[Physical rehabilitation for degenerative-dystrophic diseases of the hip joint in elderly and senile people (stage 1).]

Changes in the age structure of the planet's population are leading to an increase in the number of geriatric patients requiring replacement of large joints. Age-related weakness, loss of muscle mass, testosterone deficiency, excess weight, and the presence of concomitant diseases make the process of rehabilitation treatment labor-intensive and lead to various complications. The purpose of our work was to evaluate the effectiveness of the modernized method of physical therapy at the first stage of rehabilitation treatment in elderly and senile patients with osteoarthritis of the hip joint. All patients received standard complex therapy, including orthopedic treatment methods, drug therapy, myostimulation, massage, and manual therapy. For patients in the main group, in addition to the traditional complex, the method of physical therapy according to the stated method was added and it was recommended to wear compression hosiery (stockings) while performing the exercises. The advantage of the technique is the absence of complications and side effects, which is an important component compared to other methods of restorative treatment. Minimum costs, general availability and autonomy of performing exercises, high results achieved during the treatment process confirm the value and importance of creating similar techniques for other large joints. The developed method of physical therapy has shown its effectiveness and relevance among elderly patients and can be recommended for use among different population groups as a method of restorative treatment of osteoarthritis of the hip joint.

[Modern approaches to the primary prevention of the development of psychoactive substance dependence on the base of accounting of environmental and genetic risk factors].

In the work there was performed an assessment of the interaction of microsocial and genetic factors of the development of psychoactive substance (PS) dependence. The objects of the psycho-hygienic and molecular-genetic studies were 538 male patients from the specialized diagnostic and treatment center at the age from 17 to 65 years with a diagnosis of "PS dependence" according to F10-F09 in the ICD-10. There were determined personality predictors of early (before 25 years) manifestation of systematic abuse, such as low self-control, individualisticity, authoritarianism, unjustified optimism and reduced capacity for social adaptation. Manifestation of the PS dependence at an early age (25 years) is determined by the contribution of genotype 9R+ DAT gene in the combination with other predisposing genotypes A1 + DRD2/ANKK1, SS SERT and 7R+ DRD. The risk of development of PS dependence at a more younger age increases with the superimposition of individual predisposing genotypes ranging from 1,2 (7R+ gene DRD4) to 1,9 (A1 + gene DRD2/ANKK10 on a destructive milieu. Pairwise combinations of genotypes 7R+ DRD4 x A1+ DRD2, 7R+ DRD4 x 9R+ DAT, 9R+ DAT x A1+ DRD2, 9R+ DAT x SS SERT significantly increase the risk by 2 or more times (2.5-2.8). There was suggested an algorithm for the prenosological forecast of the development of PS dependence in adolescents and young men.

[Characteristics of central nervous system activity in patients with complications of arterial hypertension and dependence on psychomotor status and treatment].

Changes in certain CNS characteristics were used as indicators of the efficacy of antihypertensive therapy (AHT) both targeted (T-AHT) and empirical (E-AHT) designed to suppress activity of the sympathetic component of vegetative nervous system (VNS) and renin-angiotensin-aldosterone system (RAAS) in patients of different psychic status and AH. A group of 835 men (mean age 54.2+-1.8yr) was divided into cholerics, sanguinics, melancholics and phlegmatics with a high and low anxiety level (HA and LA). 416 healthy men served as controls. The following parameters were estimated: mobility of cortical processes, balance between sympathetic and parasympathetic activities, blood corrisol and aldosterone levels, oxygen utilization coefficient, resistance to breath holding, severity of dyscirculatory encephalopathy and the fraction of patients with AH complications during 12 month T-AHT for the suppression of sympathetic activity in cholerics and sanguinics by beta-adrenoblockers and PAA C- ACE inhibitors in phlegmatics and melancholics and during E-AHT (ACE inhibitors in cholerics and sanguinics, BAB in phlegmatics and melancholics). The functional activity of CNS in phlegmatics and melancholics before and during AHT was lower and severity of encephalopathy and the number ofAH complications higher than in cholerics and sanguinics. . The changes wiere more pronounced in patients with HA than in those with LA. Unlike E-AHT T-AHT (anxiolytics for cholerics and sanguinics with HA, antidepressants for phlegmatics and melancholics with HA) normalized the study parameters and decreased the frequency of complications by 2-3 times.

[New effects of telmisartan, an angiotensin 2 receptor blocker, in the treatment of arterial hypertension with metabolic disorders].

The authors undertook comparative analysis of the effica,cy and safety of PPARv-activating angiotensin-2 receptor blocker telmisartan (40--80 mg/day) in 80 patients with arterial hypertension (AH) and metabolic disorders (MD). Holter monitoring revealed a more pronounced anti-hypertensive effect of telmisartan compared with enalapril in patients with AH, MD, and compromised renal function. Similarly, telmisartan exerted more apparent positive effect on lipid and carbohydrate metabolism and had renoprotective action in patients with nephrogenic AH (it decreased proteinuria, stabilized creatinine clearance and serum potassium level whereas enalapril caused further deterioration of these parameters). It is concluded that telmisratan is more effective and safer than enalapril in patients with AH and MD.

[Association between dopamine (DRD2) and serotonin (5HTR2A) gene polymorphisms with the indicators of adolescent behavior adaptiveness].

The paper gives the results of a study of the impact of dopamine (DRD2) and serotonin (5HTR2A) genes on the development of personality characteristics in adolescents, by applying the Cattell (16PF) questionnaire. The study was performed in a group of 360 Moscow teenagers (185 girls and 175 boys) aged 14-17 years. The boys carrying the A1 allelle of the DRD2 gene were found to have a lower self-control, indiscipline, and impulsiveness. An association between the indicators of unconscientiousness, social introversion, and group independence was established in the girls with the G/G genotype of the 5HTR2A gene. Thus, gender differences have been revealed from the impact of dopamine and serotonin gene polymorphisms on the teenagers' personality characteristics that characterize the forms of disadaptive behavior, such as unconscientiousness, indiscipline, low self-control, and impulsiveness.

[Affection of cardiovascular system in antiphospholipid syndrome with non-bacterial thrombotic endocarditis].

AIM: To study characteristics of cardiovascular affection in antiphospholipid syndrome (APS) with nonbacterial thrombotic endocarditis (NBTE). MATERIAL AND METHODS: The trial included 28 patients with APS and NBTE (26 females, mean age 44 <+/- 13 years). Primary APS was diagnosed in 21 patients, secondary APS associated with systemic lupus erythematosus--in 7 patients. Transthoracic echocardiography was performed in all the patients, transesophageal echocardiography--in 86% of them. Statistic processing was made with logistic regression analysis. RESULTS: All the patients had structural valvular changes: leaflet thickening, sclerosis, vegetations, focuses of calcinosis and valvular dysfunction. Vegetations located on mitral and aortic valves in 64% and occurred on damaged heart valves in 36% patients. An important problem in APS with NBTE was systemic embolism (54%), especially with involvement of central nervous system. Logistic regression revealed association of NBTE with structural changes of aortic and mitral valves, myocardial focal fibrosis and valvular insufficiency. CONCLUSION: APS with NBTE is characterized by absolute predominance of valvular heart lesion with vegetations location on the left heart valves and high risk of embolic complications.

[Pseudoinfectious endocarditis in antiphospholipid syndrome].

The antiphospholipid syndrome (APhS) is autoimmune non-inflammatory trombotic vasculopathy, associated with damage of vessels of any caliber and localization that determines the diversity of clinical manifestations of this syndrome. One of possible localizations of thrombosis in AphS is pseudoinfective endocarditis (PsIE). We have performed analysis of clinical and laboratory features of APhS, associated with PsIE. 28 APhS patients with PsIE, average age--44+/-13 years, were included in the study. Among them 21 patients had primary form of APhS, 7 cases had secondary form of APhS. For statistical treatment of the results the logistic regression (SPSS for Windows. Release 11.5.0.) was used, the confidence level of differences between groups was determined with the use of Student's test. Heart valve abnormalities occurred in 100% of patients and included valvular thickening, induration and sclerosis, the presence of valve vegetations, focip of calcinosis and different grade of valve dysfunction. Mitral and aortal valve vegetations occurred with the same incidence (64%), both valves were been involved in 29% of cases. Positive associations with presence/development of PsIE in APhS from multivariant model data included mitral valve lesion (OR: 0.029), focal cardiofibrosis (OR: 0.084), prior valve lesion (OR: 0.087), negative associations--hemicrania (OR: 8.627) and secondary form of APhS (OR: 6.425). Moderately high titer of lupous anticoagulant (multivariant model) (OR: 3.753) seemed to be prognostic marker of PsIE. In half of patients with APhS and PsIE systemic embolisms appeared, embolic cerebrovascular complications were the most frequent (32%). The possibility of development of hemodynamically significant valve dysfunction that needs valve replacement and nececcity of making of differential diagnosis with infective endocarditis are related to other aspects, important for clinical practice.

[Pseudoinfectious endocarditis].

Nonbacterial thrombotic (noninfectious, pseudoinfectious--PIE) endocarditis is characterized by precipitation of thrombus, not containing bacteria, on the valve cusps. Mitral and aortal valves are affected most frequently. Vegetations, as a rule, do not exceed 6-7 mm and have a high inclination to embolism. Hypercoagulation plays a leading role in PIE pathogenesis. The most frequent acquired causes of sterile vegetation forming are malignant tumors and rheumatic diseases (especially systemic lupus erythematosus--SLE and antiphospholipid syndrome--APS). Valve pathology is most frequent lesion of heart in APS patients. It is supposed, that antibodies to phospholipids (aPL) have a special importance in valve lesion pathogenesis at APS, besides, changes in valve apparatus at SLE are associated exactly with aPL. Main problems of PIE patients are recurrent thromboembolism, development of valve dysfunction with clinical signs of heart failure (4-6% cases), difficulties in differential diagnostics: PIE is hard to diagnose if basic disease is accompanied by fever (diffuse diseases of connective tissue etc.). Transesophageal echocardiography is a leading method in PIE diagnostics. The main therapeutic option in PIE treatment is anticoagulant therapy: nonfractional or subcutaneous heparin in presence of systemic or pulmonary embolism, in patients with disseminated malignant tumors--complete doses of nonfractional heparin.

Cation exchangers for selective sorption of large proteins.

The sorption of bovine serum albumin, cytochrom c and fibrinogen on the series of carboxylic cation-exchangers with various concentrations of ionogenic groups has been investigated. The dependence of sorption selectivity on protein size and on concentration of ionogenic groups was demonstrated.

Bi-Langmuir isotherms' applicability for description of interaction of ion-exchange sorbents with protein mixtures.

The sorption of a protein pair on carboxylic cation exchangers with various contents of ionogenic groups is examined. The bi-Langmuir isotherm calculation is carried out from sorption data for single-component systems. It is shown that good agreement of calculated and experimental data is reached only when protein-sorbent interaction weakens because of implementation of the competitive sorption mechanism.

[Efficacy of isosorbide-5-mononitrate retard in patients with stable exertional angina].

The aim of the study was to evaluate efficiency of isosorbide-5-mononitrate (IMN) retard (40 to 80 mg/day) in 33 patients older than 60 with stable angina pectoris (functional class III-IV). The study shows that IMN is an effective and safe antianginal agent in treatment of patients with stable angina: it decreased the frequency of anginal attacks (from 4.1 +/- 0.34 to 0.8 +/- 0.13 per day, p < 0.0001), and additional nitroglycerin intake (from 2.2 +/- 0.32 to 0.2 +/- 0.05 tablets per day, p < 0.0001); according to the results of 24-hour ECG monitoring, it reduced ST-segment depression (from 2.2 +/- 0.17 to 0.9 +/- 0.09, p < 0.0001), preventing episodes of painful and silent myocardial ischemia (from 3.5 +/- 0.37 to 2.1 +/- 0.31, p < 0.0001); increased life quality as demonstrated by evaluation of physical (from 19.7 +/- 2.2 to 45.7 +/- 2.22, p < 0.0001), and mental (from 30.9 +/- 2.67 to 57.5 +/- 2.67, p < 0.0001) components using MOS-SF 36 questionnaire. Adverse effects of the drug (headache and hypotension) were observed in 6 (16.6%) patients.

[Engagement of the lungs in infectious endocarditis]. / Porazhenie legkikh pri infektsionnom éndokardite.

Clinical, biochemical, bacteriological, x-ray, electrocardiographic, ultrasonic and morphological examinations for pulmonary pathology were made in 230 patients with infectious endocarditis (IEC) treated in 1982-2001. Pulmonary involvement was found in 30% of the examinees. Pulmonary onset of IEC caused misdiagnosis in 11% cases. Its appearance can be recognized by fever (100% cases), chest pain (73%), cough (50%) and dyspnea (46%). Pulmonary affection and pulmonary onset of IEC were associated with disorders of the mitral (26 and 27%, respectively), aortic (17 and 8%, respectively), tricuspis (5 and 8%, respectively) valves or compound valvular heart disease (43 and 50%, respectively). Bacterial vegetations of the heart valves were detected in 60% patients with pulmonary lesions and 62% patients with pulmonary onset of IEC in transthoracic ultrasonography. Pulmonary lesions and pulmonary onset of IEC were caused primarily by staphylococci (73 and 67%, respectively).

[Myocardial infarction in patients with infectious endocarditis]. / Infarkt miokarda pri infektsionnom éndokardite.

Myocardial infarction (MI) developed in 9% of 230 patients with active infectious endocarditis. Development of MI was associated with worsened clinical course and poorer prognosis of infectious endocarditis. MI manifested with pain in 43 and was painless in 57% of these cases. In 29% of patients initial manifestations of MI were disturbances of cardiac rhythm and conduction, and acute left ventricular failure. This precluded timely electrocardiographical diagnosis. However repetitive ECG recordings allowed to confirm MI in all patients. Elevation of enzymes helped to diagnose MI in 81% of cases. Possible causes of MI were shutting of coronary artery ostium by vegetation from an aortic valve cusp (in 47%) and/or lowering of perfusion pressure in coronary arteries because of severe aortic insufficiency (in 62% of patients). Disturbances of hemostasis with activation of its vascular and platelet elements and hypercoagulation found in all patients with infectious endocarditis also facilitated development of MI. The data obtained explain under investigated sides of pathogenesis of MI in infectious endocarditis and allow to find ways for improvement of its diagnosis and therapy.

High-dose immunosuppression with autologous stem cell transplantation in severe refractory systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an immune-mediated disease that is responsive to suppression or modulation of the immune system. Patients with SLE who experience persistent multiorgan dysfunction, despite standard doses of intravenous cyclophosphamide (Cy), represent a subset of patients at high risk of early death. We investigated the efficacy and toxicity of high-dose immunosuppression and autologous hematopoietic stem cell transplantation (SCT) to treat such patients. Six patients (all female, age 15-29 years) with severe refractory SLE were enrolled in the clinic of our institution from 1998 to 2003. All patients were seriously ill, with SLE disease activity indices (SLEDAI) of 6-30, including two cases with central nervous system lupus, one case with lung vasculitis, and three cases with nephritis and nephrotic syndrome. All patients were registered in the European Group for Blood and Marrow Transplantation (EBMT)/European League Against Rheumatism (EULAR) database. Previous immunosuppression included pulse Cy intravenous, prednisolone (standard doses and pulse therapy), oral Cy and azathioprine, with little or no effect on disease progression. Autologous hemopoietic stem cells were collected from bone marrow (n = 4) or mobilized from peripheral blood with Cy and granulocyte colony-stimulating factor (G-CSF) (n = 2). Pre-transplant conditioning regimens included BEAM +/- ATG (n = 2), melphalan 140 mg/m2 + etoposid 1600 mg/m2 (n = 2) and Cy 200 mg/kg +/- ATG (n = 2). Median time to an absolute neutrophil count (ANC) greater than 0.5 x 10(9)/L and platelet count greater than 50 x 10(9)/L was 13 and 15 days, respectively. Three patients died on days 11, 22 and 63 due to transplant-related complications. The follow-up is now 60 and six months for two patients (complete remission), and 42 months for one other patient (partial response). All patients had experienced multiple and severe episodes of infections pre-SCT and long-term history of corticosteroid therapy (3-14 years). We conclude that achievement of prolonged, corticosteroid-free remissions is a reality. Judicious selection of patients earlier in disease or in remission, but with a high risk of relapse or further progression, will diminish transplantation-related mortality.

[Blood group-specific variability of sialic acid contents in the chorionic gonadotrophin structure]. / Gruppospetsificheskie variatsii soderzhaniia sialovykh kislot v strukture khorionicheskogo gonadotropina.

Low-pressure ion-exchange chromatography was used for isolation of chorionic gonadotropin (hCG) from urine of pregnant women. The purified hCG-preparations from various blood group donors were shown to differ in their sialic acid content. The highly purified hCG-preparations after gel chromatography were analyzed in the reaction of hemagglutination and the preliminary results suggest their blood group specificity.

Effect of the concentration of ionogenic groups in the sorbent on the separation of protein mixtures.

Investigations of sequential and simultaneous sorption of protein pairs on ion-exchangers with various contents of ionogenic groups were carried out. The transition from synergism to competition was shown to take place with a decrease in the content of the ionogenic groups. Of significant importance also is the uniformity of ionogenic group distribution in the sorbent volume. An examination of the dynamics of sorption and desorption of the proteins using sorbents with various contents of ionogenic groups allows to conclude, that the effective processes of ion-exchange chromatography can be realized only provided the competitive mechanism of sorption.