Severity Of Pathological Process Research Articles

Innate and acquired immunity indices in assessing the clinical severity of patients with childhood schizophrenia

The results of previous studies suggest pathogenetic role of immune system in the development of schizophrenia. Examination of adolescent and young adult schizophrenic patients showed that the activity/ level of distinct parameters of innate and acquired immunity correlates with acuity and severity of pathological process in the brain. Presumably, evaluation of immune system characteristics in patients with childhood schizophrenia, concerning severity of their clinical symptoms, along with potential therapeutic aspect, may be the basis for early diagnosis of these conditions, and monitoring and prognosis of the further progression of the disease. The objective of our study was to compare clinical and immunological indices in children with schizophrenia to analyze the possibility of using these parameters for determination of the degree of activity of the pathological process. Sixty-two patients (39 boys and 23 girls) from 4 to 17 years of age with childhood schizophrenia were examined. Psychopathological and psychometric methods (PANSS and CGI-S scales) were used to assess mental state of the patients. Immunological parameters were determined in blood serum taken by fingerprick. Activity of leukocyte elastase (LE) and a1-proteinase inhibitor (a1-PI) was determined by spectrophotometric method. To determine the level of autoantibodies to S-100B and MBP, we used enzyme immunoassay. The study revealed activation of innate (by activity of LE and a1-PI) and acquired (by the level of autoantibodies to S-100B and MBP neuroantigens) immunity markers in blood serum of children with schizophrenia. Correlation analysis showed the significant positive correlation between complex evaluation of activation level of the immune system and severity of the patients’ state on the CGI-S scale (r = 0.64, p < 0.0001), as well as severity of negative symptoms according to the PANSS scale (r = 0.34, p = 0.0077). The revealed correlations suggest an opportunity for using immunological parameters (LE and a1-PI activity, and antibodies to neuroantigens), as the additional laboratory criteria for the assessment of clinical state in patients with childhood schizophrenia.

Оптимізація протоколів лікування хворих на генералізований пародонтит при кардіоваскулярній патології

Взаємозв’язок між захворюваннями пародонта та соматичною патологією доведений багатьма дослідниками. Аналіз даних, отриманих нами при обстеженні 348 пацієнтів, показав, що в осіб віком до 49 років найбільш часто були діагностовані різні форми гінгівіту (36,3–51,65 %) і генералізований пародонтит (ГП) І–ІІ ступеня (48,35–59,42 %). Проте у віці 50–69 років ГП був домінуючим захворюванням серед обстежених (93,2 % осіб), при цьому 56,03 % пацієнтів мали супутню кардіоваскулярну патологію (КВП). Наші дослідження показали, що, незважаючи на значну поширеність захворювань пародонта при КВП, ці хворі систематично не відвідували лікарів-стоматологів для лікування. Проведені нами дослідження свідчать про значну роль автоімунних процесів у формуванні й прогресуванні хронічних генералізованих захворювань пародонта в пацієнтів із супутніми коморбідними станами, зокрема з кардіоваскулярною патологією. Отримані нами дані переконливо свідчать, що одним із важливих автоантигенів, що визначає форми системної запальної відповіді та прогресування локальної й системної ендотеліальної дисфункції при ГП із КВП, є білки теплового шоку. З огляду на вищезазначене був розроблений новий диференційований підхід до лікування ГП при КВП, оснований на новій концепції патогенезу. Патогенетична терапія ГП при КВП базується на симультантному лікуванні захворювань (із включенням регенеративного методу терапії) з урахуванням тяжкості патологічних процесів, що мають взаємообтяжувальний перебіг. Міждисциплінарна інтеграція лікарів-стоматологів та кардіологів дозволить оптимізувати протоколи лікування з урахуванням наявності й тяжкості соматичної патології та підвищить якість лікування ГП в умовах коморбідності.

Methodology of prenatal ultrasound examinations in congenital diaphragmatic hernia

Background. Congenital diaphragmatic hernia is a complex malformation with high anatomical and clinical variability. Prenatal ultrasound examinations allow one to assess the severity of pathological process in a particular case in order to determine the management of pregnancy, labor and neonatal period. However, the rarity of this pathology and some features of ultrasound imaging can lead to low informative value of the examination. Purpose – to present a detailed methodology of prenatal ultrasound examinations in fetal congenital diaphragmatic hernia, taking into account anatomical variants of pathology and features of US imaging at different terms of pregnancy, and to characterize the preconditions for diagnostic errors. Materials and methods. The data on prenatal ultrasound examinations of 265 high-risk pregnant women with fetal diaphragmatic hernia conducted during the period of 2007–2020 in the Department of Fetal Medicine of State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova of National Academy of Medical Sciences of Ukraine», were systemized. US examinations were performed on systems HDI 4000, ACCUVIX V20EX-EXP, ACCUVIX V10LV-EX. Isolated anomaly was detected in 192 (72.5 %) cases, associated congenital malformations in 65 (24.5 %), chromosomal pathology in 8 (3.0 %). Left-sided hernia was diagnosed in 85.7 % of cases (n = 227), right-sided – in 12.1% (n = 32), central in 1.1 % (n = 3), bilateral in 1.1 % (n = 3). Location of abdominal, retroperitoneal and thoracic organs was determined, as well as specifics of their US imaging in different terms of pregnancy. Results. Methodology of prenatal ultrasound examination of fetuses with congenital diaphragmatic hernia was developed taking into account the specifics of pathological anatomy and ultrasound imaging. Typical and rare variants of thoracic and abdominal organs’ localization in the standard cross section plane at the level of the four chambers of the heart were characterized, preconditions and variants of diagnostic errors were determined. The methods of correct measurement of the thorax, lungs, liver, and also methods of prognostic indices’ calculation for determining the degree of pulmonary hypoplasia and the degree of liver herniation were presented. Conclusions. Prenatal ultrasound semiotics of congenital diaphragmatic hernia is characterized by considerable variability, and contains significant risks of diagnostic errors. The presented methodology of unified ultrasound examinations allows for systematic assessment, which results in correct prenatal diagnosis, determination of the pathology severity, and prognosis – for the correct choice of pregnancy and labor management.

Кальцитонин, остеокальцин и остеопонтин при раке легкого

Актуальность. Маркерами рака легкого являются низкие уровни в крови гормона кальцитонина, а высокие показатели белков остеокальцина и остеопонтина, связанные между собой, отражают процессы костного метастазирования и обладают прогностической значимостью. Цель исследования: оценить уровни в крови кальцитонина, остеокальцина и остеопонтина, факторы, их определяющие, характер взаимосвязей и прогностическую роль в костном метастазировании при разных вариантах течения рака легкого. Материалы и методы. Обследованы 86 больных раком легкого в возрасте от 24 до 80 лет (в среднем 58 лет), среди которых было 84 % мужчин и 16 % женщин. Центральная форма рака имела место в 81 % наблюдений, периферическая — в 19 %. Мелкоклеточный гистологический вариант заболевания установлен у 21 % от числа больных, немелкоклеточный — у 79 %, в том числе аденокарцинома — у 38 %, плоскоклеточная карцинома — у 35 %, крупноклеточная карцинома — у 6 %. IIIA стадия опухолевого процесса отмечена в 12 % случаев, IIIB — в 21 %, IV — в 67 %. Результаты. Рак легкого сопровождается уменьшением в крови у 20 % больных остеоассоциированного гормона кальцитонина на фоне повышения концентраций опухолевых маркеров остеокальцина и остеопонтина (соответственно в 76 и 79 % наблюдений), что тесно связано с морфологическим вариантом (мелко- и немелкоклеточный), стадийностью и тяжестью течения патологического процесса, определяет развитие компрессионного синдрома, прорастание опухоли в грудную стенку, метастазирование в лимфатические узлы и кости, возникновение осложнений химиорадиотерапии в виде лучевого пневмофиброза, легочной гипертензии и миелодепрессии, а показатели остеокальцин- и остеопонтинемии обратно коррелируют с продолжительностью жизни больных. Выводы: кальцитонин, остеокальцин и остеопонтин при раке легкого являются маркерами тяжести течения заболевания, отражают метастазирование опухолевого процесса в скелет и обладают прогностической значимостью.

The usage of simulation technologies' tools to evaluate nutrition status and physical development in pediatrics

Rationale: Physical development of children is a marker of adequacy of nutrition, and affects adaptation, severity of pathological processes, rate of recovery, effectiveness of therapy, terms of hospitalization. Goals - To work out the skill of assessing physical development and nutritional status of children and adolescents in various ways, to carry out comparative analysis of methods

Cryopyrin-Associated Periodic Syndrome (CAPS) Caused by c.943A>G Variant of NLRP3 Gene: Clinical Case

Background. Cryopyrin-associated periodic syndromes is a g roup of rare congenital autoinflammatory diseases such as familial cold autoinflammatory syndrome, Muckle-Wells syndrome and chronic infantile neurological cutaneous articular syndrome. These syndromes are considered as clinical variants of one disease with different intensity of clinical features and severity of pathologic process. The onset of these syndromes is usually on the first year of life, and they start with fever, urticarial rash, various variants of joint diseases (from arthralgia to residual and persistent arthritis) and nervous system disturbances. There are only single case reports of cryopyrin-associated periodic syndromes in Russia. Clinical Case Description. The disease onset was at the age of 1 year 8 months with fever and rash as well as generalized joint syndrome. Autoinflammatory syndrome was suspected due to to results of blood tests, MRI, molecular genetic testing. Exons 2, 3 and 4 of TNFRSF1A gene and exon 4 of NLRP3 gene with nearby introns were studied with the method of direct automated sequencing. The c.943A>G variant in heterozygous state in NLRP3 gene was revealed. The child was treated with IL-1 beta inhibitor (canakinumab) with positive effect. Conclusion. Diagnostics of cryopyrin-associated periodic syndrome in children is the serious challenge. Timely decision with help of molecular genetic methods is crucial for successful target therapy.

Acute adhesive small-bowel obstruction: laparotomy or laparoscopy

Aim. To determine the capabilities of complex preoperative examination of patients with acute adhesive small-bowel obstruction for the choice of the method of surgical treatment. Methods. The diagnostic significance was studied for clinical and radiological methods in assessment of the prevalence of adhesive process in the abdominal cavity in 354 patients with acute adhesive small-bowel obstruction. Patients were divided into two groups: (1) a comparison group of 204 subjects examined by the standard protocol without the use of computed tomography and ultrasound without mapping of adhesions operated by an open procedure, and (2) the study group of 150 patients who underwent the modified diagnostic algorithm and laparoscopic adhesiolysis. To clearly understand the spread of adhesive process, on ultrasound examination the anterior abdominal wall was divided into four sectors. The severity of pathological process was assessed by enteral index and intra-abdominal pressure reflecting the degree of morphofunctional disorders. Results. The highest sensitivity (92%) among diagnostic methods was observed for X-ray contrast-enhanced computed tomography. The objective severity criteria for the patients with acute adhesive small-bowel obstruction are enteral index, intra-abdominal pressure, signs of diffuse peritonitis. The developed complex diagnostic program, presented in the form of an algorithm, was of decisive importance for the choice of the method of surgical intervention (laparotomy or laparoscopy). Conclusion. The optimal treatment option for patients with acute adhesive small-bowel obstruction is laparoscopic adhesiolysis, which should be regulated by the severity of the patient's condition and spread of the adhesion process; to determine the spread of adhesive process, a complex diagnostic program should be used, in which radiological methods take the lead.

Features of platelet reaction in acute pancreatitis

Aim. To identify the features of platelet reaction in peripheral blood in patients with acute pancreatitis. 
 Methods. We conducted a retrospective analysis of changes of platelets concentration in 19 patients with acute pancreatitis admitted to Kazan City clinical hospital №7. The age of patients ranged from 35 to 76 years, 45±12 years in average. All patients received complex treatment. The main method of surgical treatment was navigation drainage of fluid collections, peripancreatic mass and retroperitoneal space under ultrasound control performed in 11 patients. Subsequently in 4 patients due to progressive pyoinflammatory process midline laparotomy, sanitation, drainage of omental sac and purulent cavities were performed. In 4 cases aseptic pancreonecrosis resolved after conservative treatment. All patients dynamically had erythrocytes and platelets count and mean platelet volume checked. 
 Results. Analysis of platelets concentration in peripheral blood in patients with acute pancreatitis showed multidirectional character depending on the severity of pathological process. In mild acute pancreatitis the platelet count remains within normal limits. In severe pancreatitis its number increases. The highest numbers of platelets were observed on days 10-20. On discharge platelet count remained elevated. Severe pervasive pancreonecrosis (n=4) with fatal outcome was characterized by thrombocytopenia on admission with further progression. 
 Conclusion. The nature of the changes in platelet reaction in patients with acute pancreatitis depends on the severity of the pathological process and can be used as a criterion for evaluation of treatment effectiveness and prognosis of the outcome of the disease.

Клинико-морфологические особенности клеточного состава идиопатических эпиретинальных мембран у пациентов с различной остротой зрения

Among various cellular populations, ERMs contain cells with contractile features typical of myofibroblasts. This type of cells provides collagen producing and facilitates membrane contraction. The identification of ERM morphological elements at different stages of its formation remains a topical question. Purpose . To investigate the cells morphological features in a qualitative composition of epiretinal membranes in patients with different visual acuity. Material and methods . All patients were divided into 3 equal groups of 20 patients (20 eyes), depending on the initial best corrected visual acuity (BCVA). Samples of ERM were obtained from 60 patients during microsurgical operations with subseuqent. There was performed an immunohistochemistry to recognize: glial acidic fibrillary protein (GFAP), TGF-β1, α-SMA actin, cellular retinaldehyde-binding protein (CRALBP), fibronectin, CD68, CD45, aswell as collagen of II, IV, VI types. Results . Specimens, removed from eyes with a higher visual acuity, showed a more cell viability than specimens, removed from eyes with a lower visual acuity. Comparing these specimens we found significant differences in cell viability depended on cell proliferation and transdifferentiation. Our results revealed that ERMs are characterized by the intensive decreasing of glial acidic fibrillary protein (GFAP) expression and competitive increasing α-SMA actin myofibroblast-like cells in time. As a result, we detected a diffuse presence of α-SM actin–positive myofibroblasts containing TGF-β1 and collagen expression at late stages. Conclusion . Immunocytochemical analysis helps to identify the pathomorphological changes of ERM samples and to determine mechanisms of ERM formation in patients with a different severity of pathological process.

Intraoperative neuromonitoring in major vascular surgery

There has been a growing interest in using intraoperative neuromonitoring to reduce the incidence of stroke and paralysis in major vascular interventions. Electroencephalography, various neurophysiological evoked potential measurements, transcranial Doppler, and near-infrared spectroscopy are some of the modalities currently used to detect neural injuries. A good understanding of these modalities and their interactions with anaesthesia is important to maximize their value and to allow meaningful interpretation of their results. In view of the inter-individual differences in anatomy, physiological reserves, and severity of pathological processes, neuromonitoring may be a valuable method to evaluate the well-being of the nervous system during and after surgical interventions. In this review, we summarize some of their applications, efficacies, and drawbacks in major carotid and aortic surgeries.

Роль обменных процессов соединительной ткани в развитии патологических процессов разной интенсивности в желудке

Aim: To study changes in exchange of connective tissue at development of pathological process in a stomach. Methods: Patients with inflammatory processes in a stomach of various severity and cancer patients were examined. Groups were created so that weight of pathological process in a stomach and risks for health increased from group to group. 5 groups on 50 people were surveyed. In each of groups the CEA level, and the level of various fractions of hydroxyproline was defined. Results: It was revealed that the CEA levels, free- and peptide-bound hydroxyproline levels were more in groups with higher severity of pathological process. But the levels of the protein-bound hydroxyproline were less in the same groups. It is possible to assume that it is connected with growth of extent of degradation of CT in process of increase of severity of pathological process. Increasing the severity of the pathological process above a certain level causes disbalance in system of CT. It can reflect failure of adaptation in system of CT, and may be one of factors of irreversibility (chronization) of pathological process. Conclusion: The connective tissue is essentially involved in pathological processes in a stomach. At a superficial inflammation processes of synthesis and degradation of collagen are in some balance, and the increase in severity of pathological process leads to violation of this balance

INFLUENCE ON CELLULAR TARGETS FOR TREATING INFLUENZA INFECTION

Аbstract. Influenza is a highly contagious infection of humans. The use of specific antivirals leads to emergence of drug-resistant strains following by the decrease of efficacy of ethiotropic chemotherapy. In this review the data about the decrease of the level of viral replication and severity of pathological process based on the use of alternative targets of cellular instead of viral origin are presented. The medicines for decreasing the production of proinflammatory cytokines (eritoran), restricting the degranulation of mast cells (ketotifen), inhibitors of cyclooxygenases (celexocib, mesalasine, SC-560), inhibitors of sphingosine-1-phospate pathway (AAL-R) and compounds increasing the capillars stability by strengthe ning the contacts between endothelial cells (Slit protein) have been described in the review. The special attention is paid to the inhibitors of cellular pathways that are used by the virus to provide its reproduction, such as NF-κB, Raf/MEK/ERK, PI3K/AKT/mTOR. Information concerning anti-influenza activity of kinase and autophagy inhibitors is summarised as well as data about the preparations of combined mechanism of activity — glycirrhizic acid and dipeptide alpha-glutamyl-tryptophane. Further studies in the field of search and optimization of inhibitors of cellular components as remedies against influenza infection could lead to the development of novel antivirals with high efficacy, broad spectrum of activity and low probability of virus resistance.

The involvement of oxidative stress in determining the severity and progress of pathological processes in dystrophin-deficient muscles.

In both forms of muscular dystrophy, the severe Duchenne's muscular dystrophy (DMD) with lifespan shortened to about 20 years and the milder Becker dystrophy (BDM) with normal lifespan, the gene defect is located at chromosome locus Xp21. The location is the same in the experimental model of DMD in the mdx mice. As the result of the gene defect a protein called dystrophin is either not synthesized, or is produced in traces. Although the structure of this protein is rather well established there are still many controversies about the dystrophin function. The most accepted suggestion supposes that it stabilizes sarcolemma in the course of the contraction-relaxation cycle. Solving the problem of dystrophin function is a prerequisite for introduction of an effective therapy. Among the different factors which might be responsible for the appearance and progress of dystrophic changes in muscles there is an excessive action of oxidative stress. In this review data indicating the influence of oxidative stress on the severity of the pathologic processes in dystrophy are discussed. Several pieces of data indicating the action of oxidative damage to different macromolecules in DMD/BDM are presented. Special attention is devoted to the degree of oxidative damage to muscle proteins, the activity of neuronal nitric oxide synthase (nNOS) and their involvement in defining the severity of the dystrophic processes. It is indicated that the severity of the morbid process is related to the degree of oxidative damage to muscle proteins and the decrease of the nNOS activity in muscles. Estimation of the degree of the destructive action of oxidative stress in muscular dystrophy may be a useful marker facilitating introduction of an effective antioxidant therapy and regulation of nNOS activity.