Status of microcirculation and rheological properties of blood in patients with cerebral circulatory disorders

Microcirculation and rheological properties of blood were investigated over time on the basis of the findings of biomicroscopy of the bulbar conjunctiva in 61 patients with different stages of circulatory encephalopathy in the presence of arterial hypertension and atherosclerosis. Rheological properties of blood were changed at all stages of disease. Correlations between the ability of erythrocytes to aggregation and the degree of their intravascular aggregation by the findings of biomicroscopy of the bulbar conjunctiva were not found. The importance of investigation of the intravascular aggregation of erythrocytes and theological properties of blood for assessment of the cerebral vascular microcirculation, control of therapy, and verification of some aspects of the mechanism of action of various drugs was shown.     

The pathology of the foot in the atherosclerotic damage of lower extremities vessels in patients with type 2 diabetes mellitus

The results of examination of 116 patients with atherosclerotic damage of lower extremities arteries caused by type 2 diabetes mellitus are presented. At the base of data of X-Ray examination the character, frequency and localization of damage of osteoarticular apparatus of the feet were been analyzed in disorders of main blood flow in cases with diabetes mellitus. Pathologic changes were recorded in 89.9% of cases with prevalence of isolated or combined hypertrophic processes. Destructive alterations, typical for osteoarticular apparatus of the feet in diabetes mellitus (diabetic osteoarthropathy), were absent. X-Ray signs of deformating osteoarthrosis of foot articulations were revealed in 48.4% of cases with maximal rate of damage of metatarsophalangeal joints. No relationship of osteoarticular apparatus lesions rate and a grade of circulation disorder in atherosclerotic vascular disturbances in type 2 diabetes mellitus was revealed (p > 0.05). The frequency of a set of X-Ray signs of osteoarthrosis--narrowing of joint space, subchondral osteosclerosis is associated with duration of diabetes mellitus more than 10 years. The relationship between frequency of development of atrophic processes (osteoporosis) of osteoarticular apparatus of the feet in cases with main vascular disorders and severity of course of diabetes mellitus (p < 0.01). Statistically confident prevalence of rate of osteoarticular apparatus of the foot was recorded in aggravation of metabolic disturbances.     

The activity of peroxidation of lipids in biologic samples of patients with recurrent diseases of upper respiratory tracts

The parameters of peroxidation of lipids in blood and saliva were analyzed on sampling of 60 patients with recurrent diseases of upper respiratory tracts during period of remission. It is established that the content of primary and secondary products of peroxidation of neutral lipids in blood plasma is lower as compared with healthy persons. The content of end products of peroxidation of neutral lipids and products of oxidation of phospholipids in blood plasma is higher as compared with healthy persons. The characteristics of alterations of intermediates of peroxidation of lipids in various biologic samples depend on the localization of inflammatory process.     

Bringing criteria for external assessment of the quality of biochemical studies within the framework of the Federal System for External Evaluation of the Quality of Clinical Laboratory Studies, in conformity with requirements of the Order No. 45 of the Ministry of Health of Russia, 2/7/2000

Criteria for external assessment of the quality of evaluation of 23 biochemical parameters of the blood, meeting the standards of accuracy determined by the Order No. 45 of Ministry of Health of Russia of February 7, 2000 for intralaboratory quality control have been estimated. According to the data of the Federal System for External Evaluation of the Quality of Clinical Laboratory Studies, the percentage of results of analyses of test sera meeting these criteria has been estimated. Introduction of new criteria for external assessment of the quality of biochemical tests into the practice of the Federal System will not notably modify the currently used criteria with regard to the majority of biochemical parameters, except introduction of more stringent criteria for albumin and magnesium and less stringent for creatine kinase.     

三种皮神经营养血管及筋膜蒂逆行岛状瓣的应用及康复

1MATERIALSANDMETHODS1.1Materials14malecaseslivedinourhospitalfromJanuary1999toMay2002,withagerange24-74,average35.8,inwhich3casesofcombiningcutaneousdeficiencywithboneexposureaftertrauma;1casesofcutaneousdeficiencyofinternalankle;1caseofcutaneousdeficiencyoflateralankle2casesofcombiningos-teomyelitisofcalcaneumboneandcutaneousdeficiency,1caseofboneexposureofcalcaneumboneaftertrauma,2casesofdegreeIIIburnofdorsumoffootcombiningwithexposureofdeeptissue,1caseoftuberculosisulcerofwristbacka…     

Classification of microangiopathy in systemic sclerosis

AIM: To classify main types of morphological changes of nailfold capillaries in systemic sclerosis (SSc). MATERIAL AND METHODS: Nailfold videocapillaroscopy (NCS) was performed in 103 patients with SSc (34 patients with dSSc and 69 patients with ISSc) with a median age of 47.9 +/- 13.3 years and mean disease duration of 8.1 +/- 7.1 years. The control group consisted of 35 healthy persons. RESULTS: On the basis of a quantitative estimation of changes the main capillaroscopic patterns of structural changes of capillaries in SSc were distinguished. The first (early) type is characterized by changes mainly of sizes of capillaries and a rather moderate decrease of their amount. In the second (transitive) type simultaneously with change of the sizes of capillaries an appreciable decrease of the amount of capillaries with formation of avascular sites is observed. The third (late) type of changes is characterized by marked reduction of capillaries and plenty of avascular sites in the absence or presence of few dilated capillaries. NCS enables to reveal destruction and new growth of capillaries. The statistical analysis has shown authentic distinctions of NCS parameters between main types of changes and close association of these types with activity of the disease. CONCLUSION: Definition of a type of capillaroscopic changes can serve a reliable and objective criterion of a stage and activity of microangiopathy in SSc which reflects duration of illness as a whole.     

Cytomegaloviral infection in patients with hemoblastoses

AIM: To estimate the incidence of cytomegaloviral (CMV) infection and CMV disease in patients with acute leukemia at different stages of chemotherapy and in patients after transplantation of hemopoietic cells. MATERIAL AND METHODS: The trial was carried out in 33 patients with acute leukemia at different stages of chemotherapy, 20 patients subjected to transplantation of autologic hemopoietic cells and 21 patients who had received transplantation of allogenic hemopoietic cells. To study the dynamics of the CMV infection markers, enzyme immunoassay of the titer of the specific immunoglobulins M and G was made, detection of the viral antigen in immunofluorescence reaction and cultivation with fibroblast cell culture and determination of the cytomegalovirus DNA by polymerase chain reaction (PCR). RESULTS: Before chemotherapy, up to 90% patients with acute leukemia were infected with cytomegalovirus (similar rate of infection was observed in healthy donors of hemopoietic cells). By the time of transplantation all the patients were infected with cytomegalovirus. During chemotherapy of acute leukemia, the primary infection and reactivation of latent infection occurred in 30% patients, whereas CMV disease developed in 18% patients. In case of transplantation of autologic hemopoietic cells the rate of reactivation of CMV infection (15%) was one-half of that value in patients with acute leukemia (30%). Similar trend was observed in case of development of CMV disease (5% and 18%, respectively). In case of transplantation of allogenic hemopoietic cells the incidence of reactivation of CMV infection was three times higher than in case of transplantation of autologic hemopoietic cells (47.6% and 15%, respectively, p = 0.02). The incidence of development of CMV disease in case of transplantation of allogenic hemopoietic cells was also significantly higher than in case of transplantation of autologic hemopoietic cells (28.6% and 5%, respectively, p = 0.05). CONCLUSION: Cytomegalovirus is an infection agent responsible for severe complications of chemotherapy of acute leukemia and transplantation of hemopoietic cells in patients with hemoblastoses. Among hematological patients, the group of the highest risk of development of this complication includes recipients of transplantation of allogenic hemopoietic cells, particularly from seronegative donors.     

The place of ultrasound diagnosis in obstetrics]

A review is presented of the diagnostic applications of the ultrasonic scan technique in obsterics. In the 1st trimester of pregnancy the demonstration of the gestational sac and of an embryo is most important. During the further course of pregnancy the growth of the gestational sac and motions of the fetus can be observed. A disturbance in the development of the pregnancy can be deduced from these parameters. The various types of abortion can be differentiated by means of the scan. In the 2nd trimester the biometry of the fetus is most important. The motion behaviour of the fetus seems to be a good indicator of its well-being. The location of the placenta and the evidence of twins are easily demonstrable. In the 3rd trimester the biometry of the fetus is a good parameter of its maturity. The diagnosis of the fetal position is important for the management of delivery. Apart from these applications of ultrasound in obstetrics, the procedure is of great value in the diagnosis of tumours and the measurement of the true pelvis in pregnancy.     

The alterations in fatty acids content of membranes of erythrocytes and insulin resistance syndrome under primary gout

The content of fatty acids of lipids of membranes of erythrocytes in patients with primary gout depending on presence of insulin resistance syndrome. The alterations of content of fatty acids in patients with gout and insulin resistance syndrome are characterized by increase of content of saturated fatty acids and decrease of unsaturated fatty acids. At that, in the pool of unsaturated fatty acids the content of monounsaturated acids is increased and the content of polyunsaturated acids is decreased. In the pool of polyunsaturated fatty acids the increase of content of gamma-linolenic and digomo-gamma-linolenic acids and significant decrease of arachidonic and docosapentaenic acids are noted. The shifts mentioned above can play a certain role in the formation of insulin resistance syndrome in patients with primary gout.     

Knonchenszintigraphische Darstellung bewegungsgestörter Wirbelsäulensegmente

One of the most important occupations of manual therapists is the treatment of hypomobilities of intervertebral joints. Such hypomobilities of the spine are treated with different kind of manipulations or mobilisations. The pathophysiological basis of hypomobilities is subject of discussion. Objective criteria for the diagnosis of disturbed spinal mobility are missing. They are not detectable in X-ray, computertomography or NMR. The aim of this study was to detect the evidence of a biomechanical alteration of hypomobile intervertebral joints with the help of SPECT (Single Photon Emission Computed Tomography). 13 healthy, outdoor patient of the Orthopaedic University Hospital of Marburg with back pain were examined by the means of manual medicine and demonstrated a hypomobility of a intervertebral joint. In addition the spine of this patients was examined by SPECT (bone scanning). The comparison of the results of physical examination and bone scanning demonstrated that the same localisation of hypomobility was found in 75% of all cases by both methods. In 83% the same site of hypomobility was identified.     

Dynamics of the plasma fibronectin level in patients with food poisoning

A study was made of the influence of the level and biological activity of plasma fibronectin of phagocytosis and opsonic activity of blood plasma in 147 patients with food toxinfections depending on a period and degree of severity of a course of disease. Plasma fibronectin concentration was determined by rocket immunoelectrophoresis. Fibronectin biological activity was assessed by cold heparin precipitation. Opsonic activity of blood plasma before and after fibronectin inactivation in it was investigated using indices of phagocytosis which was studied by optical microscopy. Food toxinfections were attended by a decrease in the level and biological activity of plasma fibronectin returning to normal during therapy and convalescence. A degree of the reduction of the level of plasma fibronectin reflected the severity of a course of food toxinfections. Phagocytic insufficiency developed in food toxinfections. One of its mechanisms was a decrease in opsonic activity of plasma fibronectin as a result of the reduction of its level.     

Kinesitherapy in treatment of 35 cases with spinal cord injury

Background:It is significant how to reserve residual myodynamia of parients with spinal cord injury,increase the ability of self-care and make them return to the family and society.We adopted kinesitherapy to treat 35 patients with spinal cord injury and reported the results as follows.Objective:To observe the effect of kinesitherapy on the treatment of spinal cord injury.Unit:Orthopaedics Hospital of Jincheng City of Shanxi.Subjects:35 patients with spinal cord injury during January of 1999 to 2001,31 males and 4 females,aged from 16 to 71,with mean age of 35.2.The causes of wound 4 of crash wound,2 of falling wound,26 of road accident and 3 of other wounds.The site of injuries:7 in cervical vertebra,14 in thoracic spine,12 in lumbarvertebrae(T12-L1-4) and 2 in multiple segments.The courses were from 40 days to 5 years.Standard lesion degrees of ASIA92: 6 of grade A,8 of grade B,18 of grade C and 3 of grade D.Intervention:The kinesitherapy were taken in 4 stages:(1)Stage of lying in bed:exercise in bed,training motion of joints and stretching exercise mainly.(2) Stage of wheel chair:train muscles of pectoral girdle,biceps and triceps muscle of arm to increase myodynamia of upper limb.(3) Stage of standing:standing training,standing on bed from 30&;#176; to 90&;#176; to resolve postural hypotension from long-term bed,and train iliopsoas muscles,gluteus muscles,muscles of lumber and back and quadriceps of femoris.(4) Stage of walking:use proper braces according to the myodynamia until remedial walking and functional walking were achieved step by step.All the training were taken once a day.for 45 minutes per time,5 times per week and 1 course for 3 months.Results:Evaluate the effect of functional independence and rehabilitation of patients with standard by Specification of diagnosis and treatment of China Rehabilitation Medicine.Before therapy,there were non of grade 1,non of grade 2,1 of grade 3,1 of grae 4,8 of grade 5,12 of grade 6,13 of grade 7.After therapy,there were 2 of grade 1,3 of grade 2,10 of grade 3,7 of grade 4,5 of grade 5,5 of grade 6,3 of grade 7.Conclusion:Kinesitherapy could enhance the force of all the muscles which could still be used,improve the ability of residual myodynamia and functional ability and in crease the residual functions.     

The hemodynamic support of physical loading in patients with mitral valve prolapse]

Bicycle ergometry and echocardiographic studies were carried out in 29 patients aged 17-29 years with first revealed mitral valve prolapse (MVP) without any signs of mitral regurgitation. According to bicycle ergometry, the patients manifested changes in hemodynamics pointing to dysfunction of the cardiovascular system. Echocardiography discovered a reduction of the mass and a rise of the rate of contraction of the circular fibers of the left ventricle, evidence of the myocardial genesis of the hemodynamic changes. Comparison of the findings of bicycle ergometry and echocardiography allowed a conclusion about the necessity of the follow-up of patients with MVP in spite of the high level of threshold load and the lack of the clinical signs of heart failure.     

Lipid peroxidation in the blood and tissues of patients with peptic ulcer]

Investigation of 67 patients with peptic ulcer revealed a reliable activation of lipid peroxidation processes both in the blood of the patients and in the mucous membrane in the area of the ulcer location immediately. The activation of lipid peroxidation resulted in a decrease in the contents of phospholipids in the biological membranes of the mucosa cells. The alterations revealed occurred in the presence of inhibition of the antioxidant system of the body. The authors proved the efficacy of the use of antioxidant formulations and ultraviolet irradiation of the blood in the treatment of patients which resulted in acceleration of the ulcer cicatrization and the reduction of the inpatient period as well as the improvement of surgical results.     

Development of carcinoma of Vater's ampulla in an adenoma. Analysis of a personal case load and review of the literature

A retrospective analysis was undertaken of our case material of 40 histological preparations of carcinoma of the ampulla of Vater, as well as a survey of the literature of 103 adenomas of the ampulla of Vater. Signs of malignant transformation were detected in 25% of the adenomas, whilst adenomatous residues were identified in 72% of the examined carcinomas of the ampulla of Vater. Thus, an adenoma-carcinoma sequence seems to be as significant in the case of Vater's papilla as in the colo-rectal region. An epidemiological investigation confirms this hypothesis since 1. adenomas of the papilla Vateri develop 4 years prior to a carcinoma and 2. the relative sex distribution of the two diseases is approximately equal.     

颈神经在颈椎间孔及脊神经沟处受嵌压的解剖学因素

背景神经根型颈椎病中神经根能否受累,不仅与所在骨管是否狭窄、周围软组织是否存在炎性病变和肿胀有关,还与神经根外径的相对大小有关.目的通过颈神经在颈椎间孔及脊神经沟处受累的出现率,探讨神经根型颈椎病发生的解剖学因素.设计单一样本观察.单位承德医学院解剖研究室.对象甲醛固定成尸60具(男28,女32)120侧.方法在60具成尸上,用精确度0.02 mm的游标卡尺和直角规测量①脊神经沟外口宽度及其沟内段脊神经前支横径.②颈椎间孔及其脊神经根的前后径、上下径.计算颈神经前支横径与相应颈椎脊神经沟外口宽度的比值和脊神经根前后径、上下径与相应椎间孔前后径、上下径的比值.得出颈神经前支横径大于或等于脊神经沟外口宽度的出现率和脊神经根各径线大于或等于相应椎间孔各径线的出现率.主要观察指标①C3～6颈神经前支横径大于或等于相应脊神经沟外口宽度的出现率.②C3～6颈神经根上下径、前后径分别大于或等于相应颈椎间孔上下径、前后径的出现率.结果共测量成尸60具120侧(男56侧,女64侧).①颈神经根在椎间孔处可造成嵌压男女合计总出现率为24.6%其中女性明显高于男性(35.2%,10.9%,x2=6.72,P＜0.01).②颈神经前支在颈椎脊神经沟处可造成嵌压男女总出现率为6.3%,其中男性明显高于女性(8.9%,3.9%,x2=6.65,P＜0.01).结论颈神经受累不仅与骨管狭窄有关,而且与周围软组织损伤有关,通过神经根外径与椎间孔的比值和颈神经前支与脊神经沟外口宽度比值,选其≥1的出现率可直接获得神经受压的出现率.     

精细护理干预对行多层螺旋CT冠脉造影患者图像 采集成功率及生理指标的影响

目的 探究对多层螺旋CT冠脉造影患者行精细护理干预,对其图像采集成功率和生理指标的效果.方法 选取该院2013年12月~2015年12月收治的行多层螺旋CT冠脉造影患者156例,其中实施精细护理干预者104例,将其作为观察组;由于多种原因而未能实施精细化护理干预的52例患者作为对照组.对比两组采集图像成功率、心率波动情况、不同心率波动采集图像成功率、患者配合度以及护理满意度情况.结果 观察组患者图像采集成功率高于对照组,差异有统计学意义(P<0.01).观察组心率波动频率<10次/min的比例高于对照组,且观察组心率波动频率≥10次/min的比例低于对照组,差异有统计学意义(P<0.01).观察组Ⅰ类患者心率波动频率<10次/min的比例高于对照组,且观察组Ⅰ类患者心率波动频率≥10次/min的比例低于对照组,差异有统计学意义(P<0.05).观察组配合良好率高于对照组,且观察组护理满意度高于对照组,差异有统计学意义(P<0.05).结论 对行多层螺旋CT冠脉造影患者实施精细护理干预可显著提高图像采集质量,降低心率波动频率,增加患者配合度和满意度,值得推广.     

The role of polymorphic markers of vasoactive hormones genes in clinical characteristics of chronic glomerulonephritis

AIM: To examine association of polymorphic markers of I/D gene of angiotensin-converting enzyme (ACE), C(-344)T gene of aldosterone synthetase (CYP11B2) and 4a/4b gene of endothelial synthetase of nitric oxide (NOS3) with clinical picture of chronic glomerulonephritis (CGN). MATERIAL AND METHODS: The trial covered 167 CGN patients. Clinical characteristics of CGN (nephritis, debute, its clinical and morphological variants, analysis of the clinical course as regards arterial hypertension severity, rate of persistence of proteinuria (PU) of the nephrotic level for 6 months and longer, frequency of AH combination with persistent PU was made retrospectively in the groups of patients by genotypes of the genes ACE, CYP11B2 and NOS3. RESULTS: In CGN patients, carriage of the combination of allele D of ACE gene, allele C of CYP11B2 gene, and allele 4a of NOS3 gene was associated with more frequently occurring nephrotic syndrome and AH in the disease onset. A CGN course in patients with genotype DD (ACE gene) often complicates with AH, in patients with genotype CC (gene CYP11B2) and in carriers of allele 4a (gene NOS3)--with severe AH. Carriers of allele D (gene ACE) HA often combines with persistent PU the nephrotic level. A morphological variant of CGN is not associated with carriage of genotypes of polymorphic markers of genes ACE, CYP11B2 and NOS3. CONCLUSION: There is association of polymorphic markers I/D of ACE gene, C(-344)T of gene CYP11B2 and 4a/4b of gene NOS3 with clinical features of CGN. Carriers of alleles associated with high activity of PAAC--allele D of gene ACE, allele C of gene CYP11B2 and allele 4a of gene NOS3--had more severe clinical picture at all stages of the disease.     

Effect of dl-ethionine on the intestinal absorption and transport of palmitic acid-1-14C and tripalmitin-14C. Role of intramucosal factors in the uptake of luminal lipids

The effect of DL-ethionine on the uptake and transport of lipid by the rat small intestine was investigated. A cottonseed oil emulsion containing (14)C-labeled tripalmitin or palmitic acid was administered intragastrically to rats pretreated with DL-ethionine, DL-ethionine plus methionine, or saline, and the rats were sacrificed 2, 4, and 6 hr later. Lipids from the plasma, the stomach, the colon, the luminal contents of the small intestine, and the wall of the small intestine were extracted, fractionated, and their radioactivity assayed.Ethionine markedly inhibited the uptake of lipids by the small intestine. This inhibition was not related to impairment of intraluminal lipolysis since analagous inhibitions were observed when palmitic acid or predigested triglyceride (TG), obtained through a jejunal fistula from normal animals, was administered instead of tripalmitin. Ethionine also inhibited the transport of lipid from the wall of the small intestine. A significant fraction of the administered lipid remained in the wall of the small intestine, and only a small fraction was transported to the blood stream. Although most of the wall radioactivity was in the form of TG, significant proportions were also found in the free fatty acid (FFA) and partial glyceride fractions, indicating a marked inhibition of mucosal reesterification to TG.The degree of inhibition of mucosal reesterification and the degree of inhibition of transport of wall lipids were directly related to the degree of inhibition of uptake of luminal radioactivity. This relationship suggests that the rate of reesterification, the level of mucosal FFA, and the rate of transport of intramucosal TG may be of importance in determining the extent of uptake of intraluminal lipid by the mucosal cells.Since a significant fraction of the wall radioactivity was in the form of TG, the decreased transport of wall lipids was attributed to an impairment of chylomicron completion due to inhibition of either the synthesis of chylomicron apoprotein or the association of preformed TG with the protein moiety of chylomicrons. Experiments with labeled amino acids support the first possibility.     

不同时期脑卒中患者主要照顾者照护知识调查

目的 调查首次入住康复医学科的不同时期脑卒中患者主要照顾者对照护知识的掌握情况。方法 2014年7月-2015年11月入住上海市静安区老年医院神经康复医学科且符合纳入标准的脑卒中患者及主要照顾者90例,调查不同时期照顾者对于照护知识的掌握情况及其心理健康状况,并分析两者之间的相关性。结果 入院48小时内照顾者对于照护知识的总体掌握率最低;出院后3个月照顾者对于如何预防和识别再次中风,及再次中风后的处理掌握率较低;三个时期照顾者对并发症的护理掌握率均最低;照顾者各项照护知识掌握程度与自我肯定程度呈正相关,与忧郁、焦虑及健康问题总分呈负相关。结论 对于脑卒中照顾者的照护知识的教育,在形式上要多样化,不同时期的照顾者教育内容要有针对性。