卷 28, 编号 1 (2020)

目的：确定sRANKL及BMP-2水平之间IL1β、TNFa和IL4在血清的关系，并探讨它们在原发性膝关节置换术后内支架内不稳定的发病机制中的作用。

材料与方法：80例患者回顾性分为2组：第一组包括40例术后12个月内发生的骨溶解和无菌性膝关节不稳定的患者；第二组包括40例植入性炎症患者在原发性膝关节置换术后4周至12个月内发生； 对照组由20名器官捐献者组成。用酶免疫法测定血清中sRANKL的组成 (pg/ml，Biomedica，奥地利) ，BMP-2 (pg/ml，Ray Bio，美国) ，还有细胞因子—TNFα  (pg/ml) ， IL1β (pg/ml) 和IL4 (pg/ml)  (Vector-Best封闭式股份公司，新西伯利亚市，俄罗斯) 的含量。通过确定Spearman相关等级的R系数，对具有统计学意义的指标进行比较分析。

结果：在第一组患者中，术后1个月，sRANKL水平与BMP-2、TNFa和IL4浓度呈中强度正相关。12个月后，所研究的参数保持了正相关，但与IL4无关系。第二组患者术后1个月sRANKL与BMP-2、TNFa呈中度负相关。12个月后，sRANKL的平均强度与BMP-2呈负相关关系，此外，出现了新的稳健关系：负的—BMP-2与IL1β，正的—sRANKL与IL1β和TNFα，IL1β和IL4。

结论：据记载，破坏种植体周围骨组织的代谢过程，激活破骨细胞形成的促炎细胞因子占主导地位，可能是原发性膝关节置换术后患者内支架不稳定形成的致病因素。

目的：进行FORT有限公司生产包含不同血清型流感病毒的Ultrix疫苗的临床研究：菌株包括H1N1 A/California/7/2009 (H1N1) pdm 09、H3N2 A/HongKong/4801/2014、NYMCX-263B (15/184) 和 B/Brisbane/60/2008 NYMCBX-35 (15/300) Victorialineage (2016年流行病季节)、并H1N1 A/Michigan/45/2015 NYMCX-275 (16/248) 、H3N2 A/HongKong/4801/2014、NYMCX-263B(15/184) 及 B/Brisbane/60/2008 NYMCBX-35 (15/300) Victorialineage (2017年流行病季节) 。

材料与方法：免疫原性主要参数的研究包括测定平均几何抗体效价、血清保护和血清转换水平，以及免疫接种后抗体效价增加4倍的个体相对数量。用显微法测定了血凝反应的免疫原性。用与疫苗株相同的流感病毒血清型抗原检测血清。

结果：Ultrix的血清保护率达到91.7—95.8% (2016年) 和93.8—97.9% (2017年) 。含有H1N1A/California血清型的Ultrix疫苗6个月后可达到最大的血清保护水平。在2016年和2017年接种疫苗期间，所有疫苗株的平均anti-НА几何水平增加了2.55-4.36倍，在2016年首次免疫21天后，超过70%的志愿者的抗体滴度增加了4倍。

结论：包含不同血清型流感病毒的Ultrix疫苗的临床研究结果证明免疫原性参数符合专利药品委员会 (CPMPEMEA、CPMP/EWP/1045/01) 及俄罗斯联邦国家药典第十三版 (SP RF XIII)的要求。

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.

目前，凋亡的作用由一些血管疾病时来公认的。它是由遗传机制控制的程序性细胞死亡，是机体正常存在的必要条件。它的主要任务是破坏有缺陷或突变的细胞。死细胞颗粒被巨噬细胞吸收而不引起炎症反应。细胞凋亡在胚胎发生、细胞止血、肿瘤细胞破坏等过程中起着积极的作用。本过程可以分为三个阶段：信号相位、效应相、降解阶段。其主要成分是胞质蛋白酶—半胱天冬酶。半胱天冬酶是在细胞质中处于不活跃状态为无活性的酶原的形式。当被激活时，它们分裂成亚单位。Bcl-2蛋白是线粒体凋亡通路的积极参与者。它们影响线粒体外膜的通透性。细胞凋亡机制的紊乱是许多疾病的基础，包括缺血性损伤、自身免疫性疾病和恶性肿瘤。影响细胞生存或死亡的能力因其巨大的治疗潜力而闻名。目前，对控制细胞周期和凋亡的信号相位的研究正在积极开展。本文综述了血管壁内皮细胞和平滑肌细胞死亡的机制，并探讨了细胞凋亡在动脉粥样硬化中的潜在作用。

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.