Saratov JOURNAL of Medical and Scientific Research

Gladkova E.V.

Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery of Saratov State Medical University n.a. V I. Razumovsky Head of Department of Fundamental, Clinical and Experimental Studies, Candidate of Biological Sciences

Peculiarities of remodeling of hyalin cartilage at early stages of development of degenerative-distrophic processes of knee joints

Year: 2018, volume 14 Issue: №1 Pages: 70-75
Heading: pathological anatomy Article type: Original article
Authors: Gladkova E.V., Romakina N.A., Ananyeva O.E., Belova S.V., Babushkina I.V., Persova E.A., Karyakina E.M.
Organization: Saratov State Medical University
Summary:

The aim is to develop methods for detection of hyaline cartilage metabolic imbalance in patients with initial degenerative dystrophic changes in the substantiated pathogenetically knee. Material and Methods. Subject of inquiry: 50 women aged from 35 up to 57 (49.1 ±2.4), among them 36 patients with an early stage of knee osteoarthrosis made up an experimental group, 14 women without any musculoskeletal disease clinical presentations made up a control group. We carried out a complex examination including physical assessment, study of orthopaedic status, interview with the use of KOOS (Knee Injury and Osteoarthritis Outcome Score) scale, roentgenography and MRI of the knee and also a number of laboratory tests: enzyme-linked immunosorbent assay determination of the content of cytokine profile indices (IL-1, TNF-a, IL-6), cartilage oligomeric matrix protein (COMP) and bone (SerumCrossLaps and bone isozyme of alkaline phosphatase (BAP)) tissue metabolism markers in blood serum in all the groups of patients. Results. In all the patients of the experimental group the roentgenologic stage of osteoarthrosis was defined as 0-1 according to J. Lawrence and J. Kellgren, but at the same time knee degenerative changes were objectivized on the series of MR images in the form of MR signal changes of the articular cartilage, erosions and cysts, degenerative meniscus. We observed increased serum cartilage oligomeric matrix protein (COMP) in the same group and that is characteristic of hyaline cartilage destruction activation. We also detect disorders in bone tissue remodeling in the form of bone resorption intensification (Serum CrossLaps), osteogenesis increase (BAP) and activation of proinflammatory cytokine system link (IL-1, TNF-a). Conclusion. The leading pathogenetic links of the early degenerative changes of the knee are hyperproduction of proinflammatory cytokines (IL-1, TNF-a), destruction of the hyaline cartilage and disorder in bone tissue remodeling. Assessment of biochemical predictors of cartilage and bone tissue degradation along with the instrumental methods of diagnosis is of great theoretical and practical importance in the system of early detection of incipient osteoarthrosis.

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The peculiarities of bone and cartilage tissue remodeling in patients after hip joint replacement

Year: 2017, volume 13 Issue: №3 Pages: 723-727
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Gladkova Е.М., Karyakina E.V., Tsareva Е.Е., Persova Е.А., Belova S.V.
Organization:
Summary:

The aim: to study the peculiarities of structural and metabolic state of bone and cartilage tissue in patients in the first 12 months after total hip replacement with respect to their immune state and lipid peroxidation activity. Material and Methods. Significant laboratory predictors of initial signs of aseptic instability were singled out allowing estimating the peculiarities of bone tissue remodeling as well as humoral and cellular immunity state. Results. The obtained results demonstrated that impairments in T-lymphocyte system in patients with initial signs of aseptic instability of en-doprosthesis were accompanied by reduction of its total number (CD3+), among that due to the population of cytotoxic (CD3+CD8+) cells with simultaneous increase of T-helpers (CD3+CD4+) number. Activation of serum proosteoclasto-genic factors (TNF-a and IL-1(3) was noticed on the background of anti-inflammatory humoral immunity failure (IL-10). Conclusion. The estimation of cellular immunity state, content of pro- and anti-inflammatory cytokines in blood serum combined with the bone tissue state markers and indexes of lipid peroxidation and antioxidant system as well as dual-energy absorptiometry allows identifying patients with high risk of further development of aseptic instability in hip joint implant in the period of up to 12 months postsurgically which can be useful while planning prevention management of implant or its components instability.

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Prognostic opportunities for infectious inflammatory complications in primary endoprosthesis of large joints

Year: 2017, volume 13 Issue: №3 Pages: 715-719
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Belova S.V., Mamonova I.A., Puchinyan D.M., Babushkina I.V., Gladkova E.M., Adilov R.G.
Organization: Saratov State Medical University
Summary:

The aim: to study prognostic and diagnostic opportunities for infectious inflammatory complications of primary endoprosthesis of hip and knee joints on the basis of cellular immunity indices. Material and Methods. 174 patients with large joint osteoarthrosis aged 61 ±13 yrs which had undergone total joint replacement were enrolled into the study. The experimental group consisted of 22 patients with infectious inflammatory complications emerging from 6 up to 12 months postsurgically. The comparison group included 152 patients with favorable postsurgical period. We carried out WBC differentiation by subpopulations (lymphocytes, monocytes, granulocytes) and their immunophenotyping. 40 conventionally healthy individuals comprised the control group. The outcomes were estimated using the worked-out score system. Results. In patients with favorable postsurgical period total value of indices equaled not more than 4-6 points. In all the other cases the risk of infectious inflammatory complications is significantly higher and reaches its maximal values in patients with 10-12 points. Conclusion. The assessment of laboratory indices reflecting immune response of the body allows estimating the risk of infectious inflammatory postsurgical complications and diagnosing them in III grade large joint osteoarthorisis patients after total replacement.

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Comparative study of complex powdery preparations for soft tissue regeneration

Year: 2017, volume 13 Issue: №3 Pages: 705-710
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Babushkina I.V., Gladkova Е.М., Mamonova I.A., Belova S.V.
Organization:
Summary:

The aim: comparative study of regenerative activity of powdery preparations for local treatment of soft tissue injuries developed from copper and silver nanoparticles in comparison with traditional powders containing antibiotics within the conditions of an experimental conditionally aseptic wound. Material and Methods. The investigation was carried out on 80 albino rats with an experimental conditionally aseptic wound. Copper and silver nanoparticles obtained by the plasma-chemical method, sterile starch, zinc oxide, Baneocin were used. Planimetric and bacteriological research methods were applied. Results. Treatment with the developed preparations in comparison with the traditional ones containing antibiotics supplied more effective course of reparative processes as evidenced by the data of the planimetric indices. Conclusion. Besides the developed preparations due to the evident antibacterial action supplied reliable prevention of the secondary infection which is a compulsory condition for the course of reparative regeneration processes. The use of metal nanoparticles for this purpose allowed to prevent the adverse reactions which are characteristic of similar preparations containing antibiotics.

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Concentration of MMP-9, TNF-a and IL-6 in patients with tumors and tumor-like bone lesions

Year: 2017, volume 13 Issue: №3 Pages: 506-510
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Puchinyan D.M., Pavlenko N.N., Korshunov G.V., Galashina E.A., Gladkova EV.
Organization: Scientific Research Institute of Traumatology Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky
Summary:

Aim: to determine the concentration of MMP-9, TNF-a and IL-6 in blood serum of patients with benign and malignant bone tumors and feasibility of cytokine data use for differential diagnostics of the neoplastic process nature. Material and Methods. Levels of matrix metalloproteinase-9 (MMP-9), tumor necrosis factor-a (TNF-a) and interleukin-6 (IL-6) in blood serum were determined by the immunoenzyme method in 64 patients with bone tissue neoplasms (fibrous dysplasia, osteocystoma, giant-cell tumor, osteosarcoma, chondrosarcoma, bone metastases, multiple myeloma). Re-sults. MMP-9 level was heightened in patients suffered from chondrosarcoma and multiple myeloma. TNF-a and IL-6 expression was increased in cases with bone metastases. MMP-9, TNF-a and IL-6 levels were higher in cases with malignant bone neoplasms than in cases with benign bone tumors. Conclusion. MMP-9, TNF-a and IL-6 participate in the neoplastic process pathogenesis directly. Nevertheless it is too early to speak about the diagnostic value of the cytokines in cases with tumorous bone affection.

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The characteristics of cellular element of immunity before and after endoprosthesis of large joints

Year: 2016, volume 12 Issue: №2 Pages: 182-185
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Mamonova I.A., Gladkova Е.М., Uljanov V.Yu., Babushkina I.V., Belova S.V., Puchinyan D.M., Kuzmin E.S., Bezrokov L.Kh.
Organization:
Summary:

The aim of the research is to study the indices of cellular immunity in patients before and after hip joint endoprosthesis. Materials and methods. The indices of cellular element of immunity (quantitative and qualitative composition of T-lymphocytes (CD3+), T-helpers (CD3+CD4+), cytotoxic T-lymphocytes (CD3+CD8+), B-lymphocytes (CD3-CD19+), natural killers (CD3-CD16+CD56)) in 20 patients with post-traumatic osteoarthrosis of III grade preoperatively and in the dynamic follow-up on the 3rd, 7th and 21st day post-surgically. Results. Patients with osteoarthrosis showed expressed immunological impairments both before and after endoprosthesis mostly affecting T-cellular immunity element and manifesting in immunoregulatory subpopulations imbalance as well as in T-suppressors decrement, T-helpers increment and NK-cells enlargement in patients after endoprosthesis. Conclusion. Patients with osteoarthrosis showed expressed immunological impairments both before and after joint endoprosthesis. Surgical intervention resulted in the aggravation of the pre-surgical disturbances in immunodeficiency.

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Cytologic assessment of dynamics of reparative processes in the experimental conditionally aseptic wound under the action of complex preparation based on chitosan and metal nanoparticles

Year: 2013, volume 9 Issue: №4 Pages: 629-632
Heading: Macro- and Micromorphology Article type: Original article
Authors: Konyuchenko Е.А.. Zhandarova L.F., Babushkina I.V., Gladkova E.V., Mamonova I.A., Belova S.V., Karyakina E.V.
Organization: Saratov State Medical University
Summary:

Objective: assessment of dynamics of reparative processes with the help of cytological examination of the preparations obtained from a conditionally aseptic wound under the action of a complex preparation based on biopolymer chitosan and metal nanoparticles. Material and Methods. A conditionally aseptic wound was simulated in 40 white outbred rats. In comparison and experimental groups cytologic assessment of dynamics of reparative processes was carried out. A number of neutrophilic leukocytes and fibroblastic row perl 00 cells in the preparations is recorded on the 3rd, 5th, 7th, 10th, 14th day from the moment of formation of the wound with the use of the immersion objective. Results. It is established, that in the comparison group the cytologic pattern of impression smear was characterized by decrease in neutrophilic leukocytes and increase in fibroblastic row cells by the 14th day from the moment of formation of the wound. In the experimental group (the use of a complex preparation) more intensive reduction of neutrophilic leukocytes and a significant increase in fibroblastic row cells by the 10th day and a complete healing by the 14th day from the moment of formation of the wound has been determined. Conclusion. When treated by a complex preparation based of biopolymer chitosan and metal nanoparticles earlier occurrence of fibroblastic row cells in preparations and a significant decrease in quantity of neutrophilic leukocytes have been observed.

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Possibility of laboratory predictors use in assessment of aseptic instability progression in total hip replacement

Year: 2011, volume 7 Issue: №2 Pages: 437-441
Heading: Clinical Laboratory Diagnostics Article type: Original article
Authors: Karyakina Е.V., Persova Е.А., Gladkova Е.V.
Organization: Saratov Scientific Research Institute of Traumatology and Orthopedics
Summary:

The research work presents the results concerning opportunities assessment in prediction of total hip replacement in patients with coxarthrosis. It is done according to the level of biochemical markers of resorption and bone formation, determined in the blood serum by the method of solid-phase immune analysis. On the basis of monitoring of clinical and laboratory data of 50 patients and examination of 30 practically healthy persons biochemical predictors of endo-prosthesis aseptic instability in total hip replacement have been determined

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Instrumental and laboratory assessment of stressful remodelling processes in bone tissue at total hip replacement

Year: 2010, volume 6 Issue: №2 Pages: 423-428
Heading: Traumatology and Orthopedics Article type: Original article
Authors: E.V. Karjakina, E.A. Persova, E.V. Gladkova
Organization: Saratov Scientific Research Institute of Traumatology and Orthopedics
Summary:

Research objective is to estimate stressful remodelling features of bone tissue according to the densitometry data and to the level of biochemical markers of bone resorption and formation in total hip replacement (THR).
Bone tissue mineral density (BTMD), condition of calcium-phosphoric metabolism and biochemical markers of bone formation (osteocalcin and bone isoenzyme of alkaline phosphatase) and resorption (С-terminal bodypeptide of the I type collagen) have been determined in 52 patients with coxarthrosis of ll-lll stages with marked joint dysfunction before and after THR. The control group included 24 donors. The data were considered to be reliable when the probability index was р<0,05.
The reliable (р<0,05) change of BTMD was determined only in 3-6 months after the operation, whereas the change of biochemical markers of remodeling had already been done after 1,5-3 months, allowing to define the group of patients with obvious negative bone balance: strong predominance of resorption processes without compensation of the subsequent adequate osteogenesis, that subsequently could lead to significant bone tissue deficiency in the area adjacent to the endoprosthesis. Changes of indices of calcium-phosphoric metabolism were not certain during the investigation term.
ln conclusion it is to state that biochemical markers of remodeling in comparison with BTMD allow to estimate objectively features of adaptive bone tissue remodeling after THR in earlier periods and to define group of patients with sharp intensification of metabolism and obvious negative bone balance

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CYTOMORPHOLOGICAL EVALUATION AND PROGNOSIS OF BRONCHOPULMONARY COMPLICATIONS IN ACUTE AND EARLY PERIODS OF SPINAL CORD TRAUMA

Year: 2009, volume 5 Issue: №3 Pages: 370-375
Heading: Clinical Laboratory Diagnostics Article type: Original article
Authors: E.A. Konjuchenko, V.J. Uljanov, D.M. Puchinjan, I.A. Norkin, E.V. Gladkova
Organization: Saratov Scientific Research Institute of Traumatology and Orthopedics
Summary:

There were investigated 50 cytological preparations after fibro-optic bronchoscopy of 10 patients with cervical spinal cord injuries. The dynamics of broncho-pulmonary complications of spinal cord injuries was estimated on the basis of cytological broncho-alveolar lavage fluid investigations. In the work there were used clinico-neurologic methods, radiological (computer tomography and magnetic resonance imaging), endoscopic (fibro-optic bronchoscopy) and cytomorphological investigations. Cytomorphological investigations of broncho-alveolar lavage fluid were carried out on the 3-4, 7, 14, 30th days. Cellular composition of the broncho-alveolar wash-out (endopulmonary cytogramme) was estimated by calculation of more than 100 cells in 3 fields of the immersion microscope coverage. Quantitative changes of cellular elements were taken into account with respect to normal cell amount. The results were analyzed according to the average out method.
Quantitative changes of inflammatory elements in endopulmonary cytogramme were determined by the degree of endobronchitic manifestations and were corresponding to clinico-radiological picture of development of broncho-pulmonary complications in different periods of spinal cord injury

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