2016, volume 12

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.

In the course of the study the foreign and native publications concerning total hip replacement have been analyzed. The data from National Registers of various countries are presented in the study. They highlight some issues upon total hip replacement, technologies of surgical intervention advancing and most important risk factors for endoprosthetic ball dislocation.

The morbidity of depressive disorders and their role in the formation of different human pathologies emphasize the actuality of searching for new approaches in the prophylaxis and treatment of depressions. The modification of gut microbiota may be a perspective direction of clinical investigation. Development in this area is based on the review of trials which confirm the significance of gut microflora composition in regulation of mental functions in particular mood and behavior as well as the role of diet in the development of depressions. The hypothesis of the role of gut microbiota in the development of depressive conditions was discussed.

Palivizumab is known as the world's first drug with proven efficacy for passive immunization of severe infections of lower respiratory tract in preterm infants. The paper describes a clinical case of application of palivizumab (sinagis) at a newborn infant with bronchopulmonary dysplasia complicated by episodes of obstructive bronchitis. Particular attention is paid to the mechanism of action of palivizumab on the respiratory syncytial virus providing the data on a clinical picture of respiratory syncytial virus infection in a premature baby and showing the effectiveness of the drug in infants.

The article describes a clinical case of a child with an alveolar-capillary dysplasia of the lungs — a rare cause of pulmonary hypertension at a newborn. This pathology is of particular interest from a clinical point of view as it rarely occurs in the clinical practice of a neonatologist. It should be noted that the prenatal diagnosis of this disease is of significant difficulty. The authors found it necessary to highlight the cause of development, the clinical presentation and the methods of diagnostics of alveolar-capillary dysplasia of the lungs.

The literature review on the connection between atrial fibrillation and obstructive sleep apnea syndrome has been made. The etiology of sleep apnea, the mechanism of night breath pauses and possible consequences of this disorder have been described. The statistical data related to the frequency of atrial fibrillation among sleep apnea patients were presented in this article. The evidence regarding possible mechanisms of pathogenetic relation between atrial fibrillation onset and sleep breathing disorders was described. Nowadays it is assumed that night desaturations, the increase of sympathetic tonus, obesity, cardiac pathology, the increase of general inflammatory markers connected with sleep breathing disorders are the factors which contribute to the arrhythmia in patients with apnea. In the review the modern data concerning influence of apnea on the course of atrial fibrillation and recurrence of the arrhythmia relapse after cardioversion have been presented. The positive impact of sleep apnea treatment on the progress of atrial fibrillation was noted as well. The literature analysis has shown that pathogenetic mechanisms characterizing the connection between atrial fibrillation and sleep apnea have not been completely defined. The amount of published studies relating to the influence of apnea on the progress and long-term results of atrial fibrillation treatment is insufficient. There are not enough data about the frequency of different forms of atrial fibrillation in patients with apnea. There are other issues which require further investigations.

The aim of the presented paper is a meta-analysis of clinical studies on the comparative effectiveness of pharmaceutical therapy and surgical treatment such as cardiac resynchronization therapy (CRT), cardiac resynchronization therapy with cardioversion-defibrillation (CRT-D), circulatory support system and heart transplantation in patients with severe chronic heart failure (CHF). Material and Methods. Results of 41 clinical studies (29799 patients with severe CHF) were included in a meta-analysis. Data search was conducted in the following databases: Medline, Medscape, Pubmed, and websites dedicated to clinical research (National Institutes of Health, Clinical Center, ClinicalStudyResults.org, ClinicalTrials.gov). Results. As compared with pharmaceutical therapy, surgical treatment of severe CHF is better to reduce fatal risk, incidence of decompensation of CHF, frequency of cardiac arrhythmias, the need to perform or re-perform heart transplantation. It is also shown that CRT better reduced the mortality from progression of heart failure than heart transplantation. Both pharmaceutical therapy and surgical treatment improved functional class of CHF and quality of patients' life, but does not affect the left ventricular ejection fraction. Conclusion. It was found out that there was a number of significant advantages of surgical treatment of severe CHF, compared with pharmaceutical therapy. However, it is still a number of unresolved issues (particularly in relation to heart transplantation) on the effectiveness comparing pharmaceutical and surgical therapies of severe CHF

The review deals with contemporary issues of etiology, pathogenesis, classification, diagnosis and treatment of retrocervical endometriosis on the basis of existing data in the literature on this disease. Among the various forms of endometrial disease incidence retrocervical endometriosis, according to various authors, is 30-34%. The process is characterized by the formation of deep infiltrative lesions, originating from the recto-vaginal septum, without capsules and clear boundaries, extensively localizing, affecting the adjacent organs with the formation of scar-adhesions and characterizing this pathology as a multi-disciplinary (gynecological, surgical, urological). There are many options etio-pathogenesis of retrocervical endometriosis, but none of them fully explains the diversity of forms of expression and localization of this pathology. Particular attention is paid to the influence of immune and hormonal factors on the development of the disease. It is noted that currently there is no single universally accepted by clinicians and morphology full classification of retrocervical endometriosis, and there are no generally accepted standards of its diagnosis. The variants of the treatment of this disease have been considered including hormonal and immunomodulatory therapies.

The review presents the published data on relevance of problem, frequency rate and the mechanisms of occurrence of premenstrual syndrome, the necessity of complex treatment of premenstrual syndrome has been proved.

Purpose: to define key indicators of function of external breath of students of three groups of health taking into account various total sizes of a body. Material and Methods. For an assessment of breathing function, volume and highspeed characteristics the diagnosing Eton installations (Russia) and Schiller (Switzerland) were used. Results. Age peculiarities of respiratory ventilation disorders and differentiated assessment of circulatory and metabolic parameters according to the total body size in the special health groups (SHG) are analyzed in the article. Breathing volumetric characteristics were examined among the 17-18 aged students in the different health groups. Special attention is paid to the effect of the long-term severe bronchial patency disorders which lead to the respiratory muscles overstrain and the decrease of their strength endurance. This results in the lungs capacity decrease which is typical for the special health groups' students. Conclusion. It is shown that the students of the 1^st health group had lower body weight and the same body length in comparison with the 2^nd and 3^rd groups. This determined unequal role of respiration in providing vital processes in terms of educational activities, especially in case of disorders of musculoskeletal and cardio-respiratory systems.