[Proinflammatory laboratory predictors of pneumonia in ischemic stroke patients: prospective study].

BACKGROUND: Bacterial pneumonia is a frequent complication of ischemic stroke at the hospital stage. The search for prognostic laboratory markers of pneumonia remains an urgent task, as it will allow to individualize the approach to the treatment and rehabilitation of such patients. AIM: To investigate the prognostic significance of proteins of the acute phase of inflammation, as well as to evaluate them as early predictors of the development of pneumonia in patients with ischemic stroke. MATERIALS AND METHODS: The study included 302 patients in the acute period of ischemic stroke. C-reactive protein (CRP), tumor necrosis factor , interleukin-6 (IL-6), neutrophil elastase, neopterin, serum amyloid A (SAA), secreted phospholipase type 2 (sPLA2) were determined in all patients on the first day by enzyme immunoassay. Statistical data processing was carried out using SPSS and Microsoft Excel software (USA). RESULTS: At the hospital stage, pneumonia developed in 82/302 patients (27.2%; 95% confidence interval 22.332.3%). The levels of CRP, IL-6, sPLA2, SAA and neopterin significantly differed in the presence and absence of pneumonia. Step-by-step logistic regression analysis revealed the significance of IL-6 and CRP concentrations in the prognosis of pneumonia. The threshold value of IL-6 concentration was 3.45 pg/ml (sensitivity 82.4%, specificity 66.7%). The prognostic value of a positive result (PPR) in the prognosis of pneumonia was 40%, a negative result (PNR) 92%. The threshold value of CRP was 1640 mg/l with a sensitivity of 65.8% and a specificity of 74.8%. The PPR of the threshold value of the concentration of CRP was 45%, PNR 80%. CONCLUSION: The measurement of the concentration of IL-6 and CRP on the first day of ischemic stroke makes it possible to identify patients with the greatest risk of pneumonia at the hospital stage. The results of the work indicate the necessity to include CRP and IL-6 in the list of mandatory laboratory tests that should be carried out for each patient with ischemic stroke on the first day from the onset of the disease.

[Biochemical markers of thrombotic complications in the acute period of ischemic stroke].

AIM: To study the profile of biochemical markers of the hemostasis system, to clarify their role and relationships in the pathogenesis of the development of thrombotic complications (TC) of ischemic stroke (IS) and the associated assessment of the possibilities of their diagnostic application. MATERIALS AND METHODS: The study group included 302 patients (164 men, 138 women) who were admitted to the hospital with a diagnosis of IS within 24 hours of the onset of the disease. The diagnosis was confirmed by computed tomography. The average age of patients was 69 (5088) years. Blood was taken from all patients on the 1st day of the disease to determine the profile of analytes presumably associated with the pathogenesis of TC. Levels of homocysteine, protein C inhibitor, thrombomodulin, plasminogen, tissue plasminogen activator, urokinase, plasminogen activator type 1 inhibitor, t-PA/PAI-1 complex, vitronectin, plasmin-2-antiplasmin complex, D-dimer, fibronectin were determined in blood serum by ELISA. RESULTS: TC in the acute period of IS (up to 21 days) were recorded in 32 (10.6%, 95% CI 7.3714.3) patients, of which pulmonary embolism was observed in 27 (8.94%, 95% CI 5.9812.4) patients, deep vein thrombosis in 5 (1.66%, 95% CI 0.473.47) patients. The results of the study of a panel of specific proteins involved in pathogenetic processes accompanying necrosis of brain tissue in IS demonstrated that of the entire list of markers of the hemostasis system activation selected for the study, the most significant are: the concentration of fibronectin in the prognosis of the absence of TC with a threshold value of more than 61 mkg/ml and OR 4.4 (95% CI 1.512.9, p=0.011), and the concentration of the t-PA/PAI-1 complex in the prognosis of the development of TC with a threshold value of more than 14 ng/ml and OR 11.3 (95% CI 1.18109.3, p=0.03). CONCLUSION: The significance of the t-PA/PAI-1 complex and fibronectin as markers of TC in IS may be due to a violation of the activation processes of the fibrinolytic link of hemostasis and the accumulation of non-deposited compounds that damage the vascular wall.

[Modern endourological technologies new opportunities in the treatment of patients with urinary tract anomalies and in complex clinical cases].

The clinical examples of the use of modern endoscopic minimally invasive technologies in patients with urinary tract anomalies and in complex clinical cases are presented in the article. The techniques and features of percutaneous nephrolithotomy, retrograde intrarenal surgery (RIRS), antegrade ureteroscopy using f lexible scope in this category of patients are discussed. The paper confirms the efficiency and necessity of further development of endourological methods for the treatment of urolithiasis.

[Road combined trauma of the urinary system organs: organization and clinical tactics in a multidisciplinary hospital].

INTRODUCTION: Damage to the organs of the urinary system (UMS) in road trauma (DT) is 4%, of which multiple and combined - over 70%. The aim of the study is to determine the main organizational and clinical directions for improving the EMC in case of trauma OMS in a trauma center of the 1st level. MATERIAL AND METHODS: For the period from 2017 to 2020. 508 injured with road polytrauma were admitted to the hospital. Of these, trauma and secondary injuries were diagnosed in 108 people (21.3%), which were divided into three groups: the first - 73 (67.6%) victims with the injury of the OMVS, the second - 25 (23.1%) with secondary damage kidney, the third - 10 (9.3%) patients with "neurogenic bladder" with spinal trauma. The assessment of the severity of damage was carried out using the ISS scales and tables of the IH P and IH C. RESULTS: It has been shown that the introduction of an interdisciplinary approach to the organization of in-hospital routing and differentiated algorithms of medical and diagnostic tactics based on the concept of traumatic disease, led to the establishment of a final diagnosis in every third victim in the early stages, as well as to a decrease in the overall mortality rate by 3.7%, the overall mortality rate was 12,2%. The key directions for improving the efficiency and quality of care in case of dominant and concomitant trauma of the urinary system have been identified, based on the tactics of programmed multistage surgical treatment (Damage Control Urological). CONCLUSION: In the FSBI "3CVKG A.A. Vishnevsky "developed, organized and implemented a system and algorithm for the provision of specialized medical care for trauma to the Ministry of Railways, including high-tech assistance to victims of road accidents, associated with the regional and federal services of disaster medicine.

A method for analyzing the typical structure of direct costs in the cost of a laboratory test.

The basis for calculating the cost price of any product, including laboratory tests, is based on an estimate of direct costs of the production. At present, there are no systematic ideas about the structure of such costs, and approaches to their analysis have not been defined, in the management practice of medical laboratories. The purpose of this work was developing and testing a method for analyzing the structure of direct costs and their allocation bases when calculating the cost of a laboratory test. We analyzed data on the volume of laboratory tests performed in the clinical diagnostic laboratory of the National Medical Research Center of Cardiology, prices for purchased reagents and consumables, depreciation and maintenance costs of equipment, staff salaries. As a result, we proposed a typical component structure of direct costs, established the allocation bases of fixed costs, and determined the ratio of some variable cost components to onе product unit cost. On the basis of these concepts, an algorithm for calculating the total direct laboratory (technological) cost per test has been developed, which makes it possible to simulate the cost structure under conditions of arbitrarily specified variables. During the testing of the algorithm, the values of direct costs and the technological cost per test were calculated for billable (ordered) laboratory tests. Comparison of the economic efficiency of various methods, as well as modeling of changes in the cost depending on the volume of testing and the turn-around time (TAT) has been performed. It can be concluded that the approach to creating the tables of the technological cost per test based on dividing direct costs into variable and fixed costs and structuring them by components and allocation bases is an effective tool for medical laboratory management.

[Dynamics of Holter electrocardiogram monitoring in patients with chronic heart failure and atrial fibrillation on the background of cardiac contractility modulation].

AIM: To evaluate the dynamics of cardiac arrhythmias on the background of cardiac contractility modulation (MCC) in patients with chronic heart failure (CHF) and various forms of atrial fibrillation (AF) on the basis of daily electrocardiogram (ECG) monitoring. MATERIALS AND METHODS: In 100 patients with CHF and AF, the following studies were performed before implantation of the MCC device and after 12 months of follow-up: 12-channel ECG with an estimate of the width of the QRS complex, transthoracic echocardiography (EchoCG), and Holter ECG monitoring. All patients received long-term optimal drug therapy for CHF before surgery. RESULTS: The results obtained indicate that there is no effect of MCC on the development and progression of ventricular arrhythmias in patients with CHF and AF during the year of follow-up, both extrasystole and tachyarrhythmias, regardless of the etiology and LVEF (less than 35% or more than 35%), and a decrease in the frequency of AF paroxysms in patients with CHF during treatment. These results are due to the reverse remodeling of the LV myocardium under the influence of the MCC device. CONCLUSION: The use of MСС in patients with CHF and AF is a safe method of therapy that does not induce cardiac arrhythmias, including ventricular extrasystole. Large-scale comparative studies are required to evaluate these results.

[Laboratory diagnostics in medicine].

The development of clinical laboratory diagnostics is in line with the evidence-based medicine, which requires that clinical decisions have to be based on diagnostic methods with proven informativity. This creates a request for the scientific validity of the use of laboratory researches and application of probabilistic interpretation tools corresponding to the tasks. The concept of indefiniteness (analytical, biological and clinical) is at the heart of interpretation of laboratory results. The inclusion of laboratory research in clinical guidelines, the choice and appointment of this research to the patient should not be made from the position of ideas about increasing or decreasing the laboratory index in the disease, but on the basis of its scientifically proven characteristics as a laboratory biomarker sensitivity, specificity, predictive value, as well as the relationship with certain clinical events, outcomes, risks. These characteristics are probabilistic and can be defined.

[Heart - type fatty acid binding protein in prognosis of ischemic stroke at the hospital stage].

Heart - type fatty acid binding protein (h-FABP), in addition to myocardium, is also contained in the brain cells. The blood concentration of h-FABP in cerebral ischemia can be a marker of ischemic stroke course. AIM: To investigate the importance of h-FABP in the prognosis of ischemic stroke (IS). MATERIALS AND METHODS: The study included 302 patients in the acute period of ischemic stroke. All patients were determined the concentration of h-FABP in the serum 1 day by enzyme immunoassay. SPSS and Microsoft Excel software were used for statistical data processing. RESULTS: The most frequent adverse events at the hospital stage were lethal outcome (LO), thrombotic complications and pneumonia. Statistically significant differences in the level of h-FABP between the groups of presence and absence of LO were revealed both by confidence intervals of Central values and by statistical criteria. The ROC analysis values of h-FABP in the presence of the LO confirmed its predictive value, area under the curve amounted to 0.776±0.061 (0.655-0.896), p.

[MicroRNAs as Biomarkers of Cardiovascular Diseases].

The fact that microRNAs play an important role in the development and pathogenesis of cardiovascular disease is beyond doubt. This article provides a brief overview of recent data that relate to microRNA expression in various cardiovascular diseases. Detecting significant changes in the level of expression of these molecules in various diseases means that microRNAs can be considered to be potential biomarkers of human pathologies including heart failure. Studying the relationship between the mechanisms of cardiovascular disease and the level of expression of a variety of microRNAs, as well as establishing their exact relationships with the genes is an urgent problem and requires further research.

[Peculiarities of diagnosis and treatment of kidney cancer in the central military hospital].

tumor based on analysis of the treatment of patients with kidney cancer in 1339 received. Studied the characteristics such as the stepwise distribution of patients, incidence of histological types of kidney cancer, and varying degrees of tumor differentiation, the proportion of organ and organ-resecting interventions, methods of drug treatment, adoptive immunotherapy. The information about the features of.

[Translational medicine in Russian cardiology: a new stage or repetition of the past?] / Translyatsionnaya meditsina v rossiiskoi kardiologii: novyi etap ili povtorenie proidennogo?

The brief review gives the experience in using the concept of translational medicine in the practical activities of the Russian Cardiology Research and Production Complex in the past 25 years of its existence. It outlines the possible ways of developing this area in Russian medicine to solve crucial scientific and practical tasks.

Аннотация В кратком обзоре представлен опыт использования концепции трансляционной медицины в практической деятельности ФГБУ РКНПК в течение последних 25 лет существования данной организации. Очерчены возможные пути развития данного направления российской медицины для решения актуальных научных и практических задач.^ieng

[Characteristics of immune response and inflammatory reaction in atherothrombotic stroke and myocardial infarction]. / Osobennosti immunnogo otveta i vospalitel'noi reaktsii pri aterotromboticheskom insul'te i infarkte miokarda.

AIM: To study characteristics of ischemic tissue damage basing on the assessment of the correlations between markers of immune response, inflammation and apoptosis in patients with myocardial infarction (MI) and atherothrombotic stroke (AS). MATERIAL AND METHODS: Concentrations of matrix metalloproteinase-9 (MMP-9), immune complexes with cryogenic properties, soluble Fas-ligand, tumor necrosis factor alpha, interleukin-10 measured with ELISA as well as the activity of spontaneous apoptosis of mononuclear cells and surface expression of Toll-like receptors-4 and intracellular heat shock proteins measured with flow cytofluorometry were determined in the blood of 93 patients with the first AS and 94 patients with MI without concomitant inflammation in the 1st and 7th day of the disease. RESULTS AND CONCLUSION: Increased levels of the markers of immune response, inflammation, apoptosis and destruction of the extracellular matrix were identified at the beginning of MI and AS. The results provide the evidence that similar mechanisms may be involved in ischemic tissue damage. Multivariate analysis conducterd by of principal component analysis correlation matrix revealed the specificity of the relationships between all of these markers. This is the completely new approach to assessin the role and importance of defined parameters in the acute period of the myocardial ischemia and brain.

[The fetal proteins in prognosis of development of pneumonia in patients with ischemic stroke].

The searching of laboratory predictors of pneumonia in patients with ischemic stroke is an actual issue. The fetal proteins can be such biomarkers. The study was carried out to determine significance of such fetal proteins as alpha-fetoprotein, cancerous embryonic antigen, CA 19-9, CA 125, CA 15-3, CA 72-4, CYFRA 21-1 for prognosis of development of pneumonia in patients with ischemic stroke. The study included sampling of 216 patients in acute period of ischemic stroke. All patients were measured level of fetal proteins in first day from onset of disease using electrochemiluminescence immunoassay. It is demonstrated that CA 72-4 has the most significance for prognosis of development of pneumonia from all analyzed proteins and complications of ischemic stroke. The probability ratio relatively to other fetal proteins added up to 0.460 (CL 95% 0.267-0.791, p=0.011), to other complications--0.629 (CL 95% 0.433-0.913, p=0.015). The threshold value of CA 72-4 for development of pneumonia added up to 0.82 (CL 95% 0.68-0.96, p=0.011) U/ml. Under lower level of CA 72-4 the risk of development of pneumonia increases. Under higher level of CA 72-4 there is statistical probability of absence of developmnent of pneumonia. The threshold value was lower than reference interval which in the study added up to 0.85-1.42 U/ml. The detection of level of CA 72-4 on first day after onset of stroke in patients can be recommended for establishing of group of high risk of development of pneumonia and implementation of therapeutic activities.

[The alpha-fetoprotein in prognosis of survival of and functional rehabilitation of patients with ischemic stroke].

The study was carried out to determine the prognostic value of alpha-fetoprotein in development of lethal outcome and degree of functional rehabilitation of patients with ischemic stroke. The sampling included 216 patients in acute period of ischemic stroke. At the first day of development of disease they were measured the level of human alpha-fetoprotein. At the second day of disease patients were evaluated the degree of functional rehabilitation and the rate of lethal outcomes was calculated. Previously, the reference interval for alpha-fetoprotein was calculated according the guidelines of the International federation of clinical chemistry and national standard. The reference interval amounted to 0.59-3.78 mE/l. The study results demonstrated that low level of alpha-fetoprotein is related to higher risk of lethal outcome (SE=1.7, p=0.012). The increasing of level of alpha-fetoprotein over mentioned threshold value statistically significant increases probability of survival of patients. The further increasing more than 2.28 mE/l is related to subsequent good functional rehabilitation according the modifies Rankine scale (SE=1.4, p=0.001) and Barthel index (SE=1.49, p<0.001).

[Combinative methods of treatment of patients with complicated urolithiasis].

The authors showed that urolithiasis is the second disease after inflammatory nonspecific kidney and urinary tract diseases and has a tendency to increase. 3-5% of patients suffer this disease, and 30-40% of all patients of urology in-patients department suffer nephrolithiasis. Introduction into clinical practice of modern minimally invasive treatment methods changed the paradigm of treatment of urolithiasis, especially coral type nephrolithiasis - cause of 15-50% of all renal calculi. The authors presented results of combinative treatment of 183 patients with different complicated forms of urolithiasis. The technique of percutaneous nephrolithotripsy (in supine position) was modified. It helped to reduce complications, time of surgery and radiation exposure. The effectiveness of simultaneous contact ureterolithotripsy and percutaneous nephrolithotripsy in patients with renal or ureters calculi, and simultaneous litholysis and distance lithotripsy in patients with metabolic disorders is shown. Combinative methods of treatment of complicated forms of urolithiasis are based on modern minimally invasive technologies and are very effective.

[Osteoporosis and arterial stiffness: study of 103 women with mild to moderate risk of cardiovascular disease].

OBJECTIVE: to evaluate the relationship between arterial stiffness and bone metabolism in women with mild to moderate risk of cardiovascular disease (CVD). METHODS: In 103 postmenopausal women (mean age 57.0 years, 95% CI 50.0-64.0) with mild to moderate risk of CVD (SCORE<5), no more than mild hypertension, normal function of thyroid gland, without coronary artery disease, diabetes mellitus and secondary causes of osteoporosis pulse wave velocity between carotid and femoral sites (cfPWV, by applanation tonometry) and ankle and brachial sites (baPWV, by volume sphygmography) as well as bone mineral density at lumbar spine and femoral neck (by dual-energy X-ray absorptiometry) and blood serum levels of markers of bone turnover (total procollagen type I amino-terminal propeptide (PINP), osteocalcin, collagen type 1 cross-linked C-telopeptide (-CTX) by electrochemilumininescence immunoassay) were assessed. RESULTS: Compared with patients with normal mineral bone density (BMD) (n=27), patients with osteoporosis (n=31) had higher cfPWV and baPWV values (p<0.05). Patients with osteopenia did not differ from other groups (p>0.05). In osteoporosis group there were greater years since menopause, less body mass index than in normal BMD (in all cases p<0.05; ns between osteoporosis and osteopenia groups). Between all three groups there were no significant differences in age, smoking status, visit blood pressure, lipid levels and medication. CfPWV and baPWV values significantly positively correlated with age, systolic arterial pressure, years since menopause, procollagen type I N propeptide (all p<0.05), and significantly negatively correlated with BMD at hip neck (all p<0.05). Relationship between cfPWV and BMD at lumbar spine did not reach significant value (r=-0.18, p=0.068). No relationship was found between parameters of arterial stiffness and CTX and osteocalcin (all p>0.05). In the multivariate analysis cfPWV was significantly and independently associated with systolic blood pressure (=1.03, 95% CI 1.00-1.06, p=0.03) and BMD at hip neck (=0.01, 95% CI 0.001-0.07, p=0.003). CONCLUSION: Revealed association between arterial stiffness and bone metabolism may probably explain general mechanisms of arterial and bone damage in postmenopausal women with mild to moderate risk of cardiovascular disease.

[Efficacy of thiolepta in diabetic polyneuropathy: results of the study ETIKA].

Thiolepta (alpha-lipoic acid preparation) was used in treatment of 205 patients, 134 women and 71 men, mean age 59.3±10.1 years; 196 patients with diabetes mellitus (DM) type II and 9 patients with DM type I. Treatment duration was 4 weeks. Dosage of the drug was 600 mg daily. Patients were assessed neurologically and with psychometric scales. Special attention was drawn to the severity of positive and negative symptoms of neuropathy and sleep disorders. The results demonstrated the efficacy of thiolepta in diabetic polyneuropathy assessed by all parameters. The effect remained during 3 months after the end of treatment. Good tolerability and safety of the drug are highlighted.