Ist Group Research Articles

IMPLEMENTATION OF PATIENT-CENTERED MEDICAL CARE MODEL: ANALYSIS OF THE ATTITUDES OF PATIENTS WITH CORONARY ARTERY DISEASE AND COMORBIDITIES

The aim: to evaluate the attitude of patients with coronary artery disease and comorbidities to the implementation of patient-centered care in clinical practice.
 Materials and methods. We carried out questionnaire survey of two groups of patients with coronary artery disease and comorbidities. The first one consisted of 30 patients with coronary artery disease aged 61-75 (mean age 67,2±5,1 years) who were followed by the cardiologist in the therapeutic department of the State Institution of Sciences “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department. The second one – 33 military personnel with coronary artery disease aged 50-58 years (mean age 53,2±2,4 years) who came for a scheduled appointment with a general practitioner at the Outpatient Care Clinic of the National military medical clinical center “GVKG”. Methods: system analysis, questionnaire survey, statistical.
 Results. According to patient`s opinion cardiologists give much more information about pharmacological treatment, including side effects of medications used (83,3±6,8% in the Ist group vs 33,3±8,2% in the 2nd group, p<0,05) and actions to increase patients` compliance (83,3±6,8% in the Ist group vs 42,4± 8,6% in the 2nd group, p<0,05). This is related to the peculiarities of management of patients with chronic diseases in the State Institution of Science “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department, in particular, with the follow-up of high-risk cardiac patients, including scheduled appointments and monitoring of patient`s clinical conditions by a cardiologist. Emotional support was given to 93,3±4,6% of patients in the Ist group and to 18,2±6,7% of patients in the 2nd group (p<0,05). 36,7±8,8% of patients in the Ist group and 84,8±6,3% in the 2nd group ( p<0,05) indicated, that they need more information about their treatment plan and involvement in clinical decision-making. 93,3±4,6% of patients in the Ist group and 4,8±6,3 % in the 2nd group were ready to perform self-monitoring of their health conditions and participate in the decision-making process regarding their treatment.
 Conclusions. Our survey demonstrated, that the majority of interviewed patients with coronary artery disease and comorbidities are ready to use basic principles of patient-centered care. The necessity to improve patient`s information and education about clinical decision-making and physician`s practical skills in the field of implementation of patient-centered care was substantiated.

Comparison of hematopoietic stem cell transplantation and immunosuppressive therapy as the first-line treatment option for patients with severe hepatitis-associated aplastic anemia.

Hepatitis-associated aplastic anemia (HAAA) is a rare variant of acquired aplastic anemia characterized with a syndrome of bone marrow failure after hepatitis. We retrospectively analyzed the outcomes of consecutive severe HAAA patients who received immunosuppressive therapy (IST, n = 70), matched-sibling donor hematopoietic stem cell transplantation (MSD-HSCT, n = 26) or haploidentical-donor (HID) HSCT (n = 11) as the first-line treatment. In the IST group, the hematologic response (HR) rate was 55.71% at 6 months. In contrast, HSCT recipients exhibited significantly more rapid and sustained hematopoiesis (HR 76.92%, 96.15% and 96.15% at 3, 6 and 12months, respectively). The 5-year overall survival (OS) was not different among IST (83.7 ± 4.9%), MSD-HSCT (93.3 ± 6.4%) and HID-HSCT group (80.8 ± 12.3%). Compared with IST, MSD and HID-HSCT demonstrated a trend of superiority in the estimated 5-year failure-free survival rates (93.3 ± 6.4% vs 64.3 ± 6.0%, p = 0.05; 80.8 ± 12.3% vs 64.3 ± 6.0%, p = 0.57). In subsequent stratified analysis on age, we found that HID-HSCT showed its efficacy and safety among young patients. In sum, MSD-HSCT remains first-line treatment choice for HAAA, whereas HID-HSCT represents an alternative treatment choice in addition to IST for young patients (< 40 years) without a matched sibling donor.

Changes in Segmental Impedances and Selected Body Composition Parameters Assessed by Multi-Frequency Bioimpedance Analysis after Fluid Consumption in Healthy Young Population.

Objectives: Body composition (BC) analysis is a routine part of comprehensive public health care. Assessment of BC is more important source of information than BMI. Adherence to the standard measurement conditions is essential for the correct results. Our study aimed to examine the effect of acute fluid consumption on measures of body mass (BM), percentage of body fat (%BF), visceral fat (VF), percentage of body water (%BW), and impedance at 100 kHz (I100) and 20 kHz (I20) using segmental multi-frequency bioelectrical impedance analysis (SMF-BIA) in a general healthy population. Methods: 95 consecutive healthy normal-weight adults (42 men; 53 women) were involved in the study (mean ± s.d.; age 23.9±1.6 years; body mass 68.3±14.1 kg). All subjects underwent two separate series of body composition (BC) measurements at 0 (BASELINE), 30, 60, 90 min (POST): the first series after drinking 600 ml of isotonic carbohydrate/electrolyte drink (IST) and the second after no fluid administration (CON). Individual measurements were performed in the morning on two consecutive days. Results: In the IST group, BM, VF (both P<0.001), and %BF (P<0.05) increased significantly at 30 min POST compared to BASELINE. BM and VF remained elevated at 90 min POST (both P<0.001). %BW decreased significantly at 30 min POST (P<0.01) then increased at 60 min (P<0.001) and 90 min (P<0.01) POST. There were no significant changes in I100. I20 increased significantly at 30 min POST (P<0.001) then decreased at 60 min (P<0.001) and 90 min POST (P<0.01) compared to BASELINE. In the CON group, BM and VF decreased below BASELINE at 90 min POST (P<0.001), %BF, %BW and I100 did not change significantly. The difference between IST and CON was statistically significant for all POST measurement times only in BM and VF (both P<0.001). The VF results are also underlined by the detected impedance changes in the trunk area at 20 kHz (B20) and 100 kHz (B100) at 60 min and 90 min (both P<0.001). Conclusions: Our study suggests that segmental impedances and BC measurement in healthy young normal-weight adults requires strict adherence to fluid restriction at least 90 min before the measurement to avoid false impedance values and overestimation of BM and VF.

Potential Efficacy Of Citrus limon On Protein And Creatinine Profile In Ketamine treated Zebra fish, Danio rerio

This paper determines the toxicity of ketamine and its recuperation by phytochemicals of Citrus limon leaves extract. Fishes were collected, acclimatized &amp; divided into 6 groups of 5 fishes each. Ist group served as control whereas, IInd group was treated with ketamine alone. IIIrd &amp; IVth groups were treated with different concentrations of phytochemical and Vth &amp; VIth groups were given ketamine with Phytochemical. After 96 hours total protein (TPRO) &amp; creatinine levels were tested using autoanalyser from supernatant of liver and muscle tissues. Ketamine showed adverse effect on the protein concentration as well as in creatinine concentration, whereas at different concentrations, phytochemicals did not have any adverse impact and also helped in the suppression of toxic effect of ketamine. Some behavioural changes were observed after the treatment with ketamine. However such aberrant behaviour was absent in control fishes.

Obstetric and perinatal pathology in pregnant women who had complications from the group of the Great Obstetrical Syndromes

The objective: to analyze the obstetric and perinatal outcomes of childbirth in pregnant women who had complications from the group of the great obstetrical syndromes.Materials and methods. A retrospective statistical analysis of obstetric and perinatal outcomes of childbirth of 239 pregnant women (the Ist group – main one) who had complications from the group of the great obstetrical syndromes (GOS). They were divided into three subgroups: Ia subgroup included 103 pregnant women with severe preeclampsia (PE), Ib subgroup – 67 pregnant women with placental insufficiency, with clinical manifestation of fetal intrauterine growth retardation (IUGR), Ic subgroup – 69 pregnant women with spontaneous preterm birth in the gestational age 22-36 weeks. The control group (CG) included 56 practically healthy pregnant women with a normal reproductive history and uncomplicated course of this pregnancy.Statistical processing of the study results was performed using standard programs Microsoft Excel 5.0 and Statistica 6.0.Results. The incidence of gestational diabetes mellitus in patients of the I group (28 (11.7 %) women) was higher than in CG (2 (3.6 %) persons). Cervical insufficiency was diagnosed in every fifth patient of Ic subgroup (12 (17.3 %) patients; χ2=15.56, p&lt;0.01; OR=9.25; CI 95%: 2.55–33.54 relative to CG), gestational anemia – in 179 (74.8 %) pregnant women in the I group and 18 (32.1 %) women in CG (p&lt;0.01).A significantly high rate of mild congenital malformations was present in subgroup Ib (7 (10.4 %) of pregnant women; χ2=12.67, p&lt;0.01; OR=7.93; CI 95%: 2.14-29.26). 21 patients in the I group had with antenatal fetal death, 6 (5.8 %) – severe PE, 11 (16.4 %) – IUGR. Five cases of early neonatal mortality was diagnosed in the I group. The rate of perinatal mortality in the I group was high and amounted to 108.7 ‰.The operative delivery in the I group was performed in 127 (53.1 %) patients which is significantly more than in CG (χ2=42.93, p&lt;0.01; OR=4.93; CI 95%: 2.99– 8.13). In 24 (18.9 %) pregnant women in the I group the indication for operative delivery was acute distress, which is significantly more than in CG (2 (3.6 %) women; χ2=7.36, p&lt;0.01; OR=5.17; CI 95%: 1.2–22.28). The mean score on the Apgar scale in newborns in CG was significantly higher compared with the I group (p&lt;0.01).Conclusions. The course of pregnancy and childbirth in women who had complications from the group of the great obstetrical syndromes was accompanied by the development of gestational diabetes, gestational anemia and cervical insufficiency. Complications such as fetal distress, severe preeclampsia, fetal growth retardation with decompensated hemodynamic disorders of the uterine and placental blood circulation, led to a high frequency of cesarean section in these patients.

Якість зерна гібридних ліній пшениці м'якої ярої – потомків гібридів синтетиків з сортом Харківська 26

Якість зерна гібридних ліній пшениці м'якої ярої – потомків гібридів синтетиків з сортом Харківська 26

Characterization of Shifts of the Cellular Component the Immune Status of Patients with Long-Term Course of Chronic Post-Traumatic Uveitis

Purpose: to study the subpopulation composition of peripheral blood lymphocytes in patients with long — term chronic post-traumatic uveitis (CPT).Patients and Methods. There were 131 people aged 17 to 87 years, who received the surgical treatment in the Department of plastic surgery and eye prosthetics in NMITS eye diseases Helmholtz of the Ministry of health, Russia, where the removal of the eyeball by evisceration was carried out in 101 patients (70.3 %), 30 patients (29.7 % of cases) were enucleated. The study identified two groups: the Ist group– with the outcome of the injury, including non-penetrating (n = 46) and penetrating wounds (n = 51) of the eyes, were 97 patients; group II included 34 patients with complications due to single (n = 8) or repeated (n = 26) ophthalmic surgery (development of glaucoma and retinal detachment).Results. When analyzing the mean values, we found a decrease in the relative number of CD3+ CD4+ helpers/inducers in the blood of patients of both groups (up to 43.5 ± 0.81 and 42.19 ± 1.29 % versus 45.7 ± 1.19 % in the control), statistically confirmed for the 2nd group. Individual analysis revealed multidirectional shifts from the norm of cellular immune status of patients with PU in both groups. The most interesting, in our opinion, results were obtained by analyzing the relative number of effector cytotoxic cells of adaptive and nonspecific immunity. The increase in the relative content of t-cytotoxic lymphocytes CD3+ /CD8+ and NK-lymphocytes CD16+ /CD56+ was revealed with the same frequency, approximately in 18.5 and 19.5 % of cases in the PU group at the outcome of injury, in the 2nd group the increased number of these subpopulations was observed more often, amounting to 23.5 and 20.5 %, respectively.Conclusions. The results of the study on a large clinical material indicate that in long-term CPTU there is a pronounced systemic imbalance in the immunoregulatory subpopulations of lymphocytes, revealed by individual analysis in groups of patients.

Improving of Metabolic Profile With Vitamin D Supplements in Pregnant Women

Background. Serum 25-hydroxy-vitamin D deficiency is related to metabolic diseases as polycystic ovary syndrome, obesity, insulin resistance, cardiovascular diseases, cancer, gestational diabetes mellitus (GDM). Objective: To evaluate the effect of vitamin D therapy on metabolic parameters in pregnant women. Methods: There was a 16-week study of 62 participants with gestational diabetes mellitus. All pregnant women followed an appropriate diet and physical activity. Management of 37 women included 2,000 IU/day of cholecalciferol per os. Body mass index (BMI), hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), plasma 25- (OH) vitamin D, low‐density lipoprotein cholesterol (LDL‐C), homeostatic model assessment of insulin resistance (HOMA-ir) were estimated in pregnant women with GDM before and after the 16-week period. Quantitative data are expressed as the mean ± SD. The correlation between variables was assessed using the Pearson correlation coefficient. P-value <0.05 was considered statistically significant. All information was processed with SPSS 21.0. Results: The mean BMI was (30,2±2,34) kg/m2, baseline serum 25-(OH) vitamin D levels in all women were in a deficient limit (less than 30 nmol/L). HOMA in both groups was more than 3. The mean LDL‐C was (3,3±0,63) mmol/l and didn`t differ in the two groups. 25-(OH) vitamin D levels were inversely associated with BMI (r=–0.4; P=0.05), HOMA (r=–0.6; P=0.005), LDL‐C (r=–0.3; P=0.04). Vitamin D therapy has had significant improvement in plasma LDL‐C concentration, HbA1c, FPG in women with GDM (P<0.05). Compared with the Ist group cholecalciferol therapy had lead to a reduction of HOMA in the IInd group by (2,3±0,94) in 4 months (P < 0.05). Conclusions. The daily intake of vitamin D was accompanied by the significant glycemic improvement and the majority of women achieved diabetes control without insulin injections. Strong inverse correlation between 25 (OH) vitamin D levels and HOMA, reduction of HOMA can indicate improved sensitivity to insulin and benefits of vitamin D supplementation for the management of insulin resistance in GDM with vitamin D insufficiency.

Non-medicine Methods of Treatment of Gastroesophageal Reflux Disease

Few decades away a problem of throwing of acidic gastric content into an esophagus was reduced to the concept of reflux-esophagitis. In-depth study of pathogenesis of a disease resulted in “gastroesophageal reflux disease” (GERD) term which is acknowledged as leading disease of digestive system in terms of frequency and dangerous complications. GERD formation is determined by influence of numerous factors, however, it is generally accepted, that it is mainly related to insufficiency of lower esophageal sphincter (LES). Also, role of vasoactive intestinal peptide (VIP) in regulation of functional state of LES is determined. In spite of success in field of pharmacology, number of GERD patients has no downward trend which mainstreams search for non-medicine treatment methods. Physical factors affecting pathological processes by influencing regulatory processes are among these methods. Goal of this study is elaboration, scientific justification and clinical implementation of natural and preformed physical factors and acupuncture in treatment of patients with gastroesophageal reflux disease. Materials and Investigation methods: Randomized placebo-controlled study included 137 patients with gastroesophageal reflux disease, 63 (46%) men and 74 (54%) women, at the age of 18 to 65. Investigation included patients with no contraindications for physiotherapy. Patients with Barrett’s esophagus, stricture of esophagus, esophagus ulcer have also been excluded from investigation. Patients were divided into 3 groups: Ist group – 40 GERD patients, including high-frequency electromagnetic field effect and general iodine bromine bathes. II nd group - 67 GERD patients passing acupuncture treatment course. Control group was comprised of 30 GERD patients, receiving placebo MEF therapy. Treatment was carried out without medicines. Therapeutic effectiveness of complex influence of microwave electromagnetic field therapy (MEF-therapy) applied to collar area alternated with general iodine-bromine bathes on clinical manifestations of GERD is determined. Treatment course contributed to reliable decrease of increased count of VIP – a neurotransmitter, regulating LES tonus. In term, it contributed to improve of functional state of LES, reliable decrease of reflux index, and, as a result, improvement of clinical and functional indicators. Estimation of clinical manifestations of a disease among patients of 2nd group displayed positive dynamics of clinical and functional indicators. Round-clock pH-monitoring of stomach and esophageal content shows reliable decreaseof transitory relaxations of LES during single acupuncture procedure and increase of pH of gastric content. Acupuncture course also resulted in decrease of elevated VIP numbers.

Effect on anxiety of Coriandrum sativum leaf hydroethanolic extract oil and aqueous fraction in swiss albino mice

Background: Anxiety is a protective reflex and the most common disorder. This study was done to evaluate the effect of anxiolytic property of oil and aqueous fractions isolated from hydroethanolic extracts of Coriandrum sativum leaf by novel freezing technique with swiss albino mice.Methods: Hydroethanolic extract of Coriandrum sativum leaves was prepared. Oil and aqueous part were separated with freezing technique. Animals were divided into six groups. Ist group served as control and 1% DMSO was administered orally. IInd to Vth group were administered with Coriandrum sativum oil fraction and Coriandrum sativum aqueous fraction at doses of 400 and 800 mg/kg orally. VIth group was treated with diazepam 1mg/kg orally. After one hour of dosing, battery of test was done viz, elevated plus maze (EPM), light dark arena, photo actometer and rotarod.Results: One-way analysis variance (ANOVA) followed by Dunnett's multiple comparison test was used for statistical analysis. Anxiolytic property was found to be in the following order diazepam&gt;coriandrum sativum aqueous 800&gt;coriandrum sativum aqueous 400&gt;coriandrum sativum oil 800&gt;coriandrum sativum oil 400 mg/kg. All the extracts were devoid of adverse effects of motor coordination.Conclusions: Coriandrum sativum leaf possesses anxiolytic effect. The aqueous fraction of the hydroethanolic extract of the Coriandrum sativum leaf was found to be potent and further analysis may lead to identification of active compounds. The findings that the extract is non-sedating anxiolytic and is of good safety index are promising.

221-OR: Does Cell Therapy Improve the Quality of Life of Patients with Chronic Limb-Threatening Ischemia? A Randomized Controlled Trial

Background: Autologous cell therapy (ACT) is the last option for patients with no-option chronic limb-threatening ischemia (NO-CLTI) and severe pain. The aim of our study was to assess the impact of ACT on a patient’s quality of life, chronic pain and depression using standardized questionnaires. Methods: Forty patients with NO-CLTI were randomized and divided into groups treated initially with ACT (iACT, n=20) or standard conservative therapy (iST, n=16); 4 patients dropped out of the study. After 3 months, those in the standard therapy (ST) group were switched to (cell therapy crossover). All patients filled out the standardized EQ-5D questionnaire assessing their quality of life. Pain was evaluated using a special questionnaire including the Visual Analogue Scale (VAS) and Wong-Baker Faces (WB). The questionnaires were evaluated before randomization; in the iST group at 3 months after ST and then at 3 months after ACT. Results: Pain was significantly reduced in the iACT group after 3 months compared to baseline in both VAS and WB scores (both p&amp;lt;0.001); in the iST group, we observed even worsening of both pain scores without a significant difference (NS). After the cell therapy crossover of in the iST group, both pain scores increased significantly after 3 months (both p&amp;lt;0.001). Quality of life measured by EQ-5D was improved after 3 months of ACT (p&amp;lt;0.001) while not changing in the iST group after 3 months of ST (NS). After the crossover to ACT, quality of life was significantly improved also in the iST group (p&amp;lt;0.001). We observed a trend in towards a decrease in depression rate after 3 months of iACT from 45 to 33%, whereas the depression rate was slightly increased after 3 months of ST (from 56 to 61%) to decrease from 56 to 18% in the iST group after cell therapy crossover (all NS). Conclusion: Our study showed significant pain reduction in NO-CLTI patients after ACT; this treatment also led to a decrease in depression rate and overall improvement in their quality of life. Disclosure J. Husáková: None. R. Bem: None. A. Nemcova: None. V. Fejfarova: None. A. Jirkovska: None. M. Dubsky: None. Funding Ministry of Health of the Czech Republic (16-27262A); Project for Development of Research Organization (00023001); IKEM, Prague, Czech Republic

Biomechanical experimental substantiation of the fixation technique of bone allograft and recipient’s bone

A technique combining bone allografting and arthroplasty — allocomposite replacement (ACR), is widely used in orthopedic oncology. However, the risk of complications after this surgical intervention remains high — non-union of the allograft with the recipient's bone, its lysis, infection.Objective: to substantiate ACR techniques biomechanically using segmental bone allografts with intramedullary fixation in the recipient’s bone. Methods: the experiment was performed on 28 male rats (age 5 months, body weight 350–400 g). ACR of the femur was modeled with transverse (I group) and stepcut (II) osteotomy. The strength of the isolated preparations of the operated animal femurs was examined on a biomechanical stand after 3 and 6 months after the surgery. Digital indicators are processed statistically.Results: in the Ist group of animals (3 months after surgery) the strength of the operated bones was statistically significantly lower compared to the contralateral (t = –2.674; p = 0.037), and in rats with stepcut osteotomy the difference was not significant. In 6 months after surgery, bone strength with stepcut osteotomy was found to be (44.3 ± 15.6) N greater than with transverse (t = –2.838; p = 0.023). At the same time, the strength of the operated bones of animals of the Ist group was comparable with that of the contralateral limbs (t = –1.279; p = 0.248), and in the IInd exceeded them (t = 6,000; p = 0.001).Conclusions: stepcut osteotomy with subsequent fixation of the bone allograft to the recipient’s bone improves the conditions for reparative osteogenesis in the area of their contact and reduces the risk of ACR complications. Bioreconstructive surgical interventions in order to replace post-resection defects of long bones in patients with tumor lesions can improve orthopedic, functional and oncological treatment results.

Wound drainage after total hip arthroplasty

Diseases and injuries of the hip joint take a significant place in the structure of orthopaedic pathology. Total hip arthroplasty is the main treatment method of the hip joint osteoarthritis of the III–IV stages and fractures of the femoral neck in the elderly people. Objective: to analyze the effectiveness of the post­operative wound management after total hip arthroplasty without draining. Methods: a group of 140 patients (age — from 45 to 78 years) who underwent total hip arthroplasty in the period from the beginning of 2017 to April 2019 was sampled for this study. Diagnosis: hip joint osteoarthritis of the III–IV stages, aseptic necrosis of the femoral head, rheumatoid arthritis and the femoral neck fracture. The patients were divided into groups: I — the wound was drained, II — the postoperative wound was without drainage. The groups did not differ in age, sex, body mass index and distribution of diagnosis. Results: blood loss during the operation did not differ and was equal in group I — (367.59 ± 16.19) ml, II — (351.6 ± 7.97) ml. The count of erythrocytes was significantly higher in group I, which characterizes less blood loss after surgery. Prior to surgery, ESR and CRP levels did not differ significantly in both groups. After the surgery and at discharge, we noted significantly lower markers of the inflammation in the I group of patients. The maximum intense of the pain according to VAS scale was 5 points for patients of the Ist group and 9 points in the IInd group. Body temperature in patients of the Ist group elevated up to 37.7°C, II — 39.4°C. There were no differences in the timing of postoperative wound healing. Patients were activated for the next day after the surgery. Patients in group I were discharged from the hospital on average of 2 days earlier than group II. Conclusions: in the group of patients without joint draining revealed faster normalization of erythrocytes, CRP and ESR, low intensity of postoperative pain according to VAS, shortened hospital stay.

P622 Recovery of nutrient deficiency as a predictor of remission in inflammatory bowel diseases

Abstract Background Development of nutritional deficiency (ND) due to the loss of nutrients, water and electrolytes with frequent stools, nutrients malabsorption, anorexia and increased catabolism is typical for patients with IBD relapse. To determine the frequency and structure of ND in patients with IBD relapse and to evaluate the therapeutic effect of nutritional support (NS) of nutritive mixtures during the course of therapy. Methods Two-phase three-step study with prospective monitoring in patients with IBD was conducted during 3 years in the period from 2010 to 2012. The first phase was carried out using a one-time screening scales MUST and NRS, further in phase 2, the NS structure was refined. 520 patients with IBD were examined: 410 with ulcerative colitis (UC) and 110 with Crohn’s disease (CD). Results The first, 2d and 3d degree of ND were detected in 111 (27.1%), 96 (23.4%) and 42 (10.2%) patients with UC, respectively. 2d and 3d degree of ND was recorded in 48 (43.6%) and 29 (26.4%) cases in patients with CD, respectively. At the second stage of the study, 80 patients with UC were randomised into two major groups, depending on the degree of NN, were divided into groups A (2d degree of ND) and B (3d degree of ND). On basic therapy, patients of the Ist group received a diet with a high amount of protein (HAPD) and increased calorage (2500 kcal/day), while to the patients of the IId group in addition to the basic therapy, nutritional mixtures: peptamen and modulen IBD (Nestle) in the amount of 1/3 of the daily calorage were prescribed. Efficacy of treatment was evaluated on the 3 d, 4th, 12th week. At the third stage of the study, during 3 years, the long-term results were studied using index of the relapse frequency (IRF). Pick of the IRF was in the first group and by the end of the study, it was 15 (75%) and 17 (85%) cases, respectively. In the second group IRF was significantly lower: 9 (45%) and 12 (60%) (p &amp;lt;0,05). Conclusion In patients with UC and CD relapse ND of the first and 3d degree was recorded an average of 20.3% and 35%, respectively. The usе of NS provides a low-rate UC relapse, and thus stable remission of the disease.

Outcomes in Pediatric Patients with Severe Aplastic Anemia Treated with Standard Immunosuppression and Eltrombopag

Background: Immune aplastic anemia (SAA) disproportionally affects children and young adults. Immunosuppression (IST) remains the treatment of choice for patients less than 40 years of age without a fully human leukocyte antigen (HLA) matched sibling. In the pediatric population (aged &amp;lt;18 years), from NIH historic studies, horse antithymocyte globulin (h-ATG) and cyclosporine(CSA) regimes have produced good results, with an overall response rate (ORR) of 74% at 6 months, a relapse rate of 33% at 10 years, and an overall survival (OS) of 80% at 10 years (Scheinberg P, J Pediatrics 2008), generally better outcomes than in adults. Eltrombopag (EPAG) is an oral thrombopoietin-receptor agonist that has been shown to significantly improve response rates when combined with h-ATG and CSA for treatment-naïve patients (Townsley D, NEJM 2017). We report here a pediatric subgroup analysis of our clinical trial (NCT01623167) to assess whether the addition of EPAG to IST improved ORR in children with SAA. Methods: Between 2012 and 2018 a total of 39 patients &amp;lt;18 years of age with SAA were treated with front line EPAG in combination with h-ATG and CSA. We assessed ORR at 6 months, relapse rate, rate of clonal evolution, and OS. Additionally, we monitored for the development of clonal evolution and for the emergence of somatic clones. Germline testing for inherited marrow failure was performed in all patients. Response was defined by blood counts no longer satisfying criteria for SAA. Outcomes were compared to two treatment-naive cohorts: adult patients aged 18 years and older who received EPAG in combination with immunosuppression (adult EPAG group), and a historical cohort (from 1989 to 2010) of 87 pediatric patients aged &amp;lt;18 years who were treated with immunosuppression (pediatric IST group). The pediatric IST group included all patients treated with a h-ATG based regimen including h-ATG with CSA, and h-ATG with CSA and additional immunosuppression (either mycophenolate mofetil or sirolimus). A historical adult group (Adult IST group) of 322 patients treated from 1989 to 2010 with the same IST regimens as the pediatric IST group was also used as a comparator. Analyses were based on intention-to-treat. Results: Median age in the pediatric EPAG group was 15 years and in the pediatric IST group 11 years. Thirty-two patients (of an initial 39) were evaluable for response at 6 months. Seven patients (18%) were taken off study prior to 6 months to undertake bone marrow transplant, due to either failure to respond by 3 months or clinical urgency in count recovery. Overall, 28 (72%) of all treated patients achieved a response at 6 months, by comparison, responses were observed in 74% of the pediatric IST group (p=0.836) and in 83% in the adult EPAG group (p=0.143). In contrast, patients in the adult EPAG group had a significant difference in 6 month ORR compared with the adult IST group (83% versus 58%, p= &amp;lt;0.0001). The PK analysis of EPAG suggested comparable exposure in pediatric (6-17 years) and adult population. Of the 28 patients who achieved a response at 6 months, 43% relapsed, compared to 28% in the pediatric IST group (p=0.252). Median time to relapse in the pediatric EPAG group was 565 days from IST. There was no significant difference in survival between the pediatric EPAG group and either the pediatric IST group or the adult EPAG group. Clonal evolution occurred in 3 (8%) of patients (monosomy 7, del 5q, and translocation 5:12); 7% of patients evolved in the pediatric IST group. Somatic mutation testing was performed in 36 patients at baseline and was negative in all. At the 6 month timepoint, 5 patients had developed new somatic mutations (2 ASXL1, 2 ATRX, 1 BCOR), three clones appeared in responders and two in non-responders. Germline testing did not reveal any pathogenic variants. Conclusion: Eltrombopag added to immunosuppression did not improve ORR at 6 months in pediatric patients with SAA compared to our historical cohort of pediatric IST patients. In contrast, adults had much improved responses with EPAG. Some patients were taken off study prior to 6 month evaluation (18% compared to 6% in the pediatric IST group) to pursue BMT, likely reflecting recent improvements in outcomes and donor availability. In our study the addition of eltrombopag to IST did not provide any obvious therapeutic benefit to pediatric patients with severe aplastic anemia. This research was supported in part by the Intramural Research Program of the NIH and NHLBI. Disclosures No relevant conflicts of interest to declare.

Xiaokeping Mixture Attenuates Diabetic Kidney Disease by Modulating TGF-β/Smad Pathway in db/db Mice.

Xiaokeping mixture (XKP), a traditional Chinese medicine compound preparation, has achieved widespread use for diabetes mellitus and its kidney damage in clinical practice. The current study was carried out to assess the protective effect of XKP in spontaneous diabetic db/db mice and the underlying mechanism whereby XKP regulates TGF-β/Smad pathway. Male C57BLKS/J db/db mice, 12 weeks old, were randomly divided into 3 groups: the model group, 17.5 mg/kg irbesartan-treated group (IST group), and 8 g/kg XKP-treated group (XKP group), while age-matched db/m mice were selected as a control group. After 8 weeks of administration, serum and urea samples were collected from mice for biochemical tests, while the kidneys were removed for histological analysis. The expression of TGF-β/Smad pathway-related mRNA and protein were measured by RT-PCR and western blot analysis. Treatment with XKP significantly improved renal function and attenuated the pathological change of diabetic kidney disease (DKD) in renal histopathology. Furthermore, the overexpression of TGF-β1, Smad3, and p-Smad3 was inhibited, as well as the reduction of Smad7 and SIP1 was weakened by XKP. In conclusion, these results suggest that XKP could attenuate DKD by modulating TGF-β/Smad pathway.

AGE SPECIFIC CHARACTERISTICS OF ORAL HYGIENE LEVEL OF SCHOOLCHILDREN

One of the most important reasons of dental caries appearance in children is improper oral hygiene which results in the accumulation of plaque containing significant amount of pathogenic microflora. Its vital activity products cause demineralization of tooth hard tissues. This is relevant for children of all ages but the most important in first years after teething as teeth are poorly mineralized and have tendency to the appearance of carious process.&#x0D; Totally 412 children aged 6 to 16 years old attending organized children's collectives (schoolchildren from 1st to 11th year of studying) were examined. Oral cavity examination was carried out according to the generally accepted method. The level of oral hygiene was determined by Fedorov-Volodkina’s and Green-Vermillion’s indices. The research was conducted in the each age period separately and in age groups corresponding to 6-9 years (group I - elementary school), 10-13 years (group II - secondary school), 14-16 years (group III - high school). Statistical processing of the obtained data was carried out using the Student’s method. The results were considered significant at p &lt;0.05.&#x0D; Analysis of oral hygiene level according to Fedorov-Volodkіna’s technique revealed that children aged 6 to 9 years (I group) had “unsatisfactory” oral hygiene level. The research of each age period reveals that only children of 9 years old take care after their oral cavities properly. We have detected significant differences of oral hygiene level of children with caries and with intact teeth. The worst oral hygiene level was observed in children of 6 years old affected by caries.&#x0D; In children 10-13 years old (Group II) the average index of oral hygiene is 2.20 ± 0.08 points which corresponds to unsatisfactory level. This is a slightly better index comparing to the previous age group. At the every age, the hygiene index in children affected by caries is worse comparing to those who aren’t affected by it (p &lt;0,05). In children from the high school affected by caries the level of of the oral cavity hygiene ranges from 2,27 ± 0,09 in 11 years to 2,60 ± 0,21 in 10 years. These results correspond to the unsatisfactory level, but probable age differences were not discovered. Children without caries have “satisfactory” level of oral hygiene in 10 years and 11 years old and “good” level at 12 and 13 years. Thus, we observe the improvement of oral hygiene level in children with increasing of their age, especially for those with intact teeth comparing to the primary schoolchildren.&#x0D; High school children (Group III) also had an unsatisfactory average hygiene index (2.34 ± 0.10 points) and unsatisfactory rates of caries for children, which corresponded to the indices of I and II observed groups. In children who had no carious lesions detected the level o oral f hygiene at 14, 15 and 16 years was “good”. This fact indicates improvement of manual skills on oral health care of high school children.&#x0D; For more objective study concerning the oral hygiene cavity of different children, the Green-Vermillion’s index was also used. It makes possible assessment the state of the entire oral cavity.&#x0D; The average index of oral hygiene in children of the Ist group corresponds to the average value and is evaluated as “satisfactory” state of oral hygiene (Table 2). In children with caries (1.29 ± 0.09 points) and with intact teeth (0.99 ± 0.04 points) we observe the corresponding clinical situation. Significant changes were found in children of 9 years with intact teeth comparing to 6, 7 and 8 years old children. Thus, we observe an improvement of oral hygiene skills in children from elementary school.&#x0D; Children without caries lesions of the ІІnd and ІІІrd research groups have “satisfactory” and “good” of oral hygiene level. For those with caries in all age periods the result is “satisfactory”. The index of oral hygiene for children with and without caries have significant difference.&#x0D; In order to assess the level of oral hygiene objectively the preference should be given to Green-Vermillion’s index. Particular attention should be paid to the level of oral hygiene of children from elementary school pupils, since it is worse comparing to the oral hygiene level of children from secondary and high school. We do not observe a significant improvement in oral hygiene in senior children comparing to ones from secondary school. This causes the necessity in constant education and control over oral cavity care in schoolchildren.

Application of platelet rich plasma in the treatment of pain syndrome in patients with plantar fasciitis

Objective: to analyze the results of the injection of plateletrich plasma (PRP) and prolonged-acting corticosteroids in patients with plantar fasciitis (PF).Methods: 43 patients were examined (55 feet) with pain syndrome of PF. There were women 29, men — 14, average age (44 ± 1.41) years, average duration of the pain syndrome (3.5 ± 0.36) months. Together with the complex of conservative treatment for patients we prescribed locally injections: in group I (27 patients) — once 1 ml of betamethasone, in II group (16 patients) — PRP (2 ml three times with an interval of 7 days in the region of enthesis). The standard PRP method was used. The pain syndrome was evaluated with the help of VAS before, after 1, 3 and 6 months after treatment. Thickness of plantar aponeurosis (PA) was measured with sonography before and in 6 months after treatment.Results: the average level of pain syndrome before the injections in the both groups were almost identical and amounted to (7.2 ± 0.17) and (7.3 ± 0.23) points, respectively. In a month after the injection in the Ist group, the pain syndrome significantly decreased to (3.5 ± 0.12) points, which confirms fast analgesic effect of manipulation. In the IInd group, the indicators of pain decreased to (4.6 ± 0.17) points. By 6 months the results were almost identical in both groups of patients. Thickness of PA before treatment was equal in the group І (6.62 ± 0.08) mm, in ІІ — (6.81 ± 0.1) mm, so there was no difference between them. After 6 months the thickness of PA was equally reduced in both groups: in the Ist — to (4.49 ± 0.07) mm, in the IInd — to (4.42 ± 0.09) mm, which is objective criterion for the positive therapeutic effect of both methods of treatment.Conclusions: injections of PRP and prolonged-action corticosteroids provide the same positive results in the treatment of pain syndrome in patients with PF. Effect of corticosteroids is fast, but their use is limited due to a number of complications. The introduction of PRP helps to reduce pain syndrome and to normalize thickness of PA.

Effect of garlic extract on mortality and biochemical parameters of fresh water fishes Heteropneustes fossilis against Cypermethrin

To find out the effect of garlic extract (GE) on mortality different concentrations of GE (1ml/l, 2ml/l, 5ml/l &amp; 10ml/l) were administered along with the LC50 values of cypermethrin after 24, 48, 72 &amp; 96 h exposures and 10 ml/l of GE was found to be effective at which no mortality occurred. To analyze the effect of GE on biochemical parameters after acute exposure of cypermethrin, fishes were divided into 4 groups of 10 fishes each. Ist group served as control, IInd, IIIrd and IVth group were treated with toxicant (24h LC50), GE (10ml/l) and toxicant + GE respectively. Same protocol was employed using 48-96 h LC50 values &amp; 10ml/l GE. For chronic toxicity experiments fishes were divided into 4 groups of 10 fishes each. Ist group taken as control, IInd group contained 1/10th of 96 h LC50 of CYP, IIIrd group contained 10ml/l GE and in IVth group GE (10ml/l) + CYP (1/10th of 96 h LC50) for 15 days. Experiments were also carried out after 30 and 45 days exposure by same protocol. After acute and chronic exposure periods blood samples were collected, centrifuged and serum was separated to analyze biochemical parameters. Increased level of SGOT, SGPT, ALP, ACP, Creatinine, and Blood Glucose were observed during both acute and chronic exposure. Activity of Total protein was found to be decreased following acute and chronic exposure. Level of Uric acid increased in acute exposure but decreased during chronic exposure. However, garlic extract supplementation showed a remarkable reduction to these changes and all the parameters tends to become normalize. Our data indicate that garlic is a powerful antioxidant against cypermethrin induced toxicity.&#x0D; Keywords: Cypermethrin, Garlic extract, Heteropneustus fossilis, LC50.

М'ясна продуктивність корів абердин-ангуської породи різного походження

Improvement of beef production technology by the use of specialized beef breeds is one of the most important problems of the agrarian sector of national economy of Ukraine. For this purpose the main characteristics which determine meat production of cattle stock are breed, sex, age, rearing and fattening intensity and methods of live-stock handling. The leader in the number of livestock among the imported beef breeds in Ukraine is the Aberdeen Angus breed. Multi-year research of meat productivity shows that meat of this breed’s heifers is characterized by unique succulence and marbling, high quality and splendid tastiness. At the same time the negative attribute of the breed is relatively low heifers’ body weight, compared to other beef breeds, and excessive fat deposition at early age. Therefore nowadays there is a reason for breeding variety – new domestic beef breed based on Aberdeen Angus breed, which would keep high-quality tastiness and marbling of beef and would be more competitive under intensive technology. Herewith large attention should be paid to the studying of meat qualities of heifers, both of original breed and of the domestic one bred on its basis. Data concerning meat productivity of Aberdeen Angus breed heifers of various origins in conditions of year-round outdoor breeding system in the East of Ukraine are presented in the article. Subjects of research were represented by Aberdeen Angus breed heifers of British selection (the Ist group) and by forming Ukrainian Angus breed heifers (the IInd group). Research of meat qualities was carried out and was followed by testing slaughter of three heifers from each group. Performed research indicated that heifers of the IIndgroup prevailed over heifers of the same age of the Istgroup according to the main slaughtering indexes. By hot carcass weight and carcass yield in relative values heifers of the IIndgroup had more full meat and also were characterized by greater slaughtering weight and slaughtering yield. Domestic Angus breed heifers were defined by less liability to fat deposition with aging and by having more lean meat. The important point is that forming Ukrainian Angus breed heifers shows lower bones yield that heifers of British selection and also the Istgroup significantly prevails by meat yield per 1 kg of bones. To conclude it should be mentioned that forming Ukrainian Angus breed heifers results as more cost effective and competitive in conditions of current market economy.