CLINICAL AND MORPHOLOGICAL PARRALLELS IN THE COURSE OF RESPIRATORY SARCOIDOSIS

Sarcoidosis is a systemic disease characterized by the development of chronic immune inflammation and formation of granulomas. It is important to know clinical, morphological and immunologic variants of the course of this disease in order to investigate the pathomorphologic parameters of the granuloma.Of late negative trends have been observed in the changes of sarcoidosis pathomorphology. Due to the above it is important to investigate predictors for the course of this disease, including specific parameters of granulematous inflammatory process in various clinical variants not only from the point of view of diagnostics but further management tactics for those suffering from this disease

Algorithm for determining the authenticity of biomedical cell preparations containing mesenchymal stem cells

The use of mesenchymal stem cells (MSCs), which have a pronounced immunomodulatory activity, is a promising direction in the development of biomedical cell preparations (BMCPs). In oncohematology, the use of BMCPs containing MSCs is aimed at supporting hematopoiesis during cotransplantation with hematopoietic stem cells (HSCs) and suppressing immune conflicts during allogeneic unrelated transplantation and severe autoimmune processes. An obligatory stage of registration of BMCPs is confirmation of the identity of the MSC cell line (CL), which includes the establishment of morphological characteristics, evaluation of the expression of specific markers and proteins, and confirmation of the genetic stability of CL during cultivation. Determination of markers of genetic stability is possible using various methods, however, according to the recommendations of the American National Standardization Institute, the standard is the analysis of short tandem repeats (STR analysis). The purpose of the study is to develop an algorithm for determining the authenticity of BMCPs containing MSCs, including STR analysis. Material and methods. Identification of MSC cells in BMCP was performed according to the criteria of the International Society for Cell Therapy. Viable cells were counted in a Goryaev chamber. Immunophenotypic characteristics of MSCs were determined by flow cytometry. The level of production of specific proteins was assessed using enzyme immunoassay. Genetic stability markers were identified by STR analysis. Results and discussion. The methods were tested in triplicate for ten BMCP samples to confirm the reproducibility and reliability of the results. The developed algorithm for determining the authenticity of BMCP has a high accuracy, as it includes the STR analysis technique, which makes it possible to identify 19 polymorphic STR markers located on different alleles. Using the method will allow BMCP manufacturers to go through the procedure of state registration of drugs

Клещевой вирусный энцефалит в Томской области за последние 10 лет

In the given work had been lead the analysis of epidemiological data TBE for 1999—2009 on Tomsk area. The information on quantity imparted against tick-borne encephalitis, about results of research of pincers and blood at the persons who have addressed on points prevention of tick-borne encephalitis and about quantity of the diseased tick-borne encephalitis is presented. Analysis of a complex of preventive actions is spent. The reasons of formation of the long maintenance of a virus tick-borne encephalitis in blood are shown.Представлен анализ итогов эпидемических сезонов по клещевому энцефалиту 1999—2009 гг. по Томской области. Дана информация о количестве привитых против клещевого энцефалита, о результатах исследования клещей и крови у лиц, обратившихся на пункты серопрофилактики, и о количестве заболевших клещевым энцефалитом. Проведен разбор комплекса профилактических мероприятий. Показаны причины формирования длительного антигеноносительства вируса клещевого энцефалита

Клинико-функциональные особенности течения саркоидоза органов дыхания в реальной практике

As a rule, heart damage in patients with sarcoidosis of respiratory organs (SOD) is not diagnosed in time, so a very important and urgent task is to identify common heart rhythm and conduction disorders.The aim of the study was to investigate the main clinical manifestations of sarcoidosis in SOD, depending on the peculiarities of the disease course and to compare the frequency and severity of pulmonary and extrapulmonary manifestations of sarcoidosis, including myocardial lesions and electrocardiographic (ECG) signs of heart rhythm disorders.Methods. In the period 2006– 2016, the pilot open prospective uncontrolled study conducted at the Pulmonology Department of the Regional State Autonomous Healthcare Institution "Tomsk Regional Clinical Hospital" included patients (n = 84) aged 20–67 years with the diagnosis of SOD. Patients were divided into 2 clinical groups: the 1st comprised 45 (53.5%) patients with a favorable course of sarcoidosis, the second one included 39 (46.4%) patients with an unfavorable course of the disease. A full range of studies was carried out, including the analysis of medical history and clinical and epidemiological data, instrumental methods (including ECG and Holter ECG monitoring (HM), pathomorphological study of lung biopsy samples.Results. According to the data of frequency analysis of occurrence of pulmonary and extrapulmonary clinical manifestations in ODS, it was shown that the leading clinical manifestations, most frequently occurring in patients of both groups, included asthenia syndrome (72.6%), bronchial syndrome (66.7%) and fever syndrome (33%). In 33% of cases, clinical manifestations of myocardial damage were detected. In 41 (51.2%) patients in both groups, changes on ECG were recorded at rest. Regardless of the course of the disease, in 23.5% of patients of both clinical groups, according to the results of the HM ECG, rhythm and conduction disturbances were found – a combination of ventricular arrhythmias and conduction disorders (ventricular extrasystole and right His bundle branch block of various degrees) and a combination of supraventricular arrhythmias and conduction disturbances (supraventricular extrasystole and right His bundle branch block of various degrees).Conclusion. Thus, regardless of the severity of the disease course, SOD patients are concerned about complaints from both respiratory system and extrapulmonary manifestations, including cardiac complaints, as well as heart rhythm and conduction disorders (according to the results of ECG and HM ECG), the frequency of which, according to the comparative analysis, has not significantly changed in both clinical groups, which indicates the non-specific character of clinical manifestations. Как правило, поражение сердца у больных саркоидозом органов дыхания (СОД) своевременно не диагностируется, поэтому весьма важной и актуальной задачей является обнаружение часто встречающихся нарушений сердечного ритма и проводимости.Целью исследования явились изучение основных клинических проявлений при СОД в зависимости от особенностей течения заболевания и сравнительная оценка частоты и тяжести легочных и внелегочных проявлений саркоидоза, включая поражения миокарда и электрокардиографические (ЭКГ) признаки нарушений сердечного ритма.Материалы и методы. В период 2006–2016 гг. в пилотное открытое проспективное неконтролируемое исследование, проведенное в отделении пульмонологии на базе Областного государственного автономного учреждения здравоохранения «Томская областная клиническая больница», были включены пациенты (n = 84) в возрасте 20– 67 лет с диагнозом СОД. Больные были распределены на 2 клинические группы: 1-ю составили 45 (53,5 %) пациентов с благоприятным течением саркоидоза, 2-ю – 39 (46,4 %) больных с неблагоприятным течением заболевания. Проведен полный спектр исследований, включая анализ анамнестических и клинико-эпидемиологических данных, инструментальные методы (включая ЭКГ и холтеровское мониторирование (ХМ) ЭКГ), патоморфологическое исследование биоптатов легких.Результаты. По данным частотного анализа встречаемости легочных и внелегочных клинических проявлений при СОД показано, что ведущими клиническими проявлениями, встречающимися наиболее часто у пациентов обеих групп, являлись синдромы астении (72,6 %), бронхитический синдром (66,7 %), синдром лихорадки (33 %). В 33 % случаев выявлены клинические проявления поражения миокарда. У 41 (51,2 %) пациента в обеих группах в состоянии покоя зафиксированы изменения на ЭКГ. Независимо от течения заболевания, у 23,5 % больных обеих клинических групп по результатам ХМ ЭКГ обнаружены нарушения ритма и проводимости – сочетание желудочковых аритмий и нарушений проводимости (желудочковая экстрасистолия и блокада правой ножки пучка Гиса разной степени) и сочетание наджелудочковых аритмий и нарушений проводимости (суправентрикулярная экстрасистолия и блокада правой ножки пучка Гиса разной степени).Заключение. Таким образом, независимо от тяжести течения заболевания, больных СОД беспокоят жалобы как со стороны дыхательной системы, так и внелегочные проявления, включая кардиальные, а также нарушения ритма сердца и проводимости (по результатам ЭКГ и ХМ ЭКГ), частота встречаемости которых, по результатам сравнительного анализа, в обеих клинических группах достоверно не изменялась, что свидетельствует о неспецифичности клинических проявлений.

Клинико-иммунологическая характеристика больных клещевым энцефалитом в острый период в Томской области

Results of complex research of features of clinical and immunological profiles tick-borne encephalitis during the sharp period in Tomsk Region are resulted in the article. Last years redistribution of a parity of clinical displays of the sharp period in favor of prevalence of feverish forms of disease and a tendency to increase in cases of long circulation of an antigene of a virus tick-borne encephalitis is marked. One of the important reasons of such effect is decrease in immunological reactance of an organism with development of cytokine’s disbalance and expression infringement receptors of cytokines with lymphocytic cages.Представлены результаты комплексного исследования особенностей клинического и иммунологического профилей клещевого вирусного энцефалита в острый период в Томской области. В последние годы отмечаются перераспределение соотношения клинических проявлений острого периода в пользу преобладания лихорадочных форм заболевания и тенденция к увеличению случаев длительной циркуляции антигена вируса клещевого энцефалита. Одной из важных причин такого эффекта является снижение иммунологической реактивности организма с развитием цитокинового дисбаланса и нарушение экспрессии цитокинов рецепторов лимфоцитарными клетками

Клинико-иммунологические аспекты клещевого энцефалита

In this article results of the clinical-immunological analysis with different forms tick-borne encephalitis of Tomsk Region during the period from 2000 to 2008 are represented. The revealled disbalance of cytokines alongside with breach of the expressions cytokines's receptor by limphocytes's cells, can be one of the main of the reasons to inefficiency answer when introducing the infectious agent in organism and shaping the chronic form to infectious pathology, in particular, with long presence of the antigen of the virus tick-borne encephalitis in blood. The trend to increase the level sick with long presence of the antigen of the virus tick-borne encephalitis in blood, with prevalence of the persons feminine flap, mainly average and senior age for the last years is given.Приведены результаты клинико-иммунологического анализа больных с различными формами клещевого энцефалита по Томской области за период с 2000 по 2008 г. Выявленный цитокиновый дисбаланс наряду с нарушением экспрессии цитокиновых рецепторов лимфоцитарными клетками может служить одной из главных причин неэффективности иммунного ответа при внедрении инфекционного агента в организм и формирования хронической формы инфекционной патологии, в частности длительного антигеноносительства вируса клещевого энцефалита. Установлена тенденция к росту числа больных с длительным антигеноносительством вируса клещевого энцефалита с преобладанием среди них лиц женского пола преимущественно среднего и старшего возраста

RISKS AND BENEFITS OF REPERFUSION STRATEGIES IN ACUTE MYOCARDIAL INFARCTION WITH ST SEGMENT ELEVATION

The review discusses various reperfusion strategies in patients with acute myocardial infarction with ST segment elevation (STEMI), based on the evidence from international clinical trials. The modern views on real-world invasive and conservative strategies of STEMI management in European countries are presented. The key factor for patients’ survival is the timing, not the method of reperfusion. The strategy of primary percutaneous coronary intervention (PCI) may fail to reduce mortality, if the door-to-balloon time is over 60 minutes, compared to immediate thrombolytic therapy (TLT). PCI is more effective than TLT only if the time difference (door-to-balloon vs. door-to-needle) is under 2 hours. The choice of reperfusion method should be based on the patient’s risk level. Primary PCI has limitations, since this method is not widely accessible, requires specially trained staff and special equipment. Early TLT is an acceptable standard method in STEMI management, highly applicable for the Russian clinical practice. However, in patients already treated with TLT, pharmaco-invasive strategy could be the method of choice. The description of thrombolytic drugs is focussed on the agents of II and III generations – alteplase (Actilyse®) and tenecteplase (Metalyse®), respectively. Before the introduction of Metalyse®, continuous infusion of Actilyse® was regarded as the gold standard of pharmacological reperfusion therapy. Recently, it has been shown that single-bolus Metalyse® therapy is as effective as continuous Actilyse® infusion, but with better safety profile. Pre-hospital TLT with single-bolus Metalyse® therapy (5-10 seconds) provides a unique clinical opportunity for early STEMI management and maximal myocardial rescue

Optimising the treatment of patients with acute coronary syndrome without ST segment elevation

Aim. To investigate the effects of unfractionated heparin (UFH) and its combination with warfarin on clinical course and plasma hemostasis in patients with acute coronary syndrome (ACS) without ST segment elevation.Material and methods. This prospective, open, randomized study included 174 ACS individuals without ST elevation. Group I (n=100) received UFH intravenously; Group II (n=74) received UFH and warfarin. Additionally, all participants were administered cardiomagnil (300 mg at admission, then 75 mg/d). Standard anti-anginal treatment was also performed. During 150 days after the randomization, the incidence of severe coronary complications and plasma hemostasis were investigated.Results. In patients receiving UFH, a statistically significant decrease in antithrombin (AT) III concentration was observed 1 day after the randomization. UFH reduces the AT III pool, which increases the risk of recurrent angina during and after heparin therapy. In UFH group, a significant increase in soluble fibrin-monomer complex (SFMC) concentration was registered at Day 8. In UFH + warfarin group, no SFMC increase was observed at Day 8, and the adverse coronary event incidence was statistically lower from Day 15 to Day 150, since warfarin prevented the “rebound” effect (thrombosis reactivation).Conclusion. Warfarin prevented the “rebound” effect after the end of heparin treatment (recurrent angina, plasma hemostasis activation, and increased SFMC levels at Day 8)