[Sh.I. Krinitsky - an outstanding member of the Rostov school of pathologists]. / Sh.I. Krinitskii ­ vydayushchiisya predstavitel' rostovskoi shkoly patologoanatomov.

Today, more than 60 years after his death, which is a long time in today's eventful life, we remember this legendary figure with awe and gratitude and pay homage and respect to him.

INFLUENCE OF THE ACTING SUBSTANCE SODIUM DICLOFENAC ON BONE MARROW CELLS.

In humans and mammals, the homeostasis system is supported by many organs and systems, but hematopoietic remains one of the most important. A negative effect on the hematopoietic system is rejected by many factors, but the first place remains for drugs, which one in three are non-steroidal anti-inflammatory drugs (NSAIDs). The most popular among them remains the active substance "Diclofenac Sodium", which is part of many drugs. The purpose of the work is to study the action of the active substance Diclofenac sodium and its effect on the erythrocyte series of bone marrow cells of white laboratory mice in an experiment. The studies were conducted on white laboratory mice, males, 6 months old, 60 grams. The animals were divided into three groups, the first received 0.09 mg of Diclofenac sodium in the quadriceps of the thigh, the second - 0.18 mg and the third physiological solution for 96 hours. After observing all the rules of bioethics, the animals were slaughtered and the bone marrow was examined using pure immuno-magnetic separation techniques. During the study, it became known that in the first group the number of erythroblasts increased by 75%, while in the second group by 166.5%, due to the blocking of differentiation into more mature cells. The number of reticular cells decreased by 33.4%, while in the second group by 60%. A decrease in the erythrokaryocyte maturation index in the first group by 42.6% whereas in the second by 32.5%, primarily due to immature red blood cell precursors. In the first group, the leuko-erythrokaryoid ratio decreased by 9.5%, while in the second group by 12.3%. The number of megakaryocytes due to the predominant blockade of cyclooxygenase-2 increased in the first group by 266.6%, while in the second by 733.3%. It was found that the most favorable effect on red bone marrow cells has a dose of 0.09 mg, while 0.18 mg has a toxic effect and contributes to the development of cardiovascular complications.

[Parameters of cardiac muscle repolarization on the electrocardiogram when changing anatomical and electric position of the heart].

While discussing the diagnostic value of the single channel electrocardiogram a set of theoretical considerations emerges inevitably, one of the most important among them is the question about dependence of the electrocardiogram parameters from the direction of electrical axis of heart. In other words, changes in what of electrocardiogram parameters are in fact liable to reflect pathological processes in myocardium, and what ones are determined by extracardiac factors, primarily by anatomic characteristics of patients. It is arguable that while analyzing electrocardiogram it is necessary to orient to such physiologically based informative indexes as ST segment displacement. Also, symmetry of the T wave shape is an important parameter which is independent of patients anatomic features. The results obtained are of interest for theoretical and applied aspects of the biophysics of the cardiac electric field.

[Computer simulation for localization and extensiveness of myocardial ischemia].

Features of genesis of the electrocardiosignal in conditions of the myocardial ischemia under changing localization and extensiveness of the ischemia foci, as well as an impact of this process on the repolarization parameters of the electrocardiosignal were investigated using a system for 3D simulation of the heart electrical activity. The model of the ventricles of the heart is a cellular automaton with the matrix about of 10(5) elements of the "Myocardium", "His", and "Purkinje" types and with prescribed rules of their interaction. In process of the study a developed earlier method of segmentation of the modeled ventricles was used. For estimating the contribution of the "ischemic" segments to the total signal of different leads of the electrocardiograms the previously suggested method of the partial curves was used. The ischemia foci were simulated by changing the characteristics of the transmembrane action potential in selected areas of the ventricles, such as the resting potential, transmembrane action potential amplitude, duration of the plateau phase, and the steepness of the final phase of rapid repolarization in accordance with literature data. Electrocardiosignals generated by the model were processed to obtain previously selected parameters, characterizing repolarization process. The influence of size and localization of the myocardial ischemia on the parameters obtained are examined, as well-as some hypotheses about their relation with an electrophysiological state of the heart muscle are discussed.

[Electrocardiographic image of myocardial ischemia: real measurements and biophysical models. Part II].

By means of biophysical models of the heart electrical activity some alterations of the ST-T interval of an electrocardiogram were considered under changes of electrophysiological parameters of the cardiac muscle, characteristic for ischemia development. A computer program "The model of electrical activity of ischemic heart" developed in our Lab was used as a "Generator" for selection of model electrocardiosignals (ECS) when changing parameters of the transmembrane action potential (TAP) in "ischemic" area which was characterized in the model terms by its location and extent. The obvious development of ischemia was triggered by the deflection of TAP parameters from the reference values accepted for "conventional norm". For trapezoidal approximation of the TAP form chosen at the first stage of the work the following changed TAP parameters were used: (a) modification of duration of the horizontal plateau phase at the constant phase 3 slope; (b) a change in the amplitude of the plateau phase at the constant duration of this phase and all TAP; (c) modification in the slope of the fast repolarization phase at the constant duration of the plateau phase (in this case, the total duration of TAP also changes); (d) reduction in the duration of phase 2 at constant TAP duration, that, naturally, entails modification of the slope for the fast repolarization phase. We studied (out-of-scenarios developed before) separate effects of these parameters on changes of the T wave shape and the ST segment level. A number of new parameters for description of the changes observed in the ST-T interval pattern are offered and investigated. Computer experiments were performed using a system for 3D-modeling of the cardiac electrical activity. With the selected real and simulated ECSs a comparative study for diagnostic possibilities of some electrocardiographic criteria for detecting myocardial ischemia is carried out. The results obtained at this stage of work are of interest for identification and prediction of an electrophysiological state of the heart.

Structure of ice Ih and ice Ic as described in the language of Delaunay simplices.

Classification of the Delaunay simplex forms is carried out for the ideal structures of ice Ih and ice Ic. Classification according to the number of edges of different length reveals six types of simplices, while classification according to the number and mutual positions of edges of the unit length (equal to the length of the hydrogen bond) reveals five types of indices. Ice Ic is composed of simplices of three types (one of which has the form of a perfect tetrahedron), ice Ih from six simplices. Degeneracy is removed in computer models of slightly distorted ice by means of insignificant shifting of water molecules from their ideal positions. This makes it possible to provide the unambiguous partition of the crystal structure into Delaunay simplices. It is found that degeneracy removal results in the appearance of Delaunay simplices of specific forms with a very small volume (Kije simplices). The shape characteristics of simplices of different types and their percentage are calculated in the large computer models of ice. In particular, the fraction of the Kije simplices is found to be about 7.5% in ice Ih.

[Electrocardiographic image of myocardial ischemia: real measurements and biophysical models].

The peculiarities of the genesis of electrocardiosignal under myocardial ischemia in connection with an increase of its electrical inhomogeneity, as well as the electrophysiological mechanisms of morphological changes of the T wave of the electrocardiogram, including its "symmetrization" have been considered. A systemic approach to the problem has been used, which combines the mathematical, computer, and physiological modeling of the cardiac electrical activity with studies of the electric field of the human heart in terms of biophysical models. A database for the repolarization parameters of experimental electrocardiosignals ("Norm" and "Ischemia" samples) has been formed. The parameters of the ST-T interval and T wave, which could characterize the symmetry of the latter, and some additional properties of the repolarization process have been obtained. The methods of mathematical modeling were used also. Computer experiments were carried out on a system for 3-D modeling of the cardiac electrical activity at different structural levels of the object. By the results of preliminary analysis, the betaT index, which is calculated as the ratio of two maximum absolute values of the derivative of the cardiosignal at the left and right of the T wave apex, has been chosen as one of the main diagnostic markers of ischemia. There is reason to believe that the use of the betaT index allows one to recognize those deviations from the norm that are usually hidden from a physician in traditional ECG analysis. The ratios of repolarization intervals inside of the generalized QT interval have also appeared potentially informative. With the purpose to test and correct the hypotheses for conducting further investigations, some preliminary experiments on a low-resolution model for several alternatives of the degree, localization, and extensiveness of ischemia have been carried out. The results obtained at the first stage of the team-work are essential to the understanding of mechanisms of the genesis of an electrocardiographic image for myocardial ischemia and of interest for the biophysically sound development of new algorithms for computer cardiodiagnostics.

[Realization of biophysical models for the cardiac electrical activity].

Some principles for the realization of biophysical models of electrical activity of heart ventricles, presented by a double electrical layer along the surface of the electrically active myocardium and the boundary surfaces that divide model compartments with different electrophysiological properties, have been considered. The parameters of the model are the electrophysiological and anatomical characteristics of the heart, such as the geometry of ventricles and the His-Purkinje specialized conductive system, the velocity of depolarization propagation in the myocardium, the ratio of excitation velocities in "Myocardium", "His", and "Purkinje" model elements, the ,shape of transmembrane action potentials on boundary surfaces, the orientation of the own heart anatomical axes relative to the initial coordinate system, and others. The model has been included as a basic unit into a computer modeling system containing databases of simulated and real electrocardiosignals.

[Endoscopic total hip replacement in conditions of acetabulum bone structures deficiency].

76 patients with acetabulum defects of posttraumatic, oncologic, displastic or systemic character, as wall as due to complications after previous hip replacement, were operated on. The author's non-tensioned acetabular component installation technique worked out for the endoscopic total hip replacement was used. Long-term follow-up results were considered to be successful in 88.6% of cases. Maximal follow-up period is 10 years.

[Effect of sex on informative power of various electrocardiographical criteria of left ventricular hypertrophy in patients with excessive body mass].

Aim of the study was to analyze dependence of various voltage parameters of QRS complex on increase of left ventricular myocardial mass (LVMM) in samples of men and women with excessive body mass or obesity. We included data from 223 patients with excessive body mass and diagnosis of stage I - II arterial hypertension. ECG was registered in 12 standard leads. Left ventricular hypertrophy (LVH) was certified if according to echoCG data LVMM exceeded 125 g/m2 in men and 110 g/m2 in women. Depending on sex and presence of LVH all patients were divided into 4 groups: M1 (men with LVH, n=74), M2 (men without LVH, n=74), W1 (women with LVH, n=55), anb W2 (women without LVH, n=20). We analyzed amplitudes of all waves of the QRS complex as well as Sokolow-Lyons voltage parameters and the Cornell index. The following intergroup differences were most significant: between groups M1 and M2 - in amplitudes of S waves in chest leads V3, V4; between groups W1 and W2 - in amplitudes of R-waves in limb leads I and aVL, and amplitudes of S-waves in lead III. Increases of the Cornell voltage index were observed both in men and women with LVH. The following criteria had greatest sensitivity at 95% specificity: in men - SV4 > 1,1 mV (34%) and RaVL+SV3 > 2,3 mV (32%); in women - RaVL > 0,8 mV (56%) and RI+SIII > 1,5 mV (56%). Informative power of electrocardiographical diagnosis of LVH can be augmented by the use of different voltage criteria in groups of men and women. In men most informative are chest leads (SV1 - V3, RaVL) while in women - limb leads (RI, RaVL, and SIII). The use of combination parameters RaVL+SV3 > 2,3 mV (in men) and RI+SIII > 1,5 mV (in women) allows to augment sensitivity with unchanged specificity. In patients with excessive body mass voltage the Sokolow-Lyons criterion is not informative. Most significant component of the Cornell voltage criterion in groups of men with excessive body mass is amplitude of SV3, in groups of women - amplitude of RaVL.

[A relationship between the QRS maximal vector and myocardium mass of the left ventricle during the development of hypertrophy: computer modeling and real measurements].

It has been demonstrated on an model of the cardiac electrical activity that, during the course of proportional homothetic transformations of the heart and His-Purkinje system, the values of the spatial heart vector change, as a first approximation under comparable conditions, in proportion to the extension of the heart ventricle surface rather than the myocardium mass, since the magnitude of the electrocardiosignal is determined at every instant by the area of depolarized regions on the epicardium and endocardium, which corresponds to the model of a double electrical layer on the surface of the electrically active myocardium.

[Biophysical models of the heart electrical activity].

Based on the fundamental knowledge of the space-temporal organization of extracellular electrical fields of the myocardium, a system for 3-D computer modeling of the cardiac electrical activity at different structural levels of the object is being developed at the Institute of Theoretical and Experimental Biophysics. The system is based on the earlier proposed and modified biophysical model of the electrocardiosignal genesis represented by a double electrical layer along the surface of the electrically active myocardium. The system combines the model for activation and repolarization of the heart ventricles; the advanced model for the evaluation of parameters of the cardiac electric field, which makes it possible to derive model electrocardiosignals both in the direct regime of calculation of the potentials and in the regime of calculation of electrocardiosignals from preliminarily determined components of the multipole equivalent electrical heart generator; a database for the model parameters and their combinations in the form of cards of simulated "patients", and a database of modeled electrocardiosignals. In the present paper (first from three within the framework of the problem), simulation methods in electrocardiology are briefly described and a biophysical model of the heart electrical activity is presented, which has made up the basis of the system for computer modeling of forward and inverse problems of the cardiac electric field. The parameters of the model are electrophysiological, anatomical, and biophysical characteristics of the heart.

An algorithm for three-dimensional Voronoi S-network.

The paper presents an algorithm for calculating the three-dimensional Voronoi-Delaunay tessellation for an ensemble of spheres of different radii (additively-weighted Voronoi diagram). Data structure and output of the algorithm is oriented toward the exploration of the voids between the spheres. The main geometric construct that we develop is the Voronoi S-network (the network of vertices and edges of the Voronoi regions determined in relation to the surfaces of the spheres). General scheme of the algorithm and the key points of its realization are discussed. The principle of the algorithm is that for each determined site of the network we find its neighbor sites. Thus, starting from a known site of the network, we sequentially find the whole network. The starting site of the network is easily determined based on certain considerations. Geometric properties of ensembles of spheres of different radii are discussed, the conditions of applicability and limitations of the algorithm are indicated. The algorithm is capable of working with a wide variety of physical models, which may be represented as sets of spheres, including computer models of complex molecular systems. Emphasis was placed on the issue of increasing the efficiency of algorithm to work with large models (tens of thousands of atoms). It was demonstrated that the experimental CPU time increases linearly with the number of atoms in the system, O(n).

Total hip replacement for proximal femoral tumours: our midterm results.

Data from 44 patients (23 males, 21 females) with a median age of 39 (range 13-80) years who underwent total hip arthroplasty for proximal femoral tumours (1994-2004) were analysed. The histological diagnoses included 14 metastases, six osteosarcomas, six chondrosarcomas, four Ewing's sarcomas, four giant cell tumours, three malignant fibrous histiocytomas, two parosteal and two periosteal osteosarcomas, and one each primary neuroectodermal tumour, myeloid disease, and aneurysmal bone cyst. Twenty-one patients (48%) had pathological fractures. The cause of the pathological fracture was metastasis in 12 patients (57%). Twenty-eight patients (64%) had soft tissue invasion. Complications observed in 17 patients (37%) were local recurrence in two, postoperative haematoma in two, dislocation of prosthesis in five, deep infection in six, and one patient died of myocardial infarction in the early postoperative period. During our midterm survival analysis, functional results were excellent in 25% of patients, good in 57%, fair in 12%, and poor in 6%.

[Efficacy and tolerability of coaxil (tianeptine) in the therapy of posttraumatic stress disorder].

The results of a multicenter study of coaxil in the treatment of 90 patients with posttraumatic stress disorder (PTSD) are summarized. Two dosages of the drug, 75 mg daily (44 patients) and 37.5 mg daily (46 patients) have been compared. Coaxil efficacy was estimated with the Clinician Administered PTSD Scale (CAPS) and Hamilton depression scale (HAM-D). High efficacy of coaxil was shown, with 76.7 and 75.6% responders, respectively, for the dosages used. The optimum one proved to be 37.5 mg daily, which is congruent to the standard dose in the treatment of depression and provides not only the efficacy but tolerability of coaxil. The coaxil efficacy depended on a PTSD type: the drug was more effective in chronic PTSD that, in the authors' opinion, might be related to its antidepressant action.

[Surgical treatment of chronic purulent diseases of extremities' bones and great joints].

Results of treatment of chronic purulent diseases of extremities' bones (n=414) and great joints (n=136) were analyzed. Combined treatment included surgical sanation of the inflammatory focus, autospongioplasty of residual cavities and defects after sequesterectomy (87 cases), extrafocal osteosynthesis, aspiration- flushing drainage. In 46 cases of severe suppuration in the zone of hip joint's endoprosthesis the resection arthroplasty was performed, in 43 cases of severe consequences of ankle-joint's fracture-dislocations -- compression talo-tibial and calcaneo-tibial arthrodesis. The follow-up was 15 years. Positive results were seen in 93.6% patients.

[Ways of surgical technique optimization and prevention of hip endoprosthesis dislocation following total hip arthroplasty].

The article presents experience concerning intraoperative prevention of hip endoprosthesis dislocation, gained in the orthopedic surgical clinic of Moscow Regional Research Clinical Institute. The results of 1208 total articular replacements allowed the development of intraoperative dislocation-preventive measures, taking into account the approach to the hip joint, necessary mobilization of articular ends, the relative position of total endoprosthesis components. The cases of hip endoprosthesis dislocation were analyzed. The offered preventive measure system allowes reduction in total endoprosthesis dislocation rate down to 1.5%.

Computer simulation study of intermolecular voids in unsaturated phosphatidylcholine lipid bilayers.

Computer simulation of the liquid crystalline phase of five different hydrated unsaturated phosphadidylcholine (PC) lipid bilayers, i.e., membranes built up by 18:0/18:1omega9cis PC, 18:0/18:2omega6cis PC, 18:0/18:3omega3cis PC, 18:0/20:4omega6cis PC, and 18:0/22:6omega3cis PC molecules have been performed on the isothermal-isobaric ensemble at 1 atm and 303 K. (The notation n:domegapcis specifies the lipid tails: n refers to the total number of carbon atoms in the chain, d is the number of the methylene-interrupted double bonds, p denotes the number of carbons between the chain terminal CH(3) group and the nearest double bond, and cis refers to the conformation around the double bonds.) The characteristics of the free volume in these systems have been analyzed by means of a generalized version of the Voronoi-Delaunay method [M. G. Alinchenko et al., J. Phys. Chem. B 108, 19056 (2004)]. As a reference system, the hydrated bilayer of the saturated 14:014:0 PC molecules (dimyristoylphosphatidylcholine) has also been analyzed. It has been found that the profiles of the fraction of the free volume across the membrane exhibit a rather complex pattern. This fine structure of the free volume fraction profiles can be interpreted by dividing the membrane into three separate major zones (i.e., zones of the aqueous, polar, and apolar parts of the membrane) and defining five subzones within these zones according to the average position of various atomic groups in the membrane. The fraction of the free volume in the middle of the membrane is found to increase with increasing unsaturation of the sn-2 chain of the lipid molecule. This is due to the fact that with increasing number of methylene-interrupted double bonds the lipid tails become more flexible, and hence they do not extend to the middle of the membrane. It is found that there are no broad enough preformed channels in the bilayers through which small penetrants, such as water molecules, can readily go through; however, the existing channels can largely facilitate the permeation of these molecules.

[Endoprosthesis of great joints of extremities in difficult anatomic conditions]. / Endoprotezirovanie krupnykh sustavov konechnostei v slozhnykh anatomicheskikh usloviiakh.

Experience in endoprosthesis of great joints in 408 patients in difficult clinical cases associated with defects and deformations of bones of posttraumatic, oncological, dysplastic and systemic character, and also in the cases of complications after primary endoprosthesis is analyzed. Special constructions of implants, instruments, surgical technique were used depending on anatomic and functional changes. Results of endoprosthesis of great joints were accessed as successful in 95% patients in maximal period of follow-up during 13 years.

[The typology of chronic posttraumatic stress disorder]. / Tipologiia khronicheskogo posttravmaticheskogo stressovogo rasstroistva.

Psychopathological chronic posttraumatic stress disorder (PTSD) was studied in relation to clinical peculiarities of depression included in PTSD structure. One hundred and sixty-five patients, 124 men and 41 women, aged 25-48 years, were examined in general outpatient clinics. PTSD duration was from 6 to 24 months. A stress was caused by situations related to combat events (60.6%), close person's death (25.4%), assault with physical and moral violence (8.2%) and rape (5.8%). With regard to depression structure and dominating affect, 4 PTSD types--anxious (36.6%), dysphoric (26.1%), apathic (20%) and somatoform (17.7%), were distinguished. Also, their significance for the formation of patient's personality features is emphasized. A role of depression in syndrome formation in chronic PTSD is suggested.