[Stroke risk stratification in elderly patients with comorbid sarcopenia and atherosclerosis]. / Stratifikatsii riska ostrykh narushenii mozgovogo krovoobrashcheniya pri sochetanii ateroskleroza i sarkopenii u patsientov pozhilogo vozrasta.

OBJECTIVE: The study was to investigate the features of carotid arteries atherosclerosis as the leading risk factor for atherothrombotic stroke in elderly patients depending on the presence of sarcopenia. MATERIAL AND METHODS: 2 groups of patients above the working age were examined: 110 patients with normal muscle mass and 24 suffering sarcopenia. Ultrasound examination of carotid and vertebral arteries extracranial segments was performed with an assessment of atherosclerotic changes severity, atherosclerotic plaques instability, 10-year risk of stroke (according to Framingham risk score) and a 10-year risk of fatal cardiovascular disease (SCORE risk scale). RESULTS: 10-year risk of fatal cardiovascular disease was 3 [2; 5] points for patients without sarcopenia, 3 [2; 3] points for patients with sarcopenia (p=0.81). The 10-year risk of stroke was 16 [12; 18] for patients without sarcopenia, 18 [15; 22] points for patients with sarcopenia (p=0.1). Due to the ultrasound examination data the incidence of carotid arteries atherosclerotic lesions in patients without sarcopenia was 50 (46.3%), in patients with sarcopenia - 18 (75.0%) (p=0.01). Statistically significant (p<0.05) increase in the atherosclerotic plaques instability signs was revealed in patients suffering sarcopenia compared to those without it: heterogeneous echotexture - 66.7% cases versus 38.2% (p=0.01), presence of hypoechoic masses - 41.7% patients vs 12.7% (p=0.02). CONCLUSION: It is important to take into account not only traditional risk factors in the overall assessment of cardiovascular risk as well as therapeutic and preventive measures planning in elderly patients, but also pay attention to body composition since modern diagnostic systems may be not sensitive enough to identify high-risk patients with comorbid atherosclerosis and sarcopenia.

[Paradoxical air embolism of intracerebral arteries as a complication of tooth extraction]. / Paradoksal'naya vozdushnaya emboliya vnutrimozgovykh arterii kak oslozhnenie ekstraktsii zuba.

The article describes the rare clinical case, demonstrating sudden onset of neurological manifestations (seizures and consequent formation of ischemic stroke foci) in a 29 year-old female patient during tooth extraction (right lower third molar) using the high-speed dental drill. Air injection through damaged tissues caused subcutaneous emphysema in the buccal area that caused air embolism. Presence of asymptomatic congenital heart defect in the patient (atrial septal defect) allowed the bubbles of air to move paradoxically from right to left with consequent embolization of small cerebral arteries. Treatment in specialized department was successful and had beneficial effect on patient's condition.

[PRACTICE OF MANAGEMENT OF PATIENTS WITH INFECTIOUS ENDOCARDITIS IN CONDITIONS OF LOW FREQUENCY OF ETIOLOGICALLY SIGNIFICANT PATHOGENS IN THE RUSSIAN FEDERATION].

The article presents the results of a multicenter study of the etiology, antibiotic sensitivity and pharmacoepidemiology of infective endocarditis in the Russian Federation. The purpose of this study is to analyze the current practice of management of patients with infective endocarditis in conditions of low frequency of etiologically significant pathogens in the Russian Federation. The study included patients of both sexes of all age groups with definite and probable infective endocarditis. 406 cases of infectious endocarditis (240 in retrospect and 166 in the prospective part) were analyzed. Etiologically significant pathogen was isolated in 144 cases (35.5%). The structure of pathogens was dominated by gram (+) cocci (90.3%), most often - Staphylococcus aureus (46.5% of all isolated pathogens). Aminoglycosides (22.8%), parenteral cephalosporins of the III generation (22.1%) and glycopeptides (14.5%) were most frequently used in the course of starting antimicrobial therapy. When changing the mode of antimicrobial therapy, glycopeptides (18.6%), aminoglycosides (15.3%), fluoroquinolones (11.2%) and parenteral cephalosporins of generation III (9.5%) were most often prescribed.

[Diagnostic and Prognostic Possibilities of the Redox-Potential Electrochemical Measurements in Blood Plasma].

AIMS: Determination of operating characteristics of the test based on blood plasma redox potential monitoring in patients with different patho- logical conditions associated with impaired oxygen metabolism during treatment in postoperative period and expanding the range of parameters of the developed method of investigation of blood plasma redox potential. METHODS: It were examined healthy volunteers group as following group (n = 63), groups of patients with transplanted liver (n = 64), kidney (n = 59), and lungs (n = 7). Redox potential measurements were done by platinum electrode, reference electrode was silver-chlorine one. Potentiostate IPC-ProL was used to registrate and record a dependence redox potential via time. Time of measurement was 15 min. RESULTS: statistically significant differencees of redox potentials ranges was found in healthy volunteers and patients with transplanted kidney and liver. Ratio of measured redox potentials coincident with the values within the confidence interval in healthy volunteers was 12% in patients with transplanted kidney and 10% in patients with transplanted liver. We observed significant differences in the nature of changes of blood plasma's redox potential values in course of monitoring of subgroups of patients with and without complications after liver transplantation. It was found that sensitivity of electrochemical method was 85%, selectivity--69.8%, precision--85.2%. CONCLUSION: we discovered value ranges of blood plasma redox potential typicalfor different pathological states; we detected an interaction between the effect of treatment and quantitative changes in the values of the blood plasma redox potentials; criterion for early predicition of complications in patients with transplanted liver was proposed basing on redox potential monitoring during postoperative period.

[Effect of the intercellular adhesion molecule E-cadherin on the prognosis of non-small cell lung cancer].

The effect of E-cadherin on the prognosis of Stage I-II non-small cell lung cancer (NSCLC) was investigated. Tumor E-cadherin expression and its correlation with the clinical and morphological characteristics of a patient, as well as the prognostic role of this marker were studied. It was ascertained that the E-cadherin expression did not depend on patient gender and age, tumor histological pattern, location, grade, and pT category, but it was significantly related to the pN1 category (p < 0.0001). Univariate analysis revealed that the histological pattern of a tumor, nodal status, resection type (lobectomy/pulmonectomy), and E-cadherin expression level were significantly correlated with patient survival. Multivariate analysis showed that the important predictors were tumor histological pattern and resection type (p = 0.01 and p = 0.00004, respectively). A more complete study of the prognostic and predictive role of E-cadherin expression in patients with Stage I-II NSCLC will help identify a prognostically unfavorable group of patients who may be given additional treatment in the postoperative period.

[The influence of microvessel density in the tumor on the prognosis in patients with stage I-II non-small cell lung cancer after surgical treatment].

A study of the prognostic role of microvessel density in tumors of patients with stage I-II non-small cell lung cancer (NSCLC) was performed from June 2008 to June 2011. Determination of microvessel density using the marker CD31 was conducted in 114 patients. Microvessel density was significantly correlated with tumor size: so at greater than 3 cm in diameter, the content of microvessels was 68.7 +/- 3.1, with a smaller tumor size--48.6 +/- 4.5. Independent prognostic markers in patients with stage I-II NSCLC after surgery are histological type (HR = 2.97), tumor size (HR = 4.5), and the number of microvessels in tumor (HR = 3.2).

[Laser information technologies in oncosurgery].

The introduction of laser information technologies to medical practice has improved the results of reconstructive and plastic operations in oncology thanks to a possibility to plan the surgery beforehand. Sixty-eight patients were operated on at Gertsen Moscow Research Oncology Institute between 2001 and 2006; 99 stereolithographic models were used to plan different stages of the surgical intervention. The tasks fulfilled with an individual stereolithographic model, may be relatively divided into three groups: 1) planning the resection stage; 2) planning the reconstructive surgery; 3) assessing the necessity to correct the complex autograft after the reconstructive surgery. The use of laser stereolithographic modelling in surgical treatment of patients with locally advanced malignancies made it possible to complete the reconstructive operation successfully in 98.4% of the patients, and rehabilitate functionally 88.6% of the patients.

[Design of equine serum-based Marburg virus immunoglobulin].

Immunoglobulin (Ig) against Marburg fever (MF) has been obtained from the equine serum. In terms of physicochemical and immunobiological properties, the obtained preparation corresponds to the quality of heterologous commercial immunoglobulins. The application of Marburg virus (MV) Ig with a titer of no less than 1:2048 by the emergency prevention scheme 1-2 hours after intraperitoneal inoculation of guinea pigs with MV in a dose of 20-50 LD50 protected 88-100% of the animals from death. MV Ig is recommended for emergency prevention of human MF.

[Oxidative activity of electrochemically synthesized sodium persulfate solutions against some psychotropic agents].

By using some psychotropic agents as an example, investigations of the oxidative activity of electrochemically synthesized sodium persulfate solutions were continued. The derivatives of phenothiazines, xanthene, and dibenzazepines were shown to be oxidized by synthesized sodium persulfate solution to low-toxic products. Oxidation products were ascertained to coincide with the known products of their biotransformation in the body.

[Antihypoxant effect of zinc(II) bis(N-acetyl-L-cysteinato)sulfate octahydrate in acute normobaric hypoxia].

Using two models of the acute normobaric hypercapnic hypoxia (ANHH) and acute normobaric hypoxia without hypercapnia (ANWH), some parameters of the impulse activity of somatosensory cortex neurons were studied in experiments on cats. A new antihypoxant drug--aminothiol complex substance composed of zinc(II) and N-acetyl-L-cysteine (piQ-1104, 50 mg/kg)--was used for the brain protection. The substance studied showed a high antihypoxant activity in the brain neurons during all stages of both ANHH and AHWH. The average active survival time during hypoxic state was increased 2-2.5 times in comparison to the control group. The neuron activity dynamics under ANHH and AHWH conditions and after piQ-1104 injection was observed.

[Complexes of gadolinium with linear and liquid-crystalline forms of DNA].

The binding of Gd3+ ions to linear double-stranded DNA molecules in water-salt solutions or in liquid-crystalline dispersions is accompanied by sharp changes in their optical and X-ray characteristics. Depending on the initial conditions of complex formation, the binding of Gd3+ ions either to DNA bases or phosphate groups occurs, which leads to changes in the properties of the liquid-crystalline dispersions. The packing of neighboring DNA molecules in particles of the liquid-crystalline dispersion of the complex DNA-Gd3+ depends strongly on the concentration of Gd3+ ions. This process is accompanied by a decrease in the amplitude of Bragg's reflection maximum. The unique properties of the developed material open the possibilities for its practical use.

[Chronic hepatitis B and C in renal graft recipients].

Clinical and morphological features of chronic hepatitis B (CHB), C (CHC), and B+C (CHB+C) were studied in 283 renal graft recipients. High total bilirubin serum levels were detected significantly more often in CHB and CHB+C patients vs. CHC patients. High ALT activity was noted in 65% of CHB patients and only in 45% of CHC patients (p = 0.003). Stable low activity of hepatitis prevailed in renal recipients; it was noted in 56.7% of CHB patients, 66.2% of CHC patients, and 62% of CHB+C patients. The character of pathomorphological liver changes in chronic viral hepatitis was studied in 53 renal graft recipients using puncture biopsy. Histopathological activity index (HAI, Knodell R.G. et al., 1981) witnessed a more severe liver lesion in CHB vs. CHC and CHB+C. Thus, inflammatory activity in CHB was found to be minimal or low in 13 patients, and moderate or high in 11 patients, whilst a minimal or low activity in CHC or CHB+C was found in 16 and 10 patients, respectively, and a moderate activity was detected only in two and one, respectively (p = 0.016 and 0.024 compared with CHB). Advanced hepatic fibrosis or cirrhosis was significantly more frequent (p = 0.006) in CHB patients (eight out of 24) than in CHC ones (none out of 18). The rate of advanced sclerotic changes in CHB+C was lower (one out of 10 patients) than that in CHB, and similar to CHC. Thus, clinico-morphological manifestations were more prominent in renal graft recipients with CHB vs. CHC.

[Hemorrhagic (Marburg, Ebola, Lassa, and Bolivian) fevers: epidemiology, clinical pictures, and treatment].

The evaluation of the biological and epidemiological properties of Ebola, Marburg, Lassa, and Machupo viruses suggests that they are of social importance for health care authorities. The studies have created prerequisites to the development of reliable biosafety means against these pathogens. Particular emphasis is laid on the methods for infection diagnosis and on the studies to design specific protective agents--immunoglobulins and inactivated vaccines.

Serine-phosphorylated STAT1 is a prosurvival factor in Wilms' tumor pathogenesis.

Wilms' tumor (WT), one of the most common pediatric solid cancers, arises in the developing kidney as a result of genetic and epigenetic changes that lead to the abnormal proliferation and differentiation of the metanephric blastema. As activation of signal transducers and activators of transcription (STATs) plays an important role in the maintenance/growth and differentiation of the metanephric blastema, and constitutively activated STATs facilitate neoplastic behaviors of a variety of cancers, we hypothesized that dysregulation of STAT signaling may also contribute to WT pathogenesis. Accordingly, we evaluated STAT phosphorylation patterns in tumors and found that STAT1 was constitutively phosphorylated on serine 727 (S727) in 19 of 21 primary WT samples and two WT cell lines. An inactivating mutation of S727 to alanine reduced colony formation of WT cells in soft agar by more than 80% and induced apoptosis under conditions of growth stress. S727-phosphorylated STAT1 provided apoptotic resistance for WT cells via upregulation of expression of the heat-shock protein (HSP)27 and antiapoptotic protein myeloid cell leukemia (MCL)-1. The kinase responsible for STAT1 S727 phosphorylation in WT cells was identified based upon the use of selective inhibitors as protein kinase CK2, not p38, MAP-kinase kinase (MEK)1/2, phosphatidylinositol 3'-kinase, protein kinase C or Ca/calmodulin-dependent protein kinase II (CaMKII). The inhibition of CK2 blocked the anchorage-independent growth of WT cells and induced apoptosis under conditions of growth stress. Our findings suggest that serine-phosphorylated STAT1, as a downstream target of protein kinase CK2, plays a critical role in the pathogenesis of WT and possibly other neoplasms with similar STAT1 phosphorylation patterns.

Complex N-acetyl-L-cysteine compounds with biometals as self-defense factors of biological system.

We studied the effects of complex N-acetyl-L-cysteine compounds with transitional biometals on the inflammatory and adaptation reactions. Some compounds were superior to known antihypoxants and actoprotectors and exhibited significant antiinflammatory activity.

Laser stereolithography and supercritical fluid processing for custom-designed implant fabrication.

This paper describes the laser photopolymerization of a liquid mixture of polyfunctional acrylic monomers, photoinitiator and hydroxyapatite (HA). Pure polymeric and composite materials of specific shape and structure were fabricated by laser stereolithography based on images derived from three-dimensional (3D) computer modeling. The polymeric objects then were treated with supercritical carbon dioxide to remove potentially toxic residues (monomers, low molecular weight oligomers, etc.) and to provide interconnective microporosity. Finally, samples were implanted into white rats (diastolic epiphysis of femoral bone) to study living tissue response and processes of osteointegration and osteoinduction. It was shown that incorporation of HA into the composite implant structure encouraged periosteal as well as endosteal osteogenesis and improved their osteointegrative characteristics in particular. Supercritical carbon dioxide treatment significantly enhanced the biocompatibility of the materials, increasing the area of direct contact of the implant surface with regenerated bone tissue.

[Use of guinea pigs for assessing the efficacy of vaccines against Lassa fever]. / Ispol'zovanie morskikh svinok dlia otsenki éffektivnosti vaktsin protiv likhoradki Lassa.

The use of guinea pigs as a laboratory model was proven to be appropriate in investigating the vaccines developed against Lassa fever at the preclinical study stage. An adapted variant of Lassa virus was cultivated, which caused death of guinea pigs with respect for an agent's dose. Finally, it was shown to be possible to investigate the immunogenic and protective properties of the inactivated antigen of Lassa virus in experiments with guinea pigs.

[Perspective of skull reparative surgery using three-dimensional computed tomography and stereolithography]. / Perspektivy rekonstruktivnoi khirurgii cherepa s ispol'zovaniem trekhmernoi komp'iuternoi tomografii i stereolitografii.

The review presents the stages of the development and use of virtual three-dimensional CT images. A possibility to get a 3D-based real skull model and an implant for reconstruction using a 3D-prototype technique (stereolithography) is a new step to the development of reconstructive surgery.

[Potentialities of spiral computed tomography in the diagnosis and treatment of traumatic injuries of the midface]. / Vozmozhnosti spiral'noi komp'iuternoi tomografii v diagnostike i lechenii travmaticheskikh povrezhdenii srednei zony litsa.

The paper summarizes the results of examination of 169 patients referred to the surgeon in the period from 1 till 47 days after medial facial (MF) trauma by using spiral computed tomography (SCT) and the method of laser stereolitography (LSLG). The actual aspects of diagnosis and treatment are marked; the methods for the analysis of injuries of soft tissue structures and adjacent areas while orbit trauma are developed together with the methods for determination of degree of enophthalmos. Also discussed are the possibilities of SCT and LSLG in visualization of MF injuries and planning patient treatment.

[Effectiveness of cycloferon in treating virus-associated inflammatory gynecologic diseases]. / Effektivnost' tsikloferona v lechenii virusassotsiirovannykh vospalitel'nykh ginekologicheskikh zabolevanii.

Cycloferon, a low molecular weight interferon inducer synthesized in Russia, was used for treating chronic acute gynecological inflammations. The etiology of diseases was mixed in the majority of cases. Clinical efficacy of the drug was 79%. Cycloferon, an antiviral immunomodulating drug, is recommended for combined therapy of chronic and acute gynecological inflammations.