Vol 28, No 1 (2020)

Aim. To define relations between serum concentrations of sRANKL and BMP-2, IL-1β, TNFα, IL-4 as well as their role in endoprosthesis instability pathogenesis in patients following primary knee arthroplasties.

Materials and Methods. 80 patients were retrospectively divided into 2 groups: there were 40 patients with osteolysis and aseptic instabilities of knee endoprosthesises that had developed before 12 months after the surgery in the 1^st group; the 2^nd group was made up of 40 patients with implantat-associated inflammations that had developed in 4 weeks to 12 months after primary knee arthroplasties. 20 volunteer donors made up the control group. The enzyme-linked assay was used to define serum content of sRANKL (pg/ml, Biomedica, Austria), BMP-2 (pg/ml, Ray Bio, USA), cytokines TNFα (pg/ml), IL-1β (pg/ml) and IL-4 (pg/ml) (Vector-Best, CJSC, Novosibirsk, Russian Federation). The comparative analysis of statistically significant indicants was performed defining Spearman rank correlation coefficient.

Results. Positive statistically valid relations of average force between concentrations of sRANKL and BMP-2, TNFα, IL-4 were found in patients of the first group in 1 month after surgeries. In 12 months positive relations of the parameters under study subsisted although the relation with IL-4 absented. The emerging of moderate negative statistically significant relations of sRANKL with BMP-2 and TNFα was observed in patients of the 2^nd group in 1 month after surgeries. In 12 months negative relations of average force between sRANKL and BMP-2 subsisted, also new moderate relations emerged: negative relation of BMP-2 with IL-1β as well as positive of sRANKL with IL-1β and TNFα, IL-1β with IL-4.

Conclusion. We found that the disorder of metabolic processes in bone tissue surrounding the implantat with the predominance of osteoclastogenesis activating pro-inflammatory cytokines might be the pathogenic factors of endoprosthesis instability development in patients following primary knee arthroplasty.

Aim. Clinical trial of Ultrix vaccine of OOO FORT manufacture containing different serotypes of influenza virus: H1N1 A/California/7/2009 (H1N1) pdm 09, H3N2 A/HongKong/ 4801/2014, NYMCX-263B(15/184) and B/Brisbane/60/2008 NYMCBX-35 (15/300) Victo-rialineage strains (epidemiological season of 2016) and H1N1 A/Michigan/45/2015 NYMCX-275 (16/248), H3N2 A/HongKong/4801/2014, NYMCX-263B(15/184) иB/Brisbane/60/2008 NYMCBX-35 (15/300) Victorialineage strains (epidemiological season of 2017).

Materials and Methods. A study of the basic parameters of immunogenicity included determination of the geometric mean value of the antibody titer, of seroprotection and seroconversion and of relative number of individuals with 4-fold increase in the antibody titer after vaccination. Immunogenicity was determined by a micromethod in hemagglutination inhibition reaction. Sera were tested with diagnosticums obtained from serotypes of influenza virus identical to vaccinal strains.

Results. The level of seroprotection with Ultrix made 91.7-95.8% (2016) and 93.8-97.9% (2017). The maximal level of seroprotection was achieved in 6 months after vaccination with Ultrix containing H1N1A/California serotype. 2.55-4.36-Fold increase in the geometric mean value of anti-HA to all vaccinal strains was found in vaccination in 2016 and 2017, and 4-fold increase in antibody titer in more than 70% of volunteers on the 21st day after the first immunization in 2016.

Conclusion. The obtained results of clinical trials of Ultrix vaccine with different antigenic composition confirms the correspondence of the immunogenicity parameters of the drug to the requirements of the Committee for Proprietary Medical Products (CPMPEMEA, CPMP/ EWP/1045/01) and of State Pharmacopoeia of RF of XIII edition (SP SP XIII).

Aim. Analysis of functional capacities of the central nervous system (CNS) of medical personnel of maternity hospitals in the dynamics of the work shift.

Materials and Methods. Using the WAM method, the functional condition of the central nervous system of doctors (obstetricians, gynecologists, neonatologists), nurses (midwives, anesthesiologists, ward nurses) in perinatal centers and maternity hospitals in the cities of Ryazan, Smolensk, Lipetsk, and Kolomna at the beginning and end of the work shift was studied.

Results. Analysis of parameters of operational self-assessment of the functional state of the central nervous system (well-being, activity, mood) revealed the dynamics of reducing the levels of well-being and activity of the main professional groups by the end of the work shift. Calculation of the W+A/M index in the dynamics of the working shift showed its reduction in obstetricians-gynecologists and neonatologists of perinatal centers by 5.0% (p=0.024174) and 10.6% (p=0.026637), respectively; by 10.6% in maternity hospitals in both professional groups (p=0.037452 and 0.039579). Among the nursing staff of perinatal centers, the index decreased in midwives and nurses anesthesiologists by 5.3% (p=0.000752) and 10.6% (p=0.000752), respectively. In groups of nursing staff of maternity hospitals, decrease in the index was determined in anesthesiologists, midwives and ward nurses by 16.7% (p=0.006566), 10.6% (p=0.003385) and 11.2% (p=0.001059), respectively.

Conclusion. Statistically significant differences were found in the analysis of well-being parameters of neonatologists and midwives of perinatal centers, in all the studied respondents of maternity hospitals; of activity – in obstetrician-gynecologists, neonatologists and midwives of perinatal centers, in all surveyed respondents of maternity hospitals; of W+A/N index – in obstetrician-gynecologists, neonatologists, midwives, in anesthesiologists of perinatal centers and in all studied professional groups of maternity hospitals. Reduction of the functional condition of the central nervous system by the end of the work shift may indicate developing fatigue.

Aim. Evaluation of the effectiveness of mechanochemical scleroobliteration in treatment for recurrent lower extremity varicose veins (VVD).

Materials and Methods. A retrospective analysis of the results of examination and treatment of 19 patients (17 women and 2 men, average age 36.3±4.5 years) with recurrences of VVD, in whom mechanochemical sclerotherapy as the main method of treatment was used. In all cases, mechanochemical ablation of the superficial venous trunks was performed using Phlebogriph catheter. As a hardener, 3% sodium tetradecyl sulfate solution (fibro-vein) was used in the volume not more than 10 ml per procedure.

Results. According to the CEAP classification, 15 patients had C2 and 4 patients had C3 class. Recurrence of VVD in one lower extremity was diagnosed in 17 (89.5%) patients, and bilateral – in 2 (10.5%). In 6 (31.6%) cases, recurrence occurred in 5 or more years after the first operation, in 8 (42.1%) patients – after 3-5 years, in 5 (26.3%) – after 1-3 years. The diameter of varicose veins before treatment according to color duplex scanning (CDR) was 7.9±0.8 mm. The duration of the detected saphenofemoral reflux (n=10) with the trunk of the great saphenous vein (GSV) left on the hip was 5.7±1.4 s, with the length 31.2±31.4 mm. With the preserved зtrunk of the GSV, crossectomy was performed in combination with mechanochemical scleroobliteration. Crossectomy was also performed in two patients with repeated dilation of the trunk of the small saphenous vein (SSV) followed by mechanochemical scleroobliteration. In two cases, insufficient shin perforants were ligated from mini-incisions, and in two more cases, foam scleroobliteration of them was performed. Within 3 weeks after the procedure, a good result was recorded in 94.7% of cases in the form of complete occlusion of sclerotized veins with the absence of reflux in them. Only in one observation incomplete occlusion of the sclerotized vein on the hip was noted, which required a repeated procedure. Long-term results were studied in 19 patients, in 94.7% of who complete obliteration of sclerotized veins and improvement of the clinical course of chronic venous disease were recorded.

Conclusion. Mechanochemical scleroobliteration has proven to be an effective method of treatment for lower extremity VVD being a minimally invasive procedure.

The primary hyperaldosteronism also known as Conn’s syndrome, is a rarely diagnosed disease that commonly runs under a ‘mask’ of ischemic heart disease and the primary arteria hypertension (AH). Nevertheless, the incidence of the given pathology among all patients with AH makes almost 17%. On the other hand, the absence of specific clinical manifestations of the disease makes its timely and correct diagnosis difficult which is fraught with serious complications. In the article a clinical case of Conn’s syndrome and peculiarities of its diagnosis are described.

Apoptosis is recognized as a programmed cell death controlled by genetic mechanisms and required for normal existence of an organism. Its main task is elimination of defective or mutant cells. The particles of dead cells are engulfed by macrophages with no development of inflammatory reaction. Apoptosis actively participates in embryogenesis, cellular homeostasis, elimination of tumor cells, and may be divided to three phases: signal, effector, and degradation. Its main components are cytoplasmic proteases – caspases. Caspases exist in the cytoplasm in inactive condition – in the form pf procaspases. Being activated, they break down to subunits. Proteins of Bcl-2 family are active participants of the mitochondrial pathway of apoptosis. They influence permeability of the outer membrane of mitochondria. Disorders in the mechanisms of apoptosis underlie many diseases including ischemic lesions, autoimmune disorders, malignant neoplasms. The ability to influence survival or death of cell is known to possess enormous therapeutic potential. At present, active research is under way to study signal pathways that control cell cycle and apoptosis. The article discusses the mechanisms participating in death of vascular endothelium and smooth muscle cells, potential role of apoptosis in atherosclerosis is also described.

Cardiomyopathy is one of serious and complex problems of pediatric cardiology. Many of them are the cause of sudden death and are familial in character. Disappointing statistics increases the relevance of the problem of cardiomyopathy and dictates the need for in-depth study of the etiology and pathogenesis, structural bases and experience in clinical and morphological diagnosis of this pathology in children. Of particular importance from a practical point of view is the development of prognostic factors in primary and secondary cardiomyopathies. This literature review provides information on the etiology, pathogenesis, clinical manifestations, pathomorphological changes and outcomes of such cardiomyopathies as hypertrophic, dilated cardiomyopathies, non-compact left ventricular myocardium and histiocytoid cardiomyopathy. Peculiarities of restructure of the myocardium in the analyzed cardiomyopathies and their relationship with systolic and diastolic myocardial dysfunction are shown. Molecular genetic aspects of diagnosis of etiology and pathogenesis of this pathology in children are given in detail. The necessity of systematic pathomorphological study of the heart with full analysis of contractile, conducting microcirculatory and neuroautonomic structures in considered variants of cardiovascular pathology is emphasized. These data will help outline future research priorities for this group of diseases to provide earlier diagnosis, improve clinical outcomes and the quality of life of these children and their families.