[Perthes disease: immunological aspects.]

The values of cellular, humoral immunity, cytokine status, those of phagocytic activity of neutrophils (PAN) have been studied in patients with Perthes disease II and III Stages. Considering a stage of the pathological process patients (boys at the age of 8-12 years) were divided into two (2) groups. Group I included 14 patients with the fragmentation stage (Perthes disease Stage II). Group 2 include d 15 children with Perthes disease Stage III (the stage of re-ossification). Perthes disease regardless of the stage of the disease was characterized by the increase in oxygendependent and lysosomal phagocytic activity of neutrophils, the increase in the number of early extracellular traps, as well as by increased concentrations of pro-inflammatory cytokines (IL-1ß and TNFa), IgЕ, decreased concentrations of IL-18. The fragmentation stage was characterized by moderate activation of cellular immunity with a prevailing increase in the number of T-lymphocytes with early activation markers (CD25). At the re-ossification stage the predominance of T-lymphocytes was observed with late activation markers (HLADR), being accompanied by moderate activation of humoral immunity (increased concentrations of class A and G serum immunoglobulins). The obtained data can be used as additional criteria for clarifying Perthes disease stage, predicting osteonecrosis development when making decision of the feasibility of performing reconstructive surgeries on the joint.

[Oxygen-dependent mechanisms and oxidative stress in children for femoral head osteochondropathy.]

Degenerative-dystrophic processes in the articular tissues are accompanied by the changes in the values of congenital immunity, being a result of immune responses to aseptic inflammation. The purpose of this study - to investigate the oxygen-dependent mechanisms of neutrophil phagocytic activity (NBT-test, myeloperoxidase activity), the biochemical values of lipid peroxidation, the oxidative modification of proteins and the activity of enzyme antioxidant protection in children (at the age of 12-16 years) with osteochondropathy of the femoral head.The increase in spontaneous NBT-test and myeloperoxidase content in neutrophils, the decrease in NBT stimulation index, as well as the statistically significant increase in the activity of superoxide dismutase, the main producer of hydroperoxide, was revealed in the group examined. At the same time, no increase in catalase activity and in the content of lipoperoxidation products was observed, however, redistribution of the products of oxidative modification of proteins with ketone predominance was found. In case of osteochondropathy development in children the activation of the oxygendependent mechanisms of neutrophil phagocytic activity is observed, as well as the increase in the number of the secondary products of protein peroxidation - ketones. An increase in SOD activity, with a simultaneous and significant decrease in catalase activity evidence of accumulation of hydroperoxide causing neutrophil activation and chemotaxis. The study data can be used for predicting osteonecrosis development as additional criteria when decision-making of the advisability of performing reconstructive surgeries of the joint.

[HLA-DR expression on monocytes as a prognostic criterion for the development of pyoinflammatory processes at various stages of surgical treatment].

We studied relative content of CD14+HLA-DR in 214 patients including those with aseptic instability and stable implants of the knee and the hip, periprosthetic infection of the hip, chronic posttraumatic osteomyelitis of long tubular bones, and osteomyelitis generalization (sepsis). We determined HLA-DR expression on monocytes by laser flow cytofluorometry using Beckman Coulter Epics XL (USA) cytometer and monoclonal antibodies (Immunotech Company, France). It has been demonstrated, that the decrease in HLA-DR expression on monocytes can be one of the mechanisms of increasing immune disorders in patients with orthopedic pathology and monitoring HLA-DR monocytic expression can be used as a prognostic criterion of developing pyoinflammatory processes at the stages of surgical treatment.

[The indicators of immunity in patients with aseptic instability of knee joint].

The examination was applied to sampling of 17 patients with stable implants after 18-36 months after endoprosthesis replacement of knee joint and to sampling of 17 patients with developed within this time-frame aseptic instability of endoprosthesis within the same time-frame. The typing of lymphocytes of peripheral blood was implemented using laser flow cytometry. The detection of immunoglobulins, cytokines, circulating immune complexes was made applying the technique of enzymoimmunoassay. In case of development of aseptic instability the signs testifying moderate activation of immune system and starting dysfunction of monocyte macrophage component of immune system. At that, IL-6, TNFα, CD14+HLA-DR provided the most complete information on the side of diagnostic of developing aseptic instability of joint.

[The factorial analysis in evaluation of cell immunity of patients with pyo-inflammatory diseases of long bones and large joints].

The factorial analysis was applied to calculate the values of main components determining condition of cell immunity in patients with pyo-inflammatory diseases of long bones and large joints. It is demonstrated that in conditions of chronic purulent infection the main are the factors related with regulative T-lymphocytes involved in suppression of T-cell immunity. In case of development of fistula form of osteomyelitis the main role is attached to mechanisms related to markers of activation of T-lymphocytes and to derangement of expression of HLA-DR on monocytes in case of infection of prosthesis.

[An association of the protein spectrum and various immunoglobulin classes in synovial fluid in gonarthrosis].

Synovial fluid from patients with gonarthrosis was examined using biochemical and immunological studies; the levels of total protein, protein fractions, and immunoglobulins A, M, and G were measured. In a joint osteoarthrotic process, the patients' synovial fluid showed a significant increase in the levels of immunoglobulins of all classes and total protein, a change in the distribution of protein fractions, and a close correlation between IgM and a protein beta-globulin fraction.