[Goals and possibilities of therapeutic rehabilitation of oncological patients].

Various manifestations of oncological diseases encountered in the practical work of a therapist are discussed. They are related to both the clinical course of the diseases and their treatment. Characteristics of somatic disorders genesis of which is determined by the active or treated tumour are presented. The necessity of observation of oncological patients at all stages of cancer treatment and after its termination is emphasized. Goals and forms of oncological rehabilitation are described.

[Optimization of respiratory support of elderly patients with pneumonia in the early stages of respiratory failure].

The article provides an assessment of the effectiveness of noninvasive ventilation (NIV) in elderly patients with pneumonia in the early stages of acute respiratory failure (ARF). A total of 83 elderly patients with pneumonia were examined. By the method of randomization, patients were divided into 2 groups. The first group consisted of patients treated by the method of NIV, the second one of patients receiving standard oxygen therapy. The results of the study show that the use of NIV in the treatment of pneumonia, complicated by the ARF in elderly patients resulted in a significant improvement of arterial blood gas as well as hemodynamic and respiratory systems, in comparison with those of patients receiving oxygen therapy.

[Melatonin as a marker of intensity of structural and functional changes in the heart and vessels of the patients presenting with metabolic syndrome].

It is known that pathological characteristics of cardiac rhythm variability, endothelial dysfunction, and left ventricular hypertrophy may be used as independent predictors of cardiovascular complications; their combination with metabolic disorders increases severalfold the risk of cardiovascular catastrophes. The patients presenting with metabolic syndrome are characterized by the interrelation between melatonin hypersecretion, parameters of hyperactivity of the sympathetic component of the nervous system, and prognostically unfavourable variants of cardiac and vascular remodeling (including endothelial dysfunction, concentric remodeling and concentric myocardial ventricular hypertrophy). These correlations have age-specific peculiarities.

[The role of melatonin in the development of metabolic syndrome].

The level of 6-oxymelatonin sulfate, the main metabolite of melatonin (MT), in morning urine samples from patients with metabolic syndrome (MS) suggests enhanced MT production at night. This inference equally holds for aged and elderly patients despite their significantly impaired MT secretion due to age-related involution of the pineal gland. Correlation between MT hypersecretion and manifestations of MT activity also depends on the patients" age. MT test can be used as biological marker of MT and a prognostic factor of MS progress.

[Clinical parameters of the course of metabolic syndrome in advanced age]. / Klinicheskie osobennosti techeniia metabolicheskogo sindroma v pozhilom vozraste.

The proposed principles of classification of metabolic syndrome are critically considered, as they do not take into account peculiarities of its clinical course in patients of advanced and senile age. Results of examination are presented of two groups of patients of the cardiological profile, who were long observed under conditions of a departmental outpatient clinic. In the first group, evaluated were the incidence and the degree of severity of symptoms characterizing disturbances in systems of carbohydrate and lipid metabolism, peculiar to metabolic syndrome, as well as the incidence and severity of arterial hypertension and obesity. It has been established that these symptoms are more frequent in various combinations as a picture of the "incomplete" syndrome and have different incidence in the older and younger age groups. Among patients with the "complete" set of characters of the metabolic syndrome there also takes place the statistically significant polymorphism of its clinical manifestations, which allows suggesting effects of mechanism of compensation and mutual aggravation. Peculiarities of manifestations of symptoms of the metabolic syndrome in patients of the elderly group make it possible to identify prognostically favorable and unfavorable forms of the course of the syndrome and, accordingly, to optimize the therapeutic and preventive programs.

[Changes in the expression of membrane markers and in the number of human blood monocytes after single and repeated courses of visible and infrared light at therapeutic doses]. / Izmeneniia ékspressii membrannykh markerov i kolichestva mononuklearov krovi cheloveka posle ee oblucheniia in vivo i in vitro vidimym i infrakrasnym svetom v terapevticheskikh dozakh.

An attempt has been made to prove that the immunomodulating effect of therapeutic doses of polychromatic visible + infrared polarized (VIP) light at its application to a small body surface area is connected with a transcutaneous photomodification of a small amount of blood in superficial skin microvessels. For this purpose, in parallel experiments, using monoclonal antibodies, the membrane phenotype of circulating blood mononuclears was studied after irradiation of volunteers, of samples of their blood in vitvo, and of a mixture of the irradiated and non-irradiated autologous blood in a 1:10 volume ratio, thereby modeling events in vivo, when a small amount of the transcutaneously photomodified blood in the vascular bed contacts its main circulating volume. In this variant of experiment, a great similarity has been established of changes in expression of mononuclear membrane markers (CD3, CD4, CD8, CD20, CD16, HLA-DR and to a lesser degree of CD25); the ability has been proven of the photomodified blood to "translate" the light-induced changes to a much higher volume of non-irradiated blood, which might represent a mechanism of the systemic immunomodulating effect of phototherapy. Under conditions in vivo and in vitro, the most "reactive" were HLA-DR+, CD20+, CD16+, CD4+, and 0-cells. An increase of the total number of lymphocytes and monocytes has been shown by the end of the 10-day-long phototherapeutic course. The regulatory character of the single and course sessions of the VIP light on the blood immunocompetent cells is substantiated: depending on the initial state of the immune system, the VIP light can produce both stimulating and inhibitory effect on lymphoid cell subpopulations, which opens large possibilities of using this method for correction of immunological disturbances in diseases of different etiopathogenesis.

[Immunogenetic characteristics of patients with ischemic heart disease]. / Immunogeneticheskaia kharakteristika bol'nykh ishemicheskoi bolezn'iu serdtsa.

The distribution of the principal erythrocyte and HLA-antigens was investigated in 202 males aged 20-50 years with a history of myocardial infarction and various courses of coronary heart disease. The occurrence of one or the other group of antigens differed both as compared with a group of healthy subjects (619 subjects) and in relation to the anamnestic and clinical characteristics of the disease course. The findings helped to draw a conclusion as to the presence of associative links between a number of the studied antigens (A (II), MN, HLA-B7, HLA-B14, HLA-B15, HLA-CW4) and the risk of the development of, at least, some forms of coronary heart disease.

[Demonstration of individual predisposition to myocardial infarct based on immunogenetic status]. / Vyiavlenie individual'noi predraspolozhennosti k infarktu miokarda po immunogeneticheskomu statusu.

Statusometry, a method of automated quantitative assessment of the state of composite multiparametrical objects, is proposed for the detection of genetic predisposition to myocardial infarction as an instrument of integral quantitative assessment of systemic immunogenetic status on the basis of HLA phenotype. The prognostic error does not exceed 15%. Large-scale application of the new method appears a promising approach to individualization and better efficiency of preventive cardiologic treatment.

[Effects of ubinon-9, a synthetic antioxidant, on intensity of lipid peroxidation in blood platelets and plasma of patients with ischemic heart disease]. / Vliianie sinteticheskogo antioksidanta ubinona-9 na intensivenost' perekisnogo okisleniia lipidov v thrombotsitakh i plazme krovi bol'nykh ishemicheskoi bolezn'iu serdtsa.

The antioxidant ubinon-9 was tested for its effects on platelet and plasma lipid peroxidation parameters in patients with acute ischemic heart diseases. The use of ubinon-9 in the multimodality therapy of patients with ischemic heart disease was shown to result in a significant decrease in lipid peroxidation intensity by enhancing superoxide dismutase activity in the platelets and plasma from the patients. Ubinon-9 equally prevented lipid peroxidation activation during enzymatic and nonenzymatic induction in the platelets of patients with unstable angina or acute myocardial infarction. Unlike a daily dose of 30 mg, 90 mg a day is a more effective dose in reducing platelet and plasma lipid peroxidation parameters. One may suggest that addition of ubinon-9 into the routine treatment regimen allows the therapy for acute ischemic heart disease to be optimize.

[Various indices of lipid peroxidation in thrombocytes of patients with ischemic heart disease]. / Nekotorye pokazateli perekisnogo okisleniia lipidov trombotsitov u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Interaction between lipid peroxidation activation and the antioxidant system was studied in thrombocytes of patients with cardiovascular pathology. Positive correlation between superoxide dismutase activity and malonic dialdehyde content was found in healthy persons, while in patients with unstable stenocardia and acute myocardial infarction an inversion of the correlation parameters occurred. The data obtained may be used for prognosis of heart ischemic disease development.

[The immunogenetic risk factors in the nephrotic syndrome]. / Immunogeneticheskie faktory riska pri nefroticheskom sindrome.

An immunogenetic investigation was conducted of 82 patients with renal disease. 48 of them had nephrotic syndrome (NS) of different origin (glomerulonephritis, amyloidosis, diabetic glomerulosclerosis). The findings were compared to those obtained at control population studies of 619 healthy residents of St. Petersburg. A statistically significant increase in the incidence of HLA antigens A-10, B-13, B-35, B-41, DR-2, DR-7 and high homozygosity were found in NS patients. Antigen A-2 occurred statistically less frequently. A relative risk (RR) to develop the disease was in all cases > 2. Typing of NS patients and those with high diagnostic titers of antistreptolysin-O revealed in them a significantly higher occurrence (r < 0.01) of A-10 and B-40 antigens compared to controls and NS-free patients. HLA antigens appeared related to morphological variants of glomerulonephritis running with NS. The study results suggest association between genetic, etiological factors and body's response to injury. Feasibility of NS prognosis is reviewed.