ORIGINAL PAPERS
Aim: to estimate the frequency of DNMT3A gene exons 18–26 point mutations in acute myeloid leukemia (AML) patients (pts) using target automatic sequencing technique.
Material and Methods. Bone marrow and peripheral blood samples were obtained from 34 AML pts aged 21 to 64, who were treated in Sverdlovsk Regional Hematological Centre (Ekaterinburg) during the period 2012–2014. Distribution of the pts according to FAB-classification was as follows: AML M0 – 3, M1 – 1, M2 – 12, M3 – 3, M4 – 10, M5 – 2, M6 – 1, M7 – 1, blastic plasmacytoid dendritic cell neoplasm – 1. Total RNA was extracted from leukemic cells and subjected to reverse transcription. DNMT3A gene exons 18–26 were amplified by PCR. Detection of mutations in DNMT3A gene was performed by direct sequencing. Sequencing was realized using an automatic genetic analyzer ABI Prism 310.
Results. The average frequency of functionally significant point mutations in DNMT3A gene exons 18– 26 among the treated AML pts was 5.9%. They were detected in morphological subgroups M2 and M4(according to WHO classification). The average frequency of DNMT3A gene exons 18–26 point mutations among the AML M2 and M4 pts without chromosomal aberrations and TP53 gene point mutations was 14.3%. In both cases there were samples in which DNMT3A gene mutations were accompanied by molecular lesions of NPM1, KRAS and WT1 genes. AML pts with DNMT3A gene exons 18–26 point mutations characterized by poor response to standard chemotherapeutic regimens and unfavorable prognosis.
Creation of anastomoses between hollow organs of the abdominal cavity, retroperitoneal space and the small intestine always raises the question of the prevention of reflux from the small intestine into the cavity drained the esophagus, stomach, gallbladder, liver outer duct cysts of the liver and pancreas. After surgery, any reflux becomes pathological. Reflux – is an obligate precancer. So, throw the bile and pancreatic juices in the stomach, the stump of the stomach, esophagus contributes to reflux esophagitis, reflux gastritis, ulcers and gastric cancer, or a stump. After an internal drainage of cavity formation in the small intestine develops postoperative reflux disease, which is caused by the actions of the surgeon who tried sincerely to help the patient. It is possible to give the definition of such states “Iatrogenic Postoperative Reflux Disease”.
The aim of this work was to develop and put into practice a “cap” on the afferent loop of the small intestine, do not migrate into the gut lumen, with an internal cavity drainage structures of the abdominal cavity and retroperitoneal space and to evaluate clinical outcomes. As a result, the authors have developed a way to create a “cap” on a loop of the small intestine, which is used for the drainage of cavity formation, conducted research on its safety, proper functioning, accessibility, analyzed the clinical situation offers. For drainage of cavernous fistula formation impose between him and a loop of small intestine 40–50 cm from the Treitz ligament. Form a intestine anastomosis by Brown.
Above this junction length leads to the formation of the drained portion of the small intestine is about 10 cm, in the middle of which impose a “stub”. Length of discharge from the drainage area of education of the small intestine to interintestinal Brownian anastomosis is about 30 cm. To form a “plug” free land use of the greater omentum, through which by puncture-poke perform ligature of non-absorbable polypropylene material. The developed method for forming a “plug” does not cause drastic changes in the ischemic zone of operation, followed by necrosis of the bowel wall and migration "stub" into the lumen, and its efficiency is demonstrated by clinical observation of microcirculation studies, the results of the water sample, and radiological studies. Way to create a “stub” is promising for internal drainage of abdominal structures of the abdominal cavity and retroperitoneal space, to form a nutrient anti reflux eyunostomy.
Introduction. The analysis Results of surgical treatment of growing children with infantile and juvenile scoliosis (IS) can the optimal method of treatment select. In young children with significant growth potential spinal fusion may not be the best option as it limits further longitudinal growth of the spine and may to the thoracic insufficiency syndrome result. To address this problem recently several techniques focused, their have advantages and drawbacks.
Material and methods. Since 2008 year 127 patients (64 girls, 63 boys) aged (4.5 ± 2.1) years were operated on. In group I 65 patients were operated on using VEPTR (Vertical Expandable Prosthetic Titanium Rib) instrumentation, in group II 42 patients using various spinal instrumentation. 20 patients with congenital kyphosis were excluded. The average follow-up time was (5.6 ± 1.1) years.
Results. In group I average value of the primary scoliotic curve before surgery was (74.7 ± 22.9), secondary curve (42.8 ± 16.0), thoracic kyphosis (46.3 ± 27.4), lumbar lordosis (54.6 ± 14). Average value of the primary scoliotic curve after surgery was reduced to (51 ± 20) (correction 31.7%), at followup to (56.5 ± 18.5), secondary curve (31.8 ± 12.8) (25.7%), at follow-up to (32.4 ± 18.4), thoracic kyphosis (36.8 ± 20.8) (20,5%), at follow-up to (41.8 ± 21.0), lumbar lordosis (45.4 ± 12.7) (16,9%), at follow-up to (48.2 ± 11.7) (p < 0.05). Space available for lung before surgery was (84.5 ± 8.7) %, after surgery was (94.8 ± 6.7)%, at follow-up increased to (98.6 ± 5.4) % (p < 0.05). Complications included 11 implant dislocations and 1 infection. In group II average value of the primary scoliotic curve before surgery was (87.6 ± 6.6), secondary curve (47.8 ± 4.6), thoracic kyphosis (61.4 ± 10.4), lumbar lordosis (61.8 ± 4.9). Average value of the primary scoliotic curve after surgery was reduced to 50.6 ± 5.3 (correction 42.3%), at follow-up to (66.1 ± 6.3), secondary curve (24.1 ± 2.9) (49.6%), at follow-up to (37 ± 5.4), thoracic kyphosis (38.8 ± 7.7) (36.8%), at follow-up to (59.4 ± 11.2), lumbar lordosis (47.5 ± 4.1) (23.2%), at follow-up to (64.5 ± 4.5) (p < 0.05). Complications included 23 implant dislocations and 1 infection. No neurological complications.
Conclusion. Stage correction fusions using various instrumentation is a method of choice for controlled correction of growing children with IS.
The research objective is to establish the link between heat shock protein 27 and ubiquitin mRNA expression as well as Jukart tumor cell apoptosis.
The method of flow cytofluorometry has been used to evaluate apoptosis realization using FITC-labeled annexin V and propidium iodide along with the amount of reactive oxygen species. Spectrofluorimetry has been applied to register the caspase-3 activity. The content of hydroxyl radicals has been determined by spectrophotometry. The level of ubiquitin and heat shock protein 27 mRNA expression has been identified using real-time PCR. Intact Jukart tumor cells and blood lymphocytes of healthy donors served the material for the research.
Following the carried out research it has been found out that the fall in the amount of annexin V positive cells and the reduced caspase-3 activity were accompanied by the rise in the content of hydroxyl radicals and reactive oxygen species against the backdrop of the increased heat shock protein 27 and ubiquitin mRNA expression in Jukart tumor cells.
Purpose. Determine endogenous and exogenous factors influencing the pace of consolidation in osteosynthesis implants with different types of coatings. Based on the characteristics of the selected offer the best conditions for the application of bioactive structures.
Material and methods. The work is based on an analysis of surgical treatment of 1265 patients with hip fractures, tibial and shoulder. Take into account the influence of age, gender, thе timing of the operation, quality reposition, comorbidities, location and severity of the fracture, implant сoating violation bone repair.
Results. Received consolidation using bioactive plates in 99.3 % of patients. Well executed reposition 4.5 times reduced cases of delayed consolidation. The main reason for delayed fracture healing in patients older than 60 years is osteoporosis. Males under 40 years compared with women of the same age often observed slow formation of callus, which is associated with frequent presence in them of comminuted fractures. The most frequently observed sustained fusion in patients with tibial fractures, which is primarily due to the prevalence of lesions in this segment. The main mechanism of action of bioactive positive plates can be explained by the peculiarities microarchitectonics coverage closer to the physiological structure of bone, increasing the concentration of osteogenic cells around the implant and stimulation of their function. Application of bioactive plates most appropriate for osteoporosis, type C lesions, pseudoarthrosis, reoperations during migration and metal fracture, in multiple and combined injuries.
Very little research is devoted to the study of communication systemic immunological changes and local immunological changes in the tissue of the thyroid in autoimmune thyrophaties. The goal of the research was to establish immunologic and morphologic predictors of clinical course and functional outcomes of Graves’s disease (GD).
Material and methods. We examined 45 patients with GD (14 men and 31 women) aged 18–55 years (47.0 (35.0–53.0)) years, matching the following criteria: a verified diagnosis GD, accommodation in Tomsk oblast and the Tomsk not less than 10 years, the patient's consent for the study. The control group included 30 people, with an average age of (45.3 ± 5.6) years and was comparable by age and sex with GD patients. The study included: definition of the standard for GD hormonal and serological profile (free T4, free T3, and TSH, antibodies to TPO, antibodies to the TSH receptor), the cultivation of mononuclear leukocytes in complete culture medium within 24 hours with subsequent determination of interleukins concentrations (IL-2, IL-4, TNF-alpha) in culture medium using enzyme-linked immunosorbent assay, determination of the number of blood cells carrying membrane-bound receptors to IL-2, IL-4, TNF-R1 by flow laser cytometry on cytometer BD FACS Canto tmΙΙ (USA) using labeled monoclonal antibody, the standard postoperative histological examination of thyroid gland tissue samples and immunohistochemical detection in samples of thyroid tissue receptors to IL-2, IL-4, TNF-alpha.
Results. On the basis of the received results it is possible to allocate 2 clinical-immunologic and morphologic cluster of autoimmune hyperthyroidism syndrome in patients with clinical diagnosis of GD. The first includes the formation of 1 and 2 histological options GD (minimally expressed monocytes infiltration, lack of oncocytic transformation of thyroid epithelium), with some clinical characteristics (persistent and pronounced hyperthyroidism, the large size of goiter, higher titer of receptor TSH-antibody and smaller TPO-antibody, diffuse nature of the lesion), and the second – is represented by 3d histological option with oncocytic restructuring of follicular epithelium, expressed the monocyte/macrophage infiltration with the TNF-RI expression and clinical patterns, including: the older age group of patients, the smaller size of goiter, the emergence of “pseudo nodes” ultrasound, reflecting the presence of lymphoid follicles-infiltrates, more lenient for hyperthyroidism. Probably, that the 2nd cluster is a combination of “classical GD” with autoimmune thyroiditis, however, a set of clinical and laboratory-instrumental signs led to the fact that these patients were in the group of GD patients.
Conclusion. This approach (combining study of indicators of systemic and local tissue-specific autoimmune inflammation) is a promising from the point of view of separate parts coverage in the autoimmune thyroids diseases pathogenesis, approximating researchers to develop immune based therapeutic technologies.
REVIEW AND LECTURES
Juvenile idiopathic arthritis (JIA) are a group of socially significant diseases of childhood because of the high prevalence of a chronic nature, as well as a large percentage of early disability. JIA is a collection of diseases that have different start, course and outcome, as well as various etiologies, which emphasizes the difficulties in the diagnosis process in children. When this disease is progressive in nature, leads to loss of function of the musculoskeletal system, severe disability at an early age and, therefore, needs early diagnosis and adequate therapy appointment.
Significant role in identifying pathology osteoarticular system belongs radiological methods and routine radiography remains the most widely used technique included in the classification criteria of the majority of rheumatic diseases. However, it is well known that secondary structural changes in the bones precedes roentgen period, and therefore the X-rays can not be regarded as a method of early diagnosis with articular syndrome. Widely introduced in recent years, magnetic resonance imaging (MRI) has more say in the assessment of capabilities of the joints, as in addition to assessment of bone allows quantitatively and qualitatively assess changes in the synovial membrane, articular cartilage, the presence and severity of inflammatory changes in the periarticular soft tissue and bone tissue. The data obtained using MRI may be used for diagnosis, prognosis, and monitoring response to treatment, including early stage disease.
Nevertheless, despite the obvious opportunities MRI, this technique is not widely used, including the lack of clear diagnostic criteria for the disease, the lack of centralized research validated, standardized protocols for conducting MRI studies of children with articular syndrome. Thus, research is warranted to address a number of clinical and diagnostic aspects in JIA, in particular the development of the scoring system assessing the severity and progression of the disease.
METODOLOGICAL SEMINAR
Rating control of students knowledge and skills is the part of Bologna declaration of European Universitites. Optimal realization of rating system brings together the objectivity and the individual approach to student’s evaluation. Analysis of rating control possibilities in medical University and peculiarities of individual rating adaptation in the LMS Moodle are the objectives of this paper.
LMS Moodle contains enough elements quantity for evaluation and allows sum up of learning course results. First level of rating system adaptation is various intervals for different course elements. Weight coefficients for learning tasks mean second one. Third rating adaptation level is the method of calculation of final rating score for a student. There is example of rating system in medical informatics course for medical and pediatric students in the paper. Organizational, technological and financial aspects of rating introducing in the medical education are discussed.
The article presents a social-psychological indicators of stress, coping mechanisms, rigidity and psychological component gestational dominant as risk factors predisposing to deviations in the context of preparedness for motherhood, marked psychological characteristics of pregnant women main group.
Material and methods. The study was conducted on the basis of obstetric clinics SSMU, prenatal maternity hospital number 4 and the Centre for Medical Prevention (Cabinet crisis pregnancy). Total was attended by 52 women aged 18 to 44 years, at different stages of pregnancy – from 5 to 39 weeks. Methodological apparatus consisted of a structured interview questionnaire “Medical and social data of the pregnant woman” methodology for determining the stress and social adaptation of Holmes and Rage (1967), a questionnaire of coping R. Lazarus and S. Folkman (WCQ, 1988), Tomsk questionnaire rigidity G.V. Zalewski (TORZ, 1987), test on pregnant I.V. Dobryakova (1996). Data processing was carried out using statistical methods Spearman rank correlation coefficient, nonparametric Mann–Whitney U and Kruskal–Wallis H and φ * – Fisher's angular transformation.
Results. Significant psychological factors that may influence the formation of readiness for motherhood among women of the main group can be considered an unplanned pregnancy (65%), and also its not gelendost (35%).
Studies of stress resistance was detected in pregnant women from the main group low stress levels (88%), and only 12% have a high degree. Most of the women from the сomparison group reverse the situation 64% have a high degree of stress, this suggests that the presence of previously state miscarriage is for this group of stress.
On the formation of readiness for motherhood affects not only the presence of stressful situations, butalso how the woman in their lives. Using U-test Mann–Whitney, were statistically significant differences were observed among the main group and сomparison group in the following coping strategies: selfcontrol (p ≤ 0.0014), the search for social support (p ≤ 0.0015), accepting responsibility (p ≤ 0.04), and planning solutions to the problems (p ≤ 0.00016). These differences are considered as one of the risk factors for deviant motherhood main group.
In contrast to the сomparison group, where 62% of pregnant women with the optimal type PKGD, main group optimal type PKGD observed only in 38% of the respondents, which indicates that the risk of deviations in the structure of psychological readiness.
Conclusion. Risk factors such as social disadvantage, the planned abandonment of a child, the tendency to rigid behavior, inefficient use of coping strategies and low level of optimal psychological component gestational dominant testify about the possible psychological unpreparedness for the upcoming event to become a mother and as a consequence to the development of deviant motherhood.
ISSN 1819-3684 (Online)