[Computer morphometry of peripheral blood lymphocytes in elderly patients with chronic pyelonephritis.]

The aim of the study was to investigate the peculiarities of morphometric parameters of peripheral blood lymphocytes in chronic pyelonephritis in elderly patients in comparison with young and middle-aged patients. A total of 81 patients with chronic pyelonephritis in the exacerbation phase were examined. All patients were divided into three age groups according to WHO recommendations: the 1st - 42patients of young age (18-44 years); the 2nd - 17 patients of middle age (45-59 years); the 3rd - 22 elderly patients (60-74 years). Computer morphometry of lymphocytes was performed in all examined patients. In elderly patients with chronic pyelonephritis the size and сytoplasmic-nuclear ratio of lymphocytes increase. This indicates the preservation of lymphocyte defense responses at this age. In male patients with chronic pyelonephritis in the 1st and 2nd age groups the size of lymphocytes increases, and in female patients - decreases. The сytoplasmic-nuclear ratio increases in males of these age groups, while it remains unchanged or decreases in females. Indirect indications of reduced immunity in young and middle-aged women with chronic inflammation in the kidneys have been obtained.

Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region.

AIM: To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program. MATERIAL AND METHODS: A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system. RESULTS: 591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction <40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death. CONCLUSION: Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.

[Methodological recommendations for surgical care in patients with hemophilia A receiving prophylactic therapy with emicizumab]. / Metodicheskie rekomendatsii po okazaniyu khirurgicheskoi pomoshchi u patsientov s gemofiliei A, poluchayushchikh profilakticheskuyu terapiyu emitsizumabom.

Methodological recommendations for surgical care in patients with hemophilia A receiving prophylactic therapy with emicizumab. Recommendations of the expert group. Moscow, 2024.

Postcovid-19 Asthenic Syndrome.

Objective. To study the characteristics of asthenic syndrome and the potential for treating it in the postcovid period. Materials and methods. A continuous sampling method was used to select 129 patients (mean age 49.8 ± 8.9 years) after COVID-19. Study patients were selected at the clinical out-patient and polyclinic facilities in Samara in the period July-August, 2020. All patients signed informed consent. The envelope method was used to randomize patients into two groups: the study group (n = 64) received ethylmethylhydroxypyridine succinate (Neurox) 1 tablet (125 mg) three times daily for four weeks; medications in the reference group (n = 65) did not include any substances of the pharmacological antihypoxant/antioxidant/nootrope groups. Three visits (V) were made: the first (V1) was before inclusion in the study; the second (V2) was at 14 days; the third (V3) was on day 28 from treatment initiation. The dynamics of overall status (weakness, fatigue, concentration of attention, vertigo, headache, sleep impairment) were evaluated on a visual analog scale (VAS); the subjective perception of the severity of asthenia (tiredness, physical and mental fatigue, decreased motivation and activity) was evaluated using the Multidimensional Fatigue Inventory, MFI-20); cognitive functions were assessed using the Mini Mental State Examination (MMSA); and autonomic tone was assessed using the Kérdö index. Results. At the end of the study (V3), statistically significant changes in measures (VAS, MFI-20) were seen only in patients of the study group; the Kérdö Index showed no statistically significant differences. Analysis of MMSE data revealed a decline in cognitive functions in both groups, which may be linked with pseudocognitive deficit due to asthenia. Conclusions. Our studies yielded evidence of a high incidence of asthenic syndrome after COVID-19. Neurox decreased the severity and extent of the symptoms of asthenia.

[Post-COVID-19 asthenic syndrome]. / Astenicheskii sindrom u patsientov, perenesshikh COVID-19.

OBJECTIVE: To study the features of asthenic syndrome and the possibilities of its therapy in patients in the post-covid period. MATERIAL AND METHODS: The study included 129 patients with an average age of 49.8±8.9 years who had undergone COVID-19 using a continuous sample method. Patients for the study were selected at the clinical bases of outpatient clinics in Samara (Russia) in July-August 2020. All patients signed an informed consent form prior to enrollment. Patients were randomized into two groups: in the main group (n=64), ethylmethylhydroxypyridine succinate (Neurox) was prescribed 1 tablet (125 mg) 3 times a day for 4 weeks; in the comparison group (n=65), medical drugs (MD) did not contain substances from the pharmacological group related to antihypoxants/antioxidants/nootropics. Three visits (V) were conducted: the first (V1) - the period of inclusion, the second (V2) - after 14 days, the third (V3) - on the 28th day from the start of therapy. The dynamics of the general state (weakness, fatigue, concentration, dizziness, headache, sleep disorders) were evaluated on a visual-analog scale (VAS), the assessment of the subjective feeling of severity of asthenia (fatigue, physical and mental fatigue, decreased motivation and activity) - on Multidimensional Fatigue Inventory (MFI-20), cognitive functions - on Mini-Mental State Examination (MMSE), vegetative tone - according to the Kerdo index. RESULTS: At the end of the study (V3), statistically significant changes in indicators (VAS, MFI-20) were obtained only in the main group patients; no statistically significant differences were obtained for the Kerdo index. Analysis of the MMSE data revealed a decrease in cognitive functions in both groups, which may be associated with pseudocognitive deficits due to asthenia. CONCLUSIONS: We have obtained evidence of a high incidence of asthenic syndrome after COVID-19. Against the background of taking Neurox, there was a decrease in the severity and expression of asthenia symptoms.

[Significance of platelets in inflammatory and thrombotic reactions in the elderly.]

The development of thrombotic reactions that lead to undesirable clinical consequences in the elderly is known in many diseases, including pathology of the cardiovascular system. Today, data on the severity of changes in the hemostatic system in patients with a new coronavirus infection (COVID-19) and the study of platelet and plasma levels are being accumulated. In order to understand some of the mechanisms associated with platelet pathology, we present a review that summarizes information about the pathophysiological reactions of platelets in the conditions of their aging and possible mechanisms of their pathological aggregation. Perhaps the presented fundamental and clinical data will be of interest to a wide audience of specialists to discuss early antiplatelet therapy and its justification not only in patients with cardiovascular diseases, but also with COVID-19.

[The efficacy and safety of eculizumab biosimilar in patients with paroxysmal nocturnal hemoglobinuria. Results of a phase III randomized open-label comparative clinical trial].

AIM: To establish the equivalent efficacy and comparable safety profile of biosimilar Acveris and referent eculizumab product Soliris used for the treatment of paroxysmal nocturnal hemoglobinuria (PNH). MATERIALS AND METHODS: Were included in the phase III multicenter 28 PNH patients, open-label clinical trial. Participants were randomized (1:1) into 2 treatment groups: investigational product (Acveris, n=14) and referent product (Soliris, n=14). Patients received eculizumab as the intravenous infusion 600 mg once a week during the first 4 weeks, 900 mg at week 5 and then 900 mg every 14 days (2 days) up to week 27 of the study. The efficacy, pharmacokinetics, pharmacodynamics, safety and immunogenicity of the compared products were analyzed after the end of 27 weeks of the study. The primary efficacy endpoint was the area under the curve LDH concentrationtime (AUCLDH) throughout the study period weeks 527. RESULTS: The difference between the mean AUCLDH values between the Acveris and Soliris groups was 5380.0 [-38 773.87; 49 533.87] U/ldays. The 95% CI limits for the difference in mean AUCLDH values between the groups fit the preset 95% CI [-146 500.9146 500.9] U/ldays and establish the equivalent efficacy of the biosimilar and referent product according to the primary efficacy endpoint. The safety profile of both Acveris and Soliris was expected and comparable according to the proportion of patients with adverse events. The formation of binding antibodies to eculizumab was not detected in both the groups. CONCLUSION: The study established the equivalent efficacy of biosimilar product Acveris and referent eculizumab product with the evidence of effective suppression of intravascular hemolysis in PNH patients along with a comparable favorable safety profile.

[Results of phase Ib open multicenter clinical trial of the safety, pharmacokinetics and pharmacodynamics of first biosimilar of eculizumab in untreated patients with paroxysmal nocturnal hemoglobinuria during induction of therapy].

Currently, the main pathogenetic method for the treatment of paroxysmal nocturnal hemoglobinuria (PNH) is the treatment with recombinant monoclonal antibodies that block the C5 component of the complement system. Eculizumab is the first biotechnological drug, which is a monoclonal antibody, with proven clinical efficacy and safety for the treatment of patients with PNH, which is used in world clinical practice. In Russia, in the framework of the state program Development of the pharmaceutical and medical industry for 20132020 was developed Elizaria (JSC GENERIUM) the first biosimilar of the original drug eculizumab. AIM: To evaluate the pharmacokinetic and pharmacodynamic parameters, as well as safety and immunogenicity parameters of the drug Elizara in the induction phase of therapy in previously untreated patients with PNH. MATERIALS AND METHODS: The study included 11 patients with PNH aged 26 to 75 years who had not previously received eculizumab. Each of the study participants was injected with the studied drug Elizaria at a dose of 600 mg intravenously once a week for 4 weeks. RESULTS: During the clinical study, it was noted that the concentration of the studied drug significantly increased by the time the infusion was completed and then gradually decreased to a minimum at the end of the dosing interval. The average concentration of eculizumab 5 minutes before the administration of the study drug at all visits exceeded 35 g/ml, the minimum concentration sufficient to completely inhibit intravascular hemolysis in patients with PNH. The pharmacodynamic efficacy of the drug Elizaria was confirmed by a decrease in the concentration of the membrane-attack complex (MAC) after the first infusion of the drug was maintained at stable levels until visit 5. A persistent decrease in the level of MAC and a four-fold decrease in the average values of lactate dehydrogenase to visit 5 from 1286.4 to 280.9 U/l demonstrated a marked decrease in activity and stabilization of the hemolytic process against the background of the induction of therapy with Elizaria at a dose of 600 mg once a week and confirmed the effecacy of the study drug. Among the 9 adverse events, only 5 had a relationship with the studied drug, including one serious adverse event in the form of an allergic reaction, which, according to the researcher, had a possible cause-effect relationship with the infusion of the studied drug. In 2 patients, low-titer binding anti-drug antibodies were detected without neutralizing activity during treatment with the studied drug, which may indicate its low immunogenicity. CONCLUSION: The study evaluated the pharmacokinetic and pharmacodynamic properties of the drug Elizaria in the regimen of induction therapy in previously untreated patients with PNH, confirming its efficacy. The study demonstrated the safety and low immunogenicity of the study drug.

[Antiresorptive-cytokine effects of the chondroprotective therapy in patients with lower back pain]. / Antirezorbtivno-tsitokinovye effekty khondroprotektivnoi terapii u patsientov s bol'yu v nizhnei chasti spiny.

OBJECTIVE: To evaluate the antiresorptive-cytokine effects of chondroitin sulfate on non-specific lower back pain in patients with knee osteoarthritis (OA). MATERIALS AND METHODS: Using the envelope method, 231 patients were randomized into two groups: group 1 (n=116, main) received nonsteroidal anti-inflammatory drugs (NSAIDs) and chondrogard, group 2 (n=115, comparison) received only NSAIDs. The 2-month study included 3 visits (V): V1 - at the beginning of the study, V2 - after 10 days, V3 - after 60 days with the assessment of blood parameters: transforming growth factor ß1 (TFR ß1), interleukin (IL)-1ß and IL-6, beta-Crosslaps, bone matrix formation indicator P1NP (n-terminal propeptide procollagen type 1), and determination of the level of deoxypyridinoline (DPID) in the urine. RESULTS AND CONCLUSION: At the end of the study, there is a significant decrease in all studied cytokines in patients of group 1 compared to group 2, as well as indicators of beta-Crosslaps (p<0,001) and DPID (p<0,001), which may indicate the presence of its own antiresorptive-cytokine effect in chondroitin sulfate.

[General and particular issues of etiopathogenesis of peptic ulcer and gastric cancer: current status of the problem].

The development of peptic ulcer (PU) and gastric cancer (GC) is the result of the interaction of various internal and external factors. Moreover, if the role ofHelicobacter pylori(H. pylori) in the development of diseases of the stomach is fully established, the significance of many other factors continues to be discussed. Serious controversy is caused by the participation of various strains ofH. pyloriin the development of PU and GC. First of all, these are Vac- and Cag-positive strains ofH. pylori. The role of genetic human polymorphism in the development of this pathology is debatable. Especially the interleukin genes and necrotizing tumor factor alpha. The role of environmental factors in the formation of PU and GC is not fully understood. So, the role of alcohol, occupational hazards and drugs in the development of these diseases continues to be discussed. Further study of risk factors for various diseases of the stomach will optimize their prevention and treatment. The review presents a modern view of individual issues in the pathogenesis of PU and GC.

[Therapy of nonspecific lower back pain in patients with high cardiovascular risk]. / Terapiia nespetsificheskoi boli v nizhnei chasti spiny u patsientov s vysokim kardiovaskuliarnym riskom.

AIM: To evaluate the possibility of using symptomatic slow acting drugs for osteoarthritis (SYSADOA) in patients with nonspecific lower back pain and high cardiovascular risk. MATERIAL AND METHODS: The study registered as the observational program 'Possibilities of SYSADOA-therapy in patients with nonspecific lower back pain and high cardiovascular risk' was organized in outpatient clinics with sequential inclusion of patients (n=315) with lower back pain. All patients randomized into 5 main groups by method of envelopes were treated with different SYSADOA. The control group (group 6) included 63 patients without lower back pain syndrome. The duration of follow-up was 9 months. The results of the first 3 months of observation of group 1 treated with chondroitin sulfate (chondroguard) compared to the control group are presented. RESULTS: On the 21st day of therapy, the pain level decreased by more than 62% in group 1. There were no changes in the plasma hemostasis parameters (thrombin time, prothrombin index, activated partial thromboplastin time) and glomerular filtration rate, which was comparable with the control group. CONCLUSION: Chondroguard is safe for patients with comorbid osteoarthritis and high cardiovascular risk both in short and repeated long-term treatment.

Endothelial dysfunction a significant marker of adverse clinical outcome in patients with atrial fibrillation after cardioembolic stroke.

AIM: To study the prognostic significance of endothelial dysfunction (ED) markers in the development of adverse clinical outcome (death) in patients with atrial fibrillation (AF) within a year after cardioembolic stroke. MATERIALS AND METHODS: 260 patients with newly diagnosed (nAF), paroxysmal, persistent and permanent forms of AF who underwent stroke were included. Duration of observation-12 months. V1 - the beginning of the study: V2 - 180 (±5) days and V3 - 360 (±5) evaluated the level of von Willebrand factor (fW), antithrombin III (AT III) and plasminogen. RESULTS: During the year of follow-up, patients with AF who underwent and had a high mortality rate. During the whole period 38 (14.6%) patients died, 15 (23.0%) - in the group with nAF, 6 (9.2%) - in the group with paroxysmal AF, 7 (10.8%) - in the group with persistent AF and 10 (15.4%) - in the group with permanent AF. After a year of follow-up, the level of fW in patients with nAF was higher than in patients of all groups, and statistically significant in patients with paroxysmal and persistent forms of AF. At III was important in the group of patients with nAF and with a constant form of AF, in the same groups there was no statistically significant increase in a year of follow-up. It was found that in survivors with nAF at III (73.54±8.67%) higher (p=0.002) compared with the dead (65.77±6.01%). In the group of patients with paroxysmal AF in survivors of III (77.75±10.15%) higher (p=0.031) compared with the dead (69.25±5.80%). In patients with persistent AF, the survivors of III (76.57±9.09%) were higher (p=0.002) compared to the dead (65.60±2.21%). Taking into account the results of the analysis of the dynamics of ed markers, it can be assumed that AT III is the most accurate prognostic marker for the studied cohort of patients. CONCLUSION: Detection and correction of ED in AF in patients within a year after stroke can optimize the tactics of management of patients and improve the prognosis of the diseas.

[Vitamin D - prognostic marker of the risk of exacerbation in patients older than 60 years with osteoarthritis of the knee (results of the observation program DIANA)].

Aim to study the prognostic significance of vitamin D as a marker of the risk of exacerbation of osteoarthritis (OA) of the knee in patients over 60 years. MATERIALS AND METHODS: The study was conducted from 2016-2018 on the of Samara polyclinics with the inclusion of patients who have applied to a doctor for any reason and have a history of OA of the knee joint with the time of the last exacerbation of no more than 6 months. We evaluated clinical and demographic parameters, information on the drugs taken (drugs), the nature of pain by DN4, the level of cognitive deficiency by MMSE, office blood pressure data, left ventricular ejection fraction, determined the level of hemoglobin, glucose, uric acid, interleukin (IL) 1ß and IL-6, 25(OH)-D. the Duration of follow - up was 36 months. RESULTS: During 2 years of follow - up, 79 (38.3%) patients had exacerbation, which occurred in 19.4% (n=40) of cases during the first year, and in 18.9% (n=39) of cases respectively during the second year. In 35.4% of cases, the neuropathic component of pain was noted with an index of 4.37±1.05 points. Age, 25-OH-vitamin D, IL-1ß, and the presence of diabetes mellitus and chronic kidney disease are factors that affect the prognosis of exacerbation in patients with OA of the knee joint. CONCLUSION: The prognostic significance of vitamin D for the risk of exacerbation in patients with OA older than 60 years (χ2=160.9, р.

[Gastroesophageal reflux disease and esophagitis associated with the use of drugs: the modern state of the problem].

From the standpoint of evidence - based medicine, the ability of various drugs to induce the development of gastroesophageal reflux disease and esophagitis is considered. Thus, all known drugs can be divided into 3 groups: drugs that have the ability to reduce pressure in the lower esophageal sphincter, for example, ß-adrenoreceptor agonists, α-adrenoreceptor antagonists, anticholinergics, calcium channel blockers, nitrates, benzodiazepines (diazepam), estrogen, progesterone, aminophylline (theophylline), tricyclic antidepressants, selective serotonin reuptake inhibitors, glucocorticosteroids; means providing a direct damaging effect on the esophageal mucosa, as well as lowering its resistance reflyuktatu, e.g., bisphosphonates, acetylsalicylic acid / non - steroidal anti - inflammatory agents, anticoagulants, antiplatelet drugs, iron preparations, ascorbic acid, potassium chloride, quinidine, phenytoin, calcium dobesilate, 131I sodium iodide, antibiotics (tetracycline, doxycycline, clindamycin, ciprofloxacin, ornidazole, clindamycin, rifampicin), antitumor agents; drugs that impede gastric emptying: calcium channel blockers, anticholinergics. These data can be used in practice in the choice of treatment tactics, especially in individuals with a diagnosis of gastroesophageal reflux disease or heartburn.

[Interrelation of endothelial dysfunction and parameters of erythrocyte membrane oxygenation in patients with atrial fibrillation, after cardioembolic stroke.]

The aim of our work was to study the relationship between endothelial dysfunction (ED) and erythrocyte membrane oxygenation parameters in patients over 60 years of age with atrial fibrillation (AF) within a year after a cardioembolic stroke. In the period from 01 January 2014 to 30 January 2015. the authors performed a prospective observational study in which, after scrinia by the random number generated 4 groups of patients after stroke: group 1 (n=65) with newly diagnosed AF (ndAF), group 2 (n=65) - paroxysmal form of AF group 3 (n=65) is a persistent form of AF and group 4 (n=65) with permanent form of AF. The duration of observation is 1 year and conducted 3 visits (V): estimation of the parameters of erythrocyte membranes (coefficientpossible the erythrocyte membrane was calculated - dy1/dy2) by the method of laser interference microscopy, the markers of ED - von Willebrand factor, antithrombin III (at III) and plasminogen. Results: a high mortality rate was found during the year after stroke in patients of all groups, and especially in patients with ndAF, where ED disorders and parameters of erythrocyte membrane oxygenation were most significantly revealed. The obtained data allow us to say that in patients with ndAF, after stroke, older than 60 years, there is a relationship between ED and the formation of «hard¼ red blood cells with reduced dy1/dy2.

[Cognitive-cytokine effect of nonsteroidal antiinflammatory drugs in the therapy of elderly patients with osteoarthritis].

The purpose of the study was to evaluate the influence of long-term non-steroidal anti-inflammatory drugs (NSAID) therapy on the dynamics of the severity of cognitive deficits and its association with changes in the level of cytokines in elderly patients with osteoarthritis (OA). The authors performed a prospective observational study during 540±5,5 days, presented in two stages: phase I - the stage of active NSAID therapy; phase II - the stage of non-pharmacological correction of OA. The first stage included 128 patients with OA from 65 to 75 years (average age 70±4,6 years, 10,2% of males and 89,8% female). Patients from the main group were divided into four subgroups: patients of the 1st group (n=30) received the drug etoricoxib at a dose of 60 mg per day; patients of the 2nd group (n=32) - celecoxib at a dose of 200 mg daily, patients of the 3rd group (n=32) - nimesulide in dose of 100 mg per day; patients of the 4th group (n=34) - meloxicam at a dose of 7,5 mg per day. The comparison group consisted of 40 patients with similar clinical and demographic characteristics of OA, not taking NSAIDs in the previous 6 months or during the study. It was determined the pain and stiffness indexes by the WOMAC initially and evaluated the patient status at the MoCA scale and carried out laboratory diagnosis of contents in serum TGF-ß1, IL-1ß and IL-6 at all visits. Statistically significant decrease in the level of cytokines was detected during the period of 1st-3rd visits for all patients in the groups receiving NSAID, also there was an increase in cognitive function on a scale of MoCA with a high degree of correlation in relation to the performance of cytokines to the end of the study. The results of our research allow us to speak about possible influence on cognitive functions of NSAID therapy in elderly patients with OA in real clinical practice.

[Anxiety-related blood pressure variability in patients with atrial fibrillation after cardioembolic stroke]. / Trevozhno-assotsiirovannaia variabel'nost' arterial'nogo davleniia u patsientov s fibrilliatsiei predserdii, perenesshikh kardioémbolicheskii insul't.

AIM: To investigate whether of anxiety-related blood pressure (BP) variability can be corrected in patients with atrial fibrillation (AF) who have experienced cardioembolic stroke (CES). SUBJECTS AND METHODS: The investigation enrolled 125 patients (mean age, 68.5±5.7 years) with AF, who had experienced CES. The patients were randomized into 2 groups by the envelope technique: 1) 63 patients received antihypertensive drugs and an anxiolytic (adaptol) (a study group); 2) 62 patients had antihypertensive drugs only (a comparison group). Effectiveness was evaluated 2 and 6 weeks later from the time course of changes in BP readings obtained by 24-hour Holter monitoring in relation to reactive anxiety (RA) and personal anxiety (PA) scores. The latter were determined using the Spielberger-Hanin Anxiety Self-Esteem scale. RESULTS: The patients with AF who had experienced CES were noted to have high BP variability associated with increased RA and PA scores. Group 1 showed statistically significant improvements in RA and PA 2 and 6 weeks after the start of treatment. The efficiency of anti-anxiety therapy (adaptol at a dose of 500 to 1500 mg/day) in combination with antihypertensive drugs is confirmed by the normalized circadian BP profile. CONCLUSION: The incorporation of an anxiolytic into pharmacotherapy regimens could improve BP, namely, to reduce and stabilize its circadian profile.

[CLINICAL AND ENDOSCOPIC, MORPHOLOGIC AND IMMUNOHISTOCHEMICAL FEATURES OF GASTRIC ULCER IN H. PYLORI-INFECTED INDIVIDUALS RECEIVING CYTOTOXIC THERAPY].

THE PURPOSE OF THE STUDY: To determine the prognostic significance of the expression of molecules of PCNA, Bcl-2, NF-Kb and tachykinins (substance P, neurokinin A) in patients with gastric ulcer (CU) receiving cytotoxic therapy. MATERIALS AND METHODS: Total surveyed 90 patients divided into 3. equal groups. The first comparison group consisted of patients with chronic atrophic H. pylori-associated gastritis (CAG) (30 pers.). A second control group consisted of patients with gastric ulcer (30 pers.). Third, the study group consisted of 30 people. with CU suffering from hematological malignancies, in a period of complete clinical remission of the disease and receiving supportive polychemotherapy (PCT). Patients underwent endoscopy, morphological and immunohistochemical study of the mucous membrane of the antrum and body of the stomach to detect the expression of molecules of PCNA, Bcl-2, neurokinin A, substance P and factor Nf-Kb. RESULTS: The total level of dyspeptic syndrome on visual scale analogue in patients receiving chemotherapy and GU (GUpct) was significantly higher (p < 0.05) compared with patients with GU. It should be noted that patients with GUpct reducing clinical symptoms is much slower (p < 0.05). At the same time in 13 (43.3%) patients with GUpct determines the duration of ulcer healing, whereas in patients with GU in only 4 (13.3%) patients. Patients with GUpct more frequently (p < 0.05) were verified II and stage Ill chronic gastritis (CG), while Stage I--less (p < 0.05). Patients with GUpct significantly more often (p<0.05) was determined by the II degree of CG and significantly less (p < 0.05)--IV degree. Patients with GUpct determined significantly lower (p < 0.05), the expression performance PCNA, substance P and neurokinin A and higher (p < 0.05)--Bcl-2 and factor Nf-kB. CONCLUSION: GU in patients receiving chemotherapy, dyspeptic syndrome is characterized by severe, advanced stage of CG on the background of relatively low severity of CG in accordance with the classification of OLGA (2008). Patients with GUpht have a significant level of violation of regeneration changes how is this atrophy, intestinal metaplasia, dysplasia of gastric mucosa association with gross violations of the processes of epithelial cell homeostasis of epithelial cells regulation after molecules PCNA, Bcl-2, NF-kB and tachykinins (substation P, neurokinin A).

PO-59 - Hemorheologic disturbances as thrombosis risk factor in patients with some myeloproliferative neoplasms.

INTRODUCTION: In today's antithrombotic prevention we forget that hemorheologic abnormalities are part of Virchow's triad. Isn't this one of reasons that venous thromboembolism (VTE) including catheter-related thrombosis (CRT) retain high frequency despite of modern antithrombotic therapy? AIM: The aim was to investigate rheological behavior of blood in patients with some myeloproliferative neoplasms. MATERIALS AND METHODS: The study included 16 adults with Polycythemia Vera (PV), 42 young with acute lymphoblastic leukemia (ALL), and 67 healthy donors as control group. Of patients 38% had thrombosis. We measured plasma viscosity, and whole blood viscosity (WBV) by shear rate from 300 to 5 s-1. Then indices were calculated for erythrocyte aggregation, and deformability, and non-Newtonian behavior of blood. Hematocrit, erythrocytes count, erythrocyte indices, leukocyte count, fibrinogen and B-type natriuretic peptide (BNP) were analyzed simultaneously. RESULTS: Increased WBV revealed totally in PV-patients but not by all shear rates in ALL-patients. Unlike donor, in patients WBV values had no equivalence under sequential one sample measurements with a decrease and then an increase of shear rates. We speculated this difference becomes diagnostic meaning like one and by its size. WBV dependent on leukocytes count, on MCH and mainly on MCV. Forty percent of patients had elevated BNP assuming subclinical cardiac dysfunction. The latter explains discoordinated changes in shear stress values required for fully reversible erythrocyte aggregation. As a result, residual units like "erythrocyte-erythrocyte" and/or "erythrocyte-leukocyte" interferes blood stream and violates mechanically blood flow in small vessels. Moreover in PV-patients but not in ALL-patients we found loss of non-Newtonian behavior of blood later than in control group. Both myeloproliferative neoplasms lead to increased erythrocyte aggregation but not impair deformability of red blood cells. In total these facts explains chronic hypoxia in these patients. CONCLUSIONS: Patients with some myeloproliferative neoplasms has abnormal blood flow properties. Revealed hemorheologic disturbances could be as a trigger to start of VTE or to growth of blood clot in the area of permanent venous catheter. These non-hemocoagulation conditions leaded for thrombus formation makes hemorheologic therapy looking attractive for antithrombotic management. The choice of targeted methods requires to continue this study.

[[Overview Basic Provisions Consensus of the III Working Italian Group for Diagnosis and Treatment of H.Pylory-Infection].]

The purpose of the review. Outline the main points of consensus III Working Group Italian for the diagnosis and treatment of H.pylori-infection. The work of the Working Group III was the clarification of certain provisions of the Maastricht IV consensus, and, namely, the nature of H.pylori relationship with gastroesophageal reflux disease, functional dyspepsia, NSAID / aspirin gastropathy, extra-gastric diseases, detailed scope of the invasive and non-invasive methods of investigation, treatment algorithms updated H.pylori-infection antibiotic growth conditions. Indented understanding of the role of H.pylori eradication in the prevention of gastric cancer.