卷 12, 编号 3 (2020)

With rapid advances in high-performance genome analysis technology, studying of long non-coding RNAs (lncRNAs) has become a very popular topic in biomedical research. LncRNAs are a group of non-coding RNAs with a length of more than 200 nucleotides. LncRNAs play a fundamental role in cell proliferation and differentiation, and epigenetic regulation. Thus, studying lncRNAs will give a new understanding of gene regulation and will open up new possibilities for treating and diagnosing many diseases, including tumors. The identification of new molecular markers in the form of circulating lncRNAs will improve tumor detection, predicting the course of the disease, treatment planning, and diagnosing at the earliest signs of upcoming neoplastic transformation. Treatment of tumors, especially malignant ones, is also a difficult task. When surgery and chemotherapy are not effective, radiation therapy becomes the treatment of choice. Therefore, the possibility of lncRNAs being innovative therapeutic agents in tumors is a viable idea. However, the possibility of their use in modern clinical practice is limited due to the number of problems associated with significant differences between procedures for processing samples, methods of analysis, and especially strategies for standardizing results. Another problem for conducting studies on the profiling of lncRNAs expression is their large number and the diversity of their functions in tumors. Therefore, the solution of technological problems on the profiling of lncRNAs expression in tumors may open up new possibilities for the use of lncRNAs in modern clinical practice.

Purpose. To study the influence of polymorphisms of arterial hypertension genes and their various combinations on individual risk factors of sudden cardiac death.

Materials and methods. 319 young people from 18 to 24 years of age who are entering military service by conscription were examined. The survey identified 69 individuals with signs of increased risk of sudden cardiac death after being examined for secondary risk factors of sudden cardiac death and taken a blood test to determine the polymorphisms of the genes AGT 521 C>T, GNB3 825 C>T, CYP11B2 344 C>T, NOS3 786 T>C.

Results. The greatest influence on the severity of secondary risk factors was exerted by the following variants of a combination of gene polymorphisms: AGT 521 C>T and NOS3 786 T>C in the individuals with a heterozygous risk variant, both genes showed a significant increase in the duration of the corrected Q–T interval, heart rate, and a decrease in heart rate variability. AGT 521 C>T and CYP11B2 344 C>T — homozygous risk variant of the CYP11B2 344 C>T and the heterozygous risk variant AGT 521 C>T is associated with a longer duration of the corrected Q–T interval, and the heterozygous risk variant for both genes is associated with higher heart rate values. AGT 521 C>T and GNB3 825 C>T — combination of a homozygous risk variant of the gene GNB3 825 C>T and the heterozygous variant of the gene AGT 521 C>T is associated with the greatest effect on a heart rate.

Conclusions. The presence of a homozygous risk variant of the gene NOS3 786 T>C, a heterozygous risk variant of the gene GNB3 825 C>T is prognostically unfavorable for its effect on the severity of secondary risk factors for sudden cardiac death. The combination of the heterozygous variant AGT 521 C>T with a heterozygous variant of NOS3 786 T>C and a homozygous risk variant by the gene CYP11B2 344 C>T and the heterozygous risk variant AGT 521 C>T are also the most unfavorable in terms of its effect on secondary risk factors for sudden cardiac death. Secondary risk factors of sudden cardiac death are influenced by both individual polymorphisms of genes of arterial hypertension, and their various combinations.

Introduction. Rapidly developing highly specialized medical care and the emergence of new medical technologies determine the trend in surgical, minimally invasive treatment of patients with lower urinary tract symptoms due to prostatic hyperplasia. Drug therapy in elderly patients with somatic diseases poses a problem of poor compliance due to pronounced side effects caused by a drug. In this group of patients, surgical treatment of prostate hyperplasia is the most preferred solution. A doctor’s task is to choose the optimal method of surgery which will not only provide a long-term clinical effect, but also will minimize the economic costs of both surgical intervention and the postoperative period. The emergence of various types of energies for enucleating the prostate gland in urological practice has become an attractive alternative to transurethral resection of the prostate (TURP). However, when choosing surgical endoscopic intervention, it is important to consider the economic factor, which is considered to be a crucial problem in the medical care in Russia. Modern treatment options can not only prevent serious complications, and additional surgical interventions, but also improve the quality of patients’ lives. However, the introduction of new technologies is impossible without taking into account data on their cost-effectiveness.

Purpose. To compare the results and evaluate cost-effectiveness of two types of BPH endoscopic surgical treatment (bTURP, HOLEP) in elderly patients (>60 years old).

Materials and methods. The study includes patients who underwent two different methods of endoscopic treatment of HPV (bTURP, HOLEP) from October 2017 to September 2018. The inclusion criteria were the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume >40 cm³, maximum urine flow <15 ml/sec. The exclusion criteria were the presence of cystostomy drainage, oncological process of the urinary system, active inflammatory process of the genitourinary system, previous surgical interventions on the organs of the urinary system, and symptoms of an overactive bladder. In each group of the patients the following indicators were evaluated the international system for the total assessment of prostate diseases (IPSS and QoL), the international index of erectile function, the dynamics of postoperative changes in prostate-specific antigen, the maximum urine flow, the residual volume, safety of the operation, intraoperative and postoperative economic expenses as well as socio-economic consequences. Cost-effectiveness analysis was carried out by calculating the indicators “cost-effectiveness”, “cost-utility”, net monetary benefit. 20-year prediction of the results was carried out by building the Markov chain model.

Results. 150 patients operated within a year were examined. HOLEP has showed its clinical efficacy before bTURP in terms of the duration of surgery, the volume of tissue removed, the time of postoperative catheterization and the length of hospital stay which was significantly lower in the HOLEP group. However, the economic expenses associated with HOLEP were also higher compared to the bTURP group.

Conclusions. Holmium laser enucleation is the preferred method for surgical treatment of prostatic hyperplasia in the prostate of more than 40 cm³, from the point of view of surgical safety, effectiveness, and also the length of the patient’s recovery period in elderly patients. Moreover, laser operations are considered to be economically reasonable in comorbid patients associated with a minimal risk of complications.

绪论根据许多研究在世界上大多数国家，无症状性高尿酸血症的患病率呈上升趋势。血清尿酸是心血管系统状况的重要生物标志，目前有相当多的来源。 这表明了它在一些慢性新陈代谢、心血管疾病和相关死亡率方面的作用。目前，无症状高尿酸血症患者是否需要降低尿酸盐治疗尚无共识。关于风湿病患者无症状性高尿酸血症，这些情况下合并症的特殊性，降低尿酸盐治疗的频率和有效性的研究已经进行了有限的研究。

目的是研究类风湿关节炎和骨关节炎伴有无症状高尿酸血症的病程特征，并对痛风病程特征进行比较分析。

材料与方法。分析是根据圣彼得堡市痛风和无症状高尿酸血症患者病历的数据进行的，该数据由1725名痛风患者，433例类风湿性关节炎高尿酸血症患者和355例骨关节炎高尿酸血症患者的病历组成。

结果。高尿素性类风湿性关节炎患者的血小板下沉速度和C-反应性蛋白水平较高，平均水平
最高。红血球沉陷率指标；最常见的是急性心肌梗塞、慢性心脏衰竭、胆石病和非炭化脂肪
肝病。患有高血压的骨质关节炎患者的总胆固醇水平较高，平均水平最高；在这些病人中，
最常见的是心绞痛、心脏节律和传导失调、静脉曲张病、肥胖症、糖尿病和2型糖尿病。痛风患者的肾衰竭更常见。类风湿性关节炎伴高尿酸血症的患者中，有30.95％的患者开始降低尿酸盐治疗，而伴有高尿酸血症的骨关节炎患者-36.06％的患者开始尿酸降低治疗。

结论。风湿性疾病中，高尿酸血症是常见的伴随疾病。风湿性疾病与高尿酸血症的结合导致心血管疾病的风险和发生频率增加，代谢和胃肠道合并症。对风湿性疾病和无症状性高尿酸血症的高心血管疾病患者，建议降低尿酸水平，在类风湿性关节炎患者和骨关节炎患者中分别
达到34.58％和52.08％的目标尿酸水平。