The Role of the Pyruvate Dehydrogenase Complex in the Development of Ischemic-Reperfusion Syndrome

Background. One of the key components of energy metabolism is the pyruvate dehydrogenase complex (PDC), the activity of which can be targeted by some cytoprotectors. However, their role remains unclear. It is known that the activation of the PDC in tumor cells leads to an inversion of anaerobic glycolysis with an increase in the generation of free radicals in the respiratory chain and a decrease in viability. At the same time, there is evidence of increased resistance of normal cells to hypoxia and reperfusion.Objectives. Analysis of current information on the role of PDC in the development of pathologic biochemical changes in ischemic reperfusion syndrome and methods of metabolic correction using agents for regulating the activity of the considered multienzyme complex. Methods. The bibliographical search was carried out across the eLIBRARY and PubMed databases with a selection of articles published over the past 10 years in the English and Russian languages, as well as some parts of fundamental works in the selected field, published more than 10 years. To be selected for bibliographical review, the article can be of any design, reflecting the ideas about the role of PDC in the development of pathologic biochemical changes in ischemic-reperfusion lesions of various organs and tissues.Results. The bibliographical analysis indicates a decrease in the activity of PDC in myocardial tissue during a heart attack or heart failure, the activity of the enzyme in skeletal muscles decreases against the background of acute hypoxia. PDC activity also decreases under chronic stress and extensive muscular exercise. At the same time, the PDC activity remains at the normal level in the ischemic period, and the transition to the reperfusion period is accompanied by a sharp decrease in the activity of the multienzyme complex. The PDC inactivation occurring under these conditions can result from a damage by reactive oxygen species, as well as by regulatory control changes through phosphorylation/dephosphorylation. Assuming the key role of PDC in the development of energy exchange disorders against the ischemic-reperfusion injuries 2 main strategies might be offered for metabolic correction: 1) an increase in the activity of PDC (activator — sodium dichloroacetate) or compensation for its lack with substrates of the tricarboxylic acids (acetylcarnitine, β-ydroxybutyrate); 2) protection of PDC from damage (antioxidants).Conclusion. The basis of energy exchange disorders in the reperfusion period is a decrease in PDC activity, and modification of its activity is a promising direction for metabolic prevention or correction of ischemic-reperfusion injures

Application of cells of cord blood and umbilical cord: achievements, challenges and perspectives

This review focuses on the biological aspects of the use of cord blood as a valuable source of cells. The distinctive features of hematopoietic stem cells, cells of the immune system, mesenchymal stem cells are described. The analysis of the results of clinical research and development of therapeutic approaches using cord blood cells and umbilical cord for the treatment of various diseases has been carried out.Currently, the target area of cord blood research is hematopoietic stem cell transplantation, as well as cellular immunotherapy of tumor diseases, treatment of neurological diseases and regenerative medicine

Возможности клеточной терапии в торакальной хирургии

Introduction. Bronchial fistula often occurs after lung surgery. This is an extremely severe complication with high mortality. Despite the variety methods for the treatment of bronchial fistula, the results are not always effective. In our paper, we presented a method of preventing the development of bronchial fistula based on the cell therapy. The objective of the study was to evaluate the effects of the cell therapy on the regeneration of damaged bronchial tissue in an experiment on non-human primates. Methods and materials. The study was performed on 6 non-human primates. Laboratory animals were divided into 2 groups: experimental and control. The left pneumonectomy with the formation of a stump of the main bronchus was done in each primate. In the experimental group, a regenerative product was introduced into the stump; in the control group, 0.9 % NaCl solution was used. The regenerative product consisted of autologous platelet-rich plasma activated by thermal lysis and the suspension of the xenogeneic fibroblast’s culture. The primates were observed for 7, 14 and 21 days, the peripheral blood was taken to study the dynamics of biologically active substances. A histological examination of the autopsy material was performed at the end of the follow-up time. Results. On the early postoperative period, a typical inflammatory reaction was observed and resulted by the intraoperative tissue damage. Then the morphological changes were different in both group. The inflammatory were mild, the restoration of the natural function of the mucous membrane and the formation of scar tissue were earlier in the experimental group than in the control group. An analysis of the dynamics of plasma mediators in the postoperative period revealed an earlier dominance of regenerative processes in the experimental group. Conclusion. The results of the study showed that the cell therapy stimulates the tissue regeneration, thereby preventing the failure of the bronchial stump suture.Введение. Бронхиальные свищи чаще всего возникают после оперативного вмешательства на легких и являются крайне тяжелым осложнением с высокой смертностью. Способы лечения бронхиальных свищей, несмотря на их разнообразие, не всегда являются эффективными. В работе представлен способ профилактики развития бронхиальных свищей, основанный на клеточной терапии. Цель – оценить влияние клеточной терапии на регенерацию поврежденной ткани бронха в эксперименте на нечеловекообразных приматах. Методы и материалы. Исследование было выполнено на 6 особях нечеловекообразных приматов. Лабораторные животные были разделены на 2 группы: опытная и контрольная. Каждому примату была выполнена левая пневмонэктомия с формированием культи главного бронха. В опытной группе в зону культи был введен регенеративный продукт, в контрольной группе – 0,9 % раствор NaCl. Регенеративный продукт состоял из аутологичной плазмы, обогащенной тромбоцитами, активированной температурным лизисом, и культуры ксеногенных фибробластов. Период наблюдения за приматами составил 7, 14 и 21 суток, в течение которого забирали периферическую кровь для изучения динамики биологически активных веществ. По окончании периода наблюдения было проведено гистологическое исследование аутопсийного материала. Результаты. В первые сутки в обеих группах наблюдалась типичная воспалительная реакция, связанная с интраоперационным повреждением тканей, но в дальнейшем морфологические изменения в обеих группах были различными. В опытной группе воспалительные явления были слабо выражены, восстановление непрерывности слизистой оболочки и формирование рубцовой ткани начинало происходить раньше, чем в группе контроля. Анализ динамики плазменных медиаторов в послеоперационном периоде выявил более раннее доминирование репаративных процессов в опытной группе. Заключение. Результаты исследования показали, что клеточная терапия способствует ускорению процессов регенерации тканей, тем самым предотвращая несостоятельность шва культи бронха

Cytologic status changes of the conjunctiva and tears qualitative composition in patients with «dry eye» syndrome after instillation of modern topical fluoroquinolones

Aim. Use of the antibiotics for eye was approved as a rational method for reducing the risk of postoperative endophthalmitis. The aim of our investigation was to study the influence of the modern topical fluoroquinolones on the qualitative composition of tears and cytological status of the conjunctiva in patients with cataract and «dry eye» syndrome. Methods and results. 102 patients (109 eyes) aged 36–87 years was examined. Qualitative composition of tear fluid was studied with method of native tears crystallography and conjunctiva cytological study using impression cytoscopy method. In 72.3% of cases the tears crystallography showed signs of pathology. Cytological examination of conjunctiva showed dystrophy in 86,8% of cases. In 11% of the patients typical cross-shaped crystals were detected. Conclusion. Correlation dependence analysis showed statistically significant positive relationship (Spearman’s correlation r=0.53) between the presence of cross-shaped crystals in crystallography and severe dystrophy of conjunctiva epithelium. Instillation of modern topical fluoroquinolones worsen the cytological status of conjunctiva epithelium

Цитологічний статус кон’юнктиви та зміни якісного складу сльози у пацієнтів із синдромом «сухого ока» після інстиляцій сучасних топічних фторхінолонів

Aim. Use of the antibiotics for eye was approved as a rational method for reducing the risk of postoperative endophthalmitis. The aim of our investigation was to study the influence of the modern topical fluoroquinolones on the qualitative composition of tears and cytological status of the conjunctiva in patients with cataract and «dry eye» syndrome.Methods and results. 102 patients (109 eyes) aged 36–87 years was examined. Qualitative composition of tear fluid was studied with method of native tears crystallography and conjunctiva cytological study using impression cytoscopy method.In 72.3% of cases the tears crystallography showed signs of pathology. Cytological examination of conjunctiva showed dystrophy in 86,8% of cases. In 11% of the patients typical cross-shaped crystals were detected.Conclusion. Correlation dependence analysis showed statistically significant positive relationship (Spearman’s correlation r=0.53) between the presence of cross-shaped crystals in crystallography and severe dystrophy of conjunctiva epithelium. Instillation of modern topical fluoroquinolones worsen the cytological status of conjunctiva epithelium.Рациональным методом профилактики послеоперационного эндофтальмита признаны инстилляции в конъюнктивальную полость антибактериальных препаратов группы фторхинолонов. С целью изучения влияния инстилляций современных фторхинолонов на качественный состав слезы и цитологический статус конъюнктивы у пациентов с катарактой и проявлениями синдрома «сухого глаза» обследовали 102 пациента (109 глаз) в возрасте 36–87 лет. Исследовали качественный состав слезы методом кристаллографии, провели цитологическое исследование эпителия конъюнктивы методом импрессионной цитоскопии. Отмечено наличие патологических признаков в кристаллограмме нативной слезы в 72,3%, дистрофические изменения эпителия конъюнктивы – в 86,8%. В 11% случаев в кристаллограмме нативной слезы обнаружен специфический морфотип кристаллов в виде крестов. Наличие этого феномена имеет достоверную связь (r=0,53 по Спирмену) с тяжелой степенью дистрофии эпителия конъюнктивы. Инстилляции современных фторхинолонов усиливают дистрофические изменения эпителия конъюнктивы.Раціональним методом профілактики післяопераційного ендофтальміту визнано інстиляції у кон’юнктивальну порожнину антибактеріальних засобів групи фторхінолонів. З метою вивчення впливу інстиляцій сучасних фторхінолонів на якісний стан сльози та цитологічний статус кон’юнктиви у пацієнтів із катарактою та синдромом «сухого ока» обстежили 102 пацієнти (109 очей) віком 36–87 років. Вивчали якісний стан сльози методом кристалографії, виконали цитологічне дослідження епітелію кон’юнктиви методом імпресійної цитоcкопії. Встановили наявність патологічних змін кристалограми нативної сльози в 72,3%, дистрофічні зміни епітелію кон’юнктиви – в 86,8%. В 11% випадків у кристалограмі нативної сльози визначили специфічний морфотип кристалів у вигляді хрестів. Наявність цього феномена має вірогідний зв’язок (r=0,53 за Спірменом) із важким ступенем дистрофії епітелію кон’юнктиви. Інстиляції сучасних фторхінолонів посилюють дистрофічні зміни епітелію кон’юнктиви.

EVALUATION OF OXIDATIVE METABOLIC DISORDERS IN WOMEN SUFFERING FROM CHRONIC INFLAMMATORY DISEASES OF SMALL PELVIS

Aim. The study was conducted to evaluate the intensity of oxidative disorders in women suffering from a complex course of chronic endometritis and salpingo-oophoritis. Materials and methods. The study was performed on 85 women divided into 3 groups: the control group – relatively healthy patients (n=30), the 2nd group – the patients suffering from chronic endometritis (n=29), the 3rd group – the patients suffering from a complex course of chronic endometritis and bilateral salpingo-oophoritis (n=26). The indices of chemiluminescence induced by the hydrogen peroxide were determined in the blood plasma and the mixed oral liquid. The content of products of oxidative modifications reacting to the thiobarbituric acid was determined in the erythrocyte meal and the mixed oral liquid.Results. The evaluation of the content of the product of oxidative modifications in biomolecules as well as the level of luminal-dependent chemiluminescence induced by the hydrogen peroxide revealed the intensification of free-radical processes in blood and the mixed oral liquid of patients suffering from inflammatory diseases of small pelvis. The index of the thiobarbituric value and the maximal chemiluminescence flash increased by 60-70% in the blood of patients from the 2nd-3rd groups. The area of chemiluminescence flash of the blood plasma in patients suffering from chronic endometritis increased by 73%, while in patients suffering from a complex course of chronic endometritis and bilateral salpingo-oophoritis it was significantly higher – by 2.1 times. The increase in the value of the maximal chemiluminescence flash by 45% and the chemiluminescence area by 43% was detected in the mixed oral liquid of the patients from the 3rd group, while the increased value of only chemiluminescence area (by 42%) was revealed in patients of the 2nd group.Conclusion. The results of the performed study revealed that the intensity of oxidative processes on the local and systemic levels in patients suffering from a complex course of chronic endometritis and double salpingo-oophoritis was significantly higher than in patients suffering from an isolated course of endometritis

Improving the conditions of regional hemodinamics of the eyes as a method of treatment in optic neuropathy at short-sightedness of high degree.

The aim of research. To increase treatment efficacy in optic neuropathy with high myopia by performing revascularization operations in order to improve the performance of regional hemodynamics of the eyeball and improve of visual functions. Materials and methods. The study involved 56 patients (78 eyes) with high myopia in age from 18 to 36 years, 32 were men (57.1% ), 24 - women (42.9% ). All patients underwent standard ophthalmologic examination, had nonprogressive form of myopia with signs of optic neuropathy . Exclusion criteria were : myopia more than 6.0 diopters , progressive form of the disease , opaque optical surroundings, clinically significant comorbidity (glaucoma, diabetes, etc.). Study group comprised 28 patients (32 eyes). Complex of medications included vasodilators, nootropics and neuroprotective agents , vitamins. Compression bandaging of the superficial temporal artery was used with revascularization purpose. The control group consisted of 28 patients (46 eyes) who received a similar course of drug therapy. Examination of patients in both groups were performed before treatment and after 1, 6 and 12 months. Results. In the main group positive changes in visual acuity and visual fields was more pronounced and more cases of negative dynamics during the observation period were recorded. Patients in the control group in most cases achieved stabilization of the process, there was a negative trend of visual function during long-term follow-up. Analyzing the performance of retinal tomography HRT II for the reporting period in the study group noted the absence of further thinning of the nerve fibers. In the control group had a negative trend 8 eyes ( 17.39 %) having an average thickness loss of retinal nerve fibers was 0,007 ±0,00046 mm( 7.12 % of the initial level) . Prior to treatment the linear velocity of blood flow was reduced and averaged speed was 28,77 ±4,12 cm/ sec , and the resistance index increased (averaged 0,9 ± 0,08). Significant increase in the rate of blood circulation in the ophthalmic artery occurred in the study group patients who underwent surgery indirect revascularization and long-term follow averaged 10.09 % of baseline (control - 4.01% ) . Assessing the functional activity of the peripheral parts of the retina , the data to increase sensitivity threshold for phosphenes to 78,54 ± 5,42 mA in the main group and 76,42 ± 3,25 mA in the control prior to treatment. In the main group managed to reduce this figure by 14% in the control group - 10%. Analysis of the results showed positive dynamics in the study group relative to the control suggests that the conduct of the superficial temporal artery ligation for the purpose of indirect revascularization in high myopia with signs of optic neuropathy improves visual function and microcirculation with general hemodynamic eyeball helps to stabilize nerve thickness. Conclusion. 1. Performing the ligation of the superficial temporal artery for the purpose of indirect revascularization in optic neuropathy in patients with high myopia causes progressive reduction, stop the average thickness of retinal nerve fibers. 2 . Correction of eyeball hemodynamic in remote periods in the study group was improved in 78.4 % of cases and the absence of impairment was detected in 100% of cases, compared to 33.45 % and 13.36 % in the control group . 3 . Indirect revascularization performance with neuroprotective goal will improve the function of the optic nerve in 88.23 % of patients and in 35% of the primary control group , stabilize the process in 11.77 % of patients and 55 % control group

Покращення стану регіонарної гемодинаміки очного яблука як спосіб лікування оптичної нейропатії при ускладненій короткозорості високого ступеня

The aim of research. To increase treatment efficacy in optic neuropathy with high myopia by performing revascularization operations in order to improve the performance of regional hemodynamics of the eyeball and improve of visual functions.Materials and methods. The study involved 56 patients (78 eyes) with high myopia in age from 18 to 36 years, 32 were men (57.1% ), 24 - women (42.9% ). All patients underwent standard ophthalmologic examination, had nonprogressive form of myopia with signs of optic neuropathy .Exclusion criteria were : myopia more than 6.0 diopters , progressive form of the disease , opaque optical surroundings, clinically significant comorbidity (glaucoma, diabetes, etc.).Study group comprised 28 patients (32 eyes). Complex of medications included vasodilators, nootropics and neuroprotective agents , vitamins. Compression bandaging of the superficial temporal artery was used with revascularization purpose.The control group consisted of 28 patients (46 eyes) who received a similar course of drug therapy.Examination of patients in both groups were performed before treatment and after 1, 6 and 12 months.Results. In the main group positive changes in visual acuity and visual fields was more pronounced and more cases of negative dynamics during the observation period were recorded. Patients in the control group in most cases achieved stabilization of the process, there was a negative trend of visual function during long-term follow-up.Analyzing the performance of retinal tomography HRT II for the reporting period in the study group noted the absence of further thinning of the nerve fibers. In the control group had a negative trend 8 eyes ( 17.39 %) having an average thickness loss of retinal nerve fibers was 0,007 ±0,00046 mm( 7.12 % of the initial level) .Prior to treatment the linear velocity of blood flow was reduced and averaged speed was 28,77 ±4,12 cm/ sec , and the resistance index increased (averaged 0,9 ± 0,08). Significant increase in the rate of blood circulation in the ophthalmic artery occurred in the study group patients who underwent surgery indirect revascularization and long-term follow averaged 10.09 % of baseline (control - 4.01% ) .Assessing the functional activity of the peripheral parts of the retina , the data to increase sensitivity threshold for phosphenes to 78,54 ± 5,42 mA in the main group and 76,42 ± 3,25 mA in the control prior to treatment. In the main group managed to reduce this figure by 14% in the control group - 10%.Analysis of the results showed positive dynamics in the study group relative to the control suggests that the conduct of the superficial temporal artery ligation for the purpose of indirect revascularization in high myopia with signs of optic neuropathy improves visual function and microcirculation with general hemodynamic eyeball helps to stabilize nerve thickness.Conclusion. 1. Performing the ligation of the superficial temporal artery for the purpose of indirect revascularization in optic neuropathy in patients with high myopia causes progressive reduction, stop the average thickness of retinal nerve fibers.2 . Correction of eyeball hemodynamic in remote periods in the study group was improved in 78.4 % of cases and the absence of impairment was detected in 100% of cases, compared to 33.45 % and 13.36 % in the control group .3 . Indirect revascularization performance with neuroprotective goal will improve the function of the optic nerve in 88.23 % of patients and in 35% of the primary control group , stabilize the process in 11.77 % of patients and 55 % control group.Обследовали 56 пациентов (78 глаз) с близорукостью высокой степени, которые имеют признаки оптической нейропатии. В результате исследований установили, что проведение перевязки поверхностной височной артерии с целью непрямой реваскуляризации в лечении данной патологии позволяет улучшить состояние гемодинамики глазного яблока и обеспечить нейропротекцию, что проявляется улучшением зрительных функций.Обстежили 56 пацієнтів (78 очей) із короткозорістю високого ступеня, які мають ознаки оптичної нейропатії. У результаті досліджень встановили, що виконання перев’язки поверхневої скроневої артерії для непрямої реваскуляризації в лікуванні цієї патології дає змогу покращити стан гемодинаміки очного яблука й забезпечити нейропротекцію, що виявляється у покращенні зорових функцій

SONOELASTOGRAPHY IN DIAGNOSTICS AND SURGICAL TREATMENT OF PATIENTS WITH RECTOCELE

The aim of this work was an optimization of surgical strategy and improvement of results of rectocele treatment. A clinical group consisted of 87 women suffered from rectocele of 2-3 degree. The patients were divided into 2 groups in dependence of surgical strategy. Levatoroplasty and colporrhaphy were performed from transvaginal access in patients of the first group (n=38). The plasty of rectocele was made in the second group (n=49) using combined transvaginal and transrectal accesses. The surgery included a sacrospinal fixation of cupula of the vagina, colporrhaphy supplemented by transrectal «11-hour» mucopecsia on the hight up to 5 cm from dentate line. There was stated that the major diagnostic criteria of functional insufficiency of pelvic floor were the sonoelastometric study of stiffness of the perineum muscles and tonometric research of gradient of vagina pressure in case of rest and tension. They were associated with the severity of rectocele. Operative intervention was more physiological, accompanied by less rate of recurrence, more high parameters of life quality and recommended for patients with 3 degree of rectocele in the second group. The expression of functional insufficiency of vagina muscles is the basis for choice of surgical strategy in case of prolapse

COMPARATIVE RESEARCH OF TRAUMATIC INJURY OF OPEN HAND-ASSISTED LAPAROSCOPIC ANTERIOR RESECTION OF THE RECTUM

The article made a comparative assessment of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum in lateral and spinal positions. The presented technique of hand-assisted laparoscopic colon and rectal surgery is simple. There are advantages in case of obesity presence (IMT more than 30 kg/m²), in significant shortening of the mesocolon and mesentery, high fixation of splenic flexure and intimate fixation of the spleen, in case of bad preparation of the bowels in partial intestinal obstruction or in case of emergency operation, big cancer size, expressed perifocal inflammation. A comparative analysis of dynamics of hormone stress content and metabolism (cortisol, adrenaline, thyrothrophic hormone) showed their expressed increase in blood during operation after traditional surgery. Less stressed reaction was noted after hand-assisted surgery, especially in overweight patients. An application of low invasive method allowed reduction of hemorrhage, pain syndrome, terms of patient’s activation and restoration of intestinal motility after operation