The value of the analysis of the urinary stones for studying the features of urolithiasis pathogenesis

Introduction. Urolithiasis is a multifactorial recurrent disease, unevenly spread throughout the world and characterizedby the formation of urinary stones of various chemical compositions, depending on pathogenesis, etiological, and epidemiological risk factors. Understanding the composition of chemicals and their prevailing ratios can help make decisions about treatment tactics, preventive measures to reduce the risk of recurrence and the prevalence of urolithiasis.Purpose of the study. To assess the distribution of chemical components in urinary stones along with an analysis of their population significance.Materials and methods. The urinary stones were obtained from 2854 patients with urolithiasis. The composition of urinary stones was analyzed by using an infrared spectroscopy method.Results. The predominance of oxalate stones was determined in multicomponent kidney stones (83,7%) and the prevalence of urate stones (54,2%) was revealed in monocomponent kidney stones. Urinary stones with a predominance of oxalates contained significantly fewer impurities (12.4%) than urinary stones with a predominance of urates, phosphates and carbonates with an average amount of impurities >24.0%.Conclusion. The analysis of urinary stones distribution based on pathogenic factors showed that the calcium metabolism disturbances prevail in the population of the Russian Federation (88.0%)

Анестезиологическое обеспечение операций остеосинтеза шейки бедра у гериатрических больных

The purpose of the study was to evaluate the clinical efficiency of femoral 3 in 1 block using the solution of a local anesthetic in combination with an opioid versus central regional (spinal) anesthesia during operation involving osteosynthesis of the neck of the femur with cannulated screws in geriatric patients. Osteosynthesis of the neck of the femur with cannulated screws proposed by the Osteosynthesis Association (OA) was performed in 90 patients (33 males and 57 females) aged 65 to 90 (71.0±5.026) years. Two procedures were used for the anesthe-siological provision of the operation. The osteosynthesis was made in 65 patients under central regional (spinal) anesthesia (Group 1) and in 25 patients under femoral 3 in 1 block employing the solution of a local anesthetic in combination with an opioid (Group 2). Both groups were matched by age, gender, anthropometric data, and the pattern of concomitant diseases. Analysis of the findings revealed that in 40% of cases, operations made under spinal anesthesia (Group 1) used adrenomimetics: ephedrine, 0.2—0.4 mg/kg, or dopamine, 3—5 ^g^kg/min; the total infusion volume was 2254±162 ml. Colloid agents (polyglucin, 6% infucol, or 6% refortan solutions) were given to 23 (36%) of the 65 patients. The reduction in mean blood pressure was 26.3% of the baseline. Group 2 did not require the use of colloidal and/or adrenomimetics. The mean intraoperative infusion volume was 1146±109.3 ml. During surgery, hemodynamics remained stable in all the patients. All Group 1 patients operated on under spinal anesthesia experienced postoperative pain whose relief required the use of nonsteroidal anti-inflammatory drugs (ketorol, ketonal, baralgin) and opioids (promedole, omnopon), 44% of cases requiring multiple administration of narcotic analgesics within the first and second postoperative days. Analysis of the postoperative period indicated a good analgesia in the patients operated on under femoral 3 in 1 block with local anesthetic solution in combination with an opioid. At a rest, all Group 2 patients did not observe no painful sensations at the site of surgery. Thus, femoral 3 in 1 block with 40 ml of 0.25% marcaine and 10 mg of morphine hydrochloride is an effective and safe anesthesiological support in geriatric patients during operations involving the osteosynthesis with OA cannulated screws. Perineutal administration of 10 mg of morphine hydrochloride provides a good postoperative analgesia, which is an important factor in preventing cardiorespiratory complications in patients to be surgically treated.Цель исследования — сравнительная оценка клинической эффективности метода проводниковой блокады бедренного и наружного кожного нерва раствором местного анестетика в комбинации с опиоидом и центральной региональной (спинальной) анестезии при операции остеосинтеза шейки бедра канюлированными винтами у гериатрических больных. Остеосинтез шейки бедра канюлированными винтами АО произведен 90 больным (мужчин — 33, женщин — 57), в возрасте от 65 до 90 (71,0±5,0) лет. Использованы две методики анестезиологического обеспечения операции. 65 больным остеосинтез шейки бедра выполнили в условиях центральной регионарной (спинальной) анестезии (группа 1), и 25 больным в условиях проводниковой блокады бедренного и наружного кожного нерва раствором местного анестетика в комбинации с опиоидом (группа 2). Обе группы были сопоставимы по возрасту, полу, антропометрическим данным и характеру сопутствующих заболеваний. Анализ полученных данных выявил, что во время операций, проводимых в условиях спинальной анестезии (1 группа), общий объём инфузии составил 2254±162 мл, в 40% случаев применялись адреномиметические препараты: эфедрин в дозах 0,2—0,4 мг/кг или дофамин в дозе 3—5 мкг X кг/мин. Коллоидные препараты (растворы полиглюкина, инфукола 6%, рефортана 6%) применяли у 23 из 65 (36%) больных. При этом степень снижения среднего АД от исходного составляла 26,3%. В группе 2 применение коллоидных и (или) адреномиметических препаратов не требовалось. Средний объём инфузии составил 1146±109,3 мл интраоперационно. Во время оперативного вмешательства гемодинамика оставалась стабильной у всех пациентов. Все больные 1 группы, оперированные в условиях спинальной анестезии, испытывали в послеоперационном периоде боль, для купирования которой требовалось назначение нестероидных противовоспалительных препаратов (кеторол, кетонал, баралгин) и препаратов опиоидного ряда (промедол, омнопон). Причём в 44% случаев потребовалось многократное введение наркотических анальгетиков в течение первых и вторых суток после операции. Анализ течения послеоперационного периода показал хорошее обезболивание у больных, оперированных в условиях проводниковой блокады бедренного и наружного кожного нерва раствором местного анестетика в комбинации с опиоидом. В покое все больные 2 группы не отмечали болезненных ощущений в области операции. Таким образом: проводниковая блокада бедренного и наружного кожного нервов 40 мл раствора 0,25% маркаина и 10 мг морфина гидрохлорида является эффективным и безопасным методом анестезиологического пособия у гериатрических больных при операциях остеосинтеза шейки бедра канюлированными винтами АО. Периневральное введение 10 мг морфина гидрохлорида обеспечивает хорошее послеоперационное обезболивание, что является важным фактором профилактики осложнений в кардиореспираторной системе больных, подвергаемых оперативному лечению

Comparative analysis of the concentrations of proinflammatory cytokines and glycosylated ferritin in patients with idiopathic recurrent pericarditis and adult-onset Still's disease

Idiopathic recurrent pericarditis (IRP) and adult-onset Still's disease (AOSD) are polygenic autoinflammatory diseases, in the pathogenesis of which pro-inflammatory cytokines from the interleukin-1 superfamily play a central role.Aim. To compare serum concentrations of proinflammatory cytokines and glycosylated ferritin (GF) in patients with IRP and AOSD during an exacerbation.Material and methods. The study included 15 patients with AOSD, 15 — IRP. The diagnosis of AOSD was established using the Yamaguchi criteria (1992). IRP was diagnosed in accordance with the 2015 European Society of Cardiology on the diagnosis and management of pericardial diseases. Blood sampling from all patients was carried out during the recurrence period prior to the anti-inflammatory therapy initiation. The serum levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-18 (IL-18), procalcitonin, total ferritin and GF was assessed. The results obtained were compared with levels of biochemical parameters, high-sensitivity C-reactive protein (CRP), as well as with white blood cell (WBC) and neutrophil counts.Results. The median age in the AOSD group was 28 years, and the IRP — 55 years. An increase WBC count >10*109/L was detected in 10 and 9 patients in the AOSD and IRP groups, respectively. The concentration of CRP was increased in all patients and did not differ in the study groups (p=0,836).The highest values of ferritin and GF levels were found in the AOSD group (1416 ng/ml vs 408 ng/ml, p=0,008) and (12% vs 33,9%, p=0,067), respectively. In both groups, increased concentrations of IL-6 and IL-18 were determined. In the AOSD group, the concentration of IL-18 was higher than in the IRP group (2114 pg/ml vs 161,5 pg/ml, p<0,001). IL-6 concentrations in the study groups did not differ (33,9 pg/ml vs 24,9 pg/ml, p=0,4). IL-1β serum concentration in all subjects corresponded to normal values.Correlation analysis in the AOSD group revealed a direct relationship between the IL-18 and ferritin concentrations (rs=0,73, p=0,03).Conclusion. The study established a similar pattern of changes in inflammatory biomarkers in patients with AOSD and IRI. The most informative marker of inflammation was IL-18

Role of IL-6 in the immunopathogenesis of mild, moderate and severe TBI

Traumatic brain injury (TBI) results in a significant inflammatory burden that increase the production of inflammatory mediators and biomarkers. The immune system plays a key role in the pathogenesis of traumatic brain injury. Neuroinflammatory mediators released from resident glia (activated microglia and astrocytes) inside the brain recruit immune cells where cytokines are small soluble proteins that confer instructions and mediate communication among immune and non-immune cells. Interleukin-6 (IL-6) is a proinflammatory cytokine known to be elevated after trauma, and a major contributor to the inflammatory response following TBI. Previous studies have investigated associations between IL-6 and outcome following TBI, but to date, studies have been inconsistent in their conclusions. The purpose of the current study was to assessment of cerebrospinal fluid (CSF) interleukin-6 (IL-6) and MBP levels in patients with TBI. Samples of cerebrospinal fluid of 85 patients with TBI were examined. Concentrations IL-6 were measured via xMAP multiplexing technology. The control was the course of CSF in patients with concussion. An increased content was found in all patients with traumatic brain injury: 19.59 pg/mL in the group with mild traumatic brain injury; 103.6 pg/mL in the group with moderate traumatic brain injury; and 2225 pg/mL in the group with severe traumatic brain injury load versus 2.58 pg/mL in the control group. A direct correlation was found with the presence of basic myelin proteins in the cerebrospinal fluid, which indicates the degree of damage and neurodegeneration processes. Identification of the features of IL-6 content in patients with brain injury may indicate its important role in the course of disease. It also requires additional more detailed study, including comparison with IL-6 content in peripheral blood

ИСПОЛЬЗОВАНИЕ ПРОГРАММНОГО ОБЕСПЕЧЕНИЯ «DAWN AC» ДЛЯ КОНТРОЛЯ НАЗНАЧЕНИЯ ВАРФАРИНА В УСЛОВИЯХ СПЕЦИАЛИЗИРОВАННОЙ АНТИКОАГУЛЯНТНОЙ КЛИНИКИ

Warfarin remains the drug of choice for the prevention of ischemic stroke, thus optimization of methods of control of dosing this preparation becomes more topical. The aim of our study was to test computer software for monitoring anticoagulant therapy with warfarin in patients with atrial fibrillation based on the day anticoagulant hospital. A total of 6 people with atrial fibrillation undergoing treatment with warfarin in specialized outpatient clinics were monitored with the software for 3 to 6 months. At the same time, comparable 11 patients with atrial fibrillation were followed by experienced clinician. Both groups were matched by sex, age and clinical diagnosis. The comparison group consisted of 11 patients diagnosed with the same disease, of the same gender and age. We have found that in patients followed by anticoagulation software the time spent in the therapeutic INR range was twice the time in therapeutic range of patients in which the dosing and follow-up was done by experienced doctor (pВарфарин остается препаратом выбора для профилактики ишемического инсульта, в связи с чем становится актуальной оптимизация способа контроля дозы этого препарата. Целью работы была апробация компьютерного обеспечения для мониторинга терапии варфарина пациентов с мерцательной аритмией в условиях антикоагулянтной клиники. С помощью программного обеспечения наблюдались 6 человек с мерцательной аритмией, находящихся на лечении в дневном стационаре поликлиники в течение от 3 до 6 месяцев. Группу сравнения составили 11 пациентов с тем же диагнозом, сопоставимых по полу и возрасту. В результате исследования было установлено, что время пребывания МНО в терапевтическом диапазоне у пациентов, которым доза назначалась с помощью программного обеспечения, в два раза превышала таковое у пациентов, которым прием варфарина контролировал врач (

RANGING OF ANTIPHOSPOLIPID ANTIBODIES IN THE PATIENTS WITH THROMBOPHILIA AND RECURRENT MISCARRIAGE

Laboratory diagnosis of antiphospholipid syndrome (APS) is based on detection of antiphospholipid antibodies (aPLs). E.g., aPLs are directed against conformational epitopes of the so-called “co-factor” proteins: β2-gycoprotein 1 (β2-GP1), annexin V (An V) and prothrombin (Pt) that are formed during interaction with phospholipids – cardiolipin (CL), phosphatic acid (Pha), phosphatidylcholine (Pch), phosphatidylethanolamine (Pe), phosphatidylglycerol (Pg), phosphatidylinositol (Pi), phosphatidylserine (Ps). A routine methodology of detection based on ELISA testing is challenged by new tests when the antigen is absorbed on another kind of support like microbeads or membranes that can influence density of conformational epitopes for aPL’s binding. The aim of our study was to compare the results of aPLs detection by ELISA and multi-line immunodot assay (MLD). We collected blood serum samples from 45 patients with noncardioembolic ischemic strokes, 19 patients with recurrent deep vein thrombosis of lower limbs, 44 females with recurrent miscarriages, and 50 clinically healthy donors. To compare the results of aPL detection by ELISA and MLD kits, the test systems from different manufacturers were evaluated. We used an ELISA kits for detection of antibodies to CL IgG, aCL IgM, β2-GP1 produced by Euroimmun AG (Mr1) and Orgentec Diagnostica GmbH (Mr2) and MLD – for detection of antibodies to CL, β2-GP1, Pch, Pe, Pg, Pi, Ps, AnV and Pt (Medipan GmbH, Mr3). When a cut-off titer was used as the main index, 30.5% of patients were aPLs-positive with ELISA method by Mr1 and 38%, wiht Mr2. By MLD aPls were detected in 30% of patients. In the same cohort, medium and high aPLs titers (> 40 U/mL) were determined in 12% of patients using ELISA kits. Positive and highly positive aPLs titers were determined in 16% when using a new method by Mr3. Medium and high titer were detected only for antibodies to β2-GP1, CL, An V, Pha and Phs. The use of ELISA approach for detection of aPLs in patients with thrombosis and obstetric pathology is associated with relatively high number of low-positive ELISA results. Due to higher sensitivity for medium and high aPLs titers, MLD testing may be used as a confirming method for APS diagnosis

Hadronization properties of b quarks compared to light quarks in e+e- -> q qbar from 183 to 200 GeV

The DELPHI detector at LEP has collected 54 pb^{-1} of data at a centre-of-mass energy around 183 GeV during 1997, 158 pb^{-1} around 189 GeV during 1998, and 187 pb^{-1} between 192 and 200 GeV during 1999. These data were used to measure the average charged particle multiplicity in e+e- -> b bbar events, _{bb}, and the difference delta_{bl} between _{bb} and the multiplicity, _{ll}, in generic light quark (u,d,s) events: delta_{bl}(183 GeV) = 4.55 +/- 1.31 (stat) +/- 0.73 (syst) delta_{bl}(189 GeV) = 4.43 +/- 0.85 (stat) +/- 0.61 (syst) delta_{bl}(200 GeV) = 3.39 +/- 0.89 (stat) +/- 1.01 (syst). This result is consistent with QCD predictions, while it is inconsistent with calculations assuming that the multiplicity accompanying the decay of a heavy quark is independent of the mass of the quark itself.Comment: 13 pages, 2 figure