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Relevance. The pathogenesis of COVID-19 remains one of the most pressing. The literature discusses the role of iron as a factor supporting inflammatory processes, hypercoagulability and microcirculation crisis in severe COVID-19.The aim of study. was to identify changes in iron metabolism in patients with severe COVID-19 and hyperferritinemia.Material and methods. In this study, we used a content analysis of available scientific publications and our own observations of the peculiarities of the clinical picture and laboratory parameters in patients with a severe course of COVID-19 who had hyperferretinemia at the height of the disease. The main group consisted of 30 patients hospitalized in the Department of Anesthesiology, Resuscitation and Intensive Care of N.A. Semashko City clinical Hospital No. 38 with the diagnosis COVID-19, bilateral polysegmental pneumonia, severe course and hyperferritinemia. The diagnosis of a new coronavirus infection was confirmed by visualization of bilateral viral lung lesions with chest CT-scan, positive PCR test for SARS-CoV-2 and the presence of immunoglobulins to SARS-CoV-2. The control group consisted of 20 healthy volunteers. The study evaluated the biochemical parameters of iron metabolism, fibrinolysis and markers of inflammation. Changes associated with impaired iron metabolism were assessed by the level of serum iron, transferrin, daily and induced iron excretion in the urine. Statistical processing was carried out using nonparametric methods.Results. All patients with severe COVID-19 and hyperferritinemia showed signs of impaired iron metabolism, inflammation and fibrinolysis — a decrease in the level of transferrin (p˂0.001), serum iron (p˂0.005), albumin (p˂0.001), lymphocytes (p˂0.001) and an increase in leukocytes (p˂0.001), neutrophils (p˂0.001), CRP (p˂0.005), IL-6 (p˂0.001), D-dimer (p˂0.005), daily urinary iron excretion (p˂0.005) and induced urinary iron excretion (p˂0.001).Conclusions. The study showed that in the pathogenesis of the severe course of COVID-19, there is a violation of iron metabolism and the presence of a free iron fraction. The appearance of free iron can be caused by damage to cells with the “release” of iron from cytochromes, myoglobin, hemoglobin, or violation of the binding of iron to transferrin, which may be the result of a change in the protein structure or violation of the oxidation of iron to the trivalent state. When assessing the degree of viral effect on the body, one should take into account the effect of various regulators of iron metabolism, as well as an assessment of the level of free iron not associated with transferrin.

The objective: to study specific features of the course and diagnosis of respiratory tuberculosis in persons aged 70 years and older.Subjects and methods. Medical records of 93 patients aged 70 years and older who were hospitalized due to respiratory tuberculosis in 2000-2019 were retrospectively analyzed. Men made 60.2%, and women – 39.8%.Results. Often tuberculosis was detected late when referring for medical care (68.8%). In 59.4% of patients, tuberculosis was detected later than in 2 months after the onset of the first symptoms. 89.2% had multiple co-morbidities. Destruction was detected in 52.7% of patients, bacterial excretion – in 69.9%, and remaining post-tuberculosis changes – in 34.4%. Sputum conversion was achieved in 81.5% of patients and cavities were healed in 53.1%.

Background. Free radical oxidation underlies many morbid processes in various organs and tissues, including skin. A major antioxidant preventing the free radical impact is superoxide dismutase (SOD). A particularly valued SOD-containing agent is recombinant human SOD, Rexod, possessing a wide spectrum of medical applications in form of lyophilisate. Marketing of a new Rexod® injection preparation in form of solution requires research into its properties, including the impact on blood microcirculation in skin, especially with the lack of relevant clinical trials.Objectives. Evaluation of anticipated positive effects of the new injection form of Rexod® on blood microcirculation in rat skin.Мethods. The new Rexod® preparation impact on blood microcirculation in skin was studied with laser Doppler fl uometry by recording the following non-oscillatory parameters of the basal blood fl ow: microcirculation (MC), mean squared deviation (MSD) and coeffi cient of variation (CV). Blood fl ow fl uctuations were measured in a wavelet analysis at different frequency bands: 0.0095–0.02, 0.02–0.046, 0.07–0.15, 0.15–0.4 and 0.8–0.16 Hz corresponding to endothelial (Ae), neurogenic (An), myogenic (Am), respiratory (Ar) and pulse (Ap) rhythm amplitudes, respectively.Results. The new Rexod® injection preparation at a dose of 8000 U/kg after 15 min of intraperitoneal administration in rats caused a statistically signifi cant (p < 0.05) increase in the blood fl ow fl uctuation amplitudes Ae (43.1%), An (43.4%), Am (60.8%), Ar (58.3%) and Ap (32.0%) compared to the control group. Because the Ae fl uctuations coincide with nitric oxide (NO) emission episodes, such a growth indicates an elevated NO excretion by endothelial cells leading to endothelium-dependent vasodilation. The observed changes in blood microcirculation in skin are also associated with higher integral values of the basal blood fl ow, MC (33.4% increase), MSD (14.0%) and CV (27.6%), although only MC and CV values were statistically signifi cant (p < 0.05). The results obtained suggest that the new injection form of Rexod® stimulates endothelial NO excretion, exerts adrenergic relaxation in smooth muscle cells of arteriolae and arteriovenular anastomoses, reduces precapillary sphincter and arteriolar contractility through Ca2+-dependent muscle relaxation, affects respiratory modulation of the venular blood microcirculatory compartment and vegetative cardiac support, intensifi es arterial blood fl ow by increasing the cardiac output.Conclusion. Application of the new Rexod® injection form improves blood microdynamics in rat skin via stimulating endothelium-dependent and independent vasodilatation and endothelial metabolism, decelerating adrenergic vasomotor activity and peripheral microvascular resistance. These processes in coupling improve blood fl ow to nutritive microvascular bed and normalise venular outfl ow. Our results provide further insights into pharmacodynamics of recombinant human SOD (Rexod).

The objective: to assess the effect of parenteral viral hepatitis on the manifestations of respiratory tuberculosis and the nature of surgical interventions for tuberculosis.Subjects and methods. An ambispective observational study was conducted with a continuous sampling of 475 respiratory tuberculosis patients over 18 years old who underwent surgical interventions. The patients are divided into two groups: the group of RTB+PVH consisted of 92 patients with concurrent respiratory tuberculosis and chronic parenteral viral hepatitis; the group of RTB included 383 patients with respiratory tuberculosis and no parenteral viral hepatitis.Results. It was found that compared with RTB group, in RTB+PVH group (regardless of the type of hepatitis virus), a chronic course of tuberculosis was registered significantly more often (42.4%; p = 0.005; OS = 2.0); more often bacillary excretion was documented (68.5%; p = 0.035; OR = 1.7), including those with multiple and extensive drug resistance (52.4% of cases with positive sputum tests, p = 0.048; OR = 1.8). Radical (69.6%; p = 0.05; OS = 1.7) and small-scale surgical interventions (64.1%; p = 0.037; OS = 1.8) were significantly less frequently performed in RTB+PVH patients; and such patients often developed postoperative complications (8.7%; p = 0.009; OS = 2.9).

Aim. To assess the availability of patients with type 2 diabetes mellitus (DM-2) and obesity with vitamins C, A, E, D, B2, B6, niacin and betacarotene.Material and methods. We assess vitamin status of 40 patients with DM-2 (14 men and 26 women) aged 42-80 years was 60,2±1,3 (Me=60,5) with concomitant obesity and a body mass index from 31,2 to 57,4 kg 42,1±1,1 (Me=42,0), receiving oral hypoglycemic therapy. The disease duration ranged from six months to 32 years — 7,4±1,0 (Me=6,0), the level of glycohemoglobin — from 5,20% to 7,70% — 6,27±0,11 (Me=6,05). The provision of C, A, E, D, B2 vitamins and beta-carotene was assessed by their serum concentration, B6 and niacin vitamins — by excretion of their metabolites with urine.Results. Against the background of a good supply of patients with A, E, C and PP vitamins, a reduced serum concentration of 25-OH vitamin D was detected in the majority (83%) of the patients, beta carotene — in 55%, insufficient provision with vitamins B6 and B2 — 15-18%. A reduced serum concentration of 1-2 vitamins was detected in 65% of the patients. A combined deficiency of 3-4 vitamins had 25% of patients.Conclusion. The presence of vitamin deficiencies in patients with DM-2, which are a risk factor for its occurrence and the development of complications, indicates the need to optimize vitamin status. The negative association between the level of basal glycemia in venous blood and glucosuria and the concentration of γ-tocopherol may indicate certain benefits of using dietary oils with a high level of vitamer.

Objective. To establish the impact of combined application of sorbilact and L-аrginin on renal detoxicating function and the indices of the endogenous intoxication syndrome (EIS) in a period of unstable compensation of toxicosis (on the seventh day of observation). Маterials and methods. There was investigated the impact of administration of sorbilact and L-аrginin on a separate indices of the EIS of a purulent-septic genesis in patients of four Groups: Group I (control) - 31 patients with systemic inflammatory response syndrome (SIRS), Group II - 16 patients with EIS, to whom a standard therapy was conducted, Group III - 13 patients with EIS, to whom sorbilact was administered on a standard therapy base, Group IV - 10 patients with EIS, in whom a standard treatment was added by sorbilact with L-аrginin. Results. On the seventh day of the investigation the middle mass molecules (MMM) excretion in patients with EIS have constituted (7,5 ± 0,28) conventional units/min, what was by 77% higher, than in the patients of the control Group, but concentration of MMM in the blood serum have persisted in 2,1 times higher and their clearance hardly achieved a lower border of a corresponding index in patients of the control Group, thus the EIS compensation have appeared unstable. Conclusion. Application of complex, consisting of sorbilact and L-аrginin, activates a detoxication function of kidneys and reduces the endogenous intoxication severity of a purulent-septic genesis.

The objective of the study: to analyze clinical data of patients staying in a specialized unit for tuberculosis patients with concurrent HIV infection. Subjects and methods. The case histories of all patients staying in the unit for T B / H IV c o-i nfection of Surgut Clinical TB Dispensary discharged in 2016 were retrospectively analyzed, totally there were 231 such patients. Results. Tuberculous lesions in the HIV infected patients were more disseminated (pulmonary disseminated tuberculosis was in 51.1% of patients and generalized forms with lesions in the lungs and other organs were in 17.9% of patients additionally). Cavities were diagnosed in 45.5% of pulmonary tuberculosis patients, and bacillary excretion was detected in 60.4% (among HIV negative patients, registered in the city, those rates made 38.3 and 42.3% respectively). The rate of multiple drug resistance made 9.9% in all pulmonary tuberculosis patients or 44% among the patients with drug resistance, and extensive drug resistance made 1.4 and 6.1% respectively. Along with ant i-t uberculosis chemotherapy, 45.9% of patients received antiretroviral therapy, and 10.0% of them rejected it. Only 36.7% of patients completed the intensive phase of treatment, 29.7% defaulted from treatment and left hospital at their will, 17.5% died, and the remaining patients were transferred to some other medical units (for surgery or to manage some concurrent condition) or they were discharged from the hospital due to violations of the discipline. While on treatment, 57.5% of the patients with bacillary excretion had their sputum converted (by culture).

Material and methods. The studies were performed on 75 white mature rats (females) weighing 180—220g. Partial hepatectomy was performed by resection of a part of the left lobe of the liver (15—20% of the organ weight). Hyperbaric oxygenation (HBO) was performed three times (3 ata, 50 min). The first, second and third sessions were performed 4—8 hours, 24 hours and 48 hours after the surgery, respectively. The urea level was determined in the tissues of visceral organs, as well as in arterial blood (aorta), portal blood, blood from renal and hepatic veins, bile from common bile duct, and in urine on the 1st, 4th and 11th days of posthyperoxic period (days 3, 7 and 14 post-surgery).Results. Activation of the urea incretion from the operated liver to the bloodstream under hyperoxic conditions was accompanied by increased urea concentration in the arterial blood and excretion from the body with urine that was facilitated by the elimination of a stimulating effect of PHE on the reabsorption of urea in the kidneys by the HBO procedure. At the same time, the production of urea in the renal tissue was activated and further released to the circulation through the renal vein. Stimulation of the liver and intestinal urea circulation by HBO was accompanied by the preservation of the stimulating effect of PHE on its accumulation in duodenum and colon tissues. In the thyroid gland, spleen, heart, and lungs of operated rats, HBO activated the transition of the «arterial» urea from the free form to the bound one. Termination of HBO normalized the urea concentration in the arterial blood by the 11th day of the posthyperoxic period whereas urea continued to be accumulated the heart, spleen, lungs, and intestine. A preserved increased release of urea from the operated liver into the bloodstream after HBO was accompanied by partial retention in the hepatocytes of urea delivered via bloodstreem through the portal vein. On the 11th day after HBO, the repeated hyperoxic activation of the liver and intestinal urea circulation occured, as well as HBO-restored stimulation of its production in the kidneys resulted in urea release into the renal vein and excretion with urea.Conclusion. HBO provides a correcting effect on alteration of circulating urea caused by PHE.

Background. Parathyroidectomy is the only effective method to improve the clinical and laboratory manifestations of the primary hyperparathyroidism (PHPT) and reduce the risk of urinary calculi formation. However, there are controversies about the existence of renal form of PHPT and about the effectiveness of surgery with regard to the risk of stone formation. Aims. To evaluate the effectiveness of PHPT surgical treatment in relation to clinical, laboratory parameters, as well as the risk of stone formation. Materials and methods. In a prospective single-arm observation one-center nonrandomized study we included patients with PHPT in whom parathyroidectomy was performed in 2012–2015. We analyzed clinical and laboratory parameters before and after surgery in a period from 1 to 3 years. Results. The study included 105 patients, of whom 35 (33.3%) had urolithiasis. Blood calcium after the surgery decreased from 2.72 mmol/l [2,56; 2,97] to 2,3 mmol/l [2,2; 2,35], p < 0.001. Blood calcium concentration decreased to normal values in all patients. Parathyroid hormone level decreased from 206 pg/ml [123; 347] to 72,8 pg/ml [30; 113], p < 0.001. Clinical symptoms questionnaire estmation decreased from 4 points [3; 6] to 2 points [1; 4], p < 0.001. In patients with urolithiasis clinical symptoms before treatment were more pronounced – 5 points [3; 7] vs. 4 points [3; 5] (p = 0.015) and decreased more significantly – by 3 points [2; 4] vs 2 points [1; 3]. The daily calcium urine excretion decreased from 11.4 mmol/day [8.9; 13.9] to 5.4 mmol/day [4.1; 6.8], p < 0.001. In 2 cases (5.7%; CI, 0.7–19.2%) we observed the progression of urolithiasis after surgery. The age of patients correlated with daily calcium urine excretion after surgery (r = 0.69; p = 0.028). Conclusions. Parathyroidectomy normalizes blood calcium and parathyroid hormone, improves clinical symptoms and reduces the risk of stone formation.

Diabetes insipidus (DI) is a syndrome characterized by the excretion of abnormally large volumes of diluted urine. It can be caused by two fundamentally different defects that must be distinguished for safe and effective management. First: central DI, due to inadequate production/secretion of vasopressin (AVP) and nephrogenic DI, due to renal insensitivity to AVP. Second: primary polydipsia, due to suppression of AVP secretion by excessive fluid intake. This review provides methods of differential diagnosis of DI. The article highlights the availability of functional tests and pituitary MRI in correct diagnosis of central DI. Common treatment algorithms of DI and management of DI in the neurosurgical patients are also discussed. The article provides comparative data of the efficacy and safety of various pharmacological forms of desmopressin in the treatment of central DI.

Results of complex diagnosis, preoperative preparation and surgical treatment of 13 patients for large and giant pheochromocytomas are analyzed. To all the patients complex of laboratory-instrumental methods of investigation, including determination of the metanephrins excretion, ultrasonographic investigation, three-phase CT, selective roentgenocontrasting angiography was applied, what permitted to establish the diagnosis correctly and to determine the treatment tactics. In spite of a long-term existence of arterial hypertension and presence of typical clinical signs of pheochromocytomas, in 2 patients only the diagnosis was established timely. Application of selective α-аdrenoblocking agent doxasosine in initial dose of 4 mg with staged enhancement up to 12 mg in a day was the main component of preoperative preparation. Оperative intervention was performed in all patients – extended adrenalectomy with excision of adjacent parts of the fat tissue and lymphatic nodes. Dimensions of the excised pheochromocytomas have constituted (103,2 ± 10,1) × (93,1 ± 8,2) mm at average, and tumoral mass - (570,2 ± 25,1) g. In immediate postoperative period in one patient postoperative wound seroma have occurred, in 2 – an acute suprarenal insufficiency, which were eliminated by applying of conservative method. In all the patients pheochromocytomas were characterized and have constituted 4 - 7 points (in accordance to the PASS scale). In remote period the disease recurrence was absent. In immediate and remote period two women–patients have got pregnant and gave a birth to living full-term new-born children. Кeywords: pheochromocytoma; α-аdrenoblocking agents; аdrenalectomy.

The article performs analysis of glucocorticoid hormones data and their metabolites in- vestigated by methods of high-performance liquid chromatography and gas chromatography - mass- spectrometry in 47 patients with pheochromocytoma (РНЕО) and 28 patients with hormone-inactive adenoma of the adrenal cortex. We revealed increased blood levels оf biologically active glucocorticoids and elevation of urine excretion of their tetrahydrometabolites in patients with PHEO. 6 patients with PHEO showed biochemical signs of the autonomous cortisol production. A positive correlation of free normetanephrine excretion with blood cortisol, corticosterone and 11-deoxycortisol and urine excretion of tetrahydrometabolites and cortols and a negative correlation with the urine excretion of tetrahydro-11-dehydrocorticosterone were detected. An increase of the THF/THE and (THF+alloTHF+cortol)/ (THE+allo-THE+ cortolone) ratios may indicate a decrease of 11β-hydroxysteroiddehydrogenase type 2 activity in patients with РНЕО.

The wide spread of drug-resistant forms of the pathogens, complicating prevention and treatment of acute intestinal infections, determines the feasibility of using bacteriophages and immune lactoglobulins for antibacterial therapy of these diseases. The aim of this study was to investigate the antibacterial efficacy of the joint use of immune lactoglobulin and Salmonella bacteriophage in the treatment of experimental salmonellosis in mice. The experimental Salmonella infection was reproduced by means of a single intragastric administration of 2LD50 of daily agar culture of S.typhimurium. As a result, the development of Salmonella infection lasting up to 14 days was noted. The animals were divided into four groups according to the pattern of the treatment. The following preparations were used for the treatment of animals: «Lactoglobulin against opportunistic bacteria and Salmonella» dry cow, «Lactoglobulin» liquid, bacteriophage of Salmonella ABCDE groups, liquid. The preparations were daily administered to mice orally after the infection for 7 days. In the study of the joint therapeutic effect of the lactoglobulin and bacteriophage the special attention was paid to the terms of elimination of the pathogen from animal organs. Analysis of the data showed that in all four groups a positive dynamics of excretion of the pathogen of mice was revealed. In groups of animals that were treated with both drugs, the elimination of Salmonella out of organs occurred 1.5 times faster than in the control groups of mice. At the same time in the experimental groups on the third day of treatment with preparations the statistically significant decrease in the number of S.typhimurium in the contents of the large intestine of animal was revealed. The study found that immune lactoglobulin used simultaneously with Salmonella phage for 7 days reduced the severity and duration of the disease course and blocked the further development of the infectious process, promoted the efficient and rapid cleansing of animals organism of the pathogen, increased the survival of mice. The obtained data suggest the applicability of joint use of immune lactoglobulin preparations and bacteriophages in the treatment of acute intestinal infections caused by antibiotic-resistant strains of Salmonella.

It is known that almost any disease of the central nervous system is accompanied by the development of cognitive disorders. The drugs of choice in the complex therapy in this case are nootropics. On the world market racetam group, i.e. derivatives of alpha-pyrrolidone, prevails among nootropics, and the derivatives have a wide spectrum of pharmacological activity. Currently, this group continues to expand. By the employees of Perm State Pharmaceutical Academy (PSPA), ruled by Professor V.L. Gein, a new biologically active compound, a 3-pyrrolin-2-one derivative KOH-1 was synthesized. This compound is at the preclinical research stage now. The aim of this work was the development of methods for determination of KOH-1 in urine by high performance liquid chromatography (HPLC), the study of excretion KOH-1 from the organism of laboratory animals. Materials and methods . Studies on the development of methods were carried out by using a liquid chromatograph LC-20 Prominence (Shimadzu, Japan) with a diode-array detector. The validation was carried out in accordance with the requirements for bioanalytical methods, in terms of selectivity, linearity, precision and accuracy. The study of excretion of KOH-1 was performed on white non-linear male rats weighing 300-400 g. The substance KOH-1 was administered once orally in a suspension of starch mucus at a dose of 100 mg/kg. Results and discussion . As a result of the research, the method for determining the biologically active compound KOH-1 in urine has been developed. The validation showed its suitability for pharmacokinetic studies. The data on daily excretion of KOH-1 in urine after a single oral administration to rats were obtained. Conclusion. The developed conditions for the chromatographic determination of KOH-1 in urine can be used in pharmacokinetic studies, both at the preclinical and clinical stages of the study of a potential drug. The data on excretion of KOH-1 will allow to determine the ways of excretion of the preparation, and also to select a rational dosage, to identify possible contraindications to the use.

Objective : to assess the vitamin status of preschoolers according to the results of one-hour urinary vitamin excretion and the data of actual nutrition. Subjects and methods . A survey was conducted in winter 2016, covering 33 children (19 boys and 14 girls) aged from 2 to 7 years who went to a Yekaterinburg preschool educational institution. The amount of essential nutrients was calculated according to the data of actual nutrition during 5 days. The vitamin status was evaluated from the urinary excretion of thiamine, riboflavin, and 4-piridoxyl acid, by testing a morning fasting urine portion. Results. Determination of urinary excretion revealed deficiency of vitamin B2 in 24.2% of the examinees, and that of vitamins B1 and B6 in significantly more children (in 66.7–69.7%). According to the actual nutrition data, inadequate intakes of vitamins B2, A, and C were detected in 27.3–30.3% of the examinees, those of niacin and vitamin B1 in 54.5 and 69.7%, respectively. The proportion of the coincidental data obtained by two methods for assessing the vitamin status was 63.6% for vitamin B1 and 69.7% for vitamin B2. Conclusion . The findings suggest that the two methods to assess the supply of vitamins B1 and B2 are interchangeable and the children need additional vitamin intakes.

Желудочнокишечный тракт секретирует широкий спектр пептидов, регулирующих метаболические процессы и влияющих на функции почек и водносолевой баланс. Эффекты данных биологически активных веществ можно усилить увеличением их периода полужизни путем угнетения фермента дипептидилпептидазы4. Цель исследования изучение экскреции ионов натрия и воды при угнетении дипептидилпептидазы4 вилдаглиптином у крыс с различным состоянием водносолевого баланса. Методика. Состояния гипернатриемии, гиперосмии или гипоосмии моделировали пероральным введением гипертонического и изотонического растворов NaCl и воды. Результаты. Вилдаглиптин вызвал дозозависимое снижение активности фермента дипептидилпептидазы4 с максимумом эффекта при дозе 1 мг на 100 г массы тела. Его введение перед гипертонической натриевой нагрузкой увеличивало экскрецию натрия на 56, усилило реабсорбцию осмотически свободной и свободной от натрия воды. Введение ингибитора дипептидилпептидазы4 перед изотонической натриевой нагрузкой усиливало экскрецию натрия в той же степени, но не влияло на реабсорбцию воды. Инъекция вилдаглиптина, предваряющая водную нагрузку, вызвала антидиуретическую реакцию почек. Заключение. Блокада дипептидилпептидазы4 вилдаглиптином способствует выведению из организма избыточного количества натрия и изменению реабсорбции воды в зависимости от концентрации ионов натрия в сыворотке крови, вероятно, за счет увеличения периода циркуляции кишечных регуляторных пептидов, секретирующихся в ответ на пероральные нагрузочные пробы NaCl. Данные процессы ускоряют восстановление водносолевого гомеостаза в условиях поступления избытка натрия через желудочнокишечный тракт., The gastrointestinal tract secretes multiple peptides that regulate metabolic processes and influence the kidney function and watersalt balance. The effects of these biologically active substances can be intensified by increasing their halflife through inhibition of the dipeptidyl peptidase4 (DPP4) enzyme. The aim of the study was investigation of sodium and water excretion after inhibition of DPP4 with vildagliptin in rats with different states of the watersalt balance. Methods. The hypernatremic, hyperosmotic and hypoosmotic states were modeled by oral administration of hypertonic and isotonic NaCl solutions or water. Results. Vildagliptin induced a dosedependent decrease in the DPP4 activity with a maximum effect of 1 mg per 100 g of body weight. Vildagliptin administration prior to the hypertonic sodium load increased sodium excretion by 56 and stimulated reabsorption of solutefree and sodiumfree water. Administration of the DPP4 inhibitor before the isotonic sodium load increased sodium excretion to the same degree without affecting the water reabsorption. A vildagliptin injection prior to the water load resulted in an antidiuretic response of the kidneys. Conclusion. The inhibition of DPP4 activity with vildagliptin promoted removal of excessive sodium from the body and changed the water reabsorption depending on the sodium concentration in the blood serum, presumably by prolonging circulation of the intestinal regulatory peptides secreted in response to oral NaCl load tests. These processes accelerate restoration of the watersalt homeostasis in the conditions of excessive sodium delivery through the gastrointestinal tract., №3 (2019)

Purpose. Definition of types of crystalluria in various forms of urolithiasis and biochemical signs of phosphate crystals in the urine, while phosphate urolithiasis (infectious origin). Patients and methods. The study involved 144 patients with recurrent urolithiasis — 75 women and 69 men. Of these, 46 — diagnosed calculi with uric acid, 44 — calcium oxalate or mixed with a prevalence of calcium oxalate, in 54 — phosphate rocks (carbonate-apatite and/or struvite). The age of patients ranged from 21 to 74 years. 93 people have been under long-term, within 2–15 years, outpatient observation. The examination included the collection of anamnesis, general and microbiological analysis of urine, biochemical blood serum and urine on 10 indicators, reflecting renal function, state of the protein, water and electrolyte metabolism, uric acid metabolism, the chemical composition of the stone analysis. Results. It was found that in patients with calcium oxalate stones phosphaturia has been diagnosed in 2% of cases. And, along with calcium phosphate crystals they had oxalate crystals. In patients with phosphate urolithiasis phosphaturia observed in 96% of patients, in two patients (4%) they determined except phosphates also oxalate salt in urine sediment. Patients with phosphate urolithiasis at occurrence of phosphate crystalluria have metabolic state changes: increased serum uric acid concentration from 0.322 ± 0.009 to 0.367 ± 0.018 mmol/l daily renal excretion of inorganic phosphate 23.94 ± 2.93 mmol/day to 32.12 ± 4.39 mmol/day, and reduced total calcium content in urine 6.61 ± 0.94 mmol/day to 3.37 ± 0.89 mmol/day. The results led to the following conclusion. Conclusion. Biochemical signs of occurrence of phosphate crystalluria in patients with stones of infectious origin can be: the approaching level of excretion in the urine of inorganic phosphates to 32,12 ± 4,39 mmol/day, serum uric acid concentration to 0,367 ± 0,018 mmol/l, and the total content of calcium in the urine to 3.37 ± 0.89 mmol/day

Iron overload (RV) is a condition caused by excessive intake of iron, and in the absence of the specific mechanisms for its excretion - excessive accumulation in tissues and their subsequent lesion leading to functional organ failure [1]. This condition most commonly occurs as a result of regular replacement therapy with erythrocyte mass in the treatment of various anemias. According to statistics, about 500 sick children and 2 000 adults develops post-transfusion RV in Russia in every year [2]. It develops in the context of hereditary anemia (major and intermediate forms of beta-thalassemia, other hemoglobinopathies, severe membrane and enzyme defects, congenital sideroblastic and dyserythropoetic anemia, constitutional hypo- and aplastic anemia) or acquired diseases (acquired aplastic anemia, myelodysplastic syndrome (MDS), myelofibrosis, etc.). [3--5].

Цель исследования изучение влияния резекции печени (РП) на аммиакэкскретирующую функцию почек при хроническом тетрахлорметановом гепатите. Методика. Опыты выполнены на 265 беспородных белых крысах (самках) массой 180220 г. Хронический гепатит воспроизводили подкожным введением 50 раствора тетрахлорметана (CCl) на оливковом масле (0,1 мл/100 г массы тела, через сутки, c двумя двухнедельными перерывами между 6, 7 и 1314 инъекциями). На 65е сут. (последние) введения тетрахлорметана, удаляли часть левой доли печени (1520 массы органа). На 3и, 7е и 14е сут. после РП или лапаротомии ( ложнооперированные животные) в почках, артериальной и венозной крови, моче исследовали содержание аммиака, глутамина и мочевины. Результаты. Прогрессирование эндогенной аммиачной интоксикации после РП на фоне тетрахлорметанового гепатита сопровождается повышенной экскрецией аммиака почками. Однако это не устраняет артериальную гипераммониемию и не предотвращает накопление почками аммиака. Инкреция глютамина из почек в кровоток прекращается. К 14м сут. послеоперационного периода возрастает потребление глютамина из артериальной крови, что приводит к его накоплению в почках. Стимулируя выведение мочевины из организма с мочой, РП одновременно активирует её образование в почках, с дальнейшим поступлением как в кровоток, так и в мочу. В зависимости от сроков послеоперационного периода это сопровождается изменением скорости реабсорбции мочевины в почках. Заключение. Полученные результаты свидетельствуют, что при РП на фоне тетрахлорметанового гепатита почки не предотвращают прогрессирование эндогенной аммиачной интоксикации, патологическое накопление аммиака и глутамина её клетками, но сохраняют способность принимать участие в регуляции повышенного содержания мочевины в артериальной крови., Mechanical (resection) or toxic (hepatitis) liver damage alone has an ambiguous effect on renal ammonia excretion during development of endogenous ammonia intoxication. The aim. The study investigated the effect of liver resection (LR) on renal ammonia excretion in chronic tetrachlorocarbon (CCl)induced hepatitis. Methods. Experiments were conducted on 240 mongrel white rats (females) weighing 180220 g. Chronic hepatitis was induced by subcutaneous injection of 50 solution of carbon tetrachloride (CCl) in olive oil (0.1 ml/100g body weight per day with two twoweek breaks between injections 67 and 1314). LR with removal of a part of the left lobe (1520 of body weight) was performed on the 65th (last) day of CCl injections. The animals were examined on the 3rd, 7th and 14th day after LR or laparotomy (sham operation). Contents of ammonia (AM), glutamine (GN), and urea were measured in the kidney, arterial (AB) and venous ( v.renlis ) blood, and urine. Results. Progression of endogenous ammonia intoxication after LR associated with CClinduced hepatitis and increased renal excretion of Am involves three mechanisms: 1) excretion of Am that is delivered to kidneys in the free form with AB 2) stimulation of renal tubule secretion of Am that had formed in kidneys by deamidation of arterial Gn and 3) contrary to rules, partial reabsorption of Am from collecting tubules into the blood. However, this does not eliminate arterial hyperammonemia or prevent accumulation of Am in kidneys. The stimulatory effect of LR in CClinduced hepatitis on Gn incretion from kidneys to the circulation stops by the 14 day after surgery, and the accompanying increased consumption of Gn from AВ results in Gn accumulation in kidneys. LR stimulates urea excretion with urine and simultaneously activates kidney formation of urea, which further enters the bloodstream and urine. Depending on the postoperative period this is associated with changes in the rate of urea reabsorption in kidneys. Conclusions. In RP associated with CClinduced hepatitis, kidneys cannot prevent progression of endogenous ammonia intoxication and pathological accumulation of ammonia and glutamine in kidney cells but retain the ability to participate in the regulation of the increased urea level in AB., №3 (2019)

Эндогенные опиоидные пептиды играют важную роль в регуляции иммунных процессов. Цель работы - изучение влияния бета-эндорфина на уровни кортикостерона в плазме периферической крови мышей, секрецию IL-2, IL-4 и IFN-gamma мышиными спленоцитами, а также продукцию IL-1b и IL-10 перитонеальными макрофагами in vivo через 1 ч и через 6 ч после введения пептида. Методика. Исследования выполнены на беспородных мышах-самцах массой 22-25 г. Бета-эндорфин вводили однократно внутрибрюшинно в дозах 100-0,0005 мкг/кг. Через 1 или 6 ч после введения бета-эндорфина животных выводили из эксперимента, выделяли перитонеальные макрофаги и спленоциты для культивирования. Результаты. Установлено, что введение бета-эндорфина в дозах 100, 0,01, 0,0005 мкг/кг за 1 ч до выведения животных из эксперимента приводило к угнетению спонтанной продукции IL-1b макрофагами. Введение пептида за 6 ч в дозе 1 мкг/кг приводило к угнетению продукции IL-1b стимулированными макрофагами. b-эндорфин выражено снижал продукцию IL-10 во всех исследуемых дозах как при введении за 1ч, так и за 6 ч до выведения животных из эксперимента. Пептид усиливал Кон А - индуцированную продукцию IL-4 как через 1 ч, так и через 6 ч после инъекции. Продукция IL-2 спленоцитами угнеталась через 1 ч после введения пептида, и стимулировалась через 6 ч после введения. На продукцию IFN-g введение b-эндорфина влияния не оказывало. Концентрация кортикостерона в плазме крови интактных мышей под воздействием b-эндорфина не изменялась. Заключение. Бета-эндорфин, несмотря на быстрое ферментативное расщепление в организме, способен оказывать пролонгированные иммуномодулирующие эффекты, которые могут менять свою направленность с течением времени., Endogenous opioid peptides play an important role in regulation of immune processes. The work objective was to study the effect of beta-endorphin on corticosterone levels in murine peripheral blood plasma, secretion of IL-2, IL-4, and IFN-g by murine splenocytes, and production of IL-1b and IL-10 by peritoneal macrophages in vivo at 1 h and 6 h following administration of the peptide. Methods. Investigations were performed on mice weighing 22-25 g. Beta-endorphin (100-0,0005 mg/kg, i.p.) was administered once. One or six hours after the beta-endorphin administration, the animals were withdrawn from the experiment, peritoneal macrophages and splenocytes were isolated for culturing. Results. Administration of beta-endorphin at doses of 100, 0.01, and 0.0005 mg/kg 1 h before sacrificing animals led to suppression of macrophage spontaneous production of IL-1b. Administration of the peptide at a dose of 1 mg/kg within 6 hours prior to sacrificing resulted in inhibition of IL-1b production by stimulated macrophages. Βeta-endorphin at all doses reduced the IL-10 production both 1 h and 6 h before sacrificing the mice. The peptide enhanced Con A-induced production of IL-4 both 1 h and 6 h after injection. Production of IL-2 by splenocytes was inhibited 1 h after administration of the peptide and stimulated 6 h after the peptide administration. Administration of b-endorphin had no effect on the IFN-g production. b-endorphin did not change plasma corticosterone concentrations in intact mice. Conclusion. Beta-endorphin, despite its rapid enzymatic cleavage, is able to exert long-term immunomodulatory effects, which can change their direction over time., №1 (2018)

Being grown on soils with different salinity degree, Tamarix ramosissima as the major representative of crinohalophytes reveals its ability to accumulate and removal the soluble salts. This is evidenced by a conjugated analysis to determine the chemical composition of soluble salts in ground waters, salt crusts, plant tissues and the salt excretion covering the Tamarix ramosissima sprigs. In these studies the soils were represented by hydromorphic solonchaks with salt crusts 5 and 0.1 cm thick and the content of toxic salts accounted for 32.4 and 57.6 respectively. The salinity was sulfate-sodium by nature. Based upon a comparative analysis of definite anions and cations in plant tissues and the salt excretion it seemed possible to notice that their content in salt secreted is higher by 3.2-7.7 times as compared to that in plant tissues. There is much in common in the content of cations and anions in the salt excretion of Tamarix ramosissima that can be presented in the following way: Na + > Mg 2+ > Ca 2+ > K + и Cl - > SO 4 2- . It has been also established that the maximal removal of Na + and Cl - in the salt excretion doesn’t connected with the amount of given ions in ground waters. One should be assumed that the content of Na + , Ca 2+ , Mg 2+ и SO 4 2- is associated with the concentration of these cations in salt crusts of the studied solonchaks. It is worthy of note that the Cl - exudation is not dependent on its content in the ground water and salt crust being comparable with Na + exudation. Thus, Tamarix ramosissima grown under natural conditions reveals no direct dependence between the ions exudation by plants in the kind of salt excretion, the chemical composition and the amount of salts in soil (salt crust) and the ground water.

Evaluate melatonin (MT) patterns excretion at multimorbid cardiovascular pathology (MCVP) (coronary artery disease (CAD), hypertension, metabolic syndrome (MS)) with non-psychot- ic mental disorders (NPMD) anxiety/ depressive type. Identify the effectiveness of visual-auditory ef- fects in the treatment of these pathologies. Design and methods: The study included 70 men (mean age 37,46±6,74) with MCVP divided into 4 groups by simple random sampling, and 20 healthy men (mean age 38,3±6,73 g). Patients in Group 1 (n = 22) received standard therapy CAD, hypertension and NPMD, in group 2 (n = 25) standard therapy CAD, hypertension, NPMD and visual-auditory correction. Patients of group 3 (n = 23) received standard therapy CAD, hypertension, NPMD, visual-auditory correction and psychotherapy. Used in the study: complex psychological test methods and laboratory-instrumental evaluation of the cardiovascular system. Definition of 6-sulfatoxymelatonin (6-SMT) performed by ELI- SA using kits BÜHLMANNEK-M6S. Results: Identified change normal «dipper» pattern to «non- dip- per» and «night-peaker» (daily index blood pressure and 0-10%

Methotrexate (Mtx) is a cytotoxic drug from the group of antimetabolites, folic acid antagonists. High-dose (HD) Mtx in pediatric oncology are used for the treatment of osteosarcoma (OS), and other types of tumors. This therapy has allowed to achieve a five-year relapse-free survival rates up to 80 % in patients with OS. However, the high toxicity of Mtx is a serious constraint in achieving the maximum therapeutic effect, which in most cases poses the occurrence of side effects in patients on various organs and systems. Treatment should be under strict laboratory monitoring, primarily therapeutic drug monitoring the concentration of Mtx in serum. 246 children (boys – 125, girls – 121) aged 5 to 16 years with osteosarcoma (mean age 12.2 years) who were treated in N.N. Blokhin Russian Cancer Research Center from 2006 to 2013. Patients were conducted from 1 to 8 courses HD Mtx at a dose of 8 or 12 g/m2 , administered within 4 h of infusion on the background of alkaline prehydrate. Leucovorin was administered intravenously, every 6 hours, starting 24 h from the start of the Mtx infusion. 1137 courses of HD Mtx were conducted with FPIA method (analyzer TDx/Flx, Abbott, USA). The technique of monitoring of homocysteine (Hcy) in the blood serum by analyzer Vitros 5/1FS (Johnson & Johnson, USA) during the entire course of high-dose Mtx was tested. In groups calculated pharmacokinetic parameters Mtx were tested: area under the pharmacokinetic curve (MtxAUC), clearance of methotrexate (ClMtx), the elimination half-life (T1/2 ) and the total time of excretion (Ttotal). Normal excretion of Mtx was revealed at 1050 courses Mtx, corresponding to the following values: 4 h – 1109 ± 283 μmol/l; 24 h – 4,67 ± 0,95 μmol/l; 42 h – 0,38 ± 0.16 µmol/l; 48 h – less than 0,23 ± 0.04 µmol/l; 72 h of 0.07 ± 0,03 µmol/l; 96 h of 0.03 ± 0.01 µmol/l. At 87 courses identified delayed Mtx excretion, accounting for 7.6 % of all courses. In all measured parameters: hourly concentration of Mtx, Ttotal, MtxAUC, Clmtx, T1/2 , is obtained statistically significant differences between normal and delayed Mtx excretion. Patients in group of delayed excretion of methotrexate were characterized by the development of hepatotoxicity, there were also observed 4 cases of the occurrence of acute renal failure. Monitoring of biochemical parameters (alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase) also revealed differences between the two groups – hepatotoxicity directly depended on MtxAUC, ClMtx and Ttotal, and the amplitude changes in activities of enzymes from course to course by increasing the number of course decreased. Our developed methodology of monitoring of Hcy in serum during the course of HD Mtx revealed that Hcy metabolic interconnected with Mtx – the higher the concentration of Mtx, the greater the amount of Hcy released into the blood. Hcy has a close metabolic relationship with Mtx – it can serve as a marker of the efficiency of suppression of the transformation of folates. During slow excretion of Mtx Hcy significantly increased in the blood, which also suggests that it can serve as a marker of pharmacodynamic effects of HD Mtx.

Non-adaptive remodeling of cardiovascular system and progressive kidney damage at chronic kidney disease (CKD) is associated with the development of endothelial dysfunction (ED) and apoptosis. The aim of this research was to study the changes of indicators of apoptosis and ED in patients with CKD 1 stage throughout 12 months. Complex biochemical, immunoferment and tool methods were applied at patient examinations. Arterial pressure of all observed patients was resolved on target values in 12 months. However, the indicators of endothelium-dependent vasodilation (EDV) increased in 55 patients (1st group), and the peak of circulating blood volume in skin microvessels in 22 patients (2nd group) wasn't changed: 134±4 % и 136±4 %, p>0.1. The level of the annexin A5 reduced from 3.5±0.47 to 1.27±0.31 ng/ml (p 0.1 in 2nd group. Diurnal excretion of sodium chloride decreased from 6.8±0.57 g/d to 2.8±0.39 g/d (p

Changes in microbiome of the genital tract in the absence of obligate pathogens are manifested in the increasing number of opportunistic pathogens, contamination of the unusual for this type of bacterial habitats and reducing of the amount of normal flora, particularly lactobacilli. The aim of the study was to improve the efficiency of the therapy of vaginal microbiome by topical application of Gynoflor E, which is the basis of Lactobacilus acidophilus lyophilisate 50 mg (at least 100 million of viable bacteria) and 0,03 mg estriol. The study involved 120 sexually active women of reproductive age (18-45 years) complaining of discomfort in the vagina, and excretion. The drug is used by 1 vaginal tablet at night №12 the course. The results showed that the inclusion of Gynoflor E in standard methods of therapy of microbiome of the lower genital tract contributed to significant increase in the effectiveness of treatment to 86% instead of 46-53% when using only antibiotic therapy.

Features of local immunity were studied in the patients with Salmonella infection at reconvalescence, both without carriership, and in reconvalescent carriers of microbial flora (RCM). In RCMs, as compared to non-carriers, some alterations in gut microbiocenosis were revealed, along with local deficiency of antimicrobial defense factors, i.e., lactoferrin, lysozyme, secretory IgA, free secretory component, antibodies to Salmonella O-antigen, IgA, as opposed to high levels of IgM, IgG (due to IgG1 and IgG4), cytokines (IL-6, IL-8, IFNγ, IL-4). It was shown that sIgA and IgA deficiency are connected with their mangling local production, whereas the revealed increase in IgМ and IgG concentrations proved to be a consequence of increased local synthesis. Application of polyoxidonium (PO) in RCMs lead to improvement in the gut microenvironment, thus reflected by decreased contamination with facultative flora, disappearance of Proteus, Candida spp. and recovery of indigenous anaerobic flora in 92 per cent of cases. Positive dynamics of local immunity associated with PO treatment was justified by restoration of total IgA and sIgA concentrations, due to enhanced local synthesis, increase in free secretory component, higher titers of antibodies to Salmonella O-antigen, and changes in cytokine contents, with restoration of Th1/Th2 cytokine balance. Under in vitro conditions, a PO-associated suppression of anti-complement Salmonella activity was registered, thus rendering positive effects of the drug towards symbionts in the «host-parasite» system, and shortening the terms of microbial excretion in Salmonella carriers.

Aim of our clinical study was evaluation of the possibility of diagnosing of renal posttransplant complications in recipients using dynamic renal scintigraphy. Materials and methods. In this study were included 118 patients (age 21–60 (38,4 ± 9,8 yrs)), who underwent dynamic renal scintigraphy and renal transplantat biopsy. We determined time to peak uptake and excretion half-life time of radiopharmaceutical in renal transplantat and graft parenchyma. Recipients were subdivided into three groups according to histopathological findings: first – normal (n = 32), second – acute rejection (n = 43), third – chronic nephropathy (n = 43). Results . Time to peak uptake of radiopharmaceutical in graft parenchyma in patients in the fi rst group – 3,24 ± 0,54 min, second – 6,61 ± 3,28 min, third – 6,21 ± 3,17 min (p < 0,001). Time to peak uptake of radiopharmaceutical in renal graft in patients in the fi rst group – 3,87 ± 0,62 min, second – 7,4 ± 3,8 min, third – 8,03 ± 3,28 min (p < 0,001). The half-life time of radiopharmaceutical in graft parenchyma – 10,4 ± 2,95 min, second – 37,09 ± 19,44 min, third – 29,6 ± 15,52 min (p < 0,01). The half-life time of radiopharmaceutical in renal graft in the fi rst group – 12,31 ± 3,09 min, second – 43,29 ± 27,39 min, third – 52,71 ± 26,2 min (p < 0,001). Anderson–Bahadur distance: Tmax of graft parenchyma is the most signifi cant between the fi rst and the second group of patients (1,23); Tmax of renal graft gives maximum index value in chronic nephropathy (0,89), T1/2 of graft parenchyma is more once differentiated between acute rejection and chronic nephropathy (0,95). The sensitivity and the specifi city of renal scintigraphy parameters in the diagnosis of renal posttransplant complications amounted to 71,43–95,24% and 67,7–96,43%, respectively. Conclusion . Renal scintigraphy is an additional test for early detection of renal posttransplant complications and correction of recipient surveillance. The kinetic parameters of renotrophic radiopharmaceuticals provide diagnosis of acute rejection and chronic nephropathy of renal graft. The introduction of radionuclide imaging to monitor the state of renal transplantat optimizes approaches to graft biopsy.

Effective and safe diuretic torasemide has additional effects of renin-angiotensin-aldosterone system blockage. Torasemide can be used as monotherapy or combined with other antihypertensives. In low doses torasemide produces pronounced antihypertensive effect without augmentation of excretion of potassium and water with urine. Long-term administration of torasemide was not associated with significant effects on lipid, purine, carbohydrate, or electrolyte metabolism parameters. Torasemide particularly effective in postmenopausal women, as these women are more likely formed low-renin hypertension. Therefore, torasemide can be used more widely in modern clinical practice.

The paper gives the results of an open-label trial of the Uralyt-U citrate used in 30 patients with gout and nephrolithiasis. In addition to rapid urine pH optimization, the use of the drug is shown to cause a reduction in the serum level of uric acid, correlating with its enhanced excretion. The use of the agent features good compliance and fails to affect renal functional parameters.

Aim.To identify clinical and functional manifestations of hypervolemia in patients with arterial hypertension (AH).Material and methods.In total, 440 patients with Stage I-II AH were examined, including assessment of salt taste sensitivity threshold (STST), 24-hour urinary Na excretion, and NaCl excretion. In addition, 24-hour blood pressure monitoring (BPM), echocardiography (EchoCG), and psychological status assessment (SMOL, MOS SF-36) were performed.Results.In 50,5% of AH patients, daily salt intake (assessed by 24-hour NaCl excretion) was ≥16,8 g, due to adding salt to food, as well as to reduced STST. Higher salt intake was associated with more advanced clinical and functional AH manifestations. Indirect markers of hypervolemia in AH patients included higher salt intake, low effectiveness of standard antihypertensive therapy (AHT), disturbed circadian BP rhythm with inadequate nighttime BP reduction, and EchoCG signs of left ventricular volume overload.Conclusion.Complex examination of AH patients helps to identify individuals with clinical and functional manifestations of hypervolemia.

The aim of this study was to offer the optimal levels of daily iodine intake during pregnancy and lactation. One-stage epidemiological survey was carried on in two cities: Nizhny Novgorod (n = 220) and Smolensk (n = 119). The pregnant women were divided into two groups: Group 1 (n = 161) – KI (200 micrograms/day) and Group 2 (n = 178) – KI (300 micrograms/day). Reearch methods included: ultrasound examination of a thyroid, urinary iodine concentration (UIC) measuring, analysis of thyroid stimulating hormone (TSH), free thyroxin (fT4), thyroperoxidase autoantibody (AT-TPO). After 3 months of iodine prophylaxis during pregnancy the median UIC increased to 259,6 (pNN = 0.00) and 120,8 µg/l (pSm = 0.00) in the 2nd group, and in the 1st group the iodine excretion in urine has compounded 96.9 (pNN = 0.00) and 83.5 µg/l (pSm = 0.00). In Nizhny Novgorod during lactation there was an insufficient concentration of iodide in urine in group 1 and in group 2 there were normal indexes of a median urinary iodine – 88.6 and 123.2 µg/l accordingly (p = 0.00). In Smolensk the median UIC was dropped, however in 1st group it was statistically significant (p = 0.03), median urinary iodine was 41.1 and 70.3 µg/l in groups 1st and 2nd accordingly (p = 0.04). The median UIC >100 µg/l has been noted at 10.5% of women in the 2nd group, and in the 1st group of patients by sufficient UIC has not been detected. Consequently, the median level of urinary iodine indicate optimal iodine nutrition during pregnancy and lactation and the requirement of iodine is at least 300 µg/day.

Objective: to evaluate catabolic and anabolic processes in cardiosurgical patients during heart operations under extracorporeal circulation.Subjects and methods. Seventy-one patients with coronary heart disease (CHD) and acquired cardiac defects (ACD), who had been operated on under extracorporeal circulation, were examined. The plasma levels of cortisol, adrenaline, insulin, growth hormone, and albumin were measured. For determination of daily nitrogen excretion, blood and diurnal urine were sampled at the following stages: 1) before surgery; 2) postoperative (PO) day 1; 3) PO day 3; 4) PO day 7; 5) PO day 14; 6) PO day 21.Results. The preoperative daily nitrogen excretion in CHD patients was 10.4±1.0 g/day. By PO day 3, there was a significant increase in nitrogen excretion by 66%, up to 17.3±1.6 g/day (p0.05). In cardiosurgical patients, an increase in daily nitrogen excretion occurred with the elevated concentrations of the stress hormones cortisol and adrenaline.Conclusion. The magnitude of catabolic reactions after cardiosurgical interventions depends on the type of cardiac disease. In patients with CHD, the maximum catabolic reactions were recorded on PO day 3 whereas in those with ACD, they continued within three weeks postoperatively.

Objectives: the aim of the study was to investigate clinical features of thyroid function in pregnant woman in the region of natural iodine deficiency. Methods: serum thyroid stimulating hormone (TSH), free thyroxin (fT4) concentrations, urine excretion of iodine were measured. The structure and volume of thyroid gland were defined by palpation and ultrasonography. The 150 pregnant women (50 in every trimester) were included in study. Results: median of urine iodine excretion was 72.5 mkg/l, that confirm mild iodine deficiency in the region. During pregnancy median of urine excretion of iodine is significantly lower in third trimester (51.0 mkg/l), than in first (93.0 mkg/l) and in second (86.1 mkg/l). The goiter was registered more often in third trimester of pregnancy. The level of fT4 was decreased in third trimester of pregnancy. Key words: iodine deficiency, goiter, hypothyroidism pregnancy.

Surgical intervention is associated with the development of endocrine, metabolic, and inflammatory changes that may give rise to postoperative complications. Objective: to evaluate the impact of regional anesthesia on the magnitude of these changes during and after abdominal surgery. Subjects and methods. One hundred and twenty patients were examined during elective lower abdominal operations. The patients were divided into groups according to the anesthetic modality: general anesthesia alone (n=40) and in combination with continuous epidural (n=40) and spinal anesthesia (n=40). Cortisol, glucose, lactate, interleukins 6, 8, and 10 concentrations and daily urinary nitrogen excretion were studied before, during, and after surgery. Results. The two regional anesthesia modalities lowered the degree of an increase in the concentrations of cortisol, glucose, and lactate in the perioperative period and restricted a rise in the concentrations of both proinflammatory and anti-inflammatory cytokines. Spinal and epidural anesthesia both reduced daily urinary nitrogen excretion. Epidural versus spinal anesthesia/analgesia assured better quality of postoperative analgesia and was attended by less significant hemodynamic disorders. Conclusion. Both spinal and epidural anesthesia restrict the perioperative rise in the concentrations of cortisol, glucose, lactate, and cytokines and suppress protein catabolism after abdominal surgery. Key words: regional anesthesia, abdominal surgery, cortisol, protein and carbohydrate metabolism, inflammatory response.