[Vibroacoustic factors hygienic regulation principles in Russia and abroad evolution and succession].

Brief historical summary about Institute' vibroacoustic factors investigations development in the XXth century is presented. There are shown the data of noise, vibration, ultra- and infrasound hygienic rating in comparison with international approaches; the ways of its international harmonization in modern social and economic situation are selected.

[Functional state of the liver at modeling hemodynamic effects of the weightlessness in human organism].

The radioisotope researches (RR) ofcholeresis function of a liver, the ultrasonic researches (USR) of a liver, the contractile gallbladder function (GF) and the gastroduodenoscopy (GDS) were carried out at 8 men after 24 hour duration of stay in antiorthostatic position--12 degrees (AOP), simulating arising in weightlessness of hemodynamics changes in abdominal cavity. The dynamic difficulty of venous blood outflow from a liver at simulated in antiorthostatic position changes of activation choleresis on an empty stomach was produced, by increase of a zone central perfusion of a liver parenchyma, biliary ductules dilation and of a gallbladder reduction, and were accompanied by choleresis in duodenum. The activation choleresis in a liver was accompanied by of reduction of the area of radioactive marker distribution in a liver, the decrease of hepatocytes metabolic activity and concentration function ofbiliary excretion system. Specificity of a functional condition of a liver within AOP reflects reaction caused by plethoric changes induced by body position, which is negative to vector of gravity. The mechanism of the revealed changes includes occurrence dynamic venous plethora in a liver, centralization hepatic blood flow with activation choleresis activity against the background tissual blood flow depletion in peripheral zones, reduction of hepatocytes metabolic activity and concentration function biliary excretion system.

[Ultraviolet rays: problems of hygienic evaluation of the sources and regulation of the effects].

The article presents characteristics of ultraviolet rays sources used for prevention, treatment and for tanning. Difficulties in hygienic evaluation of goods are revealed. The authors defined ways to solve this problem--specify metrological support for supervision, create regulation document on sanitary and hygienic evaluation of ultraviolet rays sources.

[Coronary artery disease after renal transplantation: epidemiology, risk factors, and surgical approaches to treatment].

Coronary artery disease (CAD) is the main cause of death in renal transplant recipients. The aim of the present study was to determine the frequency and risk factors of post-transplantation CAD and its influence on the long-term results of surgery, as well as to evaluate the efficiency of myocardial revascularization in patients with severe CAD. Analysis of the observation of 479 renal recipients (332 men and 147 women) aged 38.69 +/- 11.2 was performed. The mean follow-up period was 64.56 +/- 37.44 months. Sixty-eight patients had diabetes mellitus. CAD was diagnosed in 14.8% (71 out of 479) renal recipients; in 12.7% of patients it developed de novo and was revealed 32.4 +/- 18.6 months after the surgery. Ten-year survival of renal recipients with CAD was only 39%, while in the group of non-CAD patients it was 75% (p < 0.0001). Age more than 45, male gender, diabetes mellitus, hypercholesterolemia, infections, pre-existing left ventricular myocardial hypertrophy, and renal transplant dysfunction were defined as significant risk factors of CAD de novo. Multi-factor Cox model found only age more than 45 (p < 0.009), male gender (p < 0.00001), and hyperlipidemia (p < 0.0058) to be independent risk factors of CAD. Myocardial revascularization was performed in 29 patients with coronary lesions: 27 patients underwent percutaneous transluminal coronary angioplasty with stenting and 2 patients underwent coronary artery bypass grafting (5 and 52 months after renal transplantation). However, angioplasty had to be repeated in 6 out of 27 (22%) patients within 3 to 6 months. The average follow-up duration was 23 months (2 to 74 months) after revascularization. Prolonged effect (more than 12 months) was achieved in 17 out of 29 (58.6%) patients. None of the patients developed myocardial infarction after revascularization. Two patients died 28 and 35 months after angioplasty due to extracardial complications (hepatic cirrhosis and an oncological disease); one patient died 78 months after repeated revascularization from progressive cardiac insufficiency while receiving dialysis due to a relapse of renal transplant insufficiency. Thus, CAD develops in 14.8% of renal transplant recipients; in 12.7 of patients it develops de novo. There are conventional and nonconventional post-transplantation CAD risk factors, which include renal transplant dysfunction and post-transplantation infections. Association with myocardial hypertrophy, observed in a significant number of patients, is a feature of post-transplantation CAD. Coronary revascularization, angioplasty with stenting in particular, may be considered to be an effective method of CAD treatment in renal transplant recipients.

[Hyperhydration and the cardiovascular system in patients receiving hemodialysis].

In order to evaluate the influence of volume overload on the cardiovascular system, patients on program hemodialysis were examined using ultrasonography and isotope ventriculography. The study revealed a doubtless correlation between hyperhydration, on the one hand, and arterial hypertension, an increased minute volume, and left ventricular hypertrophy, on the other. A growing left atrial contribution was shown to play an important role for the maintenance of an adequate left ventricular filling during a session of hemodialysis with ultrafiltration. The study also found paradoxal blood sequestration in the venous system during the process of ultrafiltration in patients with high parathyroid hormone levels.

Two-plane symmetry in the structural organization of man.

Manifestations of symmetry in the human structural organization in ontogenesis and phylogenetic development are analysed. A concept of macrobiocrystalloid with inherent complex symmetry is proposed for the description of the human organism in its integrity. The symmetry can be characterized as two-plane radial (quadrilateral), where the planar symmetry is predominant while the layout of organs of radial symmetry is subordinated to it. Out of the two planes of symmetry (sagittal and horizontal), the sagittal plane is predominant: (a) the location of the organs is governed by two principles: in compliance with the symmetry planes and in compliance with the radial symmetry around cavities; (b) the location of the radial symmetry organs is also governed by the principle of two-plane symmetry; (c) out of the four antimeres of two-plane symmetry, two are paired while the other two have merged into one organ; (d) some organs which are antimeres relative to the horizontal plane are located at the cranial end of the organism (sensory organs, cerebrum-cerebellum, heart-spleen and others). The two-plane symmetry is formed by two mechanisms--(a) the impact of morphogenetic fields of the whole crystalloid organism during embriogenesis and (b) genetic mechanisms of the development of chromosomes having two-plane symmetry. When comparing mineral and biological entities we should consider not the whole immobile crystal but only the active superficial part of a growing or dissolving crystal, the interface between the crystal surface and the crystal-forming environment which directly controls crystal growth and adapts itself to it, as well as crystal feed stock expressed in the structure of concentration flows. The symmetry of the chromosome, of the embrion at the early stages of cell cleavage as well as of some organs and systems in their phylogenetic development is described.

[Maintenance of the hypnotic component of general anesthesia with feed-back regulation]. / Podderzhanie gipnoticheskogo komponenta obshchei anestezii s reguliatsiei po printsipu obratnoi sviazi.

The purpose of the study was to design and investigate the closed-loop propofol system (CLPS) with a mean arterial pressure (MAP) controller in open-heart surgery. CLPS consists of a 386 PC, a blood pressure sensor and an infusion pump. The C language computer program sets the propofol infusion rate based on an empirical algorithm including proportional component to maintain the measured MAP more closely to the target MAP (85% of patient standard MAP). The propofol concentrations were calculated by the pharmacokinetic/pharmacodynamic model differential equations solving every 30s. CLPS was used in 214 NYHA II-IV patients, aged 16-74, undergoing various open-heart procedures. The mean target MAP was 75.2 +/- 4.5 mm Hg. The measured and target MAP difference did not exceed 22% perioperatively. The bispectral index varied from 42.7 +/- 1.2 (tracheal intubation) to 41.8 +/- 0.1 (skin suture) with a variation of the propofol site effect concentration ranging from 2.9 +/- 0.09 to 1.8 +/- 0.1 microg/ml. It was a closed negative correlation (r = 0.84; p < 0.01) between the propofol site effect and the MAP during the initial period of anesthesia. There were not any significant changes in the blood cortisole level during the procedures. The recovery time was 1.4 +/- 1.5 min after propofol infusion; 95.5% of patients were extubated in the operating room.

[Rocuronium (esmerone) in anesthesia during surgery under extracorporeal circulation]. / Rokuronium (ésmeron) pri anesteziologicheskom obespechenii operatsii s iskusstvennym krovoobrashcheniem.

The study was undertaken to examine the myoplegic, hemodynamic, and histamine-releasing effects of the new aminosteroidal myorelaxant Rocuronium (esmerone, Organon firm) used to maintain anesthesia in cardiac surgical patients by orienting to early tracheal extubation. Twenty two patients aged 50 +/- 3 years operated on under extracorporeal circulation were examined. At the initial stage of maintenance, the agent in a dose of 0.6 mg/kg failed to affect cardiac pump function and to elevate plasma histamine levels. A moderate vagolytic effect was shown in 45% of cases. The incidence of myoplegia reduced in patients with significant circulatory insufficiency. In the preperfusion period, Rocuronium in a dose of 10.2 +/- 0.9 micrograms/kg/min blocked neuromuscular conduction (NMC) at a level of 5.1 +/- 1.8 to 19.2 +/- 3.5%. During hypothermic extracorporeal circulation and postperfusion period, the dosage of the myorelaxant substantially decreased. After termination of Rocuronium infusion, the time of up to 95%-recovery of NMC was 63 +/- 6 min. Early tracheal extubation was conducted in 68% of the patients 69 +/- 7.6 min after the end of the operation. Residual myoplegia was absent. The predictable recovery of NMC following the use of Rocuronium creates conditions for early activation of patients operated on under extracorporeal circulation.

[New hygienic requirement in work with lead]. / Novye gigienicheskie trebovaniia pri rabote so svintsom.

A project "Hygienic requirements for work with lead" is specified. The project covers principal hygienic requirements for production (including small and individual enterprises) where lead is the main occupational hazard and determines work conditions and prophylactic measures. The authors considered new prophylactic approaches--average shift MAC for the air of workplace (0.05 mg/m3) and monitoring of serum lead level in accordance with exposure grade.

[Importance of hygienic monitoring in detection of etiological mechanisms of chronic lead poisoning in battery production plants]. / Znachenie gigienicheskogo monitoringa v vyiavlenii zakonomernostei razvitiia khronicheskoi svintsovoi intoksikatsii na predpriiatiiakh akkumuliatornoi promyshlennosti.

The authors demonstrate importance of hygienic monitoring for describing the course of chronic lead intoxication among workers of storage battery production. The authors specify and describe the principles of hygienic monitoring program, grouped and individual parameters (hygienic, medical and biologic) that are risk factors for chronic lead intoxication and subjects of control. The article contains some examples demonstrating possibilities of hygienic monitoring for matching the occupational morbidity parameters of storage battery production workers with work conditions and other parameters influencing the disease.

[Materials for adjusting MAC of lead in the workplace air]. / Materialy k korrektirovke PDK svintsa v vozdukhe rabochei zony.

The authors present materials of clinical and hygienic study checking MAC for lead in the air of workplace. The study covered 506 workers of printing, nonferrous metallurgy plants and storage battery production. The study included examination of cardiovascular, nervous, digestive systems and laboratory values and revealed high diagnostic value of serum lead level and low one of urinary lead level. High number of the groups examined and mathematical processing of incomplete selects (Caplan--Meyer assess) proved that intoxication resulted from higher lead concentrations (0.58-0.8 mg/m3). The lead levels of 0.2 mg/m3 in 23.7% of cases induced changes of 2-3 laboratory values-first signs of lead intoxication--and in 5.2% of cases some symptoms of vegetative sensory polyneuropathy were seen. These lead levels are therefore determined as minimally acting. Calculations of probability parameters for health risk helped to set MAC for lead in the air of workplace at 0.05 mg/m3 (this value is accepted by Russian Health Ministry) with mandatory control of serum lead level.

[The conclusions from an analysis of 9 approaches to determining the value of KT/Vur]. / Nekotorye vyvody iz analiza 9 podkhodov k opredeleniiu KT/Vur.

Causes underlying different results in estimation of KT/V (ur) according to 9 mathematical models are analyzed. These models are the following: 1) classic approach F.A. Gotch, 2) estimation according to E.G. Lowrei, KT/V = KT/0.6* (body mass), 3) according to R.M. Hakim, KT/V = ln(CoC), 4) according to K.K. Jindal, KT/V = 0.04*(1 - C/Co)*100% - 1.3; 5), 5) according to P. Calzavara, KT/V = (Co - C)*2/(Co + C), 6) according to J.T. Daugirdas, KT/V = ln[C/Co - 0.03 - UF/(dry mass), 7) according to C. Basile, KT/V = 0.023(1- C/Co*100%- 0.284, 8) according to P. Malchesky, 9) according to L. Garred et. al. Basing on the results of examination of a random sample of 120 patients on chronic dialysis it is inferred that the results obtained according to the approaches 1, 3 and 5 are more dependent on emergence of water sectors during the procedure leading to underestimation of KT/V value. In approaches 2, 8 and 9 the dialysis "dose" is estimated with minimal error. It is believed insufficient to estimate dialysis adequacy by KT/V only. It is proposed to make allowances also for the value of the ratio of true to apparent volume of urea distribution. The estimation should be made according to the formula: V/V = ln(Co/C)*0.6* (body mass)/KT.

[Comparison of different ways of measuring the obtained dose of hemodialysis]. / Sravnenie razlichnykh sposobov izmereniia poluchennoi "dozy" gemodializa.

The paper analyses the reasons for different variations from the calculation of KT/V(ur) by using 9 mathematical models. Analysing the survey data on 120 randomly selected patients on chronic hemodialysis has led to the conclusion that the data obtained by models 1, 3, and 5 more greatly depend on the patient's body compartmentization during a dialysis session than those by models 2, 8, 9 and they generally lower KT/V calculations as they overestimate the urea distribution volume, while with models 2, 8, and 9 the resultant dialysis dose is calculated with less errors.

[The functional characteristics of the calcium-regulating systems and the calcium content of the blood following a cadaveric kidney allograft]. / Osobennosti funktsional'nogo sostoianiia kal'tsiireguliruiushchikh sistem i soderzhanie kal'tsiia v krovi posle allotransplantatsii trupnoi pochki.

Total plasma calcium (Ca), Ca renal reabsorption, Ca tissue transport, parathyroid hormones and calcitonin were measured in fasting 30 recipients of a renal allotransplant, 95 healthy subjects, 9 primary hyperparathyroidism patients, 12 patients with bronchial asthma and exogenic hypercorticism. Total Ca proved normal in 26 but lowered in 4 recipients. Canalicular Ca reabsorption got enhanced in 17 recipients with high parathormone levels in 10 of them. Normal Ca reabsorption was registered in 13 recipients through parathormone elevated in 6 of them. Tissue Ca binding enhanced in its high reabsorption in the transplant. The binding did not depend either on parathormone secretion intensity or cyclosporin A treatment, being partially determined by steroid therapy. When investigated under Ca intravenous drop infusion in 20 recipients and 14 healthy subjects, Ca tissue binding confirmed its physiochemical nature and revealed in one third of the recipients impaired buffer capacity of the tissues as well as Ca retention and release rates. The impairment was related neither to changes in the basal level nor with secretion fluctuations of parathormone and calcitonin. Increased tissue Ca binding accounts for the absence of hypercalcemia in renal transplantation.

[The occupational morbidity of workers in the foundry shops of Russia]. / Professional'naia zabolevaemost' rabochikh liteinykh tsekhov v Rossii.

Epidemiologic studies concerning the occupational morbidity of the foundry workers were carried out for the first time within the Russian Federation. Studies revealed the causes of diseases during 13 years, helped to create the structure and prevalence of entities and analysed the parameters of development and course of diseases, which helped to define the risk groups in silicosis and vibration disease formation and establish the prophylactic measures.

[Neuroendocrine disorders in brain-dead donors at the time of multiorgan harvesting]. / Neiroéndokrinnye rasstroistva u donorov so smert'iu mozga vo vremia operatsii mul'tiorgannogo zabora.

Changes in the level of antidiuretic hormone (ADH), adrenocorticotropic hormone (ACTH), somatotropic hormone (STH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), prolactin (PL), thyroxin (T4), triiodothyronine (T3) and thyroxine-binding globulin (TBG) have been assessed before and during multiorgan excision in 22 donors with brain death. A progressing decrease in ADH blood supply and changes in ACTH, STH, FSH and PL content have been recorded. No regularities have been observed in LH level changes. TSH and thyroid hormone changes were in most cases characterized by a gradual decrease in their plasma levels. A drop in T3 concentration observed at the initial stage of the study was most pronounced with practically normal T4 and TBG values, that also decreased by the moment of heart excision. It has been concluded that brain death is accompanied by a considerable neuroendocrine disfunction and a marked syndrome of low T3 content.

[The mechanisms of the disorder of calcium homeostasis in terminal kidney failure and the allotransplantation of a cadaver kidney]. / Mekhanizmy narusheniia gomeostaza kal'tsiia pri terminal'noi pochechnoi nedostatochnosti i allotransplantatsii trupnoi pochki.

Overall 34 patients with terminal renal failure (TRF) and 81 recipients of the allotransplanted cadaveric kidney (ACK) were examined. It has been established in in-vitro experiments with modulated by additions of EDTA to the plasma and CaCl2 hypo- and hypercalcemia that the magnitude of bound calcium (standardized at the concentration of ionized calcium-Ca++1 mmol/l) decreased in the blood plasma in 65 and 61% of cases. Besides protein-bound calcium dropped in 94 and 91% of cases; the total buffer capacity of the plasma and buffer capacity of proteins fell in 59 and 87% of cases in TRF and ACK, respectively. The rise of the Ca++ content on an empty stomach seen in 21 out of 99 patients with TRF and in 42 out of 98 recipients of the ACK was caused by a decrease of calcium binding in the blood plasma, not made for by the fall of calcium supply to the blood because of "tertiary" hyperparathyroidism. Hypocalcemia detected in 38% of TRF patients was consequence to the rise of calcium binding not made for by the increased calcium supply to the blood provoked by bone resistance to parathyroid hormone.