vesicles without internal contents, or they can have secretory granules involved in the transmission of signaling information to other platelets and endothelial cells. In our study, several mechanisms of formation and separation of PM from “precursor platelets” were discovered, but their meaning is not yet fully understood and requires further study.
Conclusion. This study demonstrates the heterogeneity of the platelet population of newborns associated with their morphofunctional state. For convenience of description, three morphological classes of platelets have been devised. The hypothesis about possible mechanisms of PM formation has been formulated.
PHARMACEUTICAL SCIENCES
Objective. The aim is to study the isolation of enalapril from biological material.
Materials and methods. ((Z)-but-2-enedioic acid;(2S)-1-[(2S)-2-[[(2S)-1-ethoxy-1-oxo-4-phenylbutan-2-yl] amino] propanoyl] pyrrolidine-2-carboxylic acid) was selected as the analyte (enalapril as maleate). Extraction in the infusion mode was used as an isolation method. Column chromatography of normal pressure, TLC, spectrophotometry and HPLC are considered as methods of purification and analysis.
Results. The most comprehensive enalapril isolation in the form of maleate can be carried out from the biomatrix by methanol infusion in combination with acetone (6:4). According to the results obtained it is necessary to double (0.5 hours) the infusion of the proposed extracting mixture to isolate the analyte, and the amount of this mixture should be in relation to the amount of biomatrix as 10 to 5 or more. As an option for eliminating endogenous impurities, we recommend distribution chromatography of enalapril maleate (column (15×1 cm) of the Silasorb S-8 sorbent, dispersion 0.015 mm, isopropanol-water mobile phase (9:1)). Reliable confirmation of the analyte identity was provided by chromatographic (TLC, HPLC) and spectral (UV spectrophotometry) methods. Data on the amount of enalapril maleate in the biomatrix were obtained by the spectrophotometric method (medium - ethanol, the registration point of the signal intensity is 219 nm).
Conclusion. Quite small (up to 1.5%) fluctuations in the degree of extraction of enalapril maleate were revealed at a level of its presence in the biomatrix of 0.02-0.4%. Isolation of analyte by infusion with methanol in combination with acetone (6:4), a well-grounded optimal isolation mode and the recommended purification option make it possible to fix the recovery (83.64-85.12%) ± (3.30-4.46) enalapril from a model matrix (liver).
ISSN 1998-5754 (Online)