Pronounced Inflammatory Changes Research Articles

Genetic predictors of the risk of developing complications in the immediate postoperative period following combat trauma

Introduction. Paratraumatic eczema (PTE), being a type of microbial eczema, occurs after surgical interventions, chronic wound healing, accompanied by pronounced inflammatory changes with hyperemia, edema, exudation, soreness and itching. Genetic polymorphisms of cytokines and Toll-like receptors (TLRs) may be pathogenetic factors in the development of PTE, causing the penetration of microorganisms and violation of the protective properties of the skin barrier. Goal. To study the relationship of polymorphisms rs1800629 of the TNFα gene, rs5743708 of the TLR2 gene, rs3775291 of the TLR3 gene, rs4986790 of the TLR4 gene with the development of paratraumatic eczema in combat trauma victims. Material and methods. The study included 162 patients, of whom 82 showed signs of PTE (comparison group), 80 people had no signs of PTE (control group). Genotyping of polymorphisms was carried out using the polymerase chain reaction method with electrophoretic detection using test systems of NPF Litech (Russia). The Statistica 10 program (StatSoft, Inc., USA) was used for statistical data processing. Results. A connection with the development of PTE with variants of genotypes and alleles of polymorphisms was established: rs1800629 of the TNFα gene (χ2=6.9; p=0.033 and χ2=8.12; p=0.005); rs3775291 of the TLR3 gene (χ2=6.9; p=0.039 and χ2=5.74; p=0.018); rs4986790 of the TLR4 gene (χ2=8.17; p=0.018 and χ2=7.85; p=0.005). The increase in the chances of developing PTE was influenced by: genotypes GA (OR=1.64; 95% CI 0.83–3.24) and AA (OR=2.94; 95% CI 0.9–9.67), allele A (OR=2.13; 95% CI 1.26–3.6) rs1800629 TNFα gene; genotypes CT (OR=1.58; 74% CI 0.93–3.24) and TT (OR=1.79; 95% CI 0.67–4.8), allele T (OR=1.76; 95% CI 1.1–2.8) rs3775291 TLR3 gene; genotypes AG (OR=2.58; 95% CI 1.24–5.37) and GG (OR=3.0; 95% CI 0.31–29.47), allele G (OR=2.44; 95% CI 1.29–4.62) rs4986790 of the TLR4 gene. Conclusions. Polymorphisms rs1800629 of the TNFα gene, rs3775291 of the TLR3 gene, rs4986790 of the TLR4 gene are associated with the development of paratraumatic eczema in combat trauma victims

ОСОБЕННОСТИ ТАКТИКИ ВЕДЕНИЯ ПАЦИЕНТКИ С МНОЖЕСТВЕННОЙ МИОМОЙ МАТКИ И ДИВЕРТИКУЛЕЗОМ КИШЕЧНИКА

The purpose of this study is to study the features of management tactics for a patient with multiple uterine fibroids and intestinal diverticulosis. When analyzing this clinical case, it was revealed that surgical intervention was indicated in this case. A complication, intraoperative injury to the ileum, occurred due to severe inflammation and adhesions of the abdominal cavity caused by diverticulosis of the large intestine. The presence of pronounced inflammatory changes in the ileum with the formation of diverticular disease, followed by the development of a massive adhesive process in the intestine, was not diagnosed before surgery. Late diagnosis may be due to the patient having a mild, asymptomatic clinical picture of the disease and the absence of pronounced clinical manifestations. The patient's nagging pain in the lower abdomen could be due to either the large size of uterine fibroids or be a manifestation of the clinical picture of diverticular disease. The ileal injury was detected in a timely manner, during a planned operation, and repaired in a timely manner. The management tactics in the postoperative period were correct; all diagnostic and therapeutic appointments were carried out in full, which allowed the woman to be discharged on the 14th day of the postoperative period in satisfactory condition. The patient was given recommendations in connection with the diagnosis of diverticular disease, aimed at preventing its progression and development of complications. It is necessary, if a patient has diverticulosis, even with minor manifestations and an asymptomatic course, to assume the possibility of developing pelvic adhesive disease and to prevent the development of possible complications.

Assessment of working conditions and features of respiratory disorders in modern refractory manufacturing

Introduction. Broad prospects for development of refractory manufacturing in Russia necessitate studies of the work environment, especially of the indoor air quality, and respiratory health effects of adverse occupational factors. 
 The purpose of our study was to conduct a general hygienic assessment of working conditions of the core personnel engaged in contemporary refractory manufacturing for more than 10 years and establish their respiratory functional status.
 Materials and methods. We assessed working conditions of press operators of a Ural refractory manufacturing plant in compliance with Russian Guidelines 
 R 2.2.2006–05. The respiratory functional status was established by the results of clinical instrumental testing of refractory production workers who were examined and/or treated at the occupational health clinic of the Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers 
 in 2015–2021.
 Results. We gave a general assessment of working conditions of press operators engaged in the production of spinel periclase-carbon and fireclay-dinas molded refractories in the first refractory workshop, aluminosilicate refractories at the molding site, and corundum-graphite products in the second refractory workshop. 
 We analyzed the results of instrumental testing and established characteristics of clinical disorders of the respiratory system.
 Limitations. The study has regional (Sverdlovsk Region) and occupational (workers of a refractory manufacturing plant) limitations.
 Conclusion. Occupational risk factors for refractory production workers include silica-containing aerosols, which levels exceed maximum allowable concentrations (Class 3.1), aerosols of disintegration of aluminum oxides (in refractory workshop No. 2), iron in concentrations below MACs (Class 2), higher concentrations of volatile products of phenol formaldehyde resins (Class 3.1 in terms of phenol and up to 3.4 in terms of formaldehyde), increased noise levels for all jobs (Class 3.2), and heavy physical labour (Classes 3.1–3.3). Features of clinical respiratory disorders in the core personnel (press operators) were scarcity of complaints and physical data, absence of pronounced coniotic (respirable dust-related) X-ray findings and inflammatory (septic and allergic) blood changes. Moderate obstructive airway disorders were observed in 30 % of the examined cases.

Pathomorphological changes of the placenta in antenatal asphyxia of the fetus associated with the coronavirus disease (COVID-19) in pregnant women

The objective: to determine the pathomorphological changes in the placenta by antenatal asphyxia of the fetus associated with the coronavirus disease (COVID-19) in pregnant women.Materials and methods. 21 placentas by fetal antenatal asphyxia which occurred at different terms of pregnancy in women with COVID-19 were examined. COVID-19 was diagnosed by a positive PCR test – detection of SARS-CoV-2 RNA. The study groups were defined depending on the duration of the post-covid interval (time from the diagnosis of COVID-19 to delivery). I group (n=12) included placentas of women with antenatal fetal asphyxia, in whom the postpartum interval was 1–4 weeks; II group (n=9) – placentas of women with fetal death, in whom the postpartum interval was 5–14 weeks.In the I group, antenatal asphyxia of the fetus occurred in the term from the 13th to 36th weeks of gestation, in the II group – in period from the 29th to the 41st week. Macroscopic, organometric, microscopic methods of placenta research and a statistical method were applied. Fetal-placental index (FPI) was calculatedResults. In the studied cases, antenatal fetal death occurred in different terms of pregnancy, namely, from the 14th to the 41st week of gestation (median is 32 weeks). Pregnant women had COVID-19 from the 13th to the 35th week of gestation (median is 25 weeks); when the mother was diagnosed with COVID-19 after the 35th week, there was no case of antenatal fetal death. The severity of the course of the coronavirus disease was mild in 7 pregnant women, moderate – 12 persons, and a severe course with pneumonia was diagnosed in 2 women. The severity of morphological changes in the placenta did not depend on the severity of the course of COVID-19 in the pregnant woman (chorioamnionitis, p=1.0; intervillositis, p=0.63; obliteration of arterioles, p=0.32).In the I group, a slight increase in FPI was found up to 0.19 [0.12; 0.34], in the II group – a similar indicator was 0.16 [0.13; 0.24]. However, the absolute values of the weight of the fetus and placenta in both groups were lower than those for the given gestational age.The I group of placentas there were the pronounced inflammatory changes – placentitis: chorioamnionitis – 100% (95%CI: 85.4–100) and basal deciduitis – 91.7% (95%CI: 67.1–100). In the II group the inflammatory changes of the chorioamniotic membranes and basal plate were focal and were found in 6 placentas – 66.7% (95% CI: 29.2–94.8). Intervillositis was detected in 11 placentas – 91.7% (95%CI: 67.1–100) in the I group versus 2 placentas – 22.2% (95%CI: 1.1–58.9; p=0.006) in the II group.Villositis in the I group was determined in 8 cases – 66.7% (95%CI: 35.4–91.4) and in only one placenta in the II group – 11.1% (95%CI: 0.0–43.91; p=0.034). In the placentas of both groups the fibrinoid necrosis of the arteriole wall, proliferative changes in the vessel wall and necrosis of the endothelium were detected – 100% (95%CI: 85.4–100), dyscirculatory disorders (stasis, thrombosis, hemorrhages) were found in 75% (95% CI: 44.4–95.8) of cases in the I group and in 66.7% (95% CI: 29.2–94.8) – in the II group. An increased number of syncytial nodules was observed as a manifestation of compensatory mechanisms: in the I group – 83.3% (95%CI: 54.7–98.9), in the II group – 88.9% (95%CI: 56.1–100).All studied cases in the II group were accompanied by obliteration of the lumen of the arterioles of trunk and semi-trunk villi – 100% (95%CI: 80.9–100; p=0.0006), versus the I group – 16.7% (95%CI: 1.1–45.3). At the same time, in 6 cases in the II group the morphological manifestations of restoration of the lumen (revascularization) were detected – the formation of intravascular septa – 66.7% (95% CI: 29.2–94.8), which were not found in the I group (р=0.0093). In 100% (95%CI: 80.9–100) of placentas of the II group and in 66.7% (95%CI: 35.4–91.4) of the I group the stroma fibrosis of stem and semi-stem villi, obliteration intervillous space, and hypoplasia of terminal villi were determined.Conclusions. Statistically significant differences of placentas in antenatal asphyxia of the fetus depended on the length of the postcovid interval: in the postcovid interval of 1–4 weeks (I group) the inflammatory changes prevailed – placentitis: chorioamnionitis – 100% (95%CI: 85.4–100), intervillositis – 91.7% (95% CI: 67.1–100), p=0.006; villositis – 66.7% (95%CI: 35.4–91.4), p=0.034. When the duration of the postcovid interval increased to 5–14 weeks (II group), arteriosclerosis prevailed – 100% (95% CI: 80.9–100); p=0.0006.The cause of antenatal fetal death in the women with COVID-19 in the I group is acute placental insufficiency associated with the exudative phase of inflammation (chorioamnionitis, villositis, intervillositis). In the II group, the cause of antenatal fetal asphyxia is the formation of chronic placental dysfunction caused by the proliferation phase, which was manifested by proliferative changes in the muscular layer of arterioles and their subsequent fibrosis with obliteration of the lumen of arterioles (arteriosclerosis).

РОЛЬ ШВАННОВСКИХ КЛЕТОК В ПАТОЛОГИИ ЧЕРВЕОБРАЗНОГО ОТРОСТКА У ДЕТЕЙ

Objective: To compare the immunohistochemical (IHC) characteristics of appendices removed from children with acute appendicitis and chronic pain syndrome (CP) in the right lower quadrant of the abdomen (RLQA), as well as to define clinical and morphological correlations. Methods: The structure of fifty-one appendices of children aged 5-14 years who underwent appendectomy for chronic appendicitis/CP in the RLQA (24 patients, Group 1) and acute appendicitis (27 patients, Group 2) was assessed. Image analysis of histological sections stained with hematoxylin-eosin and immunohistochemically for S100 protein and proliferating cell nuclear antigen (PCNA) was performed. Results: Image analysis showed the presence of a significantly higher volume density (VD) and numerical density (ND) (p0.05) of immunoreactive cells when stained for S100 protein, as well as the ND of intramural ganglia (p0.05) against the background of minimal histological changes in the wall of the appendix in patients of Group 1 compared to Group 2. On the contrary, the ND of PCNA-immunoreactive cells was significantly higher in patients of Group 2 against the background of pronounced inflammatory changes in the appendix (p0.01). In the biopsy samples of the Group 1 patients, a significantly higher ND of the lymphoid nodule germinal centers was also noted (p0.05), while the ND of tingible body macrophages was higher in Group 2 patients (p0.001). These results demonstrate differences in neuroimmune parameters in the appendices in the two described nosologic groups and indicate the possible role of the appendiceal neural component as a prerequisite for developing CP in the RLQA in children. Keywords: Appendix, Schwann cell, S100 protein, PCNA, appendicitis, chronic abdominal syndrome.

Efficacy of olocizumab in treatment of COVID-19 patients

Background. Production of pro-inflammatory cytokines including interleukin 6 (IL-6) is activated in COVID-19. Using olokizumab which inhibits IL-6 production in treatment of COVID-19 is pathogenetically justified.The aim. To study in real clinical practice the efficacy and safety of using the IL-6inhibitor (olokizumab) in treatment of patients with confirmed COVID-19 pneumonia.Materials and methods. The first group included 41 hospitalized patients with confirmed COVID-19 pneumonia having complex therapy including olokizumab. The control group consisted of 66 patients with confirmed COVID-19 pneumonia who did not have therapy with IL-6 inhibitor. We analyzed clinical (volume of lung involvement, respiratory failure degree, body mass index) and laboratory data (levels of T-troponin, lactate, procalcitonin, natriuretic peptide, C-reactive protein, fibrinogen, D-dimer, ferritin, erythrocyte sedimentation rate, glomerular filtration rate).Results. The groups did not differ in gender, age, body mass index of patients, volume of lung tissue injury, and duration of hospitalization (p > 0.05). Respiratory failure of 2–3rd degree was more common in patients of the first group (χ2 = 6.3; p = 0.010). The initial levels of C-reactive protein (50.9 [34.2; 76.2] and 32.2 [9.9; 69.1] mg/L respectively; p = 0.009) and fibrinogen (6.0 [5.3; 6.7] and 5.2 [4.3; 6.2] g/l respectively; p = 0.005) in patients having therapy including olokizumab were significantly higher than in the control group. The levels of erythrocyte sedimentation rate, fibrinogen and ferritin, D-dimer, detected upon admission of patients to the hospital, didn’t have statistically significant differences. At discharge, the erythrocyte sedimentation rate in patients receiving olokizumab was statistically significantly lower (9.0 [5.5; 14.5] and 13.0 [7.0; 27.0] mm/h; p = 0.018).Conclusions. Using olokizumab in the treatment patient with COVID-19 pneumonia has demonstrated a positive effect on clinical and laboratory parameters (erythrocyte sedimentation rate, fibrinogen level) in patients with pronounced inflammatory changes and respiratory impairment.

ГИСТОЛОГИЧЕСКАЯ, МОРФОМЕТРИЧЕСКАЯ И ИММУНОГИСТОХИМИЧЕСКАЯ ОЦЕНКА ПРОТИВОВОСПАЛИТЕЛЬНОГО ДЕЙСТВИЯ АЦЕТИЛЦИСТЕИНА И ДЕКСАМЕТАЗОНА ПРИ ЭКСПЕРИМЕНТАЛЬНОМ ИММУНОГЕННОМ УВЕИТЕ

Objective. To evaluate the effect and compare the effectiveness of N-acetylcysteine (NAC) and dexamethasone parenteral administration in the form of monotherapy and combined application on the morphological parameters of inflammation and the level of IL-6 expression in the eye tissues of rabbits with experimental immunogenic uveitis (EIU) at different periods. Material and methods. In total 27 rabbits (54 eyes) were involved in the experiment, three of them were intact. 24 rabbits with reproduced EIU were divided into 8 groups (3 in each). Animals with EIU in different groups received, respectively, treatment with parenteral injections of placebo, NAC, dexamethasone or a combination of NAC and dexamethasone and were withdrawn from the experiment on the 3rd or 7th day. Subsequently, histological and morphometric assessment of the uveal tract tissues of rabbits was performed, and the level of IL-6 expression in them was determined by immunohistochemistry. Results. EIU was accompanied by pronounced inflammatory changes, as well as an increased expression of IL-6 in the tissues of the uveal tract. NAC when administered parenterally had a pronounced anti-inflammatory effect and allowed to reduce the expression of IL-6 in the eye tissues. Application of the NAC and dexamethasone combination had the most significant anti-inflammatory effect, in comparison with NAC and dexamethasone monotherapies. Conclusion. 1. Parenteral administration of NAC has an anti-inflammatory effect and reduces the expression of IL-6 in eye tissues in uveitis. 2. Combined therapy with NAC and dexamethasone has a synergistic anti-inflammatory effect. 3. The results of the study allow recommending NAC for use in the complex therapy of uveitis, in particular in combination with dexamethasone.

Влияние пиеловенозного рефлюкса на развитие острого пиелонефрита в экспериментальной модели

currently, endoscopic methods are the main option for surgical treatment of patients with urolithiasis (ICD). The widespread use of these operations has led to the development of a number of specific complications associated with the technology of their implementation. One of the frequent complications is the development of postoperative acute pyelonephritis against the background of intraoperative pyelovenous reflux.to study under experimental conditions the severity of pathomorphological changes in the ureter and kidney tissue against the background of pyelovenous reflux in the presence and absence of bacterial flora.32 mature female rabbits of the "White Giant" breed were selected as an experimental model. Experimental strain of the E. Coli microorganism 105 KOE/ml. Laboratory animals were divided into 4 groups, 1-3 experimental groups, 4 control group of observation without surgical intervention. In experimental groups, NaCl 0.9% 2.0 ml was injected into the ureteral lumen in group 1, E. Coli 1x105 CFU/ml 1.0 ml in group 2, NaCl 0.9% 1.0 ml + E. Coli 1x105 CFU/ml 1.0 ml in group 3.Results: according to the results of the study, the pathomorphological evaluation of kidney and ureter preparations revealed pronounced inflammatory changes in group 3.pyelovenous reflux does not independently lead to the development of acute pyelonephritis. The combination of reflux and microbial flora leads to inflammatory changes in the wall of the calyx-pelvic system with the development of acute pyelonephritis, which is confirmed by the results of pathomorphological examination of kidney and ureter tissue.

PATHOBIOME TRANSFORMATION AND FEATURES OF ENTERAL INSUFFICIENCY IN PATIENTS WITH PERITONITIS DURING THE COVID-19 PANDEMIC

We studied the features of acute enteral failure in patients with peritonitis in the setting of COVID-19 by studying the properties of the enteral pathobiome, biochemical, functional, pro-inflammatory and anti-apoptotic markers in diffuse peritonitis. A retrospective randomized cohort controlled study was conducted; it included 84 patients divided into two groups. Stratified randomization was used. The species composition and properties of the enteral luminal pathobiome were studied. 699 inoculations were made, resulting in 3024 isolates. The enteral morphofunctional coefficient, the level of alkaline phosphatase and its intestinal isoform were dynamically studied. In immunohistochemical studies, we studied the expression of CD-3 and Bcl-2. Patients with COVID-19 in addition to a decrease in the level of saprophytic microflora, showed a significant increase in Klebsiella spp., Candida, Clostridium spp. and Citrobacter (p≤0.05). The rate of antibiotic resistance in the comparison group was 8.3%, in the main group - 36.9%. MRSA pathogens were noted in 86.4% of cases, VRSA strains were found in 20.6% of cases. Patients with COVID-19 had a deficiency of intestinal alkaline phosphatase, which persisted even on the day 5 of treatment. Macro- and microscopic studies showed pronounced inflammatory and apoptotic changes in the intestinal wall of patients in the main group. A specific enteral pathobiome that is multiresistant to antibiotics, pronounced inflammatory and apoptotic changes in the intestinal wall, and a predisposition to perforation of the small intestine are characteristics of enteral failure in diffuse peritonitis in the setting of COVID-19.

Pathomorphological characteristics of the wound bed prior to skin autografting

Objective: to conduct a comparative pathomorphological analysis of wounds of various origins requiring full-thickness skin autografting. Materials and Methods. Histomorphological comparison of the wound bed prior to plastic surgery with full-thickness skin autografts was performed in three groups of patients: (1) during excision of scar tissue in elective surgery; (2) in case of traumatic skin detachments with autografting sensu Krasovitov; (3) when excising the granulation tissue to the fibrous layer. The object of the study included biopsy specimens from patients of three study groups. Results. The histological picture of wounds after removal of scars was characterized by well-developed dense fibrocellular connective tissue and had signs of chronic inflammation. In contrast to the cicatricial wound, acute lesions were characterized by granulation and mature dense fibrous connective tissues with pronounced inflammatory changes, each of which had its own characteristics. Conclusion. The results of the comparative analysis revealed the features of the morphological picture of wounds depending on the type of damage. In the group of acute injuries, traumatic and burn wounds, the most pronounced tissue damage was revealed. Given the obtained data, it should be assumed that full-thickness skin autografting will yield the best result in the group of patients after the planned excision of scar tissue.

Prevention of radiation-induced rectal injuries with perirectal blocks in radiation therapy.

e17507 Background: The purpose of this study was to evaluate perirectal blocks in prevention of radiation-induced rectal injuries in patients with cervical cancer. Methods: The study included 18 patients diagnosed with stage III cervical cancer (T3bNxM0) receiving chemoradiotherapy. All patients showed pronounced inflammatory and dystrophic changes in tissue planes and organs of the small pelvis due to comorbidities (diabetes mellitus, hypertension, pelvic varicose veins, proctitis, inflammatory and adhesive processes in the small pelvis reducing chemoradiotherapy effectiveness due to impaired microcirculation and increasing the risk of post-radiation complications). All patients received brachytherapy with additional perirectal administration of drugs relieving pain and inflammation and improving neurotrophic processes and microcirculation in tissues (novocaine 0.25% -20.0; milgamma 2.0; ceftriaxone 1 g; dexamethasone 8 mg). The combined administration causes drug potentiation, positively affects the nervous and neuromuscular systems, restores microcirculation and venous outflow, decreases swelling, improves tissue trophism, reduces blood vessel permeability, and improves reflexes from interoceptors. Radiation therapy was completed on schedule with the introduction of radical doses in all patients, which is challenging in patients with comorbidities leading to impaired trophism and tissue hypoxia. Results: Complete tumor regression confirmed by MRI and ultrasound was observed by the end of the treatment in 90% of patients, apparently due to the radiosensitizing effect on cervical cancer and the radioprotective effect on surrounding tissues. Conclusions: Parametrial blocks during brachytherapy improve the status of tissues of the small pelvis which, in turn, prevents radiation damage, contributes to the timely radiotherapy completion, and improves the treatment effectiveness and the quality of life of patients. This technique is especially relevant in view of the increasing number of diseases that disrupt microcirculation, and hence the oxygenation of tissues, causing tumor radio- and chemoresistance.

Comprehensive molecular and morphological study of abortion material in missed abortion of the first trimester

BACKGROUND: Missed abortion is the main cause of reproductive loss in the first trimester, and genetic causes come first in the etiology of this disease. The immunological aspects of the mother-fetus system are currently widely discussed. In this regard, the study of the immunological relationship between the mothers body and the fetus in missed abortion, depending on the chorion karyotype, as well as after suffering reproductive loss, is a topical task, as it can optimize the methods of examining patients with missed abortion and identify factors that contribute to the development of recurrent miscarriage.
 AIM: The aim of this study was to investigate the morphological and immunohistochemical characteristics of abortion material in missed abortion, depending on the presence of chorionic chromosomal abnormalities and the patients history of reproductive losses.
 MATERIALS AND METHODS: We performed a comprehensive morphological and immunohistochemical study (CD56, HLA-DR-II) of abortion material in 273 cases of missed abortion. Group 1 consisted of patients with different variants of chorionic chromosomal abnormalities (n = 169); group 2 included subjects with a normal karyotype of the chorion (n = 104). The data analysis was carried out taking into account the anamnesis of patients, depending on the presence of reproductive losses.
 RESULTS: We revealed the morphological features of the abortion material in missed abortion in cases with chromosomal abnormalities of the chorion: pronounced edema, sclerosis, necrosis of chorionic villi, more pronounced inflammatory changes in the form of moderate and severe macrophage infiltration of the decidual tissue and endometrium, and accumulations of leukocytes as microabscesses. It has been proven that the severity of inflammatory changes in abortuses depends only on the chorion karyotype and does not depend on either the duration of the presence of an unviable fetal egg in the uterine cavity, or the patients history of reproductive losses. It was shown that the CD56 and HLA-DR-II expressions in the abortion material depend on the patients history of reproductive losses, regardless of the chorion karyotype.
 CONCLUSIONS: In patients with an unburdened obstetric and gynecological history in the first missed abortion, it is advisable only to determine the chorion karyotype in order to identify the cause of missed abortion. The immunohistochemical study of the abortion material with the determination of the CD56 and HLA-DR-II expressions is important in repeated missed abortions, regardless of the chorion karyotype.

MORPHOLOGICAL CHANGES OF PERIODONTAL COMPONENTS UNDER EXPERIMENTAL LIPOPOLYSACCHARIDE PERIODONTITIS COMBINED WITH HYPERTHYROIDISM.

The aim: Investigate structural changes in the tissues of the periodontal complex under the condition of experimental lipopolysaccharide periodontitis combined with hyper¬thyroidism. Materials and methods: The studies were performed on adult white male rats, which simulated periodontitis combined with hyperthyroidism. Periodontal tissues were subjected to morphological examination on the 22nd day of the experiment. Collection of material for microscopic examinations was performed according to the generally accepted method; histological specimens were studied using a light optical microscope. Results: Morphological studies of the components of the periodontal complex of experimental animals with experimental periodontitis established the reorganization of its structural elements. Damage to the epithelium in the area of attachment of the circular ligament and erosive-ulcerative changes of the gums led to a deepening of the gingival sulcus with the formation of a deep periodontal pocket. Intense hyperkeratosis was observed in the area of the bottom of the periodontal pocket. In the own plate of the mucous membrane of the gums - significant edema, collagen fibers were disorganized, defragmented. There were pronounced destructive-degenerative and inflammatory changes of the epithelial and own plates of all areas of the gums and periodontium, damage to the nuclei and cytoplasm of keratinocytes, fibroblasts, and leukocytes. Conclusions: Experimental periodontitis combined with hyperthyroidism is accompanied by pronounced signs of destructive and inflammatory changes in the soft and dense tissues of the periodontal complex, as well as disruption of stromal-vascular interactions, which progress from reversible to irreversible disruption of periodontal connective tissue.

Limited scleroderma: sonographic pattern in the stage of erythema/edema

Objective.To describe the sonopattern of limited scleroderma (LS) in the early stages after the onset of erythema.Materials and methods.The work describes a clinical case of limited plaque scleroderma. The sonographic examination was carried out on an ultrasound scanner using a transducer with operating frequencies of 10–16–18 MHz. Material sampling for the histologic examination of the skin was performed from the area with the most pronounced inflammatory changes under sonographic control.Results.It has been found that increased echogenicity of the dermis, “blurring” of the dermis/hypodermis boundary, increased echogenicity and the “stalactite-like” pattern of subcutaneous fat occur in the frst week of the disease; normalization or a signifcant improvement of the sonopattern is noted by the end of the second week or by the beginning of the third week after the onset of erythema.Conclusion.There is a certain parallelism between the histologic and sonographic patterns, which makes it possible to adequately assess both the activity and the stage of the LS process.

Клинико-морфологический анализ трисомий и полиплоидий, как наиболее распространенных хромосомных аномалий хориона при неразвивающейся беременности

Aim. To compare the clinical and morphological characteristics of missed abortion with the most frequent variants of chromosomal abnormalities (trisomies and polyploidies) and with a normal chorion karyotype. Materials and Methods. A comparative analysis of the frequency of chromosomal abnormalities of chorion in 273 cases of early pregnancy loss was carried out in St. Petersburg in 2005-2008 and 2015-2019. It was found that within 10 years the frequency and structure of chromosomal abnormalities remained unchanged. In this connection, it was decided to analyze the clinicoanamnestic and morphological data in patients with early missed abortion with the most frequent variants of the chorionic karyotype: group A – normal chorionic karyotype (104 cases), group B – chorionic trisomy (114), group C – chorionic polyploidy (26). Results. History of recurrent miscarriage, chromosomal abnormalities of the chorion and congenital malformations of the fetus during previous pregnancies were reliably more frequent in patients of group A (with a normal chorionic karyotype). In abortion material of group A, the least pronounced inflammatory changes in the endometrium, decidual tissue and chorionic villi were detected, compared with other groups, however, signs of hormonal disorders in the form of insufficient gravid transformation of the endometrium were more common. Trisomies of the chorion were characterized by the highest mean age of the patients, no other clinical and anamnestic peculiarities were observed, morphologically this group was characterized by moderate inflammatory changes in the endometrium and decidual tissue and pronounced edema of the chorionic villi. In chorion polyploidies, chronic endometritis was more often identified anamnestically, and morphologically this group was characterized by the most pronounced inflammatory changes in chorionic villi, more pronounced lymphoid-macrophagal infiltration of the endometrium and decidual tissue with accumulations of a large number of leukocytes in them of microabscess and necrosis types. With this, the length of stay of an unviable gestational sac in the uterine cavity did not differ between the groups. Conclusions. Morphologically, all the studied groups had peculiarities permitting to suspect one or another chromosomal abnormality in case of impossibility to perform a cytogenetic examination. More aggressive inflammatory response in the endometrium in missed abortion in chromosomal abnormalities (especially in polyploidies) may play a role in chronization of the inflammatory process in the endometrium, therefore, such patients should undergo a preconception preparation, when planning the next pregnancy.

Capabilities of ultrasonography in the diagnosis of early rheumatoid arthritis and hand osteoarthritis

Objective: to compare results of ultrasound examination (US) of the wrist joints (WJ) and small joints of hands with the clinical signs in patients with early rheumatoid arthritis (eRA) and hand osteoarthriti (OAH).Patients and methods. The study included 42 patients with eRA (group 1) and 38 patients with OAH (group 2). The average age of patients with eRA was 48.60±14.86 years, the duration of clinical manifestations was 7.45±1.77 months, of patients with OAH – 54.97±12.45 years and 8.26±1.83 months, respectively. The ratio of men and women in both groups was approximately the same, the majority were women. All patients with eRA had clinical and instrumentally confirmed signs of OA: I, II, and III radiological stages of OA according to Kellgren–Lawrence were detected in 10 (23.80%), 23 (54.76%) and 9 (21.43%) patients respectively. In erosive OA II and III X-ray stage was diagnosed in 16 (42.10%) and 22 (57.90%) patients, respectively. All patients underwent ultrasound of the joints, as well as a general clinical examination, which included an assessment of the number of painful joints, the number of swollen joints, and a general assessment of pain intensity using a visual analogue scale (100 mm). RA activity was determined using the DAS28 index. We also studied laboratory parameters – the levels of CRP, rheumatoid factor and antibodies to cyclic citrullinated peptide in blood serum.Results and discussion. Comparison of the two groups of patients showed that ultrasound in B-mode and power Doppler mode with eRA and OAH showed more pronounced inflammatory and destructive changes in the wrist joints and small joints of the hands, with the exception of the distal interphalangeal joints (DIPJ). In addition, only in patients of the 1st group there was a close correlation between the enhancement of the Doppler signal and levels of inflammatory markers. Conclusion. eRA compared with OAH is characterized by more pronounced ultrasound signs of inflammatory and destructive changes in the wrist joins and small joints of the hands, with the exception of DIPJ.

ПРИЧИНЫ НЕСОСТОЯТЕЛЬНОСТИ КИШЕЧНОГО АНАСТОМОЗА ПРИ ПЕРИТОНИТЕ В ЭКСПЕРИМЕНТЕ

Objective. To determine the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis. Methods. The experiment was carried out on non-linear white rats (n=40), divided into 4 equal groups: with peritonitis (group 1), with hypovolemia (group 2), with peritonitis in combination with hypovolemia (group 3) and comparison (group 4). Colonic “end-to-end” anastomosis was performed in all rats. Peritonitis caused by injection of 10% unfiltered feces into the abdominal cavity. Hypovolemia was modeled during the operation by creating bleeding from the branch of the iliocolic artery.The rats were taken out of the experiment on the 3<sup>rd</sup> day after the operation, the state of the anastomosis and the abdominal cavity was assessed. The histological examination of the anastomotic sites was performed. The content of hypoxia biomarkers (HIF-1a, VEGF-C, VEGF-R1) in the intestinal tissue was also evaluated by ELISA. The experiment was approved by the local ethics committee. Results. In group 1, anastomotic failure was detected in rats characterized by a severe general condition due to peritonitis. In groups 2 and 3 statistically significant relationship was found between a decrease of rectal temperature (>2 °C) due to bleeding and colonic anastomotic failure (p<0.05). Morphological analysis showed the most pronounced inflammatory and microcirculatory changes in the group 3. Statistically significant differences in the level of the VEGF-C (p=0.0034) and VEGF-R1 (p=0.04795) were found between groups. Maximal ischemia of the anastomotic zone was found in rats of group 3. Conclusion. The leading factor in the pathogenesis of intestinal anastomotic failure is considered to be as a result of impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow. Monitoring and successful correction of hemodynamic disturbances in the perioperative period may become a prospect for the treatment of patients with peritonitis requiring intestinal anastomosis under these conditions. What this paper adds For the first time determination of the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis has been studied. The leading factor in the pathogenesis of intestinal anastomotic failure has been found out to be the impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow.

Occult bacteremia as a manifestation of invasive pneumococcal infection

Objective. To describe a case of occult bacteremia caused by Streptococcus pneumoniae. Results . A 1 year and 1 month old child was diagnosed with pneumococcal infection without a focus of infection. After examination of the child, the doctors excluded foci of infection characteristics of pneumococcal infection, and the discharge of St. pneumoniae from the blood enabled to diagnose occult bacteremia. Despite bacteremia and signs of systemic inflammatory response, the absence of severe clinical manifestations and signs of multiple organ failure gave grounds to exclude sepsis. Conclusion. This case demonstrates that bacteriological blood test in children with fever and without a focus of infection with pronounced inflammatory changes in the blood has important diagnostic value and helps to prescribe effective specific antibacterial therapy.

Морфологічні особливості системи мати–плацента–плід на фоні інфекцій, що передаються статевим шляхом

The objective: to identify morphological substrate of placental disorders in women with urogenital infections and miscarriages and spontaneous abortions, as well as women diagnosed with «sexually transmitted infections» who gave birth at term. Materials and methods. A morphological study of samples from 80 women of reproductive age was performed. Patients were divided into 4 groups. At the first stage, histological and immunofluorescent studies of abortuses were performed in two groups of women with spontaneous abortions and missed abortions. The I group consisted of samples from 20 patients with urogenital infections, the II group – samples from 20 uninfected women. At the first stage, a morphological (histological and immunofluorescent) study of abortions was performed in two groups of women with missed and spontaneous abortions. The III group consisted of samples from 20 patients with urogenital infections, the IV group (control) – 20 samples from uninfected women. The second stage involved organometric and histostereometric examination of the placenta from women diagnosed with «sexually transmitted infections» without differentiating the forms of the infectious process (main group, n=10), who gave birth at term, and women who were uninfected (control group, n=10) and also gave birth at term. Results. Morphological study of abortuses from infected patients showed that urogenital infections are characterized by pronounced inflammatory changes in the form of deciduitis (9 specimens – 45%); chorionitis (5 specimens – 25%) and syncytial endometritis (2 specimens – 10%). The morphological picture of necrobiosis was revealed in 25% of samples (5 specimens). In addition, amnionitis (6 specimens – 30%), villisitis (4 specimens – 20%) and basal deciduitis (3 specimens – 15%) were detected. In the group of uninfected women, the leading pathomorphological changes were signs of placental immaturity and changes in vascularization and sclerosis of the villi. Most of the studies of placenta and membranes from women who gave birth at term and had urogenital infection showed significant changes in the villous chorion with the involvement of villi of different calibers. There was a significant increase in the proportion of micropathology. The presence of small necrosis of villi was established in almost 1/3 of all cases, extensive areas of necrosis occurred, but there was no significant difference between two groups. There was a decrease in the volume of the chorionic epithelium compared with the control group. Conclusions. Pathomorphological changes of abortuses and placentas in women with STIs reflected the main links in the pathogenesis of infectious and inflammatory processes and were different from such changes in the absence of this pathology. In particular, urogenital infection is characterized by changes associated with inflammatory manifestations in abortuses, and in the group of uninfected women - with signs of placental immaturity and changes in vascularization and sclerosis of the villi. Histostereometry also revealed significant differences in the structure of the placentas of women of the main and control groups, in particular, a significant increase in the proportion of micropathology. Therefore, the prevention of pregnancy complications and pregravid preparation in women diagnosed with STIs is essential for preventing reproductive failures. Keywords: sexually transmitted infections (STIs), spontaneous abortion, missed abortion, placenta, histostereometry.

[Effect of carnosine and α-lipoic acid on hepatocyte apoptosis and the cytokine profile in induced fatty liver disease in Wistar rats].

Non-alcoholic fatty liver disease (NAFLD) is now a common liver disease affecting about a third of the world's population. In this regard, the issue of studying the pathogenetic factors of the development of this disease in order to select adequate drug therapy and biologically active substances with antioxidant properties regulating the balance of pro- and anti-inflammatory cytokines is of particular relevance. The aim of the study was to assess the effect of minor biologically active substances - carnosine and α-lipoic acid on hepatocyte apoptosis and the cytokine profile in the experimental model of the initial stage of NAFLD. Material and methods. The studies were performed on male Wistar rats with initial body weight of 150±10 g. Animals were divided into 5 groups of 8 rats each. Within 8 weeks, rats of the 1st group (control) received a complete modified diet AIN93M, in which soybean oil was replaced with sunflower oil and lard (1:1). Rats of the experimental groups consumed high-calorie choline-deficient diet (HCCDD), in which fat content was 45%, fructose content - 20% of the energy value of the diet. Rats of the 2nd group were fed HCCDD without any supplements, the 3rd group - with the addition of carnosine (75 mg/kg body weight), the 4th group - with the addition of α-lipoic acid (75 mg/kg body weight), the 5th group - with the addition of carnosine and α-lipoic acid in a total dose of 150 mg/kg body weight. The study of rat hepatocyte apoptosis was performed by flow cytometry. Hepatocytes were stained with annexin V and vital dye 7-aminoactinomycin, followed by detection on an flow cytometer. The content of cytokines and chemokines (IL-1α, IL-10, IL-17А, M-CSF, MIP-1α, MIP-3α, RANTES) in the cytoplasmic fraction of liver tissue was determined by multiplex immunoassay. Results and discussion. On the model of the initial stage of development of NAFLD in male Wistar rats the еnrichment of HCCDD with carnosine and α-lipoic acid had demonstrated a protective effect on hepatocytes with a decrease in apoptosis intensity to the level in control rats. Under the influence of HCCDD, an increase in the content of M-CSF and MIP-1α and a decrease in the levels of MIP-3α and RANTES, stimulating the migration and differentiation of various immunoregulatory populations to the parenchyma at an early stage of the formation of fatty hepatosis, in the cytoplasmic fraction of liver tissue were detected. Moreover, a decrease in the level of proinflammatory cytokines IL-17A and IL-1α and an increase in IL-10 produced mainly by Treg-populations indicate the absence of pronounced inflammatory changes in the liver of male Wistar rats at the initial stages of development of fatty dystrophy. Conclusion. Enrichment of HCCDD with both carnosine and α-lipoic acid in Wistar rats had a protective effect on hepatocytes with a decrease in apoptosis to a level in control rats. The increase in the IL-10/IL-17A ratio indicates the activation of anti-inflammatory mechanisms due to the functional predominance of Treg-cells over Th1/Th17 lymphocytes.