Development of the optimal mode of bleaching of linen materials by periodic method

The article presents the results of research on the operational properties of linen material bleached by the developed combined periodic method. The influence of the composition and concentration of components in the working solution on the quality indicators of bleaching was studied. The results of the study show that the use of the proposed combined method for bleaching linen and mixed fabrics allows you to obtain high values of the degree of whiteness and capillarity with the preservation of strength indicators and minimal destruction of cellulose fiber

CLINICAL EXPERIENCE WITH USTEKINUMAB IN THE TREATMENT OF EARLY PSORIATIC ARTHRITIS USING TREAT-TO-TARGET STRATEGY

The new Treat-to-Target (T2T) strategy in the treatment of early psoriatic arthritis (PsA) is aimed at achieving remission or low disease activity. As of now, the new biological agent ustekinumb (UST), anti-interleukin (IL) 12/23 monoclonal antibodies, was used to treat psoriasis and PsA. The paper presents clinical observations of the efficacy of UST in early PsA treated according T2T strategy. The described clinical cases demonstrate that use of UST 45 mg both alone and in combination with methotrexate for early PsA with moderate and high activity reduced manifestations of peripheral arthritis and psoriasis, promoting rapid achievement of remission or minimal disease activity. Overall, UST is well tolerated by the patients

Galectin-9 influences the Tim-3 molecule expression in natural killer different subpopulations

Galectin-9 is a b-galactoside binding lectin with expressed immunoregulatory activity. During pregnancy galectin-9 is produced by trophoblast cells and regulates the function of natural killer (NK) cells at the maternal-fetal interface via binding to Tim-3 (T-cell Ig and mucin domain-containing protein 3) molecules. Natural killer (NK) lymphocytes belong to the innate lymphoid cells, which have a cytotoxic effect on target cells and are capable of producing a large number of regulatory factors (cytokines, chemokines). Decidual NK have a tolerant phenotype and play a leading role in the regulation of invasive trophoblast growth and provide peripheral immune tolerance in the area of uteroplacental contact. Peripheral NK cells express Tim-3 molecules. Galectin-9 concentration is increased in peripheral blood during physiologic pregnancy. At pregnancy phenotype and functions of peripheral NK cells are changed to maintain the maternal–fetal immune tolerance. Peripheral NK cells migrate to the maternal-fetal interface and are transformed into a decidual NK-like phenotype cells. Galectin-9 concentration is decreased in women with a  complicated  pregnancy and miscarriage. However the galectin-9 effects on different NK cell subpopulations of peripheral blood are not investigated. Therefore, we studied the galectin-9 influence on phenotype transformation and Tim-3 expression of NK cells isolated from peripheral blood of healthy non-pregnant fertile women. CD56+NK cells were obtained by immunomagnetic separation and cultivated in vitro during 72 hours with cytokines (IL-2 and IL-15). Galectin-9 (5 ng/mL) and anti-Tim-3 (10 mg) antibodies were added to the NK cultures. Galectin-9 concentration is corresponded to its level during first trimester of physiologic pregnancy. The number of regulatory NK (CD16-CD56bright), cytotoxic NK (CD16+CD56dim/-) cells and Tim-3 expression on different NK subpopulations were assessed by flow cytometry. It was found that Tim-3 was expressed on all subpopulations of peripheral blood NK cells (CD16-CD56brightNK, CD16+CD56dimNK, CD16+CD56-NK). Incubation with galectin-9 increased the expression of Tim-3 on regulatory CD16-CD56brightNK cells and did not change on cytotoxic CD16+CD56dim/-NK cells. Galectin-9 reduced the percentage of cytotoxic CD16+CD56dimNK in culture, but did not influence the number of regulatory CD16-CD56bright NK and cytotoxic CD16+CD56-NK cells. Thus, galectin-9 regulates Tim-3 molecule expression and NK cell subpopulation distributions in vitro culture

Cyclo-coherent Approaches to the Management of Bifurcation States of Aggregate Economic Systems in the World Economy in the Conditions of Nonlinear Cyclic Dynamics

Purpose: the main goal of the article is to study the possibilities of increasing the sustainability of world economic development to the crisis fluctuations of national economies and their aggregated groups under conditions when the fluctuations induced in the global crisis by the global crisis manifest coherence features. Methods: the analysis of coherent interaction processes of a set of discrete macroeconomic cycles is performed to compare the individual data of managed economic systems with the possibilities of regulating the degree of coherence of fluctuations of key processes in the national economy. Results: the necessity of transition from consideration of a separate macroeconomic cycle as a discrete process to a coherent-resonant multicyclic paradigm of economic development under which chaotic crisis phenomena are represented as external manifestations of macroeconomic nonlinear synchronization of quasiharmonic oscillations within the framework of cyclic dynamics of various processes of economic development is substantiated. Stabilization in these conditions is achieved by forming optimal values of the package of investments that form the regions of stabilization synchronization in the economy through the "damping" of the amplitude of destructive cycles and the creation of conditions for their asymmetry, depending on the intensity of crisis fluctuations. The necessity of establishing procedures for the international coordination of the anti-crisis policies of individual states within the framework of international clusters is substantiated using the coherent resonance model arising from the synchronization of cyclical and acyclic crisis fluctuations. Conclusions and Relevance: the influence of the dynamic properties of a multicyclic system on the behavior of its local elements (cycle synchronization, cyclic and acyclic dynamics, etc.) with respect to the dynamics of compound evolutionary (including degrading) subsystems determines the probability of transitions between stationary states of the system as a result of iterative successive losses Sustainability of economic development, etc. As a result, it is possible to maintain the sustainability of economic development at various levels of governance in the world economy. The considered administrative technology is proposed as an integral part of technologies for managing economic systems as subsystems of the world economy

Возможности скрининга высокого риска поражения осевого скелета при псориатическом артрите

Objective: to determine a set of signs that are prognostically significant for identifying a high-risk axial skeletal lesion in early psoriatic arthritis (ePsA).Patients and methods. Examinations were made in 95 patients (47 men and 48 women) with peripheral arthritis lasting for ≤2 years, who met the 2006 Classification Criteria for Psoriatic Arthritis (CASPAR). The clinical characteristics of the patients were presented in our previously published work. In all the patients, a standard examination was made and the signs of inflammatory back pain (IBP) were identified according to the Assessment of SpondyloArthritis International Society (ASAS) criteria, the presence of human leukocyte antigen B27 (HLA-B27) was determined, and pelvic bone X-ray was done; regardless of whether they had IBP, 79 patients underwent magnetic resonance imaging (MRI) of the sacroiliac joints using a low-field Signa Ovation 0.35 T. Sacroiliitis (SI) diagnosed based on radiography (rSI) was considered reliable if there were bilateral changes corresponding to at least Stage II or unilateral changes corresponding to at least Stage III according to the Kellgren system. SI diagnosed based on MRI (MRI-SI) was regarded as active when osteitis was detected in the STIR mode in the bones adjacent to the joint on at least two slices or in the presence of two signals in a slice. X-ray and MRI results were assessed by an independent radiologist. The extent of a skin lesion was determined from the body surface area (BSA): the extent was regarded insignificant, moderate, and significant with involvements of <3%, 3–10%, and >10%, respectively.The patients were divided into two groups. Group 1 included 65 (68.4%) patients with the manifestations of axial PsA (axPSA): IBP, and/or rSI, and/or MRI-SI; Group 2 consisted of 30 (31.6%) patients without axial manifestations, only with peripheral PsA (pPsA). Multivariate stepwise discriminant analysis was used to identify a group of signs that were most characteristic of axPsA.Results and discussion. Comparative analysis of the two groups showed that there were more males among patients with axPsA than among those with pPsA (39 (60%) and 8 (26.7%), respectively) (p=0.003). HLA-B27 positivity was also more often detected in patients with axPSA than in those with pPsA (30 (46.6%) and 7 (23.3%) patients, respectively) (p=0.02). In the axPSA group, there were significantly more individuals with moderate and high DAS, high CRP levels, and a more severe skin lesion (BSA >3%).The investigators obtained the following discriminant classification rule associated with axPSA: 1.566 (if CRP is >5 mg/L) + 0.957 (if HLA-B27 is positive) + 0.986 (if BSA is >3%) + 1.845 (if DAS is moderate or high) + 0.6 (if the sex is male) >3.751 (p=0.0025). The sensitivity and specificity of the model were 68% and 73%, respectively.Conclusion. The combination of signs, such as male sex, HLA-B27 positivity, high or moderate DAS, CRP >5 mg/L, the extent of skin lesions according to BSA >3%, is prognostically significant for identifying high-risk axial skeletal lesion in ePSA. The proposed mathematical model can be used to screen patients for the early diagnosis of an axial lesion in ePSA.Цель исследования – определение совокупности признаков, прогностически значимых для выявления высокого риска поражения осевого скелета при раннем псориатическом артрите (рПсА).Пациенты и методы. Обследовано 95 больных (47 мужчин и 48 женщин) с длительностью периферического артрита ≤2 лет, соответствовавших критериям ПсА CASPAR (2006). Клиническая характеристика пациентов была представлена в ранее опубликованной работе. Всем пациентам проводили стандартное обследование, определение признаков воспалительной боли в спине (ВБС) по критериям ASAS, а также наличия HLA-B27, рентгенографию костей таза; 79 пациентам, независимо от наличия у них ВБС, выполняли магнитно-резонансную томографию (МРТ) крестцово-подвздошных суставов на низкопольном аппарате Signa Ovation 0,35 Т. Сакроилиит (СИ) по данным рентгенографии (рСИ) считался достоверным при наличии двусторонних изменений, соответствующих как минимум II стадии, или односторонних изменений как минимум III стадии по Kellgren. СИ по данным МРТ (МРТ-СИ) расценивался как активный при выявлении в режиме STIR остеита в прилежащих к суставу костях как минимум на двух срезах или при наличии двух сигналов на одном срезе. Результаты рентгенографии и МРТ оценивались независимым рентгенологом. Площадь поражения кожи определилась по BSA: при вовлечении <3% она считалась незначительной, 3–10% – умеренной и >10% распространенной.Пациенты были разделены на две группы. В 1-ю группу вошли 65 (68,4%) больных с аксиальными проявлениями ПсА (аксПсА): ВБС, и/или рСИ, и/или МРТ-СИ; во 2-ю – 30 (31,6%) пациентов без аксиальных проявлений, только с периферическим ПсА (пПсА). Для выделения группы признаков, наиболее характерных для аксПсА, был использован многомерный пошаговый дискриминантный анализ. Результаты и обсуждение. Сравнительный анализ двух групп показал, что среди больных с аксПсА было значимо больше лиц мужского пола, чем при пПсА: 39 (60%) и 8 (26,7%) соответственно (р=0,003). Позитивность по HLA-В27 также чаще выявлялась при аксПсА, чем при пПсА: у 30 (46,6%) и у 7 (23,3%) пациентов соответственно (р=0,02). В группе аксПсА было достоверно больше лиц с умеренной и высокой активностью заболевания по DAS, высоким уровнем СРБ и более тяжелым поражением кожи (BSA >3%). Получено следующее дискриминантное классификационное правило, ассоциированное с аксПсА: 1,566 (если СРБ >5 мг/л) + 0,957 (если HLA B-27+) + 0,986 (если BSA >3%) + 1,845 (если активность по DAS умеренная или высокая) + 0,6 (если пол мужской) >3,751 (p=0,0025). Чувствительность модели составила 68%, специфичность – 73%.Заключение. Совокупность таких признаков, как мужской пол, позитивность по HLA-B27, высокая или умеренная активность по индексу DAS, СРБ >5 мг/л, BSA >3%, прогностически значима для выявления высокого риска поражения осевого скелета при рПсА. Предложенная математическая модель может использоваться для скрининга пациентов с целью ранней диагностики аксиального поражения при рПсА

THE STATE OF NUTRITIONAL STATUS AND ITS IMPACT ON THE LEVEL OF COMORBIDITY IN PATIENTS ON HEMODIALYSIS

The aim of the study was to investigate the nutritive status and identify risk factors for cardiovascular disease in patients on hemodialysis. Material and methods. 144 patients on program hemodialysis were examined. All patients underwent general clinical and laboratory examination, lipid profile was examined, body mass index was calculated, waist and hip circumference was measured, ratio of waist circumference to the circumference of hip was determined, abdominal integral multi-frequency bioimpedansometry and multispiral computed tomography were performed. Results. Gender features of distribution of abdominal adipose tissue and dyslipidemia in patients on program hemodialysis were revealed. Women have a predominant accumulation of visceral adipose tissue, while men are characterized by a proportional distribution of subcutaneous and visceral adipose tissue in the abdominal area. Women compared to men have higher rates of atherogenic lipoprotein fractions, which level is closely related to the volume of visceral adipose tissue. Among the comorbidities in the examined patients, diseases of the cardiovascular system predominate. The regression analysis revealed that the most significant risk factor for the development of coronary artery disease is an increase in lowdensity lipoproteins, for chronic heart failure – an increase in waist circumference. Conclusions. The data obtained indicate the need to monitor the nutritional status of patients on hemodialysis to identify and correct risk factors for cardiovascular disease

ПЕРСПЕКТИВИ ЗАПРОВАДЖЕННЯ ЛІКАРСЬКОЇ РЕЗИДЕНТУРИ У ПЕДІАТРІЇ

The aim of the work – to highlight the importance of medical residency in the training of pediatricians.The main body. Medical residency should be conducted at medical universities, academies, institutes, and should become a form of specialization of doctors in certain medical specialties (after completion of internship in basic specialties), to be conducted exclusively at the appropriate clinical departments in order to obtain the qualification of a specialist doctor in accordance with the list of medical specialties approved by the Ministry of Health of Ukraine.The main task of the pediatric medical residency is deepening of the level of practical training of children’s doctors, their mastery of a certain level of professional abilities, practical skills, duties and competences within the specific medical specialization, necessary for independent medical activity in a particular pediatric specialty.Conclusion. The introduction of a medical residency in postgraduate medical education is an urgent requirement of time, is to be one of the urgent needs of the healthcare sector being reformed, and will contribute to improving the quality of postgraduate training of pediatricians and, accordingly, the preservation of children’s health.Мета роботи – висвітлити значення лікарської резидентури у підготовці лікарів-педіатрів.Основна частина. Лікарська резидентура має проводитись у медичних університетах, академіях, інститутах та стати формою спеціалізації лікарів-спеціалістів за певними лікарськими спеціальностями (після закінчення інтернатури за базовими спеціаль­ностями), що буде проводитись виключно на відповідних клінічних кафедрах для отримання кваліфікації лікаря-спеціаліста згідно з переліком лікарських спеціальностей, затвердженим Міністерством охорони здоров’я України.Основним завданням педіатричної лікарської резидентури є поглиблення рівня практичної підготовки дитячих лікарів, оволо­діння ними певного рівня професійних умінь, практичних навичок, обов’язків та компетенцій у межах конкретної лікарської спеціалізації, необхідних для самостійної лікарської діяльності за певною педіатричною спеціальністю.Висновок. Запровадження лікарської резидентури у післядипломній медичній освіті є нагальною вимогою часу, відповідатиме нагальним потребам галузі охорони здоров’я, що реформується, та буде сприяти підвищенню якості післядипломної підготовки лікарів-педіатрів і, відповідно, збереженню здоров’я дітей

Cytokine profile in psoriatic arthritis: search for relationships with inflammation and blood rheological properties

Objective. To estimate the serum levels of interleukins (IL) 6 and 10, tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) in patients with psoriatic arthritis (PSA) and their relationship with the clinical and laboratory parameters of inflammation and with erythrocyte aggregation (EA). Material and methods. The authors measured the serum levels of C-reactive protein (CRP) by immunonephelometry (BN, ProSPEC, Siemens) and those of TNF-α, IL-6 and IL-10, and VEGF by X-MAP technology using a BioPlex-200 system (Panel Human 27-Plex Bio-Rad, USA) in 80 patients with PSA [45 women and 35 men; mean age 41.7±10.5 years, mean duration of PSA and psoriasis was 5.0 (2.0; 12,5) and 15 (4; 26) years, respectively; DAS 3.9 (3.09; 5.16)]. The blood samples from 16 healthy donors matched to the examinees for gender and age served as a control. The parameters of EA [Т1(с); Кt (arb. units); β (с-1), I2,5 (%)] were estimated, by recording the rate of back light scattering. The median (Me) and interquartile range [Q25; Q75], and mean and standard deviations (M±σ) were calculated; the indicators were compared by the Mann-Whitney test and Student's t test. Correlation analysis was made using the Spearman rank correlation coefficient (R); p < 0.05 was considered statistically significant. Results. There were significantly higher serum levels of IL-6 and IL-10, TNF-α, and VEGF in patients with PSA than in the controls, and impaired blood rheological properties. There were significant correlations of the level of most cytokines (IL-6 and IL-10, VEGF) with both the values of the clinical and laboratory activity of PSA (self-rated pain, the number of swollen and tender joints, a physician's assessment of disease activity, DAS, erythrocyte sedimentation rate, and fibrinogen) and most parameters of EA (Т1, Kt и I2.5). No significant relationships were found between VEGF and CRP. Conclusion. The enhanced clinical and laboratory activity of PSA is attended by the systemic activation of immunological mediators of inflammation and neoangiogenesis and by impaired blood rheological properties, which supports the interaction of these factors in the immunopathogenesis of the diseases

CHRONIC MYELOID LEUKEMIA: EPIDEMIOLOGY AND FIFTEENTH YEARS OF THERAPY IN THE NOVOSIBIRSK REGION

The incidence of chronic myeloid leukemia from 2004 to 2018 amounted to 0.63 per 100 000 people per year. The prevalence of chronic myeloid leukemia over the past 15 years has increased from 1.88 to 7.02 case per 100 000 people. We have analyzed the therapy outcomes of chronic myeloid leukemia of patients, received imatinib treatment for more than 12 month (165 patients). Complete hematologic response is attained in 88.5 % cases (146 patients), complete cytogenetic response (CCR) (ph+&lt;0 %) – in 72.1 % cases (119 patients), major molecular response (MMR) – in 50.3 % cases (83 patients). The primary resistance to imatinib is observed in 21.8 % cases (36 patients), secondary – in 6.1 % cases (10 patients – 7 patients have lost the complete hematologic response and CCR and 3 patients have lost the CCR and MMR). The thirteen patients of those, who have primary or secondary resistance to imatinib have been treated with second-generation tyrosine kinase inhibitors (nilotinib, dasatinib) and in 93,3 % cases (14 patients) CCR have been obtained, 10 patients (66.7 %) have attained the CCR and 9 patients (60 %) have achieved MMR. Among all those patients treated with I and II generations tyrosine kinase inhibitors, we have carried out the overall survival (OS) analysis and obtained following results: the median of OS have not been achieved, 5-year OS rate is estimated as 90 %, 10-year OS rate – more than 77 %, calculated 15-year OS – more than 60 %