THE FACE OF THE ISSUE
The biography of famous native scientist, doctor of medical sciences, academician of the Russian Academy of Medical Sciences, Director of the Cancer Research Institute of Siberian Branch of the Russian Academy of Medical Sciences, head of Oncology Сhair of Siberian State Medical University Professor Ye.L. Choinzonov has been prezented. The main directions of scientific and public activity of the scientist are shown.
ASSEMBLY LECTION
The idea of the need for a dialogue of medicine and Humanities insisted declares itself in national and world scientific thought. In modern literature is a brilliant example of combining medical and humanitarian offers an American researcher Lynn Peyer (1945–2001). The "Medicine and Сulture: Varieties of Treatment in the United States, England, West Germany, and France" (1988) she explores the problem of cultural meanings as a factor in forming the medical experience. In the article on the basis of results from l. Peyer, dealt with a situation based on health consciousness and practice of appropriate cultural context, the characteristics of Western medical and cultural tradition is complemented by analysis of domestic realities.
EXPERIMENTAL AND CLINICAL INVESTIGATIONS
Study objective: study of the interrelation between the indicators of quality of life (QL) in patients with coronary heart disease and risk factors of this pathology united by the framework of metabolic syndrome (MS) and the degree of activity of systemic inflammatory response.
110 patients with coronary heart disease have been examined. Along with the complete clinical, laboratory and instrumental examination, adopted in a specialized cardiology clinic, the study of QL was carried out with the help of the MOS SF-36 questionnaire, and also the analysis of activity of systemic inflammatory response was performed.
It was shown that in the cluster of MS components there is a reverse correlation interrelation with abdominal obesity, hypertension and hyperglycemia. Also, a reverse correlation interrelation between the indicators of QL and some non-specific inflammatory markers (erythrocyte sedimentation rate, the concentration of C-reactive protein in blood) was discovered.
Research of morphofunctional properties that indicate intensity of liver injury when performing cold plasma hemostasis. The operation is an atypical resection of liver left lobe with cold plasma hemostasis. It is performed on white rats. There are a biochemical blood analysis, histological study and MRI-scanning in late period. Morphofunctional changes on the 90th and 180th day are described in the issue.
In experimental acute exudative inflammation, caused by Difco agar injection in mice hind leg, lipids derived from maral antlers and peat decreased the leg inflammatory edema and prolonged the pain reaction latent period; in analogous model in rats prevented the edema progression. In model of proliferative inflammation lipids reduced granulomatous-fibrotic tissue expansion. In adjuvant arthritis maral anthlers and peat lipids suppressed the edema development of leg in which inflammatory agent was inoculated also of intact leg and had analgesic action. Maral anthlers and peat lipids diminished pain reaction also due the resorbtive action. Maral anthlers and peat lipids in effective doses 30 and 60 mg/kg had the antiinflammatory and analgesic action to the same extent as diclofenac in dose 10 mg/kg.
The complex histologic, immunogictochemic, electronic-microscopic estimation biopsiа mucous membrane of bronchial in
87 patients with heavy sensitive and therapeutic resistant bronchial asthma. It is established, that weighting of a bronchial asthma is characterised by high indicators of functional activity of corpulent cages and ultrastructural signs of strengthening secretions processes in bocalotia mucous membrane of bronchial. Therapeutic resistant bronchial asthma of a phenotype «brittle» differs development of the Th2-dependent immune answer with eosinohyils an inflammation, ultrastructural a dyskinesia resnitch epitels.
A therapeutic resistant bronchial asthma of a phenotype «the asthma with the fixed bronchial obstruction» neutrophil inflammation, is accompanied a mucous membrane of bronchial tubes with a thickening basals membranes, height decrease epitels a layer with a degeneration epithelium and strengthening of an expression of receptors to the transforming factor of growth β1.
Opisthorchis felineus DNA extraction methods from fecal samples were compared. Comparative analysis of selected methods of DNA extraction from fecal samples containing eggs O. felineus, revealed that the most effective method for the identification of opisthorchiasis by PCR protocol is upgraded through the use of magnetic particles.
In this study we genotyped polymorphism Thr12Ser (rs1937) in TFAM gene in two groups: patients with coronary artery disease and control group (people from Tomsk population). For genotyping was used restriction fragment length polymorphism. We have found significant higher genotype CC frequency in men with coronary artery disease — 4.52% compared with control men — 0.45% (χ2 = 6.315; р = 0.043; OR = 10.45). Thus genotype CC is associated with coronary artery disease in men fromTomsk population.
The effect of donor hydrogen sulfide NaHS for electrical and contractile activity of smooth muscle cells in guinea pig ureter is present in biologically active compounds histamine and phenylephrine, an activator of adenylate cyclase forskolin, blockers of Na+/H+-exchanger, Na+,K+,2Cl–-cotransporter and potassium conductance of the membrane were studied by the method of the double sucrose gap junction. It is shown that the activating effect of NaHS largely determined by the interference of Na+-mediated ion transporters in the cAMP-dependent inhibition of the potassium conductance of the membrane of smooth muscle cells.
An experimental model of opisthorchiasis on hamsters (Mesocricetus auratus) was obtained, the DNA O. felineus was investigation by molecular methods, histological study of the liver of infected hamsters was carried. Found that the PCR system can detect O. felineus, and does not give false positive results in terms of C. sinensis, O. viverrini, Metorchis bills. Infection leads to marked changes in the liver, which are characterized by specific histological.
An infective background during pregnancy may have a negative impact on the proper metabolism of the placenta and promote it adaptive compensatory reactions. Typical adaptive compensatory reactions, which realized by terminal NAPs angiomatosis, forming uric syncytial and development of true syncytial capillary membranes were determined in Chlamydia trachomatis contamination of the lower genital tract in placenta of all studied groups.
A study of phenotypic characteristics of erythrocytes and indicators of activity of erythropoiesis in cardiosurgical patients with moderated (40 patients) and expressed (18 patients) hemolysis after coronary artery bypass grafting in conditions of cardiopulmonary bypass was carried out. Before and after the operation the contents СD35+-, СD55+-, glycophorin A+-, glycophorin B+-erythrocytes and reticulocytes in blood, free hemoglobin, erythropoietin and tumor necrosis factor α (TNF-α) in blood plasma. It was established that development expressed hemolysis is associated with higher (than under moderate hemolysis) the contents reticulocytes in blood, normal production of erythropoietin and TNF-α, and also with deficiency of СD55+-erythrocytes before operation. For patients with moderate the hemolysis normal contents of СD55+-erythrocytes in blood against hyperproduction of erythropoietin and TNF-α is characteristic at deficiency of glycophorins A+- and B+-cells in the presurgical period.
Data of the study of cGMP- and cAMP-dependent intracellular signaling systems in the insulin-mediated regulation of the platelet aggregation activity in 25 patients with DM2 and heart failure are presented. 15 healthy volunteers were recruited as a control group. To estimate cAMP- and cGMP-dependent intracellular signaling systems in the realization of insulin antiaggregational effect we used 3-isobutyl-1-methyl-xanthine — inhibitor of the phosphodiesterase V and IV, forskolin — stimulator of adenylate cyclase, zaprinast — specific inhibitor of the phosphodiesterase V. Modifiers of the adenylate cyclase/cAMP system — IBMX and forskolin — had the most prominent effect on the reduction of the aggregation of the isolated platelets.
The pepsinogenemia level is examined as a risk factor of atrophy and inflammation activity in gastroduodenal region mucous region in 20 patients with erosive and ulcerous changes this localization as before as after operations with cardiopulmonary bypass. It is marked that the values of pepsinogen 1 ((209,58 ± 14,41) μg/l) and pepsinogen 1 ((30,01 ± 4,00) μg/l) in plasma are exceeded than normal magnitudes. It is revealed that using omeprazole intravenous and peroral after that can prevent of acute ulcers and gastric bleeding in these patients and associated with decrease of pepsinogen 1 (in 1,2 times) and pepsinogen 2 (in 2,1 times) plasma levels comparing values before operation. In spite of acute ulcers and gastroduodenal bleeding default, gastropaty with erosions in antrum of stomach persists in 35% of cardiosurgical patiewnts.
Clinical and molecular-genetic examination and treatment of 140 patients with genital endometriosis is presented. Integrated treatment included surgery laparoscopic method and application of hormonal preparations (agonists gonadotropin releasing hormones, combined oral contraceptives). The most effective method of drug therapy of endometriosis after prior surgical correction was the appointment of agonists gonadotropin releasing hormone. The effectiveness of drug therapy of endometriosis correlated with special genes polymorphism of enzymes of biotransformation phase is "functionally defective genotypes 0/0" GSTT1 and GSTM1 0/0 are associated with low efficiency of medical treatment of the genital endometriosis. Assignment of drug therapy of endometriosis based on genetic polymorphism of an organism of the patient is appropriate.
The effect of glucocorticoids (GC) on the character and dynamics of changes in various tissue elements of the ovaries were studied in an experimental model of autoimmune oophoritis using histological and histochemical techniques. The content of antiovarian antibodies (AOA) was determined in the serum of experimental animals by enzyme immunoassay. Not enough effective action of GC therapy was found on the immediate and long-term results. Dynamic decrease of AOA and normalization of the specific volumes of the generative elements were accompanied by increased follicular atresia. Most of the generative structures were destructively modified.
An influence relief features and quantitative parameters of model bone mineral matrix on in vitro morphofunctional status of human prenatal stromal lung cells (HPSLC) and in vivo mice bone/marrow system remodeling has been studied. Investigations have showed that magnetron calcium phosphate (CaP) coatings are thin (thickness less than 1—2 μm), nonporous, smooth (Ra < 1 μm) layer of carboxylated apatites with the calcium/phosphorus ratio higher than stoichiometric one (more than 1.67). Such 2D surfaces have discreet structure-functional microterritories (niches) for HPSLC. Nevertheless, HPSLC maturation in osteoblasts under 4-days cultivation on such surfaces is unlikely. Poor HPSLC osteogenic committing on «smooth» (Ra < 1 μm) CaP coating is in vitro associated with an average index of artificial osteogenic niche less than 34%, weak artificial surface dissolution and elevated TNFα secretion by cell culture. A behavior of such implants with singenic bone marrow column is displayed in vivo by a degeneration of mice heterotopic osteogenesis and hemopoiesis. Methodology suggested allows apparently to imitate bone surface microterritories having “quiescent“ endosteal niches for stromal and hemopoietic stem cells.
A study of mechanisms of regulation of volume of erythrocytes in cardiosurgical patients with moderate (24 patients) and expressed (13 patients) hemolysis after coronary artery bypass grafting in conditions of cardiopulmonary bypass was carried out. It was established that development expressed hemolysis is associated with higher (than under moderate hemolysis) volume of erythrocytes after operation, reduction Са2+-dependent К+-permeability and activity of Nа+/K+-ATPazy in their against deficiency of ATP in cells. At patients with moderated hemolysis independently of an investigation phase Са2+-dependent К+-permeability of a membrane of erythrocytes doesn't differ from healthy donors, but activity of Nа+/K+-ATPazy is reduced at the sufficient content of ATP.
SCIENTIFIC AND STUDYING PROCESS: METHODIC SEMINAR
In article the essence and structure of abduction as one of types of not deductive conclusions is considered, their seat and a role in clinical diagnostics are shows.
The article concerns the methodical analysis of the lingual material for active learning — professional vocabulary and Latin word-building elements, one of the techniques of applying the intersubjective connections while introducing the professional vocabulary, namely the comparative analysis of the English and Latin lexical items.
THE PAGE OF PRACTICAL DOCTOR
The purpose of the study — to research the own results of surgical treatment of infrarenal abdominal aortic aneurysms and to identify measures to prevent possible complications. A retrospective analysis of 46 cases was done. The main cause of deaths in the early postoperative period was a myocardial infarction — in 6 ((13.1 ± 1.4)%) patients and acute ischemia of the left half of the colon — in 2 ((4.3 ± 0.8)%) cases. In the distant period the survival depended on the state of blood flow in the basin of the coronary and brachiocephalic arteries, the development of local complications and cancer. Chronic ischemia of the left half of colon was diagnosed in 8 ((20.5 ± 2.0)%) patients and was the most frequent complication in the later stages after resection of abdominal aortic aneurysms.
A study of venous hemodynamics and blood coagulation system in 40 patients operated on for large ventral hernias. Tension free hernia repair under the control of intraabdominal pressure helps to reduce stasis of blood in the veins of the legs. The development of inflammatory complications accompanied by higher levels of markers of coagulation: fibrinogen, C-reactive protein and D-dimer.
The comparative analysis of the changes of biliary system in 565 patients with alveolar Hydatid disease, hydatidosis, chronic opisthorchiasis, complicated by chronic obstructive jaundice operated in the Hepatology Center of Tomsk. Three levels of occlusion and the enlargement of the bile duct, depending on the involvement of anatomical structures of liver gall ways are Identifies. Differential-distinctive ultrasound criteria biliary hypertension with the parasitic liver problems are identified and presented, that will increase the efficiency of ultrasonic diagnosis of this pathology, choose an appropriate method of surgical correction and improve patient outcomes.
In order to determine the major variants of the traumatic disease in severeconcomitant traumatic brain injury conducted a retrospective analysis of 111 case histories. The methods of statistical modeling carried out the division of patients into four groups, depending on the time of failure of adaptation of the organism to traumatic injury.
The purpose of this search is to evaluate diagnostic capability of CT pulmonary angiography (CTPAG) in patients with pulmonary embolism. Examination results of 45 patients with suspected pulmonary embolism provided. Pulmonary embolism symptoms and frequency of their occurrence in study group described. The modification of technical CTPAG protocol proposed for to improve visualization and to reduce radiation exposure.
LITERATURE REVIEW
The main stages and reasons forchanges the role of the pharmacist in health care system were discussed in this review. Key areas for the implementation of medicines managementconcepts at the population and individual level were presented.
FROM SCIENCE TO PRACTICE
Open prospective comparative study was performed to evaluate association of basis treatment of chronic obstructive pulmonary disease (COPD) and initial levels of individual subpopulations of T-regulatory cells. Results of study suggested what high regulatory performance in COPD (CD4+FoxP3+ > 7%) associated with low effect of anti-inflammatory therapy. This findings may be taken into account at therapy appointment.
Compare characteristics of medical implants with oxide and calcium-phosphate coatings for surgical treatment of fractures of the humerus to implement them in clinical practice.
The work is based on an analysis of clinical observations and surgical treatment of 293 patients of both sexes, aged (34.1 ± 6.5) years, with closed fractures of the humerus. Bioinert plates were used in 155 patients, bioactive — at 138. The results of treatment was evaluated in terms of 2 and 4 months according to the criteria S.A. Muller (1999), C.R. Constant, A.H.G. Murley (1987), Jupiter J.B. (2006).
The osteosynthesis bioinert consolidation structures obtained in 98.1% of patients, excellent and good results were observed in 58.7%. In 1.9% of cases of fracture healing does not come, formed a false joint. In the group of patients who are treated with the use of titanium implants with calcium phosphate coating fracture healing received from 99.3% of patients, excellent and good results were seen in 73.9%. The use of bioactive plates gave significantly more good clinical response, compared with bioinert
implants, reducing the level of poor results in a formation of contractures and pseudarthrosis. In the early period of observation (up to 4 months) showed a significant reduction in neurovascular disorders, pain, improve mobility of the shoulder and elbow joints.
We estimated potential of protein legumain from opisthorchiasis agent O. felineus for application in immunodiagnosis of this disease. Bacterially expressed recombinant protein (rOF49-leg) showed strong difference in Enzyme-linked immunosorbent assay (ELISA) between infected and negative sera. These results suggest the potential of this antigen for development of serodiagnostic test for human opisthorchiasis.
The integrated study of the level of hormones in systemic circulation, estrogen reception and metabolism in patients with endometrial hyperplasia and endometrial cancer has shown that the urinary level of estrogen metabolites in patients with hyperplastic and malignant endometrium depends on the level of steroid hormones in systemic circulation. The study showed that the changes in hormonal status were characterized by a high frequency of disturbances with development of hyperestrogenemia, hypertestosteronemia. Moreover, the LH level and LH/FSH index were increased and FSH and progerterone levels were decreased. Correlation between the level of steroid hormone receptors and the level of estrogen metabolites has been identified. It confirms the theory of “estrogen” stimulation recommended for patients with proliferative endometrium.
This review covers the major works devoted to analysis of gas excretions of patients with liver diseases, the possibility of early diagnosis and monitoring of these patients on basis of their gas excretion analysis are discussed. Noninvasiveness of methods of gas analysis allows considering them as perspective and valuable for diagnostics in clinical proceeding.
ECONOMICS AND HEALTH CARE MANAGMENT
We studied the data for the period 2007—2009 about incidence by an endocrine pathologies of trained youth in Tomsk. On the basis of the system approach are studied is lead the complex analysis of the organization of the preventive help of student's youth, the effective system of actions on perfection of the organization of the medical-preventive help to students is generated and introduced.
This paper presents сhronobiological approach for estimating biological age of men of mature age, living for a long time in the north and south of the Tyumenregion. The structure of biological rhythms of physiological parameters (especially the amplitude of the rhythm) is a sensitive indicator of the functional state of a person and can be successfully used for the assessment of biological age. In persons biological age of the Nordic region to a greater degree higher than chronological age than men living in the southern region.
The bad influence of the androgenic insufficiency for men defines the need for obligatory androgenic screening of more than 50 years old patients. Testosterone level was examined. The criteria was the patients’ will to examine their status. The group consisted of 386 people from 20 to 87 years old (the average age is 58.7 years). It was found out that 160 people (41.45%) had age-related hypogonadism. Men’s androgenic deficit diacrisis algorithm was proposed for the ambulance situation.
The purpose of our research was the estimation of results of treatment of childhood acute lymphoblastic leukemia in Omskregion from 1993 to 2011. 173 children with acute lymphoblastic leukemia were included in research for an estimation of clinical efficiency and 32 children for research of quality of a life. The Kaplan—Meier method was used to estimate survival rates: overall survival was (71.0 ± 3.9)%, event free survival (66.2 ± 4.0)% and disease-free survival (75.0 ± 4.1)%. Parameters of quality of a life defined by means of questionnaire PEDQL 4.0 GCS: quality of a life at children of 8—12 years is lowered at estimation by parents and at children of 13—18 years at a self-estimation.
SHORT MESSAGES
The purpose of the study — develop the program of the treatment on pulmonary TB sufferers with bronchoobstructive syndrome (BOS). 310 patients are examined on offered to diagnostor, including questionnaire, complex of the functional methods, study prooxidant status. It Is Designed base medical program, in which match different methods of the eliminating the reasons BOS: identical anti-TB chemotherapy, influence pathogenic drug, modern schemes bronchodilator therapy, fight with smoking.
The article presents a comparative analysis of clinical and radiological parameters in patients with pulmonary tuberculosis accompanied by eosinophilia and without eosinophilia.
The study found that tuberculosis infection combined with eosinophilic reaction of the blood characterized by destructive changes in lung tissue, the presence of fibrosis, but also slowing resorption infiltrates evidence in favor of the negative effect of the hematological reactions to the course and outcome of tuberculosis infection.
The appointment of anti-TB drugs with meningitis tuberculous etiology later than the 10th day of illness in most cases leads to an unfavorable outcome of the disease and the development of serious complications. Specific therapy, conducted by the anti-TB drugs, with a high degree of penetration into the cerebrospinal fluid (isoniazid, pyrazinamide, amikacin, ethionamide) makes it possible to avoid fatal outcome in tuberculous meningitis in children, even at very late diagnosis. For suspected meningitis, and that it cannot be excluded, it is necessary to appoint a trial therapy 3—4 anti-TB drugs while there is a specification of the diagnosis.
With attracting contemporary molecular-genetic and immunological research methods, it has been established that blood eosinophilia under pulmonary tuberculosis is mediated by hypersecretion eotaxin. Susceptibility to the emergence of eosinophilic blood reaction under tubercular infection is associated with the allele G and homozygous genotype GG of the polymorphic region A-384G of the gene eotaxin as well as with allele С and homozygous genotype СС polymorphism T-51C of the gene ССR3.
The psychological status analysis by multifactor method of personality study (MMPI) was conducted among 65 TB patients with high (37) and low (28) compliance. The analysis revealed the influence of personal characteristics on adherence to treatment, what was predicted by the peak MMPI indicators on the 9-th “optimism” scale. Hence, the prospect for successful treatment outcomes is decreased due to low criticism, and tendency to anosognosia.
The aim of this study was to evaluate the level of secretion of IL-12β by mononuclear leukocytes of peripheral blood under infiltrative and disseminated pulmonary tuberculosis. Blood mononuclear cells were isolated by gradient centrifugation, then cultured in complete culture medium; the level of IL-12β production was determined by the ELISA (ELISA). Peripheral blood served as the material of the research. It has been established, that under infiltrative pulmonary tuberculosis the levels of basal, protein and lipid-induced IL-12β production were significantly lower than in healthy donors and patients with disseminated pulmonary tuberculosis. Under disseminated pulmonary tuberculosis basal IL-12β production varies within normal limits; when stimulated by protein antigen, it increases, when influenced by lipid antigen — decreases.
At treatment of patients with multidrug-resistant tuberculosis of lungs according schemes of the program DOTS-Plus was noted development different side reactions from organs and systems. We study influence of quantity indicator of drug resistance M. Tuberculosis and homeostasis’s parameters on character of side effects at 101 inhospital patients during course of treatment. Received data were subjected to statistical processing at program Statistica 6.0 for Windows.
JUBILEES
Creative biography of the known Russian surgeon and scientist – doctor of medical sciences, Honoured Physician of Russia, Honoured Science Worker of Russia, State Prize Winner of RF, Honourary Citizen of Tomsk , professor B.I. Alperovich is present-ed in the article.
ISSN 1819-3684 (Online)