The Journal of V. N. Karazin Kharkiv National University. Series «Medicine»

5-11

Authors: Marina Ivanenko, Olena Klimova, Serhii Sherstiuk, Svitlana Nakonechna

Introduction. The protection of the body against external and internal antigenic factors is executed with the help of the primary cellular and secondary resistance links. Excessive activation of adaptation reactions leads to the formation of various pathologies of inflammatory nature. Changes in the immune responses occur at all ontogenesis stages. In the present study, we conduct the experiment of induced peritonitis in animals of different ages in order to investigate more accurately adaptive responses of the immune system during inflammation.Objectives. The aim of our research was to study changes in the indicators of adaptive humoral immunity, levels of immunoglobulin A and circulating immune complexes, phagocytic activity of neutrophils and the disruption of enzymes activity, which provide the phagocyte function in the NST test on the model of induced peritonitis in animals of different ages.Materials and methods. The studies were performed on 200 white male rats. They were divided into a control group and the experimental rats, 3-and 22-month-old ones. Acute inflammation and dysbiosis in the small intestine were caused by intraperitoneal injection of lipopolysaccharide obtained from Escherichia coli strain. The material for the study was serum and blood elements of experimental animals. Results.The levels of immunoglobulin A in the blood serum of 3 and 22-month-old rats with the inflammation model were reduced in comparison with this index in control group animals. The content of the CIC in the rats blood serum of both age groups was significantly higher in comparison with the control group. All the studied indices of neutrophils phagocytic activity in the 22-month-old animals with the inflammation model were lower than in the control rats of this age. In the 3-month-old rats with the inflammation model, the index of phagocytosis completeness was significantly lower in comparison with the control group. The reduction in the reserve capacity of phagocytic cells was higher in the 22-month-old animals. An increase in the neutrophils metabolic activity and a decrease in their metabolic reserve in 3 and 22-month-old rats with the inflammation model were revealed in comparison with the parameters of the control groups.Conclusions.The results of the study indicate presence of violation of the primary cellular and secondary humoral immunity during the aging of the body and decrease in the adaptive responses of the immune system during inflammation due to an increase in antigenic effects

22-35

Authors: Zolochevsky O. O., Martynenko O. V.

Introduction.Bone repair after periprosthetic fracture is a critical issue in orthopedics.Objectives.So there isa need for research to provide new medical solutions, especially in the context of population ageing in the Ukraine.The importance of biomechanics which is concerned with the application of principles, concepts and methods ofmechanics of solid and fluid to the human body in motion and at rest is well recognized as a foundation for furtherexperimental and theoretical research in the skeletal tissues.Materials and methods.Different aspects ofbiomechanics require different concepts and methods of mechanics of solid and fluid to be used. Remodelingoccurs significantly throughout lifetime of bone that is why it can be regarded as a primary determinant of themechanical properties of bone and implant. Biomechanical analysis given in this review has been concernedwith understanding on how mechanical signals and molecular mechanisms affect the healing of Vancouverperiprosthetic femoral fracture of B1 and C-type with the useof internal fixation through a less invasive stabilizationsystem (LISS)-plate, which is screwed into the artificial hip joint.Results.Identification of such parameters asmechanical properties of bone, titanium alloys (hip prosthesis, coating, LISS-plate, screws) and implant/biomaterialinterface with bone under mechanical and biochemical loading that are very essential for predicting arthroplastyoutcomes were investigated experimentally considering elastoplastic deformation, creep, fatigue and ratcheting, aswell as, damage development in materials under discussion. Among the basic deformation features were tension-compression asymmetry, anisotropy and heterogeneity of mechanical properties. We used the three-dimensional finiteelement model derived from the reconstruction of treatment and magnetic resonance (tomographic) images.Conclusions.As a result of this model analysis, it was found that treatment rate of periprosthetic femoral fracturesafter total hip arthroplasty with the use of LISS-plates and screws for internal fixation may be controlled by meansof ABAQUS (or ANSYS) software package to reproduce the characteristic features of bone and implant in bonereconstruction in order to improve the fracture healing rate and shorten treatment duration.

44-50

Authors: Moskal O.M., Logay I.V., TurokYu.Yu., TurokY.Yu., Archiy E.Y.

ntroduction.Nonsteroidal anti-inflammatory drugs are the most commonly usedmedicines in medical practice. As literary sources show, they often cause unwantedside-effects.The purpose of our work was to evaluate the frequency, clinicalmanifestations andmorphological features of lesions of the gastroduodenal zone that arise in patients ofrheumatologic, neurological profiles and angiosurgery department during the courseof treatment with nonsteroidal anti-inflammatory drugs of different groups, to tracethe dependence of the frequency of manifestations of the pathology of the stomachand duodenum from simultaneous receiving two nonsteroidal anti-inflammatorydrugs and their combination with glucocorticosteroids and anticoagulants.Material and methods. 73 patients who had used NSAIDs for a long time and hadendoscopically confirmed medicated gastroduodenopathy. Patients were divided into3 groups depending on the profile of the department: Group I included -24 patientsof the departmentof vascular surgery; Group II -23 patients of the neurologicaldepartment; Group III -26 patients with rheumatological profile.Results.Asymptomatic clinical picture of NSAID-gastropathy was found, which didnot coincide with the available endoscopic changes in the gastroduodenal tube: in63% of cases, erosive changes in the mucous membrane were present, and stomachand duodenal ulcers were revealed in 11%. It was also found that in the group ofpatients receiving proton pump inhibitors, the incidence of gastroduodenopathy wasreliably lower (34.2%) than in patients who did not receive them (53.4%). During thisstudy, it was found that the use of selective non-steroidal anti-inflammatory drugs cansignificantly reduce the probability of developing the pathology of thegastroduodenal zone, compared with non-selective.Conclusions.The course of treatment with nonsteroidal anti-inflammatory drugsshould be as short as possible and should be carried out with minimal but effectivedoses. Parallel prophylacticadministration of proton pump inhibitors is appropriate inpatients at high risk of developing erosions and ulcers in the background of treatmentwith these drugs.

59-64

Authors: Safronov D.V.

ntroduction.Injuries are a large medical and social problem. It takes many lives and is often a cause of disability.Objectives.The work is devoted to the study of the motor-evacuation function (MEF) of the gastrointestinal tract (GIT) in patients with closed abdominal injury of varying severity.Materials and methods. 125 patients with isolated or combined blunt abdominal trauma were under observation. The main criterion for the inclusion of patients in the study was the presence of injury to the abdomen and / or retroperitoneal space, confirmed while surgery or using instrumental methods of examination. The structure of injuries was dominated by a combined trauma, which was observed in 104 (83.2%) victims; in 21 (16.8%) patients abdominal injury was isolated or multiple. Evaluation of the MEF of the gastrointestinal tract was carried out using a technique developed with the participation of the author on the basis of the available indicators widely used in practice. The severity of the injury was determined on an ISS scale.Results.The results showed that the predominant part of patients with abdominal trauma (62.4%) had a violation of gastrointestinal MEF upon admission; in 21% of patients, the state of function at the border of functional compensation was noted, and only in 16% of persons, the MEF of the gastrointestinal tract was rated as moderately and completely compensated. By severity of injury, a group of patients with moderate severity (47.2%) prevailed; a mild injury was observed in 35.2% of patients, severe injury was diagnosed in 16%, and a super-severe one was in 1.6% of injured people.Conclusions.The possibility of using the MEF indicators of the gastrointestinal tract as one of diagnostic criteria for the severity of a blunt abdominal injury is assumed

86-92

Authors: Babii O.H., Simonova I.V., Vasylenko O.O., Prylutcka K.Y., Meleshenko O.A.

Familial combined hyperlipoproteinemia is considered one of the most common genetic hyperlipidemias in the general population with estimated prevalence 0.5%–2.0% of all inherited dyslipidemias. This disorder frequently coexists with other metabolic diseases such as obesity, insulin resistance, hypertension, non-alcoholic fatty liver disease. Association of hyperlipoproteinemia and type 2 diabetes mellitus can be explained due to the fact, that familial combined hyperlipoproteinemia is caused by genetic variability, including genes encoding the upstream transcription factor 1. The last regulates nearly 40 genes implicated in lipid, lipoprotein and carbohydrate metabolism, as well as immune response. Polymorphism in the upstream transcription factor1 is strongly associated with dyslipidemia, impaired glucose tolerance, insulin resistance, and type 2 diabetes mellitus. In this report on example of clinical case we want to pay attention ofpractitioners to the problem of familial causes of hyperlipidemias, which leads to early onset of atherosclerosis, cardiovascular disease, and, finally, to premature disability of the affected person. Because of the frequent overlapping with the features of metabolic syndrome, this serious disorder is often not recognized and treated timely.Our patient was a 43 year old male, who was referred to the clinic with complaints of angina pain and dyspnoea provoked by minimal physical exertion, palpitations, irregular heartbeats, lower extremities and face oedema. At the age of thirty in the patient have developed type 2 diabetes mellitus, during last 7 years it was insulin dependent, the course was severe, glycaemia was poorly controlled by the therapy. Also he had essential hypertension III grade. At the age of 37 years the patient suffered from ST-elevated myocardial infarction, one year later occurred recurrent myocardial infarction. His family history was strongly positive for atherosclerosis and cardiovascular disease, as well as type 2 diabetes mellitus. In laboratory testing the fasting blood sample revealed a grossly lipemic serum, with total cholesterol level 17.75 mmol/L, very low density lipoproteins3.41 mmol/L, low density lipoproteins 13.64 mmol/L, high density lipoproteins 0.7mmol/L. Diagnosis: «Familial combined hyperlipoproteinemia (Fredrickson type 2B). Acute coronary syndrome: Unstable angina IIB. Postinfarction (STEMI 2014, 2015) cardiosclerosis. Essential hypertension III degree III stage. Heart failure with left ventricular systolic and diastolic dysfunction, EF 36%. III functional class NYHA. Stage D AHA. Risk score 4 (very high).Type 2 diabetes mellitus, insulin dependent, severe course. Non-alcoholic fatty liver, 2 degree. Nodular goitre Idegree, euthyroid state»was established. Management of this patient includes lifestyle modification and combined lipid lowering therapy in high doses: rosuvastatin and choline fenofibrate. Unfortunately, in this case target levels of cholesterol and triglycerides were not achieved: minimal level of total cholesterol was 12.29 mmol/L, and level of triglycerides was 41.48mmol/L. Risk estimates based on risk charts, scores, or functions used in the general population, probably grossly underestimate the realrisk of this patient with familial combined hyperlipoproteinemia. Coexistence of extremely high level of cholesterol and type 2 diabetes mellitus significantly aggravates and advances each other's course, comparing with the isolated disorders

100-107

Authors: Golubkina E. O., Silenko I. Y., Brahmbhatt H.

Introduction.Systemic sclerosis (SSc) is a rare chronic systemic disease of theconnective tissue, presenting with high level of patient-to-patient clinical variabilityof features.Objectives.The aim of our research was to study a clinical case of the clinicalcourse and difficulties in timely diagnosis of SSc in middle-age female patient.Materials and methods. Patient is a 39-year-old woman unemployed due todisability of 3rd degree. The disease manifested with Raynaud phenomenon in 2008.During 2008-2013 condition of the patient progressively worsened, new symptomsappeared as difficulty in swallowing of solid food, ulcers. In 2013 she was consultedby a surgeon and treated with antibiotics without significant effect. In October 2013shewas admitted to the rheumatology department, where she was eventuallydiagnosed with SSc, stage II (generalized), subacute course, activity II stage, withdamage to the skin (edema, induration), blood vessels (Raynaud syndrome, stage IIIischemia), joints(polyarthritis with predominant lesions of the hands, wrists, elbow,knee, feet joints, radiographic changes of II grade, functional impairment I st.),esophagus (esophagitis). The last hospitalization was due to the worsening of thegeneral condition. Patient was treated with methylprednisolone 8 mg, amlodipine 2,5mg, naftidrofuryl 200 mg tid, aspirin 75 mg, pentoxifylline 600 mg, omeprazole 20mg.Results.Our study presents the results of different laboratory and instrumentaltests conducted in the clinic: full blood count, biochemical panel, serological tests(antibodies), ECG, EchoCG, chest X-ray, upper Gl tract radiography, ultrasound ofabdominal organs, kidneys, rheovasography of the vessels of the upper limbs, X-rayof hands. Patient was consultedby gastroenterologist, vascular surgeon andgynecologist.Conclusions.An important task for the practicing physician is the ability torecognize the first signs of systemic sclerosis -“red flags”, which will help todiagnose the disease at early stages,start timely treatment to prevent irreversiblepathological changes, early disability and mortality of patients with SSc