Method for predicting gestosis in pregnant women with the risk for miscarriage of infectious genesis
FIELD: medicine, obstetrics, gynecology.
SUBSTANCE: in the first trimester of pregnancy one should study the content of CD8+CD11b lymphocytes and at their values being either equal or above 2% it is possible to predict gestosis. The present innovation enables to choose correct tactics of treating pregnant women that, in its turn, leads to decreased frequency of this complication of pregnancy and the risk for the development of fetal and neonatal pathology.
EFFECT: higher accuracy of prediction.
3 ex, 1 tbl
The invention relates to medicine, namely to obstetrics and gynecology, and can be used to predict the development of preeclampsia in women with threatened miscarriage of infectious Genesis in the first trimester.
Miscarriage remains one of the main problems of modern obstetrics. The frequency of miscarriage ranges from 10 to 25%, and in the first trimester is 50% of spontaneous abortions (5). Among the causes of miscarriage are one of the leading places occupied by urogenital infection, 29,3-43.1% of cases, causing a threat of miscarriage (11, 12, 14). In women with threatened miscarriage of infectious Genesis most often is a complication of pregnancy like preeclampsia (12, 13, 15). The frequency of preeclampsia remains high and is according to different authors from 3.5 to 20% (5, 6, 8). Preeclampsia is a risk factor maternal (11,4%) and perinatal mortality (44%) (5). Prediction of complication of pregnancy, especially its pre-clinical and early pregnancy represents a difficult clinical problem.
There is a method of prediction of preeclampsia by determining the level of lipids and phospholipids in the urine during pregnancy and 20-24 8-12 weeks (3). When the levels of lipids 513,1+65,8 and 706,4+84,7 optical unit p is h and phospholipids 5,74+1,7 and 16.5+6,1 mg/l predicted preeclampsia.
The accuracy of the method and 64.5%.
The method has drawbacks:
- the need for a dual examination of the pregnant woman in 8-12 20-24 weeks of pregnancy;
- bad choice of substrate studies, since the advent of the lipids and phospholipids in the urine is characteristic for chronic diseases of the urinary system nephritis and pyelonephritis) and other somatic pathology;
- low accuracy.
The closest technical solution is a method for predicting preeclampsia by determining the relative content of T-suppressor cells in peripheral venous blood and the rate of 18% or less predicted the development of this complication of pregnancy (4).
This method is chosen as the closest analogue (prototype).
The disadvantages of the prototype method are;
- do not specify the duration of pregnancy, which is recommended to conduct a survey;
- currently there is no such thing as a "population of T-suppressors, and the population of T-lymphocytes, previously designated by this term, is called cytotoxic T-lymphocytes (or CD8+), the function of which is different from the function pool suppressor lymphocytes, which worked authors (10);
when preeclampsia content CD8+ T cells, most accurately reflects the number of cytotoxic T-lymphocytes, the practice is Cesky does not change (9);
- the level of cytotoxic lymphocytes decreases in infectious and autoimmune diseases (viral hepatitis a and b, chronic otitis, uveitis, pneumonia in acute, chronic bronchitis, rheumatism, rheumatoid arthritis, systemic lupus erythematosus, exacerbation of chronic glomerulonephritis) and some somatic diseases, including pyelonephritis and myocarditis (7).
- do not specify the accuracy of the method.
These drawbacks can be eliminated in the proposed method.
The claimed technical result is achieved that in the first trimester of pregnancy (6-13 weeks) in peripheral venous blood of pregnant women with threatened miscarriage of infectious Genesis determine the relative content of CD8+D11b+lymphocytes and the values of this index is equal to or more than 2%, predict the development of preeclampsia with precision 83,33%, sensitivity 84,00% and specificity 80,00%.
The novelty of the proposed method lies in the fact that for the first time proposed to predict preeclampsia, by definition, the relative content of CD8+CD11b+cells in peripheral venous blood of pregnant women with threatened miscarriage of infectious Genesis in the first trimester of pregnancy.
Earlier studies of the level of CD8+CD11b+cells in pregnant women in order to predict preeclampsia was not conducted.
But what was shown what in the peripheral blood of pregnant women with severe preeclampsia at 32-40 weeks of gestation significantly increased the content of total population of CD11b+lymphocytes (9).
We assume that the gain on early pregnancy in the expression of CD11b molecules promotes migration of activated CD8+CD11b+) cytotoxic lymphocytes from the vasculature into the tissue with the subsequent development of pathological reactions both at the system and at the placental level.
The method is performed by a standard method as follows (1):
1. the selection of lymphocytes from peripheral venous blood;
2. 100 μl of lymphocytes in a concentration of 1×106cells/ml are incubated with 20 μl of monoclonal anti-CD8, FITC labeled with 20 μl of monoclonal anti-CD11b, labeled D, for 30 minutes at room temperature in the dark, after which the cells washed 1 time with 1 ml of saline by centrifugation at 1500 rpm for 2 minutes. Cells resuspended in 500 μl of saline. The reaction accounting is performed on a flow cytometer, determining the content of CD8+CD11b+cells in the lymphocyte gate. The result is read in percent (%).
Significant differences of the claimed method are:
- proposed a new prognostic parameter in the relative content of CD8+CD11b+cells in peripheral venous blood from jensens threat of miscarriage of infectious Genesis in the first trimester of pregnancy - equal to or more than 2%, is to predict the development of preeclampsia.
The essence of the proposed method is illustrated by the following examples.
Example 1: a Pregnant W., 24 years. This second pregnancy. The first pregnancy ended in miscarriage in the period of 8 weeks. In the period of 6-7 weeks was admitted to the hospital complaining of nagging pain in the lower abdomen, spotting from the genital tract. According to ultrasound - pregnancy 7 weeks, hypertonicity of the uterus, echoprint detachment of the ovum. Diagnosis: Pregnancy 7 weeks. Burdened obstetric history. Threatening miscarriage. According to the survey on urogenital infection detected antigens of chlamydia in the cervical canal and IgM antibodies to chlamydia in the peripheral blood. During the examination of the inventive method: the relative content of CD8+D11b+lymphocyte - 3.9%, which is above the forecast level for the development of preeclampsia, it is predicted the development of preeclampsia. After saving therapy she was discharged from the hospital with progressive pregnancy in the period of 10 weeks. When surveyed in 34 weeks pregnancy pregnant III. the observed increase in the blood pressure to 140/90 mm Hg, edema of the legs, the presence of pathological weight gain per week 600 g, the total weight gain was 12 kg, proteinuria of 0.066 g/L. Basemanagedentity in the hospital with a diagnosis of Pregnancy 34 weeks. Burdened obstetric history. Preeclampsia (nephropathy first degree). The pregnancy ended in timely delivery and birth of full-term newborn weighing 3200 g, 52 cm tall, with rating on a scale of Apgar 8/9 points. Conclusion: the prognosis of the claimed method was confirmed.
Example 2: a Pregnant E., 25 years. This second pregnancy. The first pregnancy ended in timely delivery and birth of full-term newborn weighing 3000 grams and height of 50 cm, with rating on a scale of Apgar 8/9 points. In the period of 12 weeks was admitted to the hospital with complaints dragging pain in the abdomen, according to ultrasound - pregnancy 12 weeks, hypertonicity of the uterus. Diagnosis: Pregnancy 12 weeks. Threatening miscarriage. According to the survey on urogenital infection identified antigens of chlamydia and Ureaplasma in the cervical canal. During the examination of the inventive method: the relative content of CD8+D11b+lymphocyte - 0.2%, which is below the forecast level for the development of preeclampsia, the development of preeclampsia is not expected. After saving therapy she was discharged from the hospital with progressive pregnancy in the period 14-15 weeks. When surveyed in 37 weeks signs of preeclampsia is not revealed. The pregnancy ended in timely delivery and birth of full-term newborn weighing 3000 g, the height of 51 cm, with an estimate of the scale And the Gare 8/9 points. Conclusion: the prognosis of the claimed method was confirmed.
Example 3: a Pregnant K., 22 years. This first pregnancy. Admitted to the hospital complaining of nagging pain in the lower abdomen, Danna m ultrasound pregnancy 10 weeks, the increase in uterine tone. Diagnosis: Pregnancy 10 weeks. Threatening miscarriage. According to the survey on urogenital infection detected in the blood of antibodies of class IgG antibodies to herpes simplex virus type 2 and trichomonads. During the examination of the inventive method: the relative content of CD8+D11b+Limpopo - 2%, which is predictive in the development of preeclampsia, it is predicted the development of preeclampsia. After saving therapy she was discharged from the hospital with progressive pregnancy in the period of 13 weeks. When surveyed in 36 weeks of pregnancy in pregnant K. revealed swelling of the legs, abnormal weight gain per week 550 g, the total gain weight 13 kg diagnosis: Pregnancy 36 weeks. Preeclampsia (dropsy of the first degree). The pregnancy ended in timely delivery and birth of full-term newborn weighing 3500 g, height of 54 cm, with rating on a scale of Apgar 8/9 points. Conclusion: the prognosis of the claimed method was confirmed.
In this way were examined 30 women at 6-13 weeks of gestation. The research results are summarized in table 1.
|Index||The number of the examined|
|a true-negative result||4|
|a false-negative result||4|
|Total: the accuracy of the proposed method - 83,33%, the sensitivity of the proposed method is 84%, specificity of the proposed method - 80%|
The advantages of the proposed method:
1. The study of peripheral venous blood of the woman is in early pregnancy (6-13 weeks), that allows to clinical manifestations of the disease to predict preeclampsia and timely measures.
2. Set the relative content of CD8+CD11b+cells in peripheral venous blood in women in the first trimester of pregnancy, is equal to or more than 2%, which predicted the development of preeclampsia.
3. High precision 83,33%, a sensitivity of 84% and specificity of 80% of the way.
Thus, the claimed method is simple to perform and allows high accuracy to predict the development of preeclampsia in women with the threat of Nevins the of pregnancy infectious Genesis in the examination in the first trimester of pregnancy, that will allow you to choose the right tactics for the management of women at risk of developing preeclampsia and will help reduce the frequency of this complication of pregnancy, the risk of developing pathology of the fetus and newborn and reduce the economic cost of treatment.
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A method for predicting preeclampsia in women with threatened miscarriage of infectious Genesis through study of peripheral venous blood, characterized in that in the 1st trimester of pregnancy examine the content of CD8+lymphocytes and CD11b if the values are equal, or Bo is 2%, predict preeclampsia.
SUBSTANCE: method involves carrying out microscopic examination of blood serum samples taken from femoral vein and cubital vein. Femoral vein sample is taken on injured side. The examination is carried out before and after treatment. The blood serum samples are placed on fat-free glass slide in the amount of 0.01-0.02 ml as drops, dried at 18-30°C for 18-24 h. The set of pathological symptoms becoming larger or not changed after the treatment in comparison to sample taken before treatment, and morphological picture of samples under comparison taken from the cubital vein showing no changes or being changed to worse, the treatment is considered to be effective.
EFFECT: enabled medicamentous treatment evaluation in course of treatment to allow the treatment mode to be changed in due time; avoided surgical intervention (amputation); retained active life-style of aged patients.
SUBSTANCE: invention relates to laboratory methods for blood analysis. Plasma is dropped in copper sulfate solution with density 1.023 g/cm3, not above, and time for drop falling on bottom of graduated cylinder with column height 243 mm is measured. The blood plasma density value is calculated by the formula:
wherein is the unknown blood plasma density (g/cm3); is copper sulfate solution density measured by areometer (g/cm3); t is average falling time of plasma drop in the copper sulfate solution (as seconds); 0.260130126 and 0.00290695 are correction coefficients. Temperature of plasma and copper sulfate solution is 20oC. Method is simple and suitable and allows carrying out analysis of small volumes of blood plasma and to reduce analysis time.
EFFECT: improved assay method.
FIELD: medicine, neurology.
SUBSTANCE: one should establish neurological status, bioelectric cerebral activity, availability of perinatal and ORL pathology in patients, establish their gradations and numerical values followed by calculation of prognostic coefficients F1 and F2 by the following formulas: F1=-31,42+1,49·a1-2,44·a2+0,2·а3+1,63·a4+0,62·а5+3,75·a6+1,8·а7-3,23·a8-0,8·а9-1,32·а10+3,26·а11+8,92·a12-2,0·a13+3,88·а14+1,79·a15+0,83·a16-2,78·a17; F2=-27,58+1,43·a1+3,31·а2+0,08·а3+3,05·а4-0,27·а5+2,69·а6+3,11·а7-6,47·a8-6,55·a9+1,99·а10+5,25·а11+7,07·a12-0,47·a13+0,13·a14+4,04·a15-1,0·a16-1,14·а17, correspondingly, where a1 - patient's age, a2 - studying either at the hospital or polyclinic, a3 - duration of stationary treatment (in days), a4 - unconscious period, a5 - terms of hospitalization since the moment of light close craniocerebral trauma, a6 - smoking, a7 - alcohol misuse, a8 - arterial hypertension, a9 - amnesia, a10 - close craniocerebral trauma in anamnesis, a11 - psychoemotional tension, a12 - meteolability, a13 - cervical osteochondrosis, a14 - ORL pathology, a15 - availability of perinatal trauma in anamnesis with pronounced hypertension-hydrocephalic syndrome, a16 - availability of paroxysmal activity, a17 - availability and manifestation value of dysfunction of diencephalic structures. At F1 ≥ F2 on should predict the development of remote aftereffects in young people due to evaluating premorbid background of a patients at the moment of trauma.
EFFECT: higher reliability of prediction.
2 ex, 1 tbl
FIELD: medicine, cardiology.
SUBSTANCE: one should register rhythmocardiogram, measure current total power in low-frequency and high-frequency areas of dynamic row of cardiointervals. Evaluation of psychophysiological state should be performed by the value of stress index S calculated due to original mathematical formula by taking into account the power of low-frequency and high-frequency constituents of the range of dynamic row of cardiointervals. In case of standard conditions of measurement - the rest lying at one's back position the value of S stress index should be considered to be equal to 1. The method enables to rapidly and noninvasively detect and range human psychophysiological state.
EFFECT: higher accuracy of evaluation.
2 dwg, 1 ex, 2 tbl
SUBSTANCE: before applying substitute hormonal therapy (SHT) on should evaluate antithrombogenic activity of vascular wall in women. For this purpose one should determine quantitative values of ADP-induced aggregation of thrombocytes, activity of antithrombin III in blood and fibrinolytic blood activity both before and after "cuff"-test. Then one should detect the indices calculated as the ratio of mentioned values both before and after carrying out the mentioned test. If mentioned indices are decreased against the norm by 20-40% women should be prescribed to undergo SHT at additional introduction of aspirin and supradin. The method provides prophylaxis of cardio-vascular diseases in this category of female patients due to correcting affected functional activity of vascular endothelium.
EFFECT: higher efficiency of prophylaxis.
1 cl, 1 ex, 4 tbl
FIELD: medicine, oncology.
SUBSTANCE: one should study the activity of catalase in the tissue of malignant mammary tumor and its perifocal area, and at ratio coefficient of catalase activity in the tissue of malignant mammary tumor to that in the tissue of perifocal area being equal to 1.0 ± 0.2 one should predict the chance for the development of new foci of lesion before their clinical manifestation, that provides necessary treatment in due time.
EFFECT: higher efficiency of prediction.
1 ex, 1 tbl
FIELD: medicine, pediatrics.
SUBSTANCE: in neonatals one should apply control set of risk factors that includes detection of maternal body temperature in the course of delivery, evaluation of neonatal's body weight at birth (g), one should characterize each risk factor and evaluate in points and by the value of the sum of points predict the risk for intrauterine infection, moreover, this set of risk factors includes extragenital pathology and its availability, chronic foci of infection and their exacerbation, acute infectious diseases occurred during pregnancy, prenatal waters, the nature of waters, moreover, if risk factors are characterized, correspondingly: the presence of one pathological disease, the presence of infection at no exacerbation, single acute infectious disease occurred during pregnancy, waters at mature pregnancy, waters color - light, moderate polyhydramnios, maternal body temperature in the course of delivery up to 37.5 C, evaluation by a certain scale being 7-8,neonatal's body weight at birth being above 2500 but below 2900 each of them should be evaluated per 1 point, if risk factors are characterized: combination of pathologies, exacerbation of chronic foci of infection occurred more than once, acute infectious diseases happened twice during pregnancy, prenatal waters at 36-wk-pregnancy, the nature of waters - meconial, pronounced polyhydramnios, maternal body temperature during delivery ranged 37.5-38 C, evaluation by a certain scale being 5-6, neonatal's body weight at birth being 1500-2500 each factor should be evaluated per 2 points, if risk factors are characterized: the presence of three and more pathological diseases, exacerbation of chronic foci of infection in every trimester of pregnancy, acute infectious diseases occurred during pregnancy in every trimester, prenatal waters 6 wk earlier the delivery terms, the nature of waters - turbid, with flavoring, maternal body temperature during delivery being above 38 C, evaluation by a certain scale being below 5, neonatal's body weight at birth being below 1500 every factor should be evaluated per 3 points, moreover, if the sum of points is not above or equal 8 points the risk for intrauterine infection in neonatals ins minimal, at the sum of points ranged 9-13 the risk is average and at the sum of points being 13 or above 13 the risk is maximal. The method takes into account extragenital pathology that creates the foundation for initial shifts in homeostasis and weakens resistance to external impacts.
EFFECT: higher accuracy of prediction.
1 ex, 1 tbl
FIELD: medicine, toxicology.
SUBSTANCE: at patient's hospitalization one should detect the values of patient's state such as: the state of consciousness, availability of spasms, scleral injectivity degree, headache, nystagmus, vertigo, ataxia, respiration frequency, exposure of poisoning substance, patient's age, concentration of carboxyhemoglobin, prothrombin index (PTI), creatinine amount and that of leukocytes, sedimentation rate and patient's body temperature. Each parameter should be evaluated in points to sum them up finally. By the value of summed up points it is possible to evaluate indication for urgent hospitalization into resuscitation department. The method enables to obtain objective evaluation for the necessity in resuscitation aid.
EFFECT: higher accuracy of evaluation.
3 ex, 4 tbl
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with differential diagnostics of prostatic cancer and other prostatic diseases at the stage of primary inspection. The method includes the detection of PCA and calculation of probability coefficient for prostatic cancer (PCC) by the following formula: where e - the foundation of natural logarithm (e=2.718…), PCA - the level of total blood PCA in ng/ml, V - patient's age in years. At PCC value being above 0.2 one should diagnose prostatic cancer and to establish final diagnosis one should perform polyfocal prostatic biopsy. The method enables to increase accuracy of diagnostics at decreased number of unjustified prostatic biopsies.
EFFECT: higher efficiency of diagnostics.
SUBSTANCE: method involves carrying out physiological examination with electroencephalogram recorded. Cognitive evoked potential method is additionally applied as neuropsychological examination for detecting hard and latent organic brain lesions causing central nervous system pathological disorders. An additional psychophysiological examination is carried out with vision analyzer test, visuomotor response test being applied for obtaining estimations of selection, discrimination, noise immunity and muscle endurance index, movement coordination, response to moving object and integral estimation of attention and ability for perceiving significant information, motor analyzer rapid response production estimation, estimation of nature of cardiovascular system response to given psychoemotional loading estimation. The examination is sequentially carried out as primary control when hiring personnel, as intermediate control in following a training course and emergency training. Psychological testing is of multi-purpose nature. To achieve it, a set reliable tests and methods of prognostic and substantial validity are applied, including intellect and project-building tests and standardized self-reports. When making decisions concerning professional validity based on test and examination results, risk group is selected from operation personnel.
EFFECT: enhanced effectiveness of occupational skill assessment.
SUBSTANCE: method involves carrying out urological examination for determining hydrodynamic resistance of ureter calculated from formula Z=8Lμ/(πR4), where Z is the hydrodynamic resistance of ureter, L is the ureter length, R is the ureter radius, μ is the urine viscosity. Angle α at which the ureter enters the urinary bladder is determined from formula cosα = 8l1μ/(ZπR4), where l1 is the perpendicular drawn from the upper edge of the ureter to the its exit projection line, μ is the urine viscosity, Z is the hydrodynamic resistance of ureter, R is the ureter radius. Vesicoureteral reflux recidivation is predicted when the angle of α+90° is less than 120°.
EFFECT: enhanced effectiveness in reducing the number of recidivation cases.
2 dwg, 1 tbl
SUBSTANCE: method involves measuring intraocular pressure. Static computer-assisted perimetry method is used in a way that luminous spot serves as test object. The spot acts upon eye in various vision field points with threshold brightness and then in growing sequence. Eye retina light-sensitivity is measured in vision field points under study. The number of points is set with patient examination program. Total light-sensitivity is measured in decibels. Medicamentous reduction of intraocular pressure is achieved with 0.5% Ocupress solution introduced as drops twice with 5-6 min long interval. The intraocular pressure being reduced at least by 4 mm of mercury column, repeated static perimetry examination is carried out. Total light-sensitivity being increased less than by 50 dB, individual initial intraocular pressure tolerance conclusion is drawn. Total light-sensitivity being increased by 50 dB or more, individual initial intraocular pressure intolerance conclusion is drawn.
EFFECT: enhanced effectiveness in determining intraocular pressure tolerance/intolerance.
SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.
EFFECT: high accuracy of diagnosis.