Educational video for training specialists in clinical laboratory diagnostics.

The adaptation of educational programs under restrictions during the SARS-CoV-2 coronavirus pandemic and after it is based not only on the widespread use of video lectures, but also on the introduction of a number of new educational technologies. Hybrid learning will become the cornerstone of future educational technologies in clinical laboratory diagnostics and will contribute to the creation of virtual practical classes with examples of analysis of laboratory testing results based on case histories (Case Technologies). The key aspect in the implementation of video cases into the educational process is the development of video materials. The use of educational video cases developed by Vector-Best in the process of training specialists in clinical laboratory diagnostics during the cycles «Retraining¼ and «General Improvement¼ at the Department of Clinical Laboratory Diagnostics of the Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of Russia was a convenient format and received positive assessment of cadets. Currently, the «IVD gallery¼ section has appeared on the FLM website and the placement of an additional educational resource - a library of educational video cases.

The importance of laboratory parameters of the lipid transport system and adipose tissue hormones in assessing the course of chronic.

The main manifestations of metabolic syndrome (MS) are disorders of carbohydrate and lipid metabolism and their hormonal regulation. The combined nature of metabolic disorders can significantly affect the course and prognosis of CHF in elderly people with metabolic syndrome. To determine the features of the combined effect of metabolic laboratory parameters and biological active factors of adipose tissue in patients with CHF and metabolic syndrome on the course of the disease. A comparison was made between a group of patients with CHF complicated by MS(n=37) and a group of patients with CHF without MS (n=37). The parameters of lipid metabolism (cholesterol CH and lipoproteins LP), the lipid transport system (ApoA1 and ApoB), leptin, adiponectin and resistin and their mutual relations were studied. The ratio of ApoB/ApoAI levels was indicative, which was 0.80±0.32 in patients with CHF without MS, and 1.12±0.46 in patients with CHF with MS (p <0.05). A significant correlation was found between the ratio of ApoB/ApoA1 levels and abdominal obesity (r=0.42, p<0.05), functional class of CHF (r=0.463, p<0.05), LDL-C level (r=0.518, p<0.05), and triglycerides (r=0.476, p<0.05). Also, significant results were obtained for the leptin/adiponectin ratio. For this ratio, 4 ranks were derived depending on the value of the leptin (ng/ml)/adiponectin (mcg/ml) ratio: less than 1 - rank 0 was assigned, with values of the ratio in the range 1 - 3 - rank 1, in the range 3.1 - 6 - rank 2, and above the value 6 - rank 3. Of the 22 patients who had improved CHF at the end of hospitalization, all at the beginning of hospitalization had a rank 0 or 1 ApoB/ApoA1 ratio. Thus, ranking the values of the ratio of ApoB/ApoA1 levels, and especially leptin/adiponectin, can suggest the probability of successful treatment of CHF or the probability of deterioration of the patient's condition, up to a fatal outcome.

Laboratory indicators of pathological changes in patients with chronic heart failure with metabolic syndrome.

The presence of metabolic syndrome (MS) significantly increases the risk of developing cardiovascular diseases that lead to chronic heart failure (CHF). The values of NT-proBNP, ST-2, and CRP markers and their mutual correlations were studied in 37 patients with chronic heart failure (CHF) without metabolic syndrome (MS) (group 1) and 37 patients with CHF with MS (group 2). The aim of the study was to determine the features of their changes in patients with CHF complicated by MS, and to rank patients by assigning a rank value to the values of NTproBNP, ST2, and CRP concentrations. The average ST2 level was 51±24 ng/ml in group 1 and 62±27 ng/ml in group 2. The average values of CRP in group 1 were 23.1±5.3 mg/l, in group 2-33.0±4.4 mg/l (p<0.05). The NTproBNP level was 2413±1586 PG/ml and 2721±1635 PG/ml in groups 1 and 2, respectively. Correlations between the values of NTproBNP and ST2, NTproBNP and CRP were demonstrated. In the group of CHF with MS, compared with the group of CHF, there were significantly more patients with the most pronounced pathological levels of damage markers: the number of patients with a General rank of 6-9 in the group of CHF with MS was 59%, in the group of CHF without MS-38% (p<0.05). Of the 18 patients who died, 17 were among those who had an overall rank of 6 to 9, only 1 patient who died after hospitalization had an overall rank of 5. At the same time, among 22 patients who had improved CHF in the outcome of hospitalization, 18 patients had a total rank from 0 to 5, and in 4 patients of this category, the clinical manifestations of CHF remained virtually unchanged. The results of ranking the level of the studied laboratory markers indicate that they can be used as a predictor of various outcomes of CHF.

[Correlation between biochemical parameters of oxidative stress, endogenous intoxication and regulation of vascular tone in patients with burn injury].

Burn injury is accompanied by the formation of reactive oxygen species (ROS). Excessive production of ROS results in oxidative stress. Peroxidation damage of proteins causes their degradation and the formation of toxic fragments con- tributing to the development of endogenous intoxication. Furthermore, burns cause pronounced inflammatory reaction in the lesion site leading to poor circulation. The purpose of this study was an investigation of relationship between disturbances in the prooxidant/antioxidant system, severity of endogenous intoxication and disturbances of endogenous vascular regulation to assess the severity and prognosis of complications in patients with burn injury. 26 patients with- burn injury were investigated; they were divided into 2 groups according to the severity of injury on the basis of Frank index (FI): group 1--FI < 60 CU and group 2--FI ≥ 60 CU. The investigation of blood serum was performed on 1-3, 7, 14, 21 and 28 day after burn injury. Malondialdehyde (MDA), total antioxidant status (TAS), the level of middle weight molecules, stable metabolites of nitric oxide (NOx) and angiotensin-converting enzyme (ACE) activity were determined in the serum. Significant increase of MDA level, decrease of TAS and NOx level were found in two groups of patients throughout the observation period. We also found a disturbance in coupled interaction of NO and ACE. These data point to the development of oxidative stress and imbalance in endogenous regulation of vascular tone. There was a trend toward more pronounced oxidative stress in group 2. Significant correlations between parameters of oxidative stress, endogenous intoxication, endogenous factors of vascular regulation, depth of burn injury and FI were obtained in two groups. MDA, TAS can serve as one of the prognostic markers of condition severity of burned patients and therapy adequacy.

[EXPECTED CONSEQUENCES OF TARGETED HUMAN BEHAVIOR MODULATION UPON EXPOSURE TO TOXOPLASMA GONDII].

The paper shows that there are more seropositive people in a group of those who have experienced road accidents (RA) and who are responsible for the latter than in a control group. The investigations have indicated that chronic toxoplasmosis may be regarded as a potential increased risk factor of RA.

[Fatty acid composition in the carotid artery tissue in the atheromatosis and lipid spot areas. Universal pathogenesis of the atherosclerosis syndrome and its symptom of intimal atheromatosis].

Gas chromatography with mass spectroscopy detection have shown that the major components of atheromatous masses in formed atherosclerotic plaques (surgery material) are the derivatives of essential polyenic fatty acids (ES poly-FA) and of the alcohol cholesterol. They undergo nonphysiological catabolism (hydrolysis) in the lysosomes of resident macrophages as components of protein macromolecules, low-density lipoproteins (LDL). In excess of palmitic triglycer- ides apoB-100 of LDL does not form ligand, and ligand-free LDL become biological in the circulation. They are uptaken via scavenger receptors by resident macrophages in the intima. When ligand LDL are physiologically uptaken via apoB-receptors, they are catabolized (oxidized) in peroxisomes but not in lysosomes. Lipid spots result from functional cellular lipoidosis which fulfills the biological reaction of inflammation and initiate the lipoidosis--vector protein for FA transport--C-reactive protein pathway. Formation of ligand-free LDL lays the basis for intracellular ES poly-FA deficiency and clinical manifestations of the atherosclerosis syndrome. Intima is the spot where large-molecular-weight (> 70 kD) biological rubbish is collected and utilized from a local intravascular pool of the intercellular medium.

[The antioxidant activity of components of blood serum of donors and recipients before liver transplantation].

The antioxidant activity is implemented in human blood serum by ascorbic acid, uric acid, amino acids, glucose, mono unsaturated fatty acids (in the first instance Ω-9 oleic acid), essential polyenoic fatty acids, thiol groups of albumins and proteins, tripeptide and pigment of bilirubin. The antioxidant activity of blood serum of donors and recipients before liver transplantation was determined The input of particular biochemical analytes into liver transplantation was determined too. The antioxidant parameters were detected using technique of termo-induced chemiluminescence under application of set of corresponding reagents. The analysis of antioxidant activity of blood serum in donors and recipients with hepatic pathology revealed in vivo a significant disorder in the syndrome of compensatory anti-inflammatory defense. Under hepatic pathology, absence of endogenous ascorbic acid, deficiency of exogenous ascorbic acid and disorder of antioxidant activity the uric acid and bilirubin become the major hydrophilic acceptors of active forms of oxygen and inhibitors of oxidative processes in vivo. In patients with physiological level of bilirubin the uric acid provides 40%-80% of antioxidant activity. In case of high hyperbilirubinemia in recipients only 9.6%. It is possible to consider hyperiricosuria under aphysiological processes as a nonspecific test of activation of biological reaction of inflammation, syndrome of compensatory anti-inflammatory defense and test of disorder of biological function of endoecology. To activate the syndrome of compensatory anti-inflammatory defense it is very important to decrease both hyperiricosuria and compensatory function of uric acid as an acceptor of active forms of oxygen by force of prolonged intake of optimal amount of ascorbic acid.

[The experience of implementation of system of quality management in the Department of Laboratory Diagnostic of the N.V. Sklifosofskiy Research Institute of Emergency Care of Moscow Health Department: a lecture].

The article presents the experience of implementation of system of quality management into the practice of multi-field laboratory of emergency medical care hospital. The analysis of laboratory errors is applied and the modes of their prevention are demonstrated. The ratings of department of laboratory diagnostic of the N. V. Sklifosofskiy research institute of emergency care in the program EQAS (USA) Monthly Clinical Chemistry from 2007 are presented. The implementation of the system of quality management of laboratory analysis into department of laboratory diagnostic made it possible to support physicians of clinical departments with reliable information. The confidence of clinicians to received results increased. The effectiveness of laboratory diagnostic increased due to lowering costs of analysis without negative impact to quality of curative process.

[Homeostasis changes during rehabilitation period after acute chemical poisoning].

The article deals with review of 78 patients of rehabilitation toxicological unit. The patients received resuscitation and detoxification. All patients were divided into three groups; 1st group--patients after poisoning with psychopharmaceuticals, 2nd group--patients after poisoning with cauterizing liquids and 3rd group--patients with encephalopathy after poisoning with neurotoxin (psychopharmaceuticals, narcotics and ethanol). Disorders of rheology, haemostasis and endotoxicosis accrued in all groups. These disorders were a signs of the erythrocytes and platelets aggregation developing and viscoelasticity disorder. Homeostasis changes during rehabilitation period need an accurate diagnostics for purposeful treatment of the defined disorders.

[Effect of normobaric hyperoxia on cerebral oxygenation, metabolism and oxidative stress in patients with subarachnoid hemorrhage caused by intracranial aneurysm rupture].

The development of cerebral vasospasm in subarachnoid hemorrhage (SAH) due to cerebral aneurysms rupture results in cerebral circulation disturbances. Application of normobaric hyperoxia can be an effective way for improving of oxygen delivery to injured brain tissues. The purpose of this study was to assess of normobaric hyperoxia influence on intracranial pressure (ICP), cerebral oxygenation and metabolism, oxidative stress and endogenous factors of vascular regulation in II critically ill patients with nontraumatic SAH due to cerebral aneurysms rupture. Increase of FiO2 from 0.3 to 0.5 and 1.0 was accompanied with brain oxygen tension (PbrO2) increase and cerebral extraction ratio for oxygen (O2ER) decrease. Application of normobaric hyperoxia had no effect on ICP, cerebral perfusion pressure, arterial blood pressure and cerebral metabolism. The results obtained from patients with nontraumatic SAH showed an evident increase of oxidative stress which had a significant effect on vascular endothelial function, causing an imbalance in the endogenous regulation of vascular tone. Application of normobaric hyperoxia was not accompanied by an increase of free-radical processes in critically ill patients with nontraumatic SAH due to cerebral aneurysms rupture.

[The comparative characteristic of coefficients of endogenic intoxication under severe acute pancreatitis].

The sample included 43 patients with severe acute pancreatitis. Two coefficients of endogenic intoxication were applied: Kei1 = (AMP/ECA)x 100, AMP -average molecular peptides, ECA--effective concentration of albumin and Kei2 = (Kplp/aos/ECA) x 100, PLP--products of lipid peroxidation, AOS--indicators of antioxidant system. ECA--effective concentration of albumin. The comparative characteristic of both coefficients is given. It is established that Kei2 provides more informative indicators of endogenic intoxication in patients died at third day after operation. The study proved that both Kei can be applied for evaluation of endogenic intoxication and prognosis of generalized pancreonecrosis depending on resources of laboratory service.

[The dynamics of endogenic intoxication in patients with extensive burns].

The sampling consisted of 22 patients with extensive burns with total affected area from 20% to 84% of body surface and with deep burns area from 10% to 40%. The suppurative complications in the form of sepsis were diagnosed in 10 and the transitory bacteremia in 12 victims. The total and effective concentration of albumin, the content of medium molecular peptides in dynamics at 1-3, 7, 14 and 21 days from the moment of trauma were detected to objectively evaluate the endogenic intoxication. The degree of intensity of endogenic intoxication was studied using such integral indicator as effective utilization factor In patients with extensive burns the endogenic intoxication was diagnosed on the basis of total and effective concentration of albumin and increase of content of medium molecular peptides. However the detection of endogenic intoxication of the basis of effective utilization factor is a more informative as compared with the analysis of these indicators separately and, hence, it promote the prescription of more appropriate disintoxication therapy its effectiveness evaluation including.

[Medico-social characteristics of patients with septic complications after penetrating thoracic wounds].

232 cases of septic complications after penetrating thoracic injury were analyzed. All patients were divided into groups according to the injury mechanism and inhabitancy. Patients with medico-social deviations, as well as patients with hemocontact infections, mental insanity and social deviations were marked out. 75% of patients were reported to have any medico-social deviations. Among them the distributing was as follows: persons with no fixed abode (100%), women (91%), patients over 50 years (86.2%) and patients after knife thoracic injury (77.4%). Among patients with hemocontact infection the majority were incomers from the near-abroad countries (37%), victims of assault (20%) and patients aged 31-40 years (18.4%).

[Medical and social characteristics of patients with septic complications of the closed thoracic injury].

231 cases of septic complications after the closed thoracic injury were analyzed. All patients were divided into groups according to the injury mechanism and inhabitancy. Patients with medico-social deviations, as well as patients with hemocontact infections, mental insanity and social deviations were marked out. The leading mechanisms of the closed thoracic injury were: fall from a height (34.2%), assault and battery (24.7%) and automobile accident (16.4%). 51.1% of patients were reported to have any medico-social deviations. Among the patients with socially important infections, the distribution was as follows: persons with no fixed abode (50%), incomers from the near-abroad countries (36.4%), victims of assault (28.1%) and pedestrians (21.4%).

[The endogenic intoxication during the early post-operational period in patients with combined intraabdominal injury and massive loss of blood].

The sample of 39 patients with combined intraabdominal injury and massive loss of blood are examined. The loss of blood consisted from 1.5 to 3.0. The assessment of endogenic intoxication was established according the indices of total and effective concentrations of albumin and mean molecular weight peptides. The endogenic intoxication coefficient (mean molecular weight peptides/effective concentration of albumin x 1000) was used. The application of endogenic intoxication coefficient permits to monitor more meaningfully the development of endogenic intoxication in victims against the background of treatment measures. The results are the pathogenic foundation of implementation of more intensive disintoxication activities in the complex therapy of this category of patients.

[The oxidation stress, lipid metabolism and their relationship in patients with severe course of hypertension disease in aggregate with carotid stenosis].

The experimental samplings consisted of 25 patients with severe course of hypertension disease in aggregate with atherogenic carotid stenosis before and after carotid endarterectomy and 21 donors. The study was organized to analyze in lipid profile blood serum the content of malonic dialdehyde, ceruloplasmin, alpha-tocopherol, nitric oxide and angiotensin converting enzyme. The study established that in patients took place a reliably increased level of malonic dialdehyde, ceruloplasmin, alpha-tocopherol, nitric oxide and angiotensin converting enzyme. The patients with this pathology have a reliable positive correlation between the concentration of malonic dialdehydeand lipoproteids of very low density (r = 0.51), malonic dialdehyde and triglycerides (r = 0.36), malonic dialdehyde and cholesterol (r = 0.3). This data confirms the important role of peroxidation of lipids in the development of atherosclerosis. Therefore, the enhancement of oxidation stress and expressed dislipoproteidemia are established in patients with hypertension disease with carotids atherosclerosis as a background. This result testifies the pathogenic significance of these phenomena in the mechanisms of homeostasis disorders.

[The immune reactions by the esophagus injuries, complicated by mediastinitis].

The comparative analysis of 56 immunograms of patients with mediastinitis, caused by the esophagus trauma is represented. The mean values of 9 immunologic parameteres (the so called "norm of the pathology") were set for patients with noncomplicated mediastinitis. A novel method of the immune status evaluation for the patients with the acute surgical conditions and SIRS has been suggested. If early applied, the method allows substantive immunotherapy for such patients.

[Taxonomic characteristics and mixed communities of wound infection agents in patients of reanimation and surgical departments of a hospital].

AIM: Study of taxonomical structure ofwound infection agents, prevalence of mixes, and detection of character of their possible connection with the results of various microorganisms population interaction in septic wounds. MATERIALS AND METHODS: A microbiological study of material from patients with wound infection (WI), 582 of those were cured in reanimation and intensive therapy departments (RITD; group 1) and 1455 - in surgical departments (SD; group 2), was performed. Taxonomic membership and ability to coexist was determined in 4129 microorganisms strains. Etiological role of the agents was evaluated by using values of consistency rate (CR). Species that were present in more than 50% of samples were considered consistent, in 25 to 50%--additional, and in less than 25%--random. Frequency rates (FR) were also determined, that is the fraction of a certain species (genus) of the microorganism (in %) from all the isolated cultures that correspond to 100%. For the determination of the significance of individual species of the agent in the structure of mixed microorganism populations, FR - their fraction (%) in mixed population from the number of strains of this species that correspond to 100% - was calculated. RESULTS: A significant part of the microorganisms strains, more frequently in reanimation department (65.5%), caused wound suppuration in populations mixed with other species of the agents. In reanimation and surgical departments consistent species of wound infection agents were not detected. A leading etiological role of Staphylococcus aureus (FR 19.2% and 23.9%) was determined, and FR of S. aureus strains in mixes was 64.6% in RITD and 46.8% in SD. The parameters ofotheragents of WI in the comparison groups were similar. However FR among mixes in RITD were significantly higher for streptococci that do not belong to S. pyogenes species (72,5%), and also nonfermentative microorganisms (67,2%), and in SD - in Klebsiella pneumoniae mixes. For agents of wound infection especially in RITD, low species diversity was characteristic and the number of mixes variants is significantly higher. In RITD mixed infections develop more frequently, and the ecological community of microorganisms reaches higher values than in SD. CONCLUSION: During the analysis of microbiologi-cal data in RITD and SD general patterns and specific features of taxonomical structure, prevalence of mixed populations and character of their ecological community in wound infection was determined.