[Nutritional status of old patients on programmed hemodialysis].

AIM: To study nutritional status of old patients on programmed hemodialysis. MATERIAL AND METHODS: A total of 82 patients aged 60-88 years were divided into two groups by age: group 1 (n = 41) consisted of 60-75 year-olds, group 2 (n = 41) included 76-year-olds and older. The nutritional status (NS) was assessed by anthropometric and laboratory data, a prognostic hypotrophy index. RESULTS: In group 1 NS was normal in 65.9% patients while in group 2--only in 29.2%. Older patients had obesity in 21.9% cases. CONCLUSION: It is shown that two thirds of presenile and senile patients have abnormal nutritional status. Taking into consideration the fact that protein-energy insufficiency is an unfavourable factor affecting the patients'survival, old patients need a special control of nutritional status and its early correction.

[Diagnosis and treatment of sterile pancreonecrosis].

The experience in the treatment of 77 patients with sterile pancreonecrosis is analyzed. The importance of USE as an effective method of screening-diagnosis is emphasized. Computed tomography provides a more accurate diagnosis of pancreonecrosis and complications of it. Lethality in pancreonecrosis correlates with necrosis severity. More than 50% necrosis-affected parenchyma in combination with three and more systemic complications is an unfavorable prognostic factor. Hemofiltration and early management with carbapenem antibiotics arrest progression of multiorgan failure and pyoseptic complications in 75% of cases. Laparoscopic sanation of the abdominal cavity is necessary only for patients with peritonitis. This procedure may be supplemented with laparoscopic cholecystectomy and endoscopic papillosphincterotomy with lithoextraction directly during sanation.

[Use of fragmin in program hemodialysis of patients with terminal chronic renal failure].

The subjects of the study were 60 patients at the end stage of chronic renal failure of various origins, who were on program hemodialysis (PHD) in Dialysis Center of City hospital #20. The main group consisted of 25 patients, who were administered fragmin (Pfizer, USA), a low-molecular heparin, for hypocoagulation during the procedure of hemodialysis. The drug was administered in a bolus dose of 5000 aXa ICU into the arterial line after connecting it to a fistula needle. The control group (35 patients) received unfranctionated heparin (UFH) in a conventional way (a bolus of 2000 to 2500 IU before the beginning of the procedure, followed by 1200 to 1500 IU/h in a continuous infusion, stopped 1 hour prior to the end of the dialysis). The following parameters were measured at the beginning and the end of the procedure: the number of thrombocytes, hemoglobin and hematocrit levels, activated partial thromboplastin time, activated coagulation time, antithrombin III level, and anti-Xa factor activity. Standard regimen of UFH administration allowed satisfactory hypocoagulation, but the necessary dose was hard to select. A bolus dose of fragmin led to adequate hypocoagulation in all the patients: there were no fibrin or blood clots in the lines or the dialyzer, or hemorrhage from the sites of puncture after the procedure. Anti-Xa-factor activity grew after a bolus injection of fragmin. By the end of the procedure the inhibitory activity of fragmin towards Xa-factor remained at the level of 0.44 +/- 0.7 IU/ml. The results show that a single dose of fragmin is effective and safe during a standard procedure of hemodialysis lasting up to 5 hours.

[Effect of structural factors on the stability of duplexes formed by oligonucleotide conjugates with minor groove ligands].

The effect of structural factors on the stability of duplexes formed by DNA minor groove binders conjugated with oligonucleotide mono- or diphosphoramidates of the general formula Oligo-MGBm (where Oligo is an oligonucleotide; m = 1 or 2; MGB is -L(Py)2R, L(Py)4R, -L(Im)4R, or -L(Py)4NH(CH2)3CO(Py)4R; Py is a 4-aminopyrrol-2-carboxylic acid residue, L is a gamma-aminobutyric acid or an epsilon-aminocaproic acid residue, R = OEt, NH(CH2)6NEt2, or NH(CH2)6N+Me3) was studied by the method of thermal denaturation. The mode of binder interaction with minor groove depends on the conjugate structure; it may be of the parallel head to head type for bisphosphoramidates and of the antiparallel head to tail type for monophosphoramidates of a hair-pin structure. The effects of the duplexes with parallel orientation (bisphosphoramidates, MGB is L(Py)4R, m = 2) and those of the hairpin structure with the antiparallel orientation (monophosphoramidates, MGB is L(Py)4(CH2)3CO(Py)4R, m = 1) on Tm values were close. The influence of the linker (L) and substituent (R) structures upon Tm was more pronounced for monophosphoramidate (MGB is L(Py)nR, m = 1) than for bisphosphoramidate (MGB is L(Py)nR, m = 2). No more than two oligopyrrolcarboxamide residues (either in parallel or antiparallel orientations) can be incorporated into the duplex minor groove. Moreover, it was shown by the example of monophosphoramidates (Oligo-L(Py)4R and Oligo-L(Py)4NH(CH2)3CO(Py)4R) that the addition of a second ligand capable of incorporation into the minor groove increased Tm of the corresponding duplex in comparison with the duplex formed by the starting monophosphoramidate. At the same time, the introduction of the ligand incapable of incorporating decreased the Tm value. The mode of interaction of the conjugated ligand with the oligonucleotide duplex is determined by its structure. For example, dipyrrolcarboxamide containing an ethoxy group at the ligand C-end stabilizes the duplex due to the stacking interaction with the terminal A*T pair, whereas tetrapyrrolcarboxamides stabilize the duplex by incorporation into the minor groove.

[Extracorporeal detoxication in combined treatment of surgical sepsis]. / Ekstrakorporal'naia detoksikatsiia v kompleksnom lechenii khirurgicheskogo sepsisa.

The methods of extracorporeal detoxication acquire special importance in combined treatment of sepsis. The sessions of plasmapheresis, hemodialysis and isolated ultrafiltration were performed in 61 of 83 patients with sepsis. Indications to these methods are determined, their efficacy is evaluated. It is established that administration of antibiotics and immunoglobulins after sessions of plasmapheresis and hemodialysis to achieves therapeutic drug concentration in blood. It is difficult to select the dose of antibiotics and immunodrugs in permanent round-the-clock ultrafiltration since the part of them are eliminated through the filters. Overall lethality was 20.4% (17 of 83 patients died), in the group of patients with severe polyorganic insufficiency and septic shock who needed extracorporeal detoxication--27%.

[Effect of linker length on the photomodification process of tyrosine residues in N-(tyrosyl)-N'-(5-azido-2-nitrobenzoyl)diaminoalkanes]. / Vliianie dliny linkera na protsess fotomodifikatsii ostatka tirozina v N-(tirozil)-N'-(5-azido-2-nitrobenzoil)diaminoalkanakh.

N-(Tyrosyl)-N'-(5-azido-2-nitrobenzoyl)-1,4-diaminobutane, containing a Tyr residue connected with the photoreactive aryl azide group through the diaminobutylene linker, was synthesized as a model for studying the photomodification of Tyr residues in proteins. This compound and the compound with a shorter, 1,2-diaminoethylene linker, obtained previously, were subjected to computer modeling to find their minimal-energy conformations. The aromatic rings of Tyr and 5-azido-2-nitrobenzoic acid residues in the latter compound were localized in parallel planes at a distance of approximately 0.3 nm between them and were shown to be implicated in stacking interactions. On the contrary, the planes of aromatic rings of the former compound with a longer, diaminobutylene linker were found to be situated perpendicularly to each other, with the distance between the centers of the rings being approximately 0.6 nm. The computer analysis was confirmed by experimental results: when studying the photomodification of the compound with the diaminobutylene linker, neither stable products of the Tyr photomodification nor unstable products capable of transformation into stable products in the dark were found. On the contrary, such products were previously identified in the case of the compound with diaminoethylene linker. The formation of amino, nitro, azoxy, and azo derivatives was common for the photomodification of both compounds.

[The nature of stabilization of the tandem DNA duplex pTGGAGCTG (pCAGC + (Phn-NH-(CH2)3-NH)pTCCA) based on the UV-, CD-, and two-dimensional NMR spectroscopy data]. / Priroda stabilizatsii tandemnogo DNK-dupleksa pTGGAGCTG (pCAGC + (Phn -NH-(CH2)3-NH)pTCCA) po dannym UF-, KD- i dvumernoi IaMR-spektroskopii.

Properties and three-dimensional structure of the tandem DNA duplex pTGGAGCTG.(pCAGC+(PhnL)pTCCA) in aqueous solution, where L is an amino linker and Phn is an N-(2-hydroxyethyl)phenazinium residue, were studied spectrophotometrically and by two-dimensional 1H NMR spectroscopy (COSY and NOESY). When a tandem complex involving a Phn residue-bearing oligonucleotide is formed, the dye aromatic system intercalates into the double helix at the nick site and takes part in two stacking interactions: a strong one (3.5-4 A) with the T5-A12 base pair of its own duplex moiety and a weak one (4-5 A) with the C4-G13 pair of the adjoining duplex (mainly with the C4 base). This arrangement of the dye residue, providing a cross-interaction of the phenazinium moiety with the base pairs of the adjacent duplex structures, results in the stabilization of the whole tandem complex.

[Structure of an oligonucleotide of bleomycin A5 from 13C-NMR data]. / Struktura oligonukleotidnogo proizvodnogo bleomitsina A5 po dannym spektroskopii 13C-IaMR.

The localization of the covalent bond in the conjugates of bleomycin A5 and oligonucleotides was established by 13C NMR using the bleomycin derivative of uridine-5'-phosphate synthesized as a model compound. The phosphate group of the nucleotide was shown to form a phosphamide bond with the primary amino group of the spermidine moiety of bleomycin A5. The formation of the P-N bond causes the downfield shift of the signals of the neighboring carbon atoms of the spermidine fragment by 1.8 and 4.2 ppm and the splitting of the signal of the C-2 atom of the spermidine fragment with J 6.8 Hz due to vicinal spin-spin coupling with the phosphorous atom.

[Programmed hemodialysis in middle and old age]. / Programmnyi gemodializ v pozhilom i starcheskom vozraste.

28 patients treated by programmed hemodialysis (PH) were followed up from 1985 to 1991. All the patients were over 60 years old. 16 patients died within month 1-60 since PH initiation. Overall PH duration for the whole group reached 24.6 +/- 3.58 months. Pretreatment urea and creatinine in plasma of senile patients were significantly lower than in young patients not resulting, though, in uremia reduction. The findings show that it is not valid to consider creatinine a determinant for starting hemodialysis in senile patients. Despite multimorbidity, more rapid progression of atherosclerosis and complicated establishment of the vascular approach, senile patients successfully adapt to PH regimen, need less numerous weekly PH hours. By anemia manifestations, incidence of hyperparathyroidism and polyneuropathy, senile patients did not differ much from their younger counterparts.

[Specific plasma sorption of proteinases--a new approach to the treatment of acute pancreatitis]. / Spetsificheskaia plazmosorptsiia proteinaz--novyi podkhod k lecheniiu ostrogo pankreatita.

The authors treated destructive forms of acute pancreatitis for the first time by means of specific plasma sorption of proteinases with the use of a proteinase plasma sorbent which is an acid-stable proteinase inhibitor immobilized on sepharose (ASI-Sepharose). Specific plasma sorption of proteinases on ASI-Sepharose was applied to the treatment of 29 patients with various forms of acute destructive pancreatitis. At the end of specific plasma sorption procedure the activity of blood plasma proteolytic enzymes in the patients reduced by 60-75%, which was attended by marked improvement of the condition in most cases; aggravation of the patients' condition was not encountered. The mortality in this group was 20.7% and was due to complications occurring during the development of the main disease. The mortality rate among patients treated by specific proteinase plasma sorption is much lower than that recorded in the USSR for destructive forms of acute pancreatitis which ranges from 30 to 75%.

[Cascade use of plasmapheresis and plasma filtration in the treatment of rheumatoid arthritis]. / Kaskadnoe primenenie plazmafereza i plazmofil'tratsii v lechenii revmatoidnogo artrita.

The effect of incorporation of cascade plasmapheresis and plasma filtration in multimodality therapy was studied in 4 patients with rheumatoid arthritis (RA). The result was estimated as "excellent" (complete disappearance of clinical symptoms of the articular syndrome and normalization of the activity laboratory indices) in one patient; "good" (the reduction of clinicolaboratory activity) in 2 patients and "satisfactory" (the reduction of symptoms of the articular syndrome without changes of a degree of general activity of disease) in one patient. Cascade plasmapheresis and plasma filtration significantly improved clinical and many laboratory indices of RA activity and humoral immunity indices during treatment. A long period of observation is required to assess long-term results of the effect of this method. A great advantage of the method is a possibility of decreasing substitution protein solutions without negative effects with relation to the blood total protein level. The absence of a necessity of catheterization of central vessels, more complete blood separation into plasma and erythrocytes make cascade plasmapheresis and plasma filtration more preferable. Good tolerance of the procedure, fast improvement, a chance to avoid side-effects of drug therapy, a lower risk of allergic reactions to plasma substitutes as compared to those in plasmapheresis and lymphocytoplasmapheresis make the method promising for RA treatment.

[Clinical observation of the repeated use of isolated ultrafiltration in treating chronic circulatory insufficiency]. / Klinicheskoe nabliudenie povtornogo primeneniia izolirovannoi ul'trafiltratsii v lechenii khronicheskoi nedostatochnosti krovoobrashcheniia.

Repeated courses of isolated ultrafiltration performed 4 times within 19 mos. in patients with chronic heart failure against a background of drug therapy resulted in remissions. The authors assessed positively the clinical effect of each course of procedures supported by the results of echocardiographic investigations. No significant changes in laboratory findings were noted.

[Affinity modification of rabbit skeletal muscle creatine kinase by a fluorescent analog of ATP: gamma-(azidoanalide)-1, N6-ethenoadenosine triphosphate]. / Affinnaia modifikatisiia kreatinkinazy iz skeletnykh myshts krolika fluorestsentnym analogom ATP--gamma-(p-azidoanilid)-1, N6-étenoadenozintrifosfatom.

A modification of active centers of creatine kinase was performed by fluorescent analog of ATP: gamma-(p-azidoanilidate)-1, N6-etheno ATP. The affinity of the analog to the enzyme and the enzyme protection against modification by substrates were investigated. The stoichiometry of the label binding to the enzyme is 2:1. The results obtained suggest that one subunit of the enzyme is modified more rapidly than the other, the modification rate difference being insignificant. The covalent binding of the analog to the enzyme results in a 4-5 fold increase of fluorescence intensity of the label, probably due to the analog conformational changes of specific interaction with the enzyme. The label bound enhances the fluorescence upon addition of the substrates. The dissociation constant of the enzyme ADP complex calculated from the titration curve is practically equal to the value estimated from experimental data on the use of the fluorescent probe 2-toluidinonaphthalene-6-sulfonate. The possibilities of application of gamma-(p-azidoanilidate)-1,N6-etheno ATP for investigation of functional and structural characteristics of the enzyme are discussed.