Diagnostic levels of sepsis biomarkers in children with oncological diseases.

The data on the diagnostic levels of sepsis markers in blood plasma in 117 patients with oncological diseases at the age from 1 to 18 years are presented. The patients were divided into 4 groups depending on the outcome of the clinical course of the inflammatory process or infectious complications: group 1 - patients with no complications of anticancer treatment (n = 13/11.1%), group 2 - the presence of a systemic inflammatory response in patients (n = 64/54.7%), group 3 - patients with sepsis (n = 27/23.1%), group 4 - patients with septic shock (n = 13/11.1%). The threshold level of presepsin between groups 1 and 2 was 202 pg/ml, 371 pg/ml between groups 1 and 3, 604 pg/ml between groups 2 and 3 and 1500 pg/ml between groups 3 and 4. For procalcitonin, the threshold level between groups 1and 2 was 0.23 ng/ml, 0.48 ng/ml between groups 1 and 3, 0.51 ng/ml between groups 2 and 3 and 3.9 ng/ml between groups 3 and 4. The threshold value of C-reactive protein in patients with solid tumors was 12.6 g/l between groups 1 and 2. In patients with oncohematological diseases, the threshold level of C-reactive protein was 43.4 g / L between groups 2 and 3, 77.1 g / L between groups 2 and 4. According to the ROC analysis, presepsin was superior to procalcitonin and C-reactive protein in the diagnosis of septic complications.

Valence band structure and charge distribution in the layered lanthanide-doped CuCr0.99Ln0.01S2 (Ln = La, Ce) solid solutions.

The comprehensive study of the electronic density distribution of CuCr0.99Ln0.01S2 (Ln = La, Ce) solid solutions was carried out using both X-ray photoelectron and emission spectroscopy. It was found that cationic substitution of chromium with lanthanum or cerium atoms does not significantly affect the atomic charges of the matrix elements (Cu, Cr, S) in the lanthanide-doped solid solutions. The copper atoms in the composition of CuCrS2-matrix and the lanthanide-doped solid solutions were found to be in the monovalent state. The chromium and lanthanide atoms were found to be in the trivalent state. This fact indicates the isovalent cationic substitution character. The sulfur atoms were found to be in the divalent state. The near-surface layers contain the additional oxidation forms of sulfur (S0, S4+, S6+) and copper (Cu2+) atoms. The detailed analysis of the valence band structure using DFT calculations has shown that partial DOS distribution character of the matrix elements is preserved after the cationic substitution. The experimental valence band spectra structure of CuCrS2-matrix and CuCr0.99Ln0.01S2 is determined by the occupied copper d-states contribution. The contribution of the lanthanide states in the valence band structure is lower in comparison with those for the matrix elements. The major contribution of the lanthanide states was found to be mainly localized near the conduction band bottom.

[Multiple embolism of arterial vessels of the systemic circulation: classification, clinical manifestations, and outcomes]. / Mnozhestvennye émbolii arterial'nykh sosudov bol'shogo kruga krovoobrashcheniia: klassifikatsiia, klinicheskie proiavleniia, iskhody.

Embologenic arterial obstruction remains an extremely important problem of modern medicine. Emboli may affect virtually all arterial vessels of the greater circulation and in some cases arterial emboli may be multiple. The purpose of the present study was to work out a classification of multiple arterial emboli. Analysing the clinical material including over 30 years a total of 1804 patients with embolism of the aorta and major arteries of the limbs made it possible to define the range of the terms used and to submit for discussion a classification describing a situation where emboli affect simultaneously several arteries or occur repeatedly. Both cases involve several emboli migrating from the primary source into the arterial bed, therefore we suggest that all these emboli be called multiple. Simultaneous multiple emboli were classified as combined, multifocal, and layered, with repeated emboli classified as preceding, recurrent, early and remote. Simultaneous emboli were observed in 91 (5%) patients, of these, in 22 - combined, in 49 - multifocal, in 19 - layered, and in 1 case - combined and multifocal. Repeated emboli were revealed at various terms and encountered virtually in each third patient. Overall mortality amongst the patients with embolism of the aorta and arteries of the limbs over 30 years amounted to 13%, having over the last decade decreased to 7.6%. Multiple arterial emboli significantly influenced the outcomes of treatment, with the mortality rate in combined emboli increasing virtually to 50% and that in multifocal and layered emboli exceeding 20% (p<0.05). Early recurrent emboli in the postoperative period were observed in 6.8% of patients, significantly deteriorating the prognosis (mortality - 49.2%). In the remote period, 22.4% of the patients were operated on for recurrent embolism of arteries of the extremities, with more than 25% of the patients having experienced emboli of cerebral or visceral arteries. Recurrent thromboembolic complications played a significant role in the thanatogenesis in each 4th patient.

[Ultrastructural changes in the endocardium and endocrine cardiomyocytes in the wall of the left atrial appendage in patients with atrial fibrillation]. / Ul'trastrukturnye izmeneniya endokarda i endokrinnykh kardiomiotsitov v stenke levogo ushka bol'nykh s fibrillyatsiei predserdii.

OBJECTIVE: To study ultrastructural changes in endocardial tissues and endocrine cardiomyocytes of the left atrial appendage in patients with atrial fibrillation. MATERIAL AND METHODS: Electron microscopy was used to examine the endocardium and endocrine cardiomyocytes of the left atrial appendage in 8 patients with long-standing paroxysmal and persistent atrial fibrillation and in one patient with coronary heart disease without rhythm disturbance (a control group). RESULTS: The investigation revealed that all the patients with atrial fibrillation had similar ultrastructural changes in all endocardial layers and endocrine cardiomyocytes of the left atrial appendage. The endothelium showed massive desquamation of endothelial cells. Predominantly single sharply flattened cells and small cytoplasmic fragments remained on the endocardial surface. The latter devoid of endothelial coating was represented by subendothelial loose connective tissue with noticeable signs of edema. The latter was also observed in the dense fibrous connective tissue of the endocardium. The accumulation of large amounts of edema fluid in the subendothelium led to endothelial cell flattening and desquamation. There was no leukocytic infiltration in the tissue of the endocardium or fibrin and desquamated endothelial cell accumulation on its surface. The endocrine cardiomyocytes exhibited disorders as cytoplasmic swelling, complete or partial lysis (necrosis) of individual myofibrils, and lower levels of endocrine granules and their location near or in direct contact with the sarcolemma. CONCLUSION: The study has shown that long-standing atrial fibrillation deteriorates the main factors that determine normal endothelial function: edema in subendothelial tissue disrupts its interaction with endothelial cells and leads the latter to detach from the endocardium; ultrastructural changes in the endocrine cardiomyocytes that produce hormones can impair systemic blood pressure control and intracardiac hemodynamics.

[Adiponectin gene expression in local fat depots in patients with coronary heart disease depending on the degree of coronary lesion].

AIM: To determine the dependence of adiponectin gene expression by subcutaneous, epicardial and perivascular adipocytes on the degree of coronary lesion in coronary heart disease. MATERIALS AND METHODS: 84 patients with coronary artery disease were examined. Of these, 39 people showed a moderate degree of atherosclerotic lesion of the coronary bed (less than or equal to 22 points) on the SYNTAX Score scale, 20 severe (2231 points), and 25 extremely severe (more than 32 points). Upon admission to the hospital, all patients underwent an echocardiographic study (Echocardiography, Acuson, Germany) with the calculation of the ejection fraction (EF) of the left ventricle (LV) to assess its systolic function. During a planned surgical intervention (coronary bypass surgery, CABG), adipocytes of subcutaneous, epicardial (EAT) and perivascular adipose tissue (PVAT) were taken. Adiponectin gene expression was evaluated by polymerase chain reaction (real-time PCR) using TaqMan probes. Statistical analysis was performed using Statistica 9.0. RESULTS: The maximum level of adiponectin expression was detected in adipocytes of PVAT, and the minimum EAT. With an increase in the degree of atherosclerotic lesion of the coronary bed, the expression of the adiponectin gene in adipocytes of local depots significantly decreases r=-0.82; p=0.023. Moreover, the low level of gene expression in EAT correlated with a decrease in LV EF by r=0.73; p=0.03. In adipocytes of subcutaneous and especially PVAT, gene expression was the highest in patients with a moderate degree of coronary lesion. CONCLUSIONS: Low adiponectin gene expression in EAT is associated with an increase in the degree of atherosclerotic lesion of the coronary bed and a decrease in LV EF.

[Expression of gene and content of adiponectin in fatty tissue in patients with ischemic heart disease]. / Ékspressiia gena i soderzhanie adiponektina v zhirovoi tkani u patsientov s ishemicheskoi bolezn'iu serdtsa.

The purpose of the study was to investigate the features of expression and adiponectin content in the adipocyte culture of subcutaneous, epicardial, and perivascular adipose tissue and the effect of various doses of rosuvastatin on these processes. 29 patients with coronary artery disease were examined. Adipocytes were isolated from the samples of SAT, EAT and PVAT which were taken during coronary artery bypass surgery, followed by cultivation in the presence of rosuvastatin and evaluation of gene expression and adiponectin concentration. Adipocytes SAT, EAT and PVAT differed in the level of adiponectin secretion and expression of its gene. On day 1 of cultivation the expression of the adiponectin gene in the EAT was 2.3 times lower than in the PVAT. On day 2 of cultivation the expression of the adiponectin gene was reduced both in the EAT and the PVAT as compared to the SAT. When rosuvastatin was added at a concentration of 1 mmol/L, adiponectin gene expression in PVAT was higher than when rosuvastatin was added at a concentration of 5 mmol/L, in the adipocyte culture of SAT effect was opposite. Thus, the adipocytes of EZhT and, to a greater extent, PAS, can be a therapeutic target for statins in the case of the pathological activation of adipose tissue.

[Lifespan of patients after endured embolism of the aorta and major arteries of the limbs]. / Prodolzhitel'nost' zhizni bol'nykh, perenesshikh émbolii aorty i magistral'nykh arterii konechnostei.

The authors analysed the remote results of treatment of patients having endured embologenic arterial obstruction. Over the last 47 years, specialists of the Department of Cardiovascular Surgery No1 of the North-Western State Medical University named after I.I. Mechnikov have rendered emergency medical care to a total of 3,455 patients presenting with embolisms of the aorta and arteries of the limbs. The remote results of treatment were followed up in 978 patients within the terms varying from 1 year to 30 years. The cumulative survival of patients at 1 year of follow up amounted to 72±2.9%, at 2 years to 55±3.3%, at 3 years to 46.1±3.3%, at 5 years to 33.5±3.4%, and at 10 years to only 17.8±3.8%. The subanalysis of the remote results of treatment of patients having sustained arterial embolisms was carried out in three groups of patients, depending on the character of the underlying disease. In patients of the 1st group, the development of arterial embolism was caused by atrial fibrillation of non-valvular aetiology, taking course on the background of hypertensive disease, IHD. The cumulative survival of patients of this group at 1 year of follow up amounted to 66.6±4.5%, at 3 years to 37.5±4.8%, at 5 years to 23.1±4.9% and at 10 years to less than 6%. Death was caused by progressing cardiovascular insufficiency in more than 60% of patients, by acute myocardial infarction in nearly 20% of cases and in 10% by impairment of cerebral circulation. In patients of the 2nd group, arterial embolisms were the consequences of endured infarction; their cumulative survival at 1 year of follow up amounted to 70.1±6.5%, at 3 years to 34.5±7.1%, at 5 years to 23.6±6.6%, and at 10 years to 12.5±6.5%. Patients of the 3rd group suffered from acquired heart valve disease of rheumatic aetiology, with the cumulative survival at 1 year amounting to 76.8±5.4%, at 3 years to 56.3±6.4%, at 5 years to 43.3±6.7% and at 10 years to 19.6±6.9%. In the thanatogenesis of more than 60% of patients there were thromboembolic complications, with progressing cardiac insufficiency present in nearly 30% of cases. The pattern of the remote results of treatment of patients with embolisms of the aorta and arteries of the limbs is strongly suggestive of the necessity of working out a comprehensive programme of medical rehabilitation.

[Use of spectral index of heart rate variability as a predictor of poor clinical outcome in patients with severe combined chest trauma].

Use of spectral index of heart rate variability as a predictor of poor clinical outcome in patients with severe combined chest trauma. The article provides information on results of research of connection between spectral index of heart rate variability, got during 5-minutes record of echocardiography in acute period of traumatic disease, and severity of trauma, severity of health condition and level of impairment of consciousness in patients with combined chest trauma. Defined correlating connections between separate indexes of spectral analysis of heart rate variability and scales, reflecting health status severity and severity of trauma when admission the patients. Defined accurate differences between indexes of a power of very low frequency, low frequency and high-frequency waves, indexes of a vagosympathetic balance in groups of patients with poor clinical outcome and lethal outcome. Proved the possibility of the use of definite, during 12 hours after getting injury, relative powers of low- frequency and high-frequency waves, expressed in normalized units, index of a vagosympathetic balance as physiological markers of poor clinical outcome in patients with severe combined chest trauma.

[Risk factors for myocardial infarction recurrence in young and middle-aged males].

AIM: To assess a set of risk factors (RF) for coronary heart disease in myocardial reinfarction patients aged less than 60 years. SUBJECTS AND METHODS: A multitude of probable RFs that might predispose to the development of MI or provoke its occurrence were studied in 526 male patients aged less than 60 years, who had primary (n = 281) and repeated (n = 245) myocardial infarction (MI) from the results of hospital treatment. RESULTS: Lipid metabolic disturbances, smoking, arterial hypertension (AH), foci of chronic infection, and overweight were ascertained to be the most common RFs in patients less than 60 years. There was a history of dyslipidemia (100%), AH, heart failure, and cardiac arrhythmias in the complicated course of repeated MI. When these RFs are combined, the likelihood of disease complications and death increases. CONCLUSION: According to the results of estimation of the spread of RFs for myocardial reinfarction, it is proposed to enhance the monitoring of lipidogram readings, blood pressure value, magnitude of the symptoms of heart failure, and serum glucose levels, and infection foci sanitization and to improve patients' awareness about a risk from smoking and lower physical activity.

[Specific features of myocardial infarction in young and middle-aged subjects].

The aim of the study was to obtain an insight into the origin and specific features of myocardial infarction (MI) in 322 subjects below 60 yr of age. Most patients had anginous complaints. The incidence of non-anginous forms of MI in patients aged below 45 and 46-60 years was estimated with reference to the occurrence of complications. The structure of these complications and causes of their fatal outcome were elucidated. The prevalence of risk factors of MI in the survivors and patients who died was obtained.

[Polyposis of the stomach. Endoscopic treatment or follow-up?].

Out of 3243 patients with gastric polips, polyposis was diagnosed in 298 ones including 135 cases of complicated and 163 cases of uncomplicated forms. Hyperplastic polips were diagnosed in 281 patients. Along with hyperplastic polyps, solitary adenomas were diagnosed in 9 cases, Peitz-Jegerc polyps - in 6, and juvenile polyps - in 2. Polypectomy was performed in 153 patients: partial - in 104, and total - in 49. Follow-up was carried out in 98 non-operated patients, indications for endoscopic surgery were seen in 18 cases. After partial endoscopic polypectomy, repolypectomy was performed in 24 cases: single - in 8, multiple - in 16. Repeated endoscopic treatment after total polypectomy was performed in 3 patients. There were no cases of polyp transformation into cancer. Open surgical treatment was not performed. There were no severe complications after endoscopic treatment.

[Prognostic value of SAPS II and APACHE II scales in patients with multiple organ failure syndrome during early postoperative period after oncological surgery]. / Prognosticheskoe znachenie shkal SAPS II i APACHE II u bol'nykh s sindromom poliorgannoi nedostatochnosti rannego posleoperatsionnogo perioda posle onkokhirurgicheskikh vmeshatel'stv.

The key fixed task was the following: detection, as soon as possible, of patients with a high risk of lethal outcome; an objective assessment of the condition of patients during the early postoperative period by using a quantitative evaluation (SAPS II, APACHE II); and defining of the prognostic value of SAPS II and APACHE II after oncology surgeries. The in-hospital lethality amounted to 53% in 73 patients with MOFS during the early postoperative period after oncology surgeries. The formalized (numerical) score, according to SAPS II and APACHE II, made it possible to detect patients with a higher risk of lethal outcome yet during the very first day after oncology surgeries. If the score of SAPS II or APACHE II topped 30 (on the first day after surgery), then the in-hospital lethality exceeded 50%. The information density of the SAPS II and APACHE II systems turned out to be identical, however, SAPS II appears to be more convenient in terms of practical usage since it demands the evolution of a smaller number of physiological parameters.

[Diagnosis and treatment of patients with acute postintubation and post-tracheostomy stenosis of the larynx and trachea]. / Diagnostika i lechenie bol'nykh s ostrymi postintubatsionnymi i posttrakheostomicheskimi stenozami giortani i trakhei.

The data on diagnosis and treatment of 200 patients with acute postintubation laryngostenosis (LS) and tracheostenosis (TS) are reviewed. Peculiarities of tracheostomy technique practiced in critical care units are specified. Postintubation and posttracheostomy alterations in the larynx and trachea detected endoscopically are described. Effective endosurgical methods are proposed to avoid multistage surgical rehabilitation for recovery of the respiration function in 97% LS and TS patients.

Energy intake and prostate tumor growth, angiogenesis, and vascular endothelial growth factor expression.

BACKGROUND: A sedentary lifestyle coupled with excessive energy intake is speculated to be a factor associated with increased incidence of prostate cancer. We have investigated the effects of energy intake on prostate tumor growth in experimental animals. METHODS: Two transplantable prostate tumor models, i.e., the androgen-dependent Dunning R3327-H adenocarcinoma in rats and the androgen-sensitive LNCaP human carcinoma in severe combined immunodeficient mice, were studied. R3327-H tumor growth and relevant tumor biomarkers (proliferation index, apoptosis [programmed cell death], microvessel density, and vascular endothelial growth factor [VEGF] expression) were compared in ad libitum fed control rats, ad libitum fed castrated rats, and groups restricted in energy intake by 20% or 40%. A second set of experiments involving both tumor models examined tumor growth in ad libitum fed rats or in animals whose energy intake was restricted by 30% using three different methods, i.e., total diet restriction, carbohydrate restriction, or lipid restriction. All P values are two-sided. RESULTS: R3327-H tumors were smaller in energy-restricted or castrated rats than in control rats (P<.001). Tumors from energy-restricted rats exhibited changes in tumor architecture characterized by increased stroma and more homogeneous and smaller glands. In castrated rats, the tumor proliferation index was reduced (P<.0001), whereas apoptosis was increased in both energy-restricted (P<.001) and castrated (P<.001) rats. Tumor microvessel density and VEGF expression were reduced by energy restriction and castration (P<.003 versus control). Restriction of energy intake by reduction of carbohydrate intake, lipid intake, or total diet produced a similar inhibition of growth of R3327-H or LNCaP tumors. These effects were associated with reduced circulating insulin-like growth factor-I. CONCLUSIONS: Our observations are consistent with the hypothesis that energy restriction reduces prostate tumor growth by inhibiting tumor angiogenesis. Furthermore, dietary fat concentration does not influence prostate tumor growth when energy intake is reduced.

[The surgical and endoscopic treatments of benign submucosal tumors of the esophagus, stomach and duodenum]. / Khirurgicheskoe i éndoskopicheskoe lechenie dobrokachestvennykh podslizistykh opukholei pishchevoda, zheludka i dvenadtsatiperstnoi kihki.

Analysis of the results of various modes of treatment and follow-up of 160 patients with benign submucosal tumors (BST) was carried out. Most often histological type of BST was leiomyoma (43.7%). BST were mainly located in the stomach (68.7%). 22 patients underwent open operations, 37--endoscopical removal of BST, 101 patients were followed-up from 5 to 10 years. The analysis of the material makes it possible to come to the conclusions about advisability of endoscopical treatment. The results of which are not inferior to surgical method of treatment. In patients with absence or slow growth of BST endoscopic follow-up is valid.

[Vibration bouginage in the cicatricial strictures of esophagus]. / Vibratsionnyí sposob buzhirovaniia pri rubtsovykh strikturakh pishchevoda.

In 66 patients for the dilation of the cicatricial stricture of the esophagus vibration method was used. In 48 patients the vibrator was attached to proximal end of the bouge, in 18 patients the vibration device was introduced directly in the area of the stricture. The suggested method provided an easy and fast dilation of the stricture in 63 patients. In 3 cases surgical treatment was carried out because multiple strictures in separate areas resulted in complete obliteration of the esophagus. There were no complications due to the vibrobouginage. For the treatment of inflammatory disorders of the esophagus and for prophylaxis of the scar formation in the area of stricture in 29 patients the therapeutic laser irradiation was used. This treatment has ensured promising results.

Diet: the neglected variable in chemical safety evaluations.

The objectives of this review are to alert the community of toxicologic pathologists to the types and significance of various diets fed to experimental animals used in safety evaluations of drugs and other chemicals, to acquaint investigators with dietary nutrients and contaminants of significance to research animals, to review some of the consequences of improper or inadequate diets on results of safety evaluations, and, finally, to offer a brief introduction to a highly promising new digital specimen technology for evaluating histopathology of tissues from animals used in safety evaluations with the aid of computers. Results that form the basis for this review have accumulated for more than 4 decades during research conducted during appointments at the University of Missouri, Columbia; Auburn University; Massachusetts Institute of Technology; and Boston University School of Medicine. The methods used in these studies have generally been state-of-the-art at the time the studies were conducted and involved an integration of techniques and methods used in fundamental nutrition, toxicology, and experimental pathology. Some of these investigations have shown that contaminants, naturally occurring and man-made, intentional and nonintentional, do occur in commercial animal diets; that essential nutrients, including total calories, protein and fat, can be provided in less or more than adequate amounts for the species of animal used in safety evaluations; and that such variables can influence responses to chemicals through effects on xenobiotic metabolism, immunocompetence, secondary diseases, and other factors. Under such conditions, serious differences in final interpretation of human risk for a drug or other chemical can contribute to failure to gain approval for a potentially valuable therapeutic agent. This review discusses the significance of various dietary components with examples of their effects on response of the animal to chemicals and demonstrates why nutrients, new technologies for assessing their effects, and other components in the diet should be accorded greater consideration by investigators and regulators.

Digital imaging in anatomic pathology.

Advances in computer technology continue to bring new innovations to departments of anatomic pathology. This article briefly reviews the present status of digital optical imaging, and explores the directions that this technology may lead over the next several years. Technical requirements for digital microscopic and gross imaging, and the available options for image archival and retrieval are summarized. The advantages of digital images over conventional photography in the conference room, and the usefulness of digital imaging in the frozen section suite and gross room, as an adjunct to surgical signout and as a resource for training and education, are discussed. An approach to the future construction of digital histologic sections and the computer as microscope is described. The digital technologic applications that are now available as components of the surgical pathologist's workstation are enumerated. These include laboratory information systems, computerized voice recognition, and on-line or CD-based literature searching, texts and atlases and, in some departments, on-line image databases. The authors suggest that, in addition to these resources that are already available, tomorrow's surgical pathology workstation will include network-linked digital histologic databases, on-line software for image analysis and 3-D image enhancement, expert systems, and ultimately, advanced pattern recognition capabilities. In conclusion, the authors submit that digital optical imaging is likely to have a significant and positive impact on the future development of anatomic pathology.