Monomeric form of C-reactive protein in the assessment of the residual inflammatory cardiovascular risk in patients with subclinical carotid atherosclerosis.

Aim      To study the relationship between monomeric C-reactive protein (mCRP) and the progression of asymptomatic carotid atherosclerosis in patients with a moderate risk for cardiovascular diseases (CVD) as assessed with the SCORE model.Material and methods  The study included 80 men and women aged 53.1±5.8 years assigned to the category of a moderate risk for CVDs by the SCORE model with a low-density lipoprotein cholesterol (LDL-C) level of 2.7-4.8 mmol/l and asymptomatic, hemodynamically insignificant (<50% luminal narrowing) carotid atherosclerosis according to ultrasonic data. All patients were prescribed atorvastatin to achieve a LDL-C level <2.6 mmol/l. After 7 years of follow-up, ultrasonic examination of carotid arteries was performed, and concentrations of high-sensitivity C-reactive protein (hsCRP) and mCRP were measured.Results A concentration of LDL-C <2.6 mmol/l was achieved in all patients. The progression of atherosclerosis as determined by an increased number of atherosclerotic plaques (ASPs), was observed in 45 (56 %) patients. At 7 months of follow-up, concentrations of cCRP were higher in the group of patients with progressive carotid atherosclerosis, while the levels of hsCRP did not differ between the groups. Increased mCRP concentrations were associated with changes in variables of the "atherosclerotic load", including the number of ASPs, total ASP height, and the intima-media thickness (IMT). In patients with a median mCRP concentration of 5.2 [3.3; 7.1] µg/l and more, the increases in mean ACP number and total ASP height were considerably higher than in patients with mCRP concentrations lower than the median (3.9 and 2.7 times, respectively), whereas the odds ratio for the progression of asymptomatic carotid atherosclerosis was 5.5 (95 % confidence interval, CI: 2.1-14.6; p=0.001). ROC analysis showed that the concentration of hsCRP had no predictive value for prognosis of asymptomatic carotid atherosclerosis (p=0.16), while the area under the ROC curve (AUC) for mCRP was 0.75±0.056 (95 % CI: 0.64-0.86; p=0.001).Conclusion      According to the results of 7-year follow-up, the plasma concentration of mCRP was significantly higher in patients with an increased number of ASPs than in patients without this increase. An increased level of mCRP may indicate a higher inflammatory risk of CVD.

[Otogenic and rhinogenic intracranial complications: meningitis and brain abscess in adults]. / Vnutricherepnye oslozhneniia vospalitel'nykh zabolevanii nosa i ukha: meningit i abstsessy mozga u vzroslykh.

The purpose of this study is to review etiology, diagnosis and management strategies of rhinogenic and otogenic meningitis and brain abscess in adults. Current diagnostic procedures, effective surgery and antibiotic treatment are discussed. The clinical case of diagnosis and successful treatment of the patient with rhinogenic meningitis and brain abscesses is presented.

[The specific pathogenetic features of the development of chronic tonsillar pathology]. / Patogeneticheskie osobennosti formirovaniia khronicheskoi tonzilliarnoi patologii.

The authors discuss the mechanisms underlying the development of chronic tonsillar pathology confirmed by the methods of histological, autoradiographic, and bacteriological diagnostics. The new aspects of vital activity of microorganisms in the parenchymal tissue of the palatine tonsils are highlighted that account for the low effectiveness of the conservative therapy of chronic tonsillitis and give evidence of the necessity of the surgical treatment of this condition.

[The post-streptococcal diseases in the clinical practice].

The authors describe various clinical forms of streptococcal infections, the pathogenetic mechanisms underlying these conditions, and peculiarities of their clinical picture. Also considered are the modern methods employed for laboratory diagnostics of streptococcal infections. The probability of the risk of development of post-streptococcal diseases in the children is evaluated. Measures for the prevention of these conditions are proposed.

[Differential diagnostics of chronic tonsillitis based on the severity of manifestations of tonsillogenic intoxication of the organism].

The objective of the present study was to elucidate the objective diagnostic criteria for the differentiation between various forms of chronic tonsillitis (CT) based on the results of clinical, bacteriological, and serological investigations. A total of 13 patients presenting with various forms of CT were available for the examination. The mathematical analysis of the data thus obtained made it possible to identify the most clinically significant diagnostic criteria allowing to verify the form of CT. It is concluded that their application in the combination with the classification of chronic tonsillitis proposed earlier by B.S. Preobrazhensky and V.T. Pal'chun can be recommended for the choice of the most adequate strategy for the treatment of the patients chronic tonsillitis on an individual basis.

[Peculiarities of clinical and laboratory characteristics of the activity of streptococcal infection in the patients presenting with tonsillar pathology].

The objective of the present study was to characterize peculiar clinical and laboratory features of trivial tonsillitis for the substantiation of the necessity of prescription of antibacterial therapy. A total of 386 patients presenting with various forms of trivial tonsillitis were available for the determination of anti-streptococcal antibody (ASLO, anti-DN-ase B, ASPH) levels. The results of the measurement were compared based on the Centor scale generally used to estimate the necessity of prescribing antibacterial therapy for the treatment of sore throat. It is concluded that laboratory studies of characteristics of S. Рyogenes activity are needed in all the patients presenting with tonsillitis in order to elucidate the etiological factors responsible for pharyngalgia and the necessity of prescription of antibacterial therapy for the prevention of pyogenic systemic complications of streptococcal infection.

[Modern approaches to diagnostics of the diseases associated with chronic tonsillitis].

The objective of the present study was to analyse risk factors and the clinical course of general diseases and disorders associated with chronic tonsillitis. We overviewed domestic and foreign periodicals and present the data thus obtained together with the results of our original investigations. The study permitted to elucidate the risk factors of the complicated clinical picture of chronic tonsillar pathology and substantiate the necessity of the active surgical treatment for the prevention of the development of toxico-allergic forms of this disease. The importance of thorough diagnostics of the diseases concomitant with chronic tonsillitis both for the purpose of identification of its form and for the prevention of the development of serious life-threatening complications is emphasized.

[The modern view of toxico-allergic manifestations of chronic tonsillar pathology, its etiological and pathological role in the evolvement and development of general diseases].

The objective of the present study was to analyse etiological and pathogenetic mechanisms underlying the development of toxico-allergic manifestations in the patients presenting with chronic tonsillitis. The overview of the publications in the Russian and foreign literature provided materials for substantiating the expediency of the treatment of various forms of chronic tonsillitis on an individual basis. The necessity of further studies of toxico-allergic manifestations of chronic tonsillitis and the use of the active surgical strategies for the management of toxico-allergic forms of the disease is emphasized.

[Immunological aspects of laboratory diagnosis of chronic urticaria]. / Immunologicheskie aspekty laboratornoi diagnostiki khronicheskoi krapivnitsy.

High prevalence of allergic diseases necessitates search for new methods of laboratory diagnosis thereof. We studied the diagnostic significance of the count of cells expressing low-affinity receptors to IgE (CD23+ cells) and compared this test with skin tests with non-infectious allergens and measurement of total serum IgE. 104 patients with various forms of chronic relapsing urticaria were examined. The count of CD23+ cells was markedly increased in atopic urticaria. The increase in the count of these cells and correlation with the results of skin test were less expressed in infectious allergic urticaria. In other forms of chronic urticaria characterized by negative results of skin tests the count of CD23+ cells was normal. The level of total serum IgE was low virtually in all patients. Hence, the count of cells carrying low-affinity receptors to IgE is highly informative, detecting IgE-mediated reactions in the patients, though this parameter does not allow identification of the allergen. This test can be used in complex with other methods of allergodiagnosis, particularly in cases when skin tests are for this or that reason impossible.

[B-lymphocyte regulation of the functional activity of hematopoietic stem cells. I. The effect of activated B-lymphocytes from the murine spleen on the proliferation of syngeneic hematopoietic stem cells of the bone marrow]. / B-limfotsitarnaia reguliatsiia funkstional'noi aktivnosti krovetvornykh stvolovykh kletok. I. Vliianie aktivirovannykh B-limfotsitov selezenki myshei na proliferatsiiu singennykh krovetvornykh stvolovykh kletok kostnogo mozga.

The hemopoietic stem cells (HSC), obtained from the mouse bone marrow and transferred into lethally irradiated syngeneic mice, do not form colonies of hemopoietic cells in the spleen of recipients. The colony formation has been observed after transplantation of HSC together with bone marrow B-lymphocytes or precursors of T-lymphocytes (PTL), and has been mediated through soluble products of nonimmunoglobulin nature produced by B-cells. In distinction from bone marrow B-cells, the interaction of splenic B-lymphocytes with the HSC fraction does not initiate this process, but suppresses it in the presence of bone marrow PTL. The interaction of B-lymphocytes activated by LPS (in vitro) or sheep erythrocytes (in vivo) with HSC or with a mixture of HSC and PTL resulted in the formation of splenic colonies. However, the induction of colony formation has been observed only in the presence of mature T-lymphocytes (phenotype Thy-1, Sc-1), revealed as an admixture to HSC, and has been abolished after their removing in the process of fractionation of bone marrow and receiving the purified HSC fraction. It requires some membranous interaction of regulatory cells.

[Effects of B-lymphocytes from different organs on hemopoietic colony formation in the spleen by bone marrow cells]. / Vliianie B-limfotsitov raznogo organnogo proiskhozhdeniia na formirovanie krovetvornykh kolonii v selezenke kletkami kostnogo mozga.

The influence of B-lymphocytes from various sources on splenic colony formation was studied in the syngeneic system. B-lymphocytes were obtained by panning with IgG-fraction of rabbit anti-mouse Ig, absorbed on Petri dishes. In addition, adherent cells, Thy-1+ and SC-1+ were eliminated from the fraction of Ig(+)-cells. SC-1- and SC-1+ fractions, containing, respectively, stem cells and T-lymphocyte precursors, were obtained by panning with IgG-fraction of rabbit anti-SC-1 serum. SC-1- cells transferred to irradiated syngeneic mice did not induce colony formation in the spleen. Introduction of SC-1- and SC-1+ cells induced formation of colonies. A similar helper effect occurred when SC-1(-)-cells were introduced with bone marrow or lymph node B-cells, but not with splenic B-cells. Splenic, but not bone marrow and lymph node B-cells inhibited colony formation by combination of SC-1- and SC-1+ cells. All effects of Ig+ cells were abolished by treatment of cells with rabbit anti-MBLA serum. Thus, B-cells of various origin can either enhance or inhibit colony formation. The enhancing of inhibitory effect after B (MBLA+)-cells elimination from suspension of bone marrow and lymph node (but not spleen) Ig(+)-cells resulted from the activity of B-contrasuppressors.