Saratov JOURNAL of Medical and Scientific Research

Shakhmartova S.G.

Scientific Research Institute of Traumatology Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky Physician of Department of Clinical Laboratory Diagnostics, Candidate of Medical Science

Hemostasis test parameters in patients requiring revision knee arthroplasty

Year: 2018, volume 14 Issue: №2 Pages: 266-271
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Girkalo M.V., Shakhmartova S.G., Shpinyak S.P., Mandrov A.V., Kozadaev M.N., Puchinyan D.M.
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Objective: comparative analysis of the blood coagulation system in patients requiring revision arthroplasty of the knee joint in connection with the developed infectious and aseptic complications after total arthroplasty. Material and Methods. 37 patients with complications of total knee replacement were examined. Patients were divided into 2 groups: 1st — with signs of suppuration (n=19); 2nd — withsigns of aseptic instability of the endoprosthesis components (n=18). The control group consisted of 22 conditionally healthy people. Studied screening coagulation: activated partial thromboplastin time, prothrombin time, fbrinogen concentration, thrombin time, antithrombin III, protein C, the content of soluble fbrin-monomer complexes and D-dimers. Results. There was an increase in activated partial thromboplastin time in patients of group 2, prothrombin time — in patients of groups 1 and 2 compared with the data obtained in the control group (p<0.001). An increase in the content of soluble fbrin- monomer complexes and D-dimers was recorded in the blood plasma of patients of the 1st and 2nd groups compared to their level in the control group (p<0.001). Conclusion. The data of local coagulogram tests in patients requiring revision arthroplasty of the knee joint refect the signs of maladaptation in the hemostatic system at the preoperative stage of examination. It is worth noting the lack of information content of the screening coagulogram, as its basic tests do not refect changes in the whole system of homeostasis, the search for new informative research methods remains relevant today.

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The capacity of the thrombin generation test in the diagnostics of hemostasis system disorders in patients with osteoarthritis

Year: 2018, volume 14 Issue: №3 Pages: 602-606
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shakhmartova S.G., Vorobyova I.S., Puchinyan D.M.
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Aim: to determine the diagnostic significance of thrombin generation test parameters in the diagnostics of hemostatic disorders in patients with osteoarthritis of large joints in preoperative period. Material and Methods. 137 subjects have been investigated, among whom there were 115 hip and knee osteoarthritis patients, submitted for primary arthroplasty (68) and re-prosthetics (47); control group — 22 conventionally healthy blood donors. All subjects underwent plasma hemostasis study and thrombin generation test with two activators — RB (TF 2 pmol/ml) and RC-low (TF 5 pmol/ ml). Osteoarthritis patients were divided into two groups according to the results of thrombin generation test. The 1st group included patients with an adequate response to the stronger activator (t-lagR >t-lag ow, tt-peak^tt-peak^^), the 2nd —with an inversion response (t-lagRBlow). Results. In trie control group and group 1 patients, the thrombin formation process is more pronounced when using an activator with a high TF(RC-low) content than when using an activator with a lowTF (RB) content, which is regarded as an adequate reaction of thrombin formation to the action of a stronger agonist. Patients of the 2nd group inresponse to the action of the activator with a high content of TF was observed inhibition of the reaction of formation of thrombin, which was reflected in the slowdown in the speed of the generation of this enzyme and reduce its quantity. Conclusion. The use of two activators with different concentrations of tissue factor in the test of thrombin generation allows the nature of the response of the hemocoagulation system to initiate the process of thrombin formation to identify patients with adequate and inadequate response.

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Biomarkers content in blood serum of patients with osseous neoformations

Year: 2016, volume 12 Issue: №3 Pages: 358-361
Heading: Clinical Laboratory Diagnostics Article type: Original article
Authors: Korshunov G.V., Pavlenko А.А., Puchinyan D.M., Shakhmartova S.G.
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The aim of the study was the estimation of several biomarkers in differentiation diagnostics of tumour diseases in osseous system. Material and methods. 160 patients with benign (115) and malignant (45) osseous neoformations were investigated. Neopterine, tumour necrosis factor (TNF-а), interleukin-6, adhesion molecules of vessel endothe-lium (sVCAM-1) and vascular endothelial growth factor (VEGF) levels were identified by ELISA solid-phase test and compared with the levels of 20 apparently healthy individuals. Tumor verification was fulfilled by X-ray, CT, MRI and histomorphological essay. Results. Both benign and malignant osseous tumour patients showed increased levels of neopterine, TNF-а and interleukin-6 being more significant with malignant processes. The level of sVCAM was decreased in patients of both groups and VEGF level corresponded to the control, these indexes did not show any differences between the groups. The assessment of diagnostic value of these cytokines indicates that positive results for TNF and neopterine give the ground for the final diagnostic decision while the same results for interleukin-6 give moderate basement for diagnostic decision. Conclusion. Increased TNF-а and neopterine levels allow substantiating the difference between benign and malignant osseous tumours and improving diagnostic quality.

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Markers of systemic inflammatory response in coxarthrosis

Year: 2013, volume 9 Issue: №4 Pages: 679-683
Heading: Clinical Laboratory Diagnostics Article type: Original article
Authors: Korshunov G.V., Shakhmartova S.G., Puchinyan D.M.
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Objective: to detect markers of the systemic inflammatory response syndrome in patients with coxarthrosis by means of assessment of the status of the hemostasis system, endothelium function and inflammation intensity. Material and Methods. The indices of the plasmatic hemostasis, levels of VCAM-1, ICAM-1, ELAM-1, VEGF-A, neop-terin were analyzed. Results. It has been found that among the patients with hip coxarthrosis a group of patients (47%) with endothelium dysfunction, cellular immunity activation, a high content of Soluble Fibrin Monomer Complex and D-dimers and a group of patients (53%) without any abnormalities in these parameters should be differentiated. Conclusion. Among the patients with hip coxarthrosis a group with signs of a systemic inflammatory response syndrome (occurrence of endothelium dysfunction, cellular immunity activation, a high content of Soluble Fibrin Monomer Complex and D-dimers) and a group of patients with reference values of these parameters can be determined. The markers of the systemic inflammatory response syndrome in cases with hip osteoarthrosis are Soluble Fibrin Monomer Complex and D-dimers, high levels of intercellular adhesion molecule-1 (slCAM-1), vascular cell adhesion molecule-2 (sVCAM-1), cell adhesion E-selectin-1 (ELAM-1) and Neopterin (Np).

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