[Comparative efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney disease].

Aim To compare efficacy and safety of direct oral anticoagulants (DOACs) for prevention of stroke in patients with nonvalvular atrial fibrillation and reduced creatinine clearance.Material and methods Systematic search for literature and indirect comparison of DOACs were performed.Results The indirect comparison included five randomized clinical trials. The DOACs were comparable by the efficacy of preventing stroke and systemic embolism. The safety profiles had differences. Apixaban significantly decreased the relative risk of major bleeding compared to rivaroxaban by 27 % (relative risk (RR) 0.73; 95 % confidence interval (CI): 0.55-0.98). The apixaban advantage was even greater in the group of patients with a creatinine clearance <50 ml/min: RR was reduced by 48 % compared to rivaroxaban (RR=0.52; 95 % CI: 0.32-0.84), by 50 % compared to dabigatran 300 mg/day (RR=0.50; 95 % CI: 0.31-0.81), and by 48 % compared to dabigatran 220 mg/day (RR=0.52; 95 % CI: 0.32-0.85)Conclusion The indirect comparison of DOACs showed that their efficacy was comparable. With respect of safety, apixaban is the preferrable DOAC for patients with atrial fibrillation and creatinine clearance below 50 ml/min.

[Idiopathic hypercalciuria. Diagnosis and treatment].

Most patients with idiopathic hypercalciuria and calcium nephrolithiasis have a family history of the disease. Idiopathic hypercalciuria is a metabolic abnormality with various causes and developmental pathways. The systematic review describes specific mutations associated with idiopathic hypercalciuria and nephrolithiasis. Detection of these mutations may provide a better understanding of the pathogenesis of this heterogeneous disease and personalize patient management depending on the detected polymorphisms. A promising treatment option for a mutation in the vitamin D receptor gene is thiazide diuretics in combination with bisphosphonates. Among bisphosphonates, the drug of choice which has been most strongly supported by research evidence is alendronate.

Great saphenous vein stripping and nerve injury: the role of stripping direction.

AIM: Although saphenous nerve (SN) injury represents a complication of great saphenous vein (GSV) stripping, little is know about the techniques to minimize the risk of nerve injury. This is still controversial if the stripping direction could be related to the incidence of nerve injury. METHODS: A prospective comparative study to compare upwards and downwards total GSV stripping during saphenectomy with regard to the occurrence of postoperative SN injury has been designed. Electroneurogram measurement and clinical identification of nerve injury have been performed 1 day before surgery, 1 week, 12 weeks and 1 year after surgery. RESULTS: Although clinical evaluation of nerve injury was found to be similar among upwards and downwards stripping both at one and 12 weeks after surgery, ENG measurement showed a higher incidence of lesions after the downwards stripping both at one and 12 weeks after surgery. No clinical or ENG findings of nerve injury was found 1 year after surgery. CONCLUSION: Upwards method is less traumatic than downwards total GSV stripping in terms of incidence of SN injury, as confirmed by electrophysiological nerve studies.

[The place of novel oral anticoagulants in prevention and treatment of venous thromboembolism]. / Mesto novykh peroral'nykh antikoaguliantov v profilaktike i lechenii venoznykh tromboémbolii

The notion "venous thromboembolism" combines two processes: thrombosis of deep veins and pulmonary artery thromboembolism. The necessity in long-term adequate anticoagulant therapy as the basic treatment of patients with deep vain thrombosis does not give rise to doubts, it should be started prior to instrumental verification of the diagnosis. The past decade was marked by the appearance on the pharmaceutical market of a new oral anticoagulant: selective blocker of the Xa factor of blood coagulation system - rivaroxaban. According to the data of large-scale randomized clinical trials, the efficacy and safety of rivaroxaban are comparable to those of traditional conventional anticoagulant therapy (non-fractionated/low-molecular-weight heparin NFH/LMW + warfarin). Indisputable advantages of new agents are as follows: the lack of the necessity in laboratory monitoring, no interaction with foodstuff, minimal interaction with other drugs, minimal risk for the development of haemorrhage, and simplicity of dosing.

Safety and efficacy of saphenectomy in elderly patients.

AIM: The aim of this study is to evaluate safety and efficacy of saphenactomy in elderly patients. PATIENTS AND METHODS: A total of 358 patients with varicose veins of the lower limbs treated between January 2001 and December 2011. 213 of these were patients under 65 years old and 145 patients were over this age. We have evaluated short- and long-term complications to compare the results among young and elderly patients. RESULTS: Postoperative complications that occurred were: infection, haematoma, nerve injury (paresthesia and pain) and deep vein thrombosis. Although a trend towards better results was observed among the young patients, no significant differences were shown in our experience. CONCLUSION: Elective saphenectomy has a good outcome also in the elderly patients. The slightly higher rate of complications that occurred in older patients is not significant and does not support advising against the use of this surgical approach in the elderly. So in our opinion saphenectomy is quite safe and feasible also in patients over 65 years.

[Application of extremely high frequency (EHF) therapy as a method of complex therapy of the elderly patients with mixed form of bronchial asthma].

The effectiveness assessment of using EHF-acupuncture to prevent the attacks in the patients of mixed forms of bronchial asthma is given. The article presents the special scheme of treatment of patients of different age groups in different phase of the disease using the points of acupuncture with the application of EHF.

[A method for creating fuzzy neural-network models using the MATLAB package for biomedical applications].

Problems of MATLAB-based simulation of hybrid neural networks for data classification in biomedical applications are considered. The neural-network structure is used as a defuzzifier. Graphic interfaces for constructing fuzzy neural-network models are suggested. Methods for merging models constructed using different MATLAB packages and an algorithm for constructing a fuzzy neural-network model are suggested. The algorithm includes both modules for tuning membership functions of the fuzzy system fuzzifier, and modules for tuning the parameters of the defuzzifier implemented as a two-layer neural-network structure of the perceptron type.

[Effectiveness of laser puncture in elderly patients with bronchial asthma accompanied by chronic rhinosinusitis].

We apply laser puncture to influence biological active points with infra red laser ionizing at scheme with effect of treatment of asthma bronchial with chronic accompanied by rhino sinusitis. The clinical effectiveness of treatment was seen in positive dynamics of clinical, instrumental and spirographycal indices regarding bronchial asthma and concomitant rhinitis as well, which was confirmed by X-ray examination. Application of laser punctureto treat the elderly patients with asthma bronchial accompanied by rhino sinusitis is an effective method having no side effects that can be used in an ambulatory and in a hospital.

[Sarcoidosis and sarcoid-like granulomas in the liver]. / Sarkoidoz i sarkoidopodovnye granulemy v pecheni.

Based on examination of 2450 liver biopsy specimens it has been shown that different granulomas occur in 4% of all the biopsy specimens. Of these, sarcoid-like granulomas are detectable in 13.5% of cases. Diagnosis of liver sarcoidosis is always based on the clinicomorphological findings with regard to an injury to at least of one more organ or tissue characteristic for such a disease. Sarcoid impairment of the liver is not infrequently coupled with chronic liver disease. The greatest difficulties may occur in differential diagnosis between primary biliary cirrhosis and sarcoidosis.

[T-lymphocytes of the gastric mucosa in peptic ulcer]. / T-limfotsity slizistoi obolochki zheludka pri iazvennoi bolezni.

Chronic ulcer edges and pylorus of 6 stomachs removed because of ulcer and 10 biopsies of the stomach pylorus from patients with duodenal ulcer were studied. T-helpers and T-suppressors (cytotoxic) were revealed by the indirect three-step immunoperoxidase method with the use of monoclonal antibodies OKT-4 and OKT-8, respectively. T-suppressors (cytotoxic) prevailed among interepithelial gastric lymphocytes in both normal conditions and ulcer. T-helpers dominated in the mucosa tunica propria. They ensure immunoglobulin synthesis after the antigen stimulation and favour the activation of other immunocompetent cells. Both cell types are found in the lymphoid nodules and their centres. Helicobacter pylori seems to take part in the activation of all components of local immune system of the stomach.

[Liver morphology in delta virus hepatitis]. / Morfologiia pecheni pri del'ta-virusnom gepatite.

Biopsy material from two groups of patients with liver diseases is studied. 12 patients with a high titer of total anti-delta (D)-antibodies are included into the 1st group. In this group, among patients with total antibodies to D-infection D-antigen in the liver tissue is found in 6 cases with a pronounced chronic aggressive hepatitis (CAH) and active liver cirrhosis (ALC). The 2nd group consisted of 30 patients with CAH and ALC and D-antigen was observed in 10 cases. Hepatocyte degeneration and pronounced lobular infiltration were the only distinctive feature of liver morphology in D-positive cases as compared to the D-negative ones. The presence of D-antigen always correlated with an active inflammatory process.

[Stellate reticuloendotheliocytes in cirrhosis of the liver]. / Zvezdchatye retikuloéndoteliotsity pri tsirrozakh pecheni.

The material from 113 point liver biopsies was studied. In 11 biopsy samples hepatic cirrhosis of viral origin was diagnosed, in 15 there was an alcoholic cirrhosis of the liver, and in 23--primary biliary cirrhosis. The comparative group included 8 patients with CPG, 13 with CAG, 32 with alcohol induced fatty dystrophy and 12 with non-alcoholic fatty dystrophy. Twenty six biopsy samples in which there were no inflammatory changes, the hepatic structure was unaltered, were used as controls. Stellate reticuloendotheliocytes were identified by means of acid-alpha-naphthyl-acetate esterase test. Quantitative assessment of stellate reticuloendotheliocytes (SR) was made stereometrically. In cases of primary biliary cirrhosis (PBC), active viral and alcoholic cirrhosis significant SR activation was found (due to hepatic parenchyma necroses) to maintain homeostasis. The biggest SR activation was revealed in PBC which is connected with the involvement of the immune mechanisms in this disease.

[Stellate reticuloendotheliocytes of the liver in chronic hepatitis]. / Zvezdchatye retikuloéndoteliotsity pecheni pri khronicheskom gepatite.

59 liver biopsies were studied. Chronic active hepatitis (CAH) was diagnosed in 25 and chronic persisting hepatitis (CPH) in 8 cases. No liver structure changes or inflammatory processes were found in 26 biopsies of control group. Stellate reticuloendotheliocytes (SR) were identified by a reaction on acid alpha-naphthylesterase. Quantitation of SR was performed stereometrically. The proportion of SR in the control was 1.08 +/- 0.06 v.%, nonactive cells predominated. The quantity and activity of SR in CPH were like control. The number of SR in CAH significantly increased (2.14 +/- 0.17%) as compared to the control. The number of active cells increased up to 42 +/- 5.8% against 30 +/- 3.0% in control. Activation of SR in CAH comparing to CPH is possibly due to step-like necrosis characteristic for CAH. SR phagocyte the products of hepatocyte destruction providing host homeostasis. Activation of SR phagocytosis is followed by an enhanced secretion of lysosomal enzymes having growth stimulating effect. This allows one to speak about the participation of these cells in reparative regeneration of liver.

[Immunoglobulin-secreting stomach cells in peptic ulcer]. / Immunoglobulinsekretiruiushchie kletki zheludka pri iazvennoi bolezni.

The mucous membrane of the fundal and pyloric parts of 26 stomachs resected for peptic ulcer was examined. The edges and bottoms of the ulcers were studied. The cells secreting immunoglobulin (Ig) of A, M, and G classes were detected by indirect immunoperoxidase method. The proportions (in per cent) of lymphocytes, plasma cells and Ig-containing cells were determined stereometrically. The intact mucous membrane of the fundal part contains 2.17% lymphocytes and 7.5% plasma cells. The portions of IgA-, IgM- and IgG-secreting cells were 0.99%, 0.39%, and 0.13%, respectively. In atrophic antral gastritis, plasma cell infiltration of the mucosa increases 2 1/2-fold, the number of lymphocytes remaining unchanged. The number of immunocytes secreting IgA and IgM increases almost 4-fold and that of secreting IgG over 13-fold. In the ulcer edges, plasma cell infiltration of the stroma reached 10.83% whereas the number of Ig-secreting cells was the same as in the pyloric part in the same patients. The activation of the secretory immune system in peptic ulcer is due to significant antigenic stimulation. The most predominant are the IgA-containing cells. A marked increase of IgG synthesis indicates the defect of autoregulation of the local immunity and may be of pathogenetic importance for the development of autoaggression which would facilitate progression and chronicity of the ulcer.