EXPRESSION OF PROGRAMMED CELL DEATH RECEPTOR IN ENDOMETRIAL CANCER PATIENTS WITH METABOLIC DISORDERS.

AIM: To study the expression of the programmed cell death receptor (PD-1) and its ligand (PD-L1) by immunocompetent cells in endometrial cancer patients with metabolic disorders. MATERIALS AND METHODS: Populations and subpopulations of lymphocytes were analyzed by flow cytometry. Antibodies against CD279 were used to detect PD-1 on the CD4+ and CD8+ T cells. Antibodies against CD14 and CD274 were used to detect PD-L1 on monocytes. RESULTS: In patients with severe metabolic disorders, the expression of PD-1 on CD8+ and CD4+ lymphocytes and the expression of the corresponding PD-L1 on CD14+ cells before treatment and after radiation therapy were higher than in the control group. CONCLUSION: Theincreased expression of PD-1 and PD-L1 receptors by immunocompetent cells can be considered a new prognostic marker in endometrial cancer patients with morbid obesity.

DIAGNOSTIC AND TACTICAL IMPORTANCE OF STUDYING SHORT CHAIN FATTY ACIDS IN DIFFERENT BIOLOGICAL SUBSTRATES TOOK PLACE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE, LUNG CANCER AND COMMUNITY-ACQUIRED PNEUMONIA DEVELOPED AFTER ANTICANCER THERAPY.

The main aim of the study is to examine microbiocenosis of lower respiratory tract and intestine in patients with chronic obstructive pulmonary disease (COPD), lung cancer (LC), lung cancer with community-acquired pneumonia (CAP) and to determine their role in the etiological diagnosis of lower respiratory tract infections (LRTi), including those that develop during cancer chemotherapy (CC), to discuss the possibility of optimizing the treatment tactics. MATERIALS AND METHODS: To solve this task were examined 147 patients and 30 healthy individuals were divided into 4 groups, according to nosology. The number of patients in the COPD group was 38 people, m / f-35/3, median age 63 (57; 69) years, in the LC group -60 people, m / f - 56/4, with a median age of 65 (58; 71) year; LC groupwith CAP -21 persons m / f - 17/4, with a median age of 73(69; 75) years, in the LC group with CAP developed in the period up to 30 days after the end of chemotherapy (LC with CAP / CC) -28 persons m / f - 22/6, with a median age of 70 (67; 73) years, the norm group -30 healthy persons m / f- 26/4, median age 48(40,691 years. The spectrum of short-chain fatty acids (SCFA) sputum (in bronchoalveolar lavage standards group) and test groups of feces were studied by gas-liquid chromatographic analysis (GLC analysis). Results of the study. In the norm group: total absolute content of SCFA (X) in sputum was 0.032 mg / g, the relative content of acetic acid (pC2) 0906 u, propionic acid (pC3) 0.085 u, butyric acid (pC4) 0.009 u, anaerobic index (Al) -0.104 units. According to the analysis the total absolute content of SCFA in the sputum may be expressed as follows: ∑ SCPA (C2-C4) norm (0,032) <∑ SCFA (C2-C4) COPD (0,201) <∑ SCFA (C2-C4) RL (0,463) < ∑ SCFA (C2-C4) LC with CAP (0.510) < RCMP ∑ (C2-C4) LC with CAP / CC (0.612) (mg / g), the differences are statistically significant when compared with the norm. The findings of the relative content of C2-C4 show a statistically significant increase of the relative content of propionic and butyric acids: PC3 (0,085) pC4 (0.009) norm pC2 (0.846) COPD> pC2 (0.792) LC> pC2 (0.765) LC with CAP> pC2 (0.719) LC with CAP / CC (u) in patients of all study groups compared to the norm, and between groups. And the more pronounced changes in the content of SCFA in the sputum are ascertained in lung cancer with CAP during chemotherapy. *The values of Al in the studied groups are displaced to more negative values: Al (- 0.104) rate> Al (- 0.190) COPD> Al (- 0.257) RL> Al (- 0.307) LC with CAP> Al (- 0.391) LC with CAP / CC (sing.) compared with the norm and between groups. The findings of SCPA in feces in the group norm: ~1 SCFA 10.51 mg / g, 0.634 units pC2, pC3 0,189 units, 0,176 units pC4, -0.576 Al units. The total absolute content of SCFA in feces can be expressed as follows: ∑ SCFA (C2-C4) LC (4,11) <∑ SCFA (C2-C4) COPD (4,81) <∑ SCFA (C2-C4) norm (10 51) (mg / g), the differences were statistically significant when compared with the norm; depending on the chemotherapy, preceding the development of the CAP: ∑ SCFA (C2-C4) norm (10,51)> ∑ SCFA (C2-C4) LC with CAP / che- motherapy (5,54)> ∑ SCFA (C2-C4) LC CAP (4,96)> ∑ SCFA (C2-C4) LC (4.11) (mg / g). Results of the study of the relative content of C4-C2 also demonstrate a statistically significant increase of the relative content of propionic and butyric acids: pC3 (0.189), pC4 (0.176) norm pC2 (0.590) COPD> pC2 (0,560) LC> pC2 (0.529) LC with CAP> pC2 (0.503) LC with CAP! chemotherapy (u) in patients of all study groups in comparison with the norm. And the more pronounced changes in the content of SCFA in feces are ascertained at LC with CAP during chemotherapy. The values of Al intestinal ecological community of all groups are displaced to more negative values when compared with the norm: Al (- 0.576) norm> Al (- 0.695) COPD> Al (- 0.786) LC> Al ('0.890) LC with CAP> Al (- 0.988) LC with CAP / chemotherapy (u), with the most significant changes were observedin the group of LC with CAP during chemotherapy. Conclusion, Increased absolute SCFA concentration in patients with CQPD, lung cancer, lung cancer with CAP, LC with CAP! CC in comparison with the norm indicates increased number and activity of anaerobic flora, the most significant changes observed in patients with lung cancer with CAP, developed in the period up to 30 days after the end of chemotherapy. The unidirectional changes in SCFA parameters in the sputum and stool demonstrate the dependence of microorganism biocenosis. The resulting information can be used in the etiological diagnosis of LRTI, as well as the development of therapeutic and preventive measures flAw Af infprtiniis rnmnlications and treatment of these patients.

[Microflora metabolites of different habitats in bronchopulmonary diseases].

PURPOSE: To investigate the content and profile of metabolites of bronchopulmonary and intestinal microflora, especially such as short chain fatty acids (SCFA) in various biological substrates in patients with lung malignant tumors on the background of COPD. Estimate their diagnostic and tactical implication. MATERIALS AND METHODS: The study involved 98 patients with diseases of the bronchopulmonary system. According to the basic nosology patients were divided into two main groups: COPD (38 patients), and lung cancer in combination with COPD (hereinafter LC) (60 patients). The diagnosis was verified by modern methods of examination. Group of norm included 30 healthy individuals. Groups matched by gender and age. The microbiological examination of sputum and feces was conducted in the studied groups of patients. SCFA in sputum and feces of patients with COPD and LC were identified by GLC method. In healthy individuals the SCFA investigation was performed in bronchial washings, obtained during bronchoscopy in 20 people, the SCFA investigation in feces was performed in 30 people. RESULTS: Study of the content and profile of short-chain fatty acids (SCFA) in patients with COPD and lung cancer (LC) in various biosubstrates indicate on the obvious changes in microbiocenosis ofbioptate (bronchopulmonary and intes- tinal), characterized by the dominance of residual and facultative anaerobic microorganisms in the spectrum. Except that more pronounced changes are ascertained at LC. Also, changes of the SCFA parameters in the sputum may indicate on the alterations in the metabolism of epithelial cells of the lower respiratory tract (LRT). Unidirectional change the SCFA in sputum and feces can indicate on either translocation of microflora in the LRT out of the intestine, and on the possible systemic changes in themetabolism of epithelial tissue in the oncological process. The identification of SCFA by GLC method in various biological substrates can be used in examination of patients with lung cancer for diagnostic purposes (for objectification of microecological violations), as well as to evaluate the prognosis of the disease and its complications.

[Experimental study of Grippferon antiviral activity against Mexican pandemic influenza virus A/H1N1/2009 in vitro].

Analysis of the efficacy of Grippferon vs. the reference drugs Realdiron and Reaferon-EC against the influenza virus A(H1N1)/2009 in susceptible static cell cultures showed that in the concentrations tested it was efficient in inhibition of the virus cytopathic activity and generation of specific hemagglutinin.

[Modern characteristics of epidemiology and prevention of community-acquired pneumonia in military staff].

AIM: To study the effectiveness of system for prevention of community-acquired pneumonia (CAP) in military teams and determine the main ways for its improvement. MATERIALS AND METHODS: Data on incidence of CAP in military staff during 1993 - 2008 were used. Analysis of morbidity was performed using classical methods of epidemiological analysis. RESULTS: Registered incidence of CAP in military staff was 5 - 7 times higher compared with average incidence in adult population of the country. Main factors determining realization of CAP epidemic process mechanisms in military teams were revealed. Two-fold and more rise in incidence of CAP and acute respiratory infection in military recruits is forecasted for 2010. Effect of use of Pneumo 23 vaccine for freshmen recruits is grounded. CONCLUSION: Immunization of military staff with Pneumo 23 vaccine considered effective and needed component in complex of prophylactic measures performed in troops.

[Organizational-epidemiological aspects of prophylaxis of outhospital pneumonia in military communities].

The article presents actual questions of epidemiology of outhospital pneumonia (OP), peculiarities of epidemic process of these infections in troops in now-day conditions and updates of main directions of their prophylaxis. It was marked that alongside with clearly defined tendency of lowing, the morbidity by OP in the Armed Forces of RF is still rather high--in 5-7 folds higher than among adult population of the country. Whereby it is predicted further complication of sanitarium-epidemiological situation in connection with increase of call-up. The article uncovers the main factors, supplying the realization of mechanism of epidemic process of OP in military collectives. Vaccination of staff by registered in RF multipartial pneumococcal vaccine Pnevmo-23 is considered as an effective and necessary medical measure in complex of prophylactic measures, effectuating in troops.

[Nonreconstructive revascularizing operations in limb ischaemia].

Presented herein are the findings of experimental studies substantiating interrelationship between osteogenesis and blood circulation, as well as effects of surgical interventions based on excitation of reparative regeneration of the bone and aimed at improvement of blood circulation in the extremities. Reflected also are the main indications for the use of each operative intervention concerned. Based on the clinical findings obtained by follow up of 1,477 patients operated on for limb ischaemia secondary to obliterating arterial lesions efficacy of the methods of treatment devised is demonstrated.

[Dynamics of acoustic properties of skin integument and hydroxyproline content during surgical treatment of congenital limb malformation].

The aim of the work was to examine mechanical and acoustic properties of the skin and collagen metabolism in patients with congenital and developmental malformation (CDM) of extremities. Acoustic tests were performed in 39 patients with forearm CDM and in 30 with leg CDM aged 4-18 years using an ASA-4 apparatus (Russia and Yugoslavia). Mean radial and ulnar lengthening was 6.4 +/- 1.0 (5.5-8) cm, tibial and fibular lengthening 5.0 +/- 1.2 (3-8) cm, and femoral lengthening 6-12 cm. Longitudinalvelocity of sound 1 and 2 months after distraction was 42.3% and 62.9% respectively higher than the preoperative value (p < 0.05). A similar increase (36.8 and 58.4% respectively) was recorded with the ASA-4 sensor in the transverse position. Acoustic inhomogeneity in the thigh skin also increased during distraction. Maximum free to protein-bound hydroxyproline ratio in blood was measured in the end of distraction (0.58 +/- 0.04) and in the beginning of fixation (0.6 +/- 0.01). Its subsequent decrease reflected structural and metabolic changes related to proliferative and biosynthetic processes in the skin, fibrillogenesis, and altered homogeneity patterns.

[Diagnostic significance of podography in patients with gonarthrosis].

Results of podography in 48 women aged 24-62 (46.6 +/- 2) years with bilateral gonarthrosis of metabolic/dystrophic etiology (grade I, II, III by N.S. Kosinskaya's osteoarthrosis classification) were analysed using a DIASLED-SCAN computed system (Sankt-Peterburg). Qualitative and quantitative changes detected by podography proved to be typical of different stages of female knee osteoarthrosis. A summary table illustrating dynamics of quantitative podogram characteristics as a function of severity of the disease is presented.

[The interrelationship between compact tissue defect and bone shaft cavity circulation].

The intraosseous pressure of tissue fluid, the electrical resistance between electrodes and the parameters of hemodynamics in tibial shaft cavity were measured experimentally. It was established that the occurrence and increase of compact defects led to the enhancement of fluid filtration from capillaries and tissue blood filling, whereas the reduction of compact defects led to hemodynamics parameter decrease. The shunting influence of newly formed regenerate bone capillaries cause an arterial wall elasticity increase and volumetric circulation rate limitation. The filtration-and-resorption balance of bone shaft cavity restored and circulation enhanced after compact defect healing.

Muscle spindles in elongation of the extremity: proprioceptive conflict or activity deficit?

Comparison of electrophysiological and morphological parameters of shin muscles of experimental animals during shin elongation by Ilizarov's method indicates involvement of muscle spindles into reconstruction of the skeletal muscular tissue in response to its dosed distraction, which results in temporary deficit of specific somatosensory afferentation.

[Peculiarities of sciatic nerve endoneurium cellular composition in hip distraction osteosynthesis in dogs].

Using light and electron microscopy, sciatic nerve endoneurium cellular content was studied in 14 adult mongrel dogs subjected to hip elongation for 28-35 days after osteotomy. For light microscopy, semithin sections were prepared. The application of an automated image analysis has demonstrated a moderate increase in macrophage, fibroblast and mast cell content, which remained undetected during visual examination. The morphofunctional state and the distribution of these cells is suggestive of their participation in the extracellular matrix synthesis and remodeling, angiogenesis control, blood flow and endoneurial fluid content regulation in the process of peripheral nerve structural adaptation to extremity elongation.

[Changes in hemodynamics of tibial diaphysis in case of blood flow disorder in superficial femoral artery].

Changes in tibial hemodynamics have been studied experimentally after applying a clamp (n=41) and resection of superficial femoral artery (n=22) in 63 adult dogs. It has been revealed with the help ofrheovasography that, in case of blood flow disorders in the superficial femoral artery, anastomoses with deep femoral artery branches contribute to maintenance of blood circulation in tibia, and in this connection the parameters of tibial blood flow may significantly differe from those of circulation in the leg soft tissues. Preservation of intraosseous pressure all along tibial diaphyseal cavity demonstrates a possibility of using its driving force to compensate for the circulatory insufficiency in the leg soft tissues and, moreover, in that part of the bone the environment of which in ischemia is involved.

[Functional state of lower extremities muscles at the patients with shin congenital defects before and after treatment with Ilizarov device].

Results of examination (dynamometry, electromyography, ultrasonography) of 34 patients aged 6 to 23 years before and after treatment with Ilizarov's method are analyzed. Decrease of dynamometry and electromyography parameters, ultrasonic data are evidence of hard structural and functional disorders of motor system of these patients. Decrease of force and activation characteristics of tested muscles of operated extremity after removal of external fixator relates to high level of central protective inhibition and prolonged afferentation dysbalance at somatosensory system. Degree of recovery is limited and depends on patient age: recovery resources are presented at children before 8 years, but at juveniles they are depleted during the growth.

[Description of rearrangement of distraction reclaim in the extension of the lower extremities and elimination of their deformity in patients with various etiology of shortening].

The data of X-ray and computed tomographic studies of a long tube distraction reclaim were analyzed in 80 patients who had limb shortening and deformity of varying etiology. The analysis has shown that during distraction there is a positive correlation between the increase in the connective-tissue interlayer area of a distraction reclaim and the overall increase in the area of the distraction reclaim (their ratio is not greater than 30% under the optimal elongation conditions). During fixation there is a decrease in the ratio of the area of a growth zone to the total area of a reclaim and in its total density with a parallel increase in the density of cortical laminae of a newly formed bone. Complete organotypic rearrangement comes to the end in the range of 1-3 years depending on the magnitude of pathomorphological and biomechanical changes and limb function.

[Ultrastructural characteristics of endotheliocytes of skeletal muscle hemomicrocirculatory bed during tibial lengthening using G. A. Ilizarov technique].

The method of transmission electron microscopy was used to study the ultrastructure of endotheliocytes in the hemomicrocirculatory bed of the anterior tibial muscle of adult dogs during tibial lengthening with Ilizarov method. The capacity of endotheliocytes to reduction and renewal was established. The tension stress induced in the biological tissues of the lengthened limb stimulates and supports high activity of endotheliocyte nuclear apparatus, which is characterized by the prevalence of euchromatin. Presence of capillaries with closed lumen at all time points studied is indicative of a prolonged angiogenesis process in the terminal parts of the hemomicrocirculatory bed, which is accompanied by regeneration and growth of the muscle fibers. After the cessation of distraction, while the muscle tissue continued to grow and differentiate, the endotheliocyte growth and the activation of their synthetic apparatus was noted.

[Use of hinge joints in devices for treatment of human locomotor system].

An analytical review of hinge joints used in external osteosynthesis apparatuses is presented. The goal of this review was to help to optimize the construction of new external osteosynthesis apparatuses based on hinge joints and to improve the procedure of their installation. Several variants of hinge joint construction are considered. The review points out the specific properties of these joints that have to be taken into account in development of medical equipment.

[Peculiarities of repair osteogenesis during the transverse traction of the longitudinal diaphysis fragment under the conditions of intraosseus vessel preservation].

The application of technique for obtaining the tibial fragment (split) with a preserved vascular network of the nutrient artery and its branches, that participate in the blood supply of this bone area, permits to detect significant osteogenetic potential of both endosteum and undifferentiated bone marrow cells. Under these conditions it was possible to increase the bone thickness 2 to 3 times in short time. The regeneration process in this case is characterized by a rapid course and formation of large massive of cancellous bone. The results of this study suggest that an adequate blood supply, stable fixation of bone using Ilizarov apparatus and the chosen rate of split displacement create the favorable conditions for the active osteogenesis.

[Primary hemodynamic changes at the tunneling of bone diaphysis].

This paper describes one of the mechanisms of the effect of bone tunneling on limb circulation. The study was carried out in 33 adult mongrel dogs with the leg length measuring 10 to 12 cm. The tunneling of tibial bone diaphysis was performed using 1.8-mm-diameter wire. Measurements were the made of the pressure in the bone diaphyseal cavity. Medullography was accomplished over time. It has been revealed that the growth in the size of the compact substance defect led to the lowering of the pressure in the bone diaphyseal cavity associated with its stabilization at a new level. After the healing of the bone defects the pressure was restored. Medullography performed over time has demonstrated that the substrate filling the compact substance defects prior to their healing is permeable for aqueous solutions. This allowed the conclusion that the cause of pressure lowering was translocation of the interstitial fluid from the diaphyseal cavity to the bone-surrounding tissue. To replenish the amount of the interstitial fluid, filtration from the vascular bed of the diaphyseal cavity was increased providing for pressure stabilization.