[Markers of the course of obliterating atherosclerosis of lower limb arteries]. / Markery techeniia obliteriruiushchego ateroskleroza arterii nizhnikh konechnostei.

AIM: The purpose of the study was to determine the level of substances damaging the vascular endothelium, as well as to assess their effect on the functional state of the endothelium and the course of obliterating atherosclerosis of lower limb arteries. PATIENTS AND METHODS: The study included a total of 112 people, subdivided into three groups: those with an unfavourable course of obliterating atherosclerosis of lower limbs arteries (n=48) - group 1, patients with obliterating atherosclerosis of lower limbs arteries with a conventionally favourable course (n=48) - group 2, and apparently healthy volunteers (n=16). In all subjects, the following parameters were analysed: stable metabolites of nitric oxide II, endothelin-1, homocysteine and basal insulin. RESULTS: The level of stable nitric oxide metabolites (p<0.001 as compared with group 1; p<0.045 compared with group 2) was lower in the groups of patients with obliterating atherosclerosis of lower limb arteries (88.5±7.3 µmol/L in group 1; 161.5±8.6 µmol/L in group 2) as compared with healthy volunteers (226.0±28.6 µmol/L). In its turn, the level of nitric oxide was statistically significantly lower (p<0.001) in group 1 patients as compared with those of group 2. The level of endothelin-1 turned out to be higher (p<0.001) in group 1 (2.1±0.1 ng/ml) as compared with group 2 (1.6±0.1 ng/ml). Comparing group 1 patients with healthy volunteers (1.4±0.1 ng/ml), the level of endothelin-1 had also higher values (p<0.001). The level of endothelin-1 did not differ (p=0.270) as compared with group 2 and healthy volunteers. Comparing the homocysteine level in patients of the examined groups (20.7±0.8 µmol/L in group 1 patients and 18.1±0.6 µmol/L in group 2 patients) with healthy volunteers (13.0±0.4 µmol/L) demonstrated an increase in the parameters (p<0.001). The level of homocysteine turned out to be higher in group 1 patients than in those of group 2 (p<0.001). The level of basal insulin turned out to be significantly higher in the studied groups of patients with obliterating atherosclerosis of lower limb arteries (24.9±4.6 mIU/L in group 1; 8.0±0.7 mIU/L in group 2) than in healthy volunteers (5.1±0.5 mIU/L). Statistically significant (p<0.001) hyperinsulinemia was observed in group 1 as compared with group 2. CONCLUSION: Hyperhomocysteinemia and hyperinsulinemia are predictors of an unfavourable course of the disease. In a high level of these parameters, one may predict an unfavourable course of obliterating atherosclerosis of lower limb arteries.

In Vitro Effects of Sodium Nitroprusside and L-Nω-Nitroarginine Methyl Ester (L-NAME) on Activity of Lysosomal Cysteine Proteinases and Lysosomal Membrane Permeability.

The direct effect of 5 mM L-NAME and 0.1 mM sodium nitroprusside on activity of lysosomal cysteine proteinases and permeability of lysosomal membrane was studied in vitro after 1, 2, and 4 h of incubation. Isolated from the liver of intact female rats lysosome suspensions were used. Both substances reduced total activity of cathepsin H and did not affect cathepsin B at all time intervals. L-NAME increased cathepsin L activity at all incubation times, while sodium nitroprusside increased activity of this enzyme after 2-h incubation and reduced it incubation after 4-h incubation. L-NAME demonstrated a membrane-destabilizing effect in in vitro experiments, while sodium nitroprusside on the contrary stabilized lysosomal membranes.

[Medical care of adolescents]. / Meditsinskoe obespechenie podrostkov.

The authors discuss staged transfer of adolescents aged 15-17 years to pediatric outpatient institutions by discontinuing their transfer to general therapeutic and prophylactic institutions and thus initiate continuous medical services for children till the age of 18 years within the framework of pediatric service. Experience gained in the Ryazan region is presented and the basic features in organization of public health organs and institutions of the territory in this direction are described; the role of complex prophylactic measures and inter-departmental approach to solution of this problem are discussed.