卷 27, 编号 3 (2019)

Aim. To study peculiarities of synovial medium of a joint in patients with III stage coxarthrosis (CA) using methods of ultrasound and biochemical examination.

Materials and Methods. Ultrasound examination (US) of hip joints (n=18) and biochemical examination of synovial fluid (n=12) were conducted in patients with posttraumatic III stage CA. Echographic examination was carried out using diagnostic devices Voluson 730 PRO (Austria) and Hitachi (Japan) equipped with transductor with 7.5 MHz frequency. Total protein was measured in alkaline medium with copper sulfate. Protein fractions of synovial fluid were separated using a method of separation of a mixture of proteins to fractions or to individual proteins. The activity of catalase enzyme was determined by speed of degradation of hydrogen peroxide and of liberation of cell from its excess. Processes of peroxide oxidation of lipids (POL) were assessed by measurement of the content of the primary (diene conjugates, DC) and secondary (malondialdehyde, MDA) products of POL. Products of lipoperoxidation and of oxidative modification of proteins were presented as an estimated coefficient of sum and ratios. Lipid spectrum (cholesterol, triglycerides) was measu-red using a colorimetric method.

Results. There were revealed structural disorders in the synovial medium of the joint. US data showed thickening of synovial and fibrous membranes of the joint capsule by 60 and 40% of the age-related norm, separation of fibers of the fibrous membrane of the joint. Biochemical examination of synovial fluid revealed reduction in the activity of enzymes of antioxidant system and accumulation of peroxidation products which evidences development of a local oxidative stress in the joint medium. In development of destructive processes in the region of joints affected by arthrosis, the activity of free radical processes considerably increases which leads to decompensation of antioxidant mechanisms with development of imbalance in the anti-oxidant protection system.

Conclusion. In clinical practice, diagnosis of degenerative-dystrophic processes in the joint, along with X-ray data, should also include the results of biochemical and ultrasound methods of examination.

Effect on the microcirculatory bed of the bony tissue is one of promising approaches to treatment of osteoporosis.

Aim. To study anti-osteoporotic properties of endothelioprotectors: L-arginine, L-norvaline and rosuvastatin.

Materials and Methods. Osteoprotective properties of L-arginine, L-norvaline and rosuvastatin, and also of a reference drug– strontium ranelate – were studied on 152 female rats of Wistar line using a model of hypoestrogen-induced osteoporosis. Anti-osteoporotic and endothelioprotective effect of the drugs were evaluated by laser dopplerflowmetry (LDF) of the proximal metaphysis of the femoral bone, morphometry of trabeculae of bone, and also by calculation of the coefficient of endothelial dysfunction.

Results. LDF showed that maximal increase in microcirculation of the proximal metaphysis of the femoral bone, in comparison with animals with untreated osteoporosis (61.52±3.74 perfusion units, PU) was achieved with L-norvaline (115.25±5.36 PU, p<0.001) and rosuvastatin (106.57±5.22 PU, p<0.001), less expressed effect was demonstrated by L-arginine (98.10±4.48 PU, p<0.001) and a reference drug – strontium ranelate (86.49±4.99 PU). A similar tendency was observed in morphometry of trabeculae of bone: in the group with untreated osteoporosis the diameter of trabeculae was 61.68±1.24 µm, in the group with use fL-norvaline – 91.86±1.8 µm (p<0.001), in the group with use of L-arginine – 86.64±1.39 µm (p<0.001) and in the group with use of strontium ranelate – 89.08±1.09 µm.

Conclusion. L-arginine and L-norvaline and also rosuvastatin possess the property of improving a morphofunctional condition of bone tissue and may be recommended for further preclinical study.

A study of the effect of motor activity on the health condition of students that generalizes peculiarities of the morphological status and of physical development on the whole, permits to identify mechanisms controlling health factors.

Aim. Determination of the peculiarities of the dynamics of morphological status of students with different levels of motor activity in the period of study at aninstitution of higher education (IHE).

Materials and Methods. A prospective study of physical health of 630 students of 17-22 years of age in the period from 2010 to 2018. In students, the body length, body mass, chest circumference and other parameters were measured and the somatotype was determined every year in the period of study at anIHE (5 years).

Results. It was found that in the period of study at anIHE, growth processes continued only in 51.9% of examined boys and gradually terminated at 21-22 years of age, and in 36.9 % of girls with termination at 21-22 years. In most students increment of the body mass and chest circumference was recorded, there were also found boys and girls with these parameters remaining unchanged during period of study at anIHE, and in some cases their decline was found. The increment of the body mass and chest circumference was demonstrated to slow down with termination of growth processes, but did not stop altogether which resulted in increase in the amount of students with excessive weight. This was also facilitated by reduction of the level of motor activity in senior years when physical culture classes are no longer included into the curriculum. The dependence of growth processes in boys and girls at the age of 17-22 years on the level of motor activity was revealed that influenced the speed and direction of increment of the total dimensions of the body and the type of body-build. According to our data, the majority of boys support a high level of motor activity to buildup the body mass, and girls lead an active way of life to decrease the body mass and to keep it on the optimal level.

Aim. To study the level of fetuin-A (FA), bone mineral density (BMD) and certain markers of bone remodeling in patients with rheumatoid arthritis (RA).

Materials and Methods. 110 Patients with RA and 30 conventionally healthy patients were examined. In both groups the levels of FA and BMD were determined. In the group of patients with RA the levels of C-telopeptide of type I collagen, N-terminal propeptide of procollagen I, 25-hydroxy-cholecalciferol, total alkaline phosphatase, total calcium of blood were determined.

Results. The mean concentration of FA in blood serum of patients with RA was 765.67±120.66 µg/mL, which was below the respective parameter in donors – 812.95±76.21 µg/mL (p=0.0437). In the group of patients with RA with osteoporosis (n=52) the mean level of FA was 733.65±135.84 µg/mL, and in the group without osteoporosis – 794.37±97.7 µg/mL (p=0.0044). The level of FA was also reduced in patients with osteoporotic fractures (n=24) – 694.79±110.47 µg/mL against 785.45±116.43 µg/mL in patients without osteoporotic fractures (n=86; p=0.00091). A positive correlation relationship was found between the level of FA and BMD of L1-L4 (r=0.194; p=0.042), femoral neck (r=0.328; p<0.0001) and proximal femur (r=0.293; p=0.002), and the level of 25-hydroxy-cholecalciferol (r=0.259; p=0.006), and the negative correlation relationship – with C-telopeptide of type I collagen (r=-0.203; p=0.033).

Conclusions. Patients with RA with reduced FA level were characterized by a higher detection rate of osteoporosis and of osteoporotic fractures, and by a lower BMD of L2-L4, femoral bone and proximal femur. Besides, a lower level of FA was associated with a lower level of 25-hydroxy-cholecalciferol and with a higher level of C-telopeptide of type I collagen which permits to suggest existence of osteoprotective function in this glycoprotein.

目的：研究跳动心脏手术的安全性和有效性对于损坏左冠状动脉主干（MLCA）以及和急性冠脉综合征（ACS）的患者，并确定手术的最佳时间。

材料与方法：这项工作是在分析62例MLCA病变患者的检查和治疗的基础上进行的。所有患者根据手术方式的不同分为两组：第一组的患者（n=31）在人工循环（AC）条件下进行了手术， 第二组的患者（n=31）在跳动心脏进行了手术。两组的患者可比较按主要的临床人口统计指标。EuroSCORE II量表用于评估不良结局的风险。

结果：对于病变MLCA及ACS的患者在跳动心脏进行手术干预允许减少手术时间（253.44±36.84与188.13±45.37分钟相比，p=0.0001），手术后出血量（607.00±432.34 ml与413.21±167.08 ml相比，p=0.03），输血制剂的使用频率（47.62％与18.18％，p=0.04）。然而，血运重建治疗方法完整性在AC组出现较高的结果（2.93±0.8与2.29±0.82相比，p=0.005）。并且，在AC的条件下手术延期的期间为14-30天出现与死亡率上升有关。在跳动心脏手术期间无出现死亡现象。

讨论：在ACS发病后的早期，对MLCA病变患者的跳动心脏进行手术是安全和有效的。在使用人工循环时的最佳手术周期为7-14天。在跳动心脏进行的手术中致死性和术后并发症发现在手术7天前及7-14天后，后来的14天无差异。

According to the point of view that has been dominating for many years, pancreatoduodenal resection was indicated only for localized tumors of the pancreas without involvement of the major vessels. In view of the prevalence of this pathology, many authors have recently pointed out the need to perform resection of a pancreatic tumor in a single bloc with the vessels involved, which gives a chance to increase the resectability in a larger number of patients.

Aim. Analysis of resectability of pancreatic tumors on the basis of the data of current clinical research. In recent decades many different surgical approaches have been improved which increases chances for successful and safe surgical intervention. The data of the analysis of literature on vascular reconstructions in surgery for tumors of the hepatopancreatobiliary zone showed that resections and reconstructions of the mesenteric portal venous segment permit to increase resectability of tumor and should correspond to the fundamental principles of surgical oncology. To date, in terms of the incidence of postoperative complications and mortality, no statistically significant differences were found between the group of patients in whom vascular resection was performed, and the group with a standard pancreatoduodenal resection. A thorough preoperative selection of patients along with the correct strategy of venous reconstruction is equally important for correct and successful resection of the blood vessels en bloc.

目的：探讨心电图（ECG）研究方法在诊断阵发性心动过速的可能性，其中包括其他脉搏传导的方法（CAP）。以P. 41岁的患者为例， 演示了用于识别心律失常的类型、发生的机理，以及Wolf-Parkinson-White Syndrome的额外进行途径主题的一个庸俗方法的可能性。在这张ECG上，记录了缩短的PQ间隔、三角波、扩大的心室综合波与重新极化过程受损的出现。在aVL和V1导联中出现QRS复合物呈阳性形式，提示了左侧后外侧CAP的存在。

结论：一种广泛应用的常规ECG检查方法允许确定心律失常的本质、选择治疗策略、进行复杂的有创操作前评估疾病的预后。

本文以I.P. Pavlov院士诞辰170周年以及颁发诺贝尔奖115周年为主题。作者反映了这位伟大科学家在科学工作中的主要方向，并强调了他的研究成果在血液循环生理学、消化作用以及高级神经活动生理学领域对现代医学的相关性。

To professor V.V. Davydov`s 80th birthday