Method for monitoring individuals with risk of early atherosclerosis and suffering from type 2 diabetes mellitus

FIELD: medicine.

SUBSTANCE: clinical medical history data are determined as follows: body weight index (BWI), kg/m2; waist circumference (WC), hip circumference (HC), waist-to-hip ratio, type 2 diabetes mellitus diagnosed in close relatives, arterial hypertension (AH) diagnosed. The laboratory data are measured as follows: plasminogen activator inhibitor-1 (PGAI-1), nmole/l; nitrogen oxide (NO) metabolites, %; resistin, ng/ml; insulin resistance (IR), mIU/ml; triglycerides (TG), mmole/l; high density lipoprotein cholesterol (HDLPC), mmole/l; fibrinogen, mg/dl; impaired fasting glucose (IFG), mmole/l; glycosylated haemoglobin (HbAlc), %; impaired glucose tolerance (IGT), mmole/l; homocystein (HC), mcmole/l; TNF-α, pg/ml; C-reactive protein, mg/l; endothelin and fibrinogen. The derived values are scored. The total score is used to determine a risk of atherosclerosis in the patients suffering from type 2 diabetes mellitus: extremely high, high, moderate and low. Taking into account the detected degree of risk, a dosage of aspirin and statins are determined, as well as a monitored mode of blood lipids, urinary albumin and blood creatinine is specified.

EFFECT: method enables determining a degree of risk of the atherosclerosis progression as shown by the clinical medical history and laboratory data, as well as specifying individual pathogenetic therapy for the patient that leads to reducing developing cardiovascular complications.

4 tbl, 1 ex

 

The invention relates to medicine, namely to internal medicine.

Diabetes mellitus (DM) type 2 is one of the major independent risk factors of atherosclerosis. According to the European guidelines for treatment of dyslipidemia under cardiovascular risk understand the likelihood of the patient's cardiovascular disease (CVD)due to atherosclerosis development, within a certain period. There are a number of systems to assess the risk of CVD, of which the most famous Meminjamkan scale risk assessment SCORE (Systematic assessment of coronary risk), ASSIGN (Scottish risk assessment model), PROCAM (Prospective Münster study of cardiovascular disease) and who (world health organization). Patients suffering from diabetes type 2 or diabetes type 1 with microalbuminuria, automatically belong to the group of VERY high or HIGH risk.

However, due to latent early type 2 diabetes, effaced the clinical picture, half of the patients the disease is detected after 7-12 years from its beginning. In addition to hyperglycemia, which is considered as the main risk factor of complications of diabetes, there are other factors, the presence of which can accelerate the development and progression of angiopathies in patients with sa is ary diabetes. In several studies, including the MONICA study shows that the classical risk factors of atherosclerosis are not fully explain the development of cardiovascular complications, as their prevalence is around 15% in women and 40% men. As a result, continued intensively search for other causes of atherothrombosis (Ametov A. C., 2005; Chazov E. I., 2007).

Today there is no doubt the fact that in the pathogenesis of vascular damage and atherosclerosis important role of circulating blood homocysteine, C-reactive protein (CRP), fibrinogen (Shevchenko O. P., 2004; Cooper, I. A., 2007; Lysov C. A., 2007; Zvereva I. C., 2009; Gireiev E. Yu, 2010; grewal A. C., 2010; Markovska N. In., 2010; Bataille R., 1992; D. Gook, 2000; Bhatt D. L. 2008). However, despite the unconditional effect of many biochemical parameters in the pathogenesis of atherosclerosis in diabetes mellitus, many clinical studies have noted the apparent lack of correlation of clinical symptoms with specific markers of atherosclerosis. For example, in the study S. A. Burov and others found no relationship between obesity and the level of resistin and tumor necrosis factor α (TNF α).

Achievable technical result is the provision of individual monitoring of people at risk of early development of atherosclerosis in patients with diabetes mellitus type 2.

On on the basis of the above, we have developed a method for estimating the risk of atherosclerosis, with regard to indicators: the inhibitor of plasminogen activator-1 (IAPG-1), NO - metabolites of nitric oxide, resistin, insulin resistance (IR), TG - triglycerides, HDL cholesterol, Fibrinogen, BMI - body mass index, IFG - impaired fasting glucose HbAlc, IGT - impaired glucose tolerance, HZ - homocysteine, TNF-α, C-RB.

To develop a new method for assessing the risk of atherosclerosis in patients with type 2 diabetes, we surveyed patients with diabetes mellitus type 2 moderate and severe severity. The diagnosis of diabetes mellitus (DM) was established according to the International classification of diseases X-revision (ICD-10), prepared by the world health organization (who, Geneva, 1992).

All patients (table 1) was assessed anthropometric data, which included measurement of height, the definition of body mass, waist and hips to determine body mass index (BMI) and the relationship of waist circumference to hip circumference (ON/ABOUT). Carbohydrate metabolism was assessed by fasting glucose, glycosylated hemoglobin (HbAlc), insulin resistance, disorders of glucose tolerance.

For calculation of insulin resistance (IR) used a small model of homeostasis with the definition of the index, HOMA-IR (D. Metthews et al., 1985), as well as impaired glucose tolerance (IGT). Assessment of blood lipid spectrum included ODA is dividing the total cholesterol (TC), cholesterol high density lipoprotein (HDL cholesterol), triglycerides (TG). In addition, all patients was determined by the level of fibrinogen, an inhibitor of plasminogen activator-1 (IAPG-1), NO - metabolites of nitric oxide, resistin, HZ - homocysteine, TNF-α, and CRP.

Table 1
The main clinical and laboratory parameters in patients with type 2 diabetes.
IndexUnitsValue
The body mass index (BMI)kg/m232,4
The ratio of waist circumference to hip circumference (ON/ABOUT)cm1,05
Impaired fasting glucose (IFG)mmol/lbeing 9.61
Insulin resistance (IR)mIU/ml16,14
Impaired glucose tolerance (IGT)mmol/l6,16
Glycosylated hemoglobin (HbAlc) %9,26
HDL cholesterolmmol/l0,84
Triglycerides (TG)mmol/l2,18
Inhibitor of tissue plasminogen activator-1 (IAP-1)nmol/l1,31
Fibrinogenmg/DL397,6
Endothelinfmol/ml0,37
The resistinng/ml19,85
Metabolites of nitric oxide (NO)%amounted to 38.66
Homocysteineµmol/l32,13
The tumor necrosis factor (TNF-α)PG/ml8,7
C-reactive protein (CRP)mg/lare 5.36

To evaluate the integrated effect of various clinical and biochemical parameters on the development of atherosclerosis in b is selected type 2 diabetes, and to identify the most important predictors influencing the development of atherogenic lesions of blood vessels was performed multiple regression analysis. This was composed of the dependency matrix of the main parameters of atherosclerosis (triglycerides and HDL) in patients with type 2 diabetes and clinical and biochemical parameters, which were divided into 4 groups:

1. Clinical-anamnestic indicators: body mass index, heredity, the ratio of waist circumference to hip circumference and the presence of arterial hypertension.

Biochemical parameters

2. Carbohydrate metabolism: insulin resistance, impaired fasting glucose, impaired glucose tolerance, glycosylated hemoglobin.

3. Hormonal and metabolic parameters: fibrinogen, tissue inhibitor of plasminogen activator-1 (IAP-1), resistin and homocysteine.

4. Anti-inflammatory: the metabolites of nitric oxide (NO), CRP, TNF-alpha, endothelin.

According to the regression analysis revealed that the level of triglycerides, which determines the risk of developing atherosclerosis in patients with type 2 diabetes, depended on the level of all indicators, with greater intensity from endothelin, impaired fasting glucose, plasminogen, resistin and the relationship of waist circumference to hip circumference, and measure HDL cholesterol was inversely dependent on all indicators, with a large intensity from endothelin, disorders of glucose on an empty stomach, plasminogen and the relationship of waist circumference to hip circumference.

According to cluster analysis clusters were formed according to the proximity of the selected criteria. Based on this proposed scale risk assessment. The most important criteria received a score of 4, less significant 1, 2, 3, respectively (table 2).

Table 2
Scale risk assessment development of early atherosclerosis in patients with type 2 diabetes
The estimated parameterPoints
Clinical-anamnestic data
1BMI
26,5 and more1
2FROM/ABOUT
0,66-0,672
0,97-1,053
1,15-1,214
3Heredity (presence of diabetes Diab is and type 2 in close relatives) 2
4Arterial hypertension (140/90 mm RT.article and more) - 1
Carbohydrate metabolism
5Insulin resistance
less 15,901
15,91-18,652
More 18,663
6Impaired fasting glucose
Less 8,822
8,83-of 9.303
More than a 10.744
7Glycosylated hemoglobin
Less 9,491
9,50-are 11.622
More 11,633
8
Less of 6.201
More 6,212
9Nitric oxide (NO)
Less 40,101
More 40,112
10The tumor necrosis factor α
Less of 8.371
More scored 8.382
11C-reactive protein
More 1,901
12Endothelin
less than 0.331
More 0,344
13The resistin
Less - 8,0 1
8,03-20,603
More 20,614
14Fibrinogen
More 287,841
15Homocysteine
More 21,401

According to the obtained cluster analysis we can calculate the risk of atherosclerosis in patients with type 2 diabetes, taking into account the specific indicators: the inhibitor of plasminogen activator-1 (IAPG-1), NO - metabolites of nitric oxide, resistin, insulin resistance (IR), TG - triglycerides, HDL cholesterol, Fibrinogen, BMI - body mass index, IFG - impaired fasting glucose, HbAlc, IGT - impaired glucose tolerance, HZ - homocysteine, TNF-α, C-RB.

The described model for practical application are presented in the form of a table, the doctor is enough to make the values of the above indicators in this table to obtain a conclusion on the risk of development of atherosclerosis.

The method is as follows.

Determine the clinical and anamnestic data: body mass index (BMI), to the/m 2; waist circumference, hip circumference (ABOUT), of/ABOUT, diabetes mellitus type 2 in close relatives, the presence of arterial hypertension (AH). Determined by laboratory data: the level of an inhibitor of plasminogen activator-1 (IAPG-1), nmol/l; metabolites of nitric oxide (NO), %; resistin, ng/ml; insulin resistance (IR), mIU/ml; triglycerides (TG), mmol/l; cholesterol high density lipoprotein (HDL cholesterol), mmol/l; fibrinogen, mg/DL; impaired fasting glucose (IFG), mmol/l; glycosylated hemoglobin (HbAlc), %; impaired glucose tolerance (IGT), mmol/l; homocysteine (HZ), µmol/l; TNF-α, PG/ml; C-reactive protein, mg/l; endothelin and fibrinogen.

The obtained values assign scoring according to table 2. Identified points summarise and conclude on the risk of development of atherosclerosis in patients with type 2 diabetes:

26 points or more - extremely high risk;

20-25 points - high risk,

from 14 to 19 points - average risk,

below 14 points - low risk.

According to the obtained scale risk assessment of early atherosclerosis development we have developed recommendations for monitoring of patients with type 2 diabetes.

1. All patients, along with treatment of the underlying disease (type 2 diabetes), lifestyle changes and diet recommended the following :

To reduce the frequency of micro - and macros distich complications associated with atherosclerosis, a correction of lipid metabolism disorders. Therefore, according to the recommendations of the International Federation of diabetologists and the European office of the world health organization study of lipid metabolism is desirable to carry out every six months, but not less than 1 time per year. During treatment with statins in high doses, frequency studies of lipid metabolism increases to 1 per 2-3 months to monitor the effectiveness of medication. In addition, to prevent the development and rapid progression of diabetic kidney disease should be actively identify early stages of diabetic nephropathy, because that diabetic nephropathy is currently the leading cause of high morbidity and mortality of patients with diabetes. The earliest criterion in the development of diabetic nephropathy (before the appearance of proteinuria) is microalbuminuria. Taking into account daily fluctuations excretia albumin, to confirm the true microalbuminuria should be placed at least two positive results within 4-6 months. With annual screening for diabetic nephropathy necessary to diabetic type 2 diabetes since diagnosis of diabetes.

2. According to the recommendations of the American diabetes Association (the YES), the purpose of acetylsalicylic acid shows all DM2 patients for secondary prevention of CHD. Aspirin should be prescribed in a daily dose of up to 76-162 mg.

According EASD/European Society of Cardiologists Guidelines for Diabetes/Cardiovascular diseases, ongoing statin treatment should be appointed the majority of patients with DM-2 (Shestakova, M. C. Comments endocrinologist to Guidelines on diabetes, prediabetes and cardiovascular disease ESC-EASD 2007 / "diabetes" 2008, No. 1, S. 97-99). The most expedient is the individual selection of doses of statins, based on the degree of risk of atherosclerosis. High doses are encouraged to leave only for people with very high risk for more rapid achievement of target levels of cholesterol (M. N. Davidson, J. G. Robinson. Safety of Aggressive Lipid Management. J Am Coil Cardiol 2007; 49: 1753-62).

Table 3
A differentiated approach in the diagnosis and therapy of early atherosclerosis in patients with type 2 diabetes
The degree of risk for early atherosclerosisScreeningThe treatment
1) determination of blood lipid spectrum of 1 times in 3 months
extremely high risk of developing atherosclerosis2) determination of excretia of albumin in the urine and the rate of creatinine is not less than 1 time in 6 months1) aspirin (75-162 mg/day)
2) statins (in high doses up to 80 mg/day)
1) determination of blood lipid spectrum 1 time in 6 months
high risk of developing atherosclerosis2) determination of excretia of albumin in the urine and the rate of creatinine is not less than 1 time in 6 months1) aspirin (75-162 mg/day)
2) statins (in medium doses of 20-40 mg/day)
1) determination of blood lipid spectrum is not less than 1 time in 6 months
the average risk of developing atherosclerosis2) determination of excretia of albumin in the urine and the rate of creatinine 1 times in 12 months1) aspirin (75-162 mg/day)
2) statins (minimal dose not exceeding 10 mg/day)
1) determination of blood lipid spectrum 1 time in 12 months
low risk of developing atherosclerosis2) determination of excretia of albumin in the urine and the rate of creatinine at least 1 time in 12 months1) aspirin (75-162 mg/day)

2. As the treatment of hypertension preference should be given to drugs from groups:

A) angiotensin converting enzyme Inhibitors (ACEI) or

B) Antagonists of receptors of angiotensin II.

Clinical example

Example. B-Naya N., 43 years. Diagnosis: Diabetes mellitus type 2, moderate for the aggravation.

Unwell the last 1.5 months. Complaints of weakness, dizziness, irritability. The diagnosis of diabetes mellitus set a year ago. Notes the presence of diabetes mellitus type 2 from my mother.

Objectively: height 162 cm, weight 63 kg BMI is 24, the ratio of waist to hip circumference is - 0.97. The correct shape. Skin and visible mucous net. Language and wet clean. Light - vesicular breathing. Heart tones are clean, rhythmic. The pulse is 70/min, BP-120/80. The abdomen is soft, painless, liver and spleen not palpable. From the anamnesis it is known that her mother died from myocardial infarction.

Biochemi the mini-research

Triglycerides - 1,78, HDL cholesterol - 1,21; impaired glucose 8,4, impaired glucose tolerance - 5,8, insulin resistance was 13.8, glycosylated hemoglobin - 6.5; resistin - 27,5, fibrinogen - 426,87, homocysteine - 32,4, NO - 45,6, TNF - 8,2, SLO - 7,5, endothelin - 0,33, plasminogen 0.5 in.

The obtained values are substituted in table 2 and calculate a measure that defines the degree of risk of development of atherosclerosis.

Table 4
The scale of assessment of the risk of early development of atherosclerosis in patient N.
Clinical-anamnestic data
BMI
Less 26,5 (24)0
FROM/ABOUT
0,97-1,05 (0,97)3
Heredity2
Arterial hypertension0
Carbohydrate metabolism
Insulin resistance is more 13,71 (13,8)2
Impaired fasting glucose
8,83-of 9.30 (8,4)3
Glycosylated hemoglobin
Less 6,50 (6,5)1
Impaired glucose tolerance
Less of 6.20 (5,8)1
Nitric oxide (NO)2
More 40,11
The tumor necrosis factor α
Less of 8.37 (8,2)1
C-reactive protein1
More than 1.9 (7,5)
Endothelin1
Less (0,33)
The resistin
More 20,61 (27,5)4
Fibrinogen
More 287,84 (426,85) 1
Homocysteine
More 21,40 (32,4)1

Based on our tables calculated risk of atherosclerosis: 1×6+2×3+3×2+4=22.

Thus, the risk of development of atherosclerosis in this patient is assessed as high, and despite the fact that in this patient the lipid profile of blood in norm, according to the recommendations, the patient additionally had been given advice on nutrition, plan further observations assigned to aspirin and statins in appropriate doses. After 6 months of follow-up lipid level triglyceride constituted by 1.68 mmol/l, which corresponds to the target level, it is necessary first to reduce the concentration of triglycerides in the blood <150 mg/DL (1.7 mmol/l). A sample of microalbuminuria negative. It is recommended to continue the chosen therapy and repeat the research results in 6 months.

Our proposed method allows to determine the risk of atherosclerosis, which is important in clinical situations when the diagnosis is established based on the results of the lipid spectrum. In addition, the subsequent selection of treatment allows you to select individual pathogenetically-based therapy for pale is the which leads to the reduction of cardiovascular complications.

Way of monitoring people at risk of early development of atherosclerosis and diabetes mellitus type 2, which includes the determination of clinical and anamnestic data: body mass index (BMI), kg/m2; waist circumference, hip circumference (ABOUT), of/ABOUT, diabetes mellitus type 2 in close relatives, the presence of arterial hypertension (AH), and laboratory data: the level of an inhibitor of plasminogen activator-1 (IAPG-1), nmol/l; metabolites of nitric oxide (NO), %; resistin, ng/ml; insulin resistance (IR), mIU/ml; triglycerides (TG), mmol/l; cholesterol high density lipoprotein (HDL cholesterol), mmol/l; fibrinogen, mg/DL; impaired fasting glucose (IFG), mmol/l; glycosylated hemoglobin (HbAlc), %; impaired glucose tolerance (IGT), mmol/l; homocysteine (HZ), µmol/l; TNF-α, PG/ml; C-reactive protein, mg/l; endothelin and fibrinogen; the resulting values assign scoring: BMI of 26.5 and more - 1 point; FROM/ABOUT: 0,66-0,67 - 2 points, 0,97-1,05 - 3 points, 1,15-1,21 - 4 points; diabetes mellitus type 2 in close relatives: 2 points; AG: 1 point; IL: less 15,9 - 1 point, 15,91-18,65 - 2 points, more 18,66 - 3 points; NH: less 8,82 - 2 points, 8,83-of 9.30 - 3 points, more than a 10.74 - 4 points; HbAlc: less 9,49 - 1 score of 9.50-are 11.62 - 2 points, more 11,63 - 3 points; IGT: less 6,20 - 1 point, more 6,21 - 2 points; NO: m is it 40,10 - 1 point, more 40,11 - 2 points; TNF-α: less of 8.37 - 1 point, more scored 8.38 - 2 points; C-reactive protein: more than 1,90 - 1 point; endothelin: less than 0.33 - 1 point, more 0,34 - 4 points; resistin: less 8,02 - 1 point, 8,03-20,60 - 3 points, more 20,61 - 4 points; fibrinogen: more 287,84 - 1 point; homocysteine: more 21,40 - 1 point; the points are added up and the sum of 26 points or more to determine the presence of extremely high risk of atherosclerosis in patients with T2DM type and in patients receiving standard therapy it is also prescribed aspirin 75-162 mg/day and statins - up to 80 mg/day, monitoring of blood lipid spectrum spend 1 time in 6 months, and excretion of albumin in urine and measure creatinine blood - not less than 1 time in 6 months; if the sum 20-25 points determine the presence of high risk and in patients receiving standard therapy it is also prescribed aspirin 75-162 mg/day and statins 20-40 mg/day, monitoring of blood lipid spectrum spend 1 time in 3 months, and excretion albumin in the urine and measure creatinine blood - not less than 1 time in 6 months; if the amount from 14 to 19 points determine the presence of medium risk in patients receiving standard therapy it is also prescribed aspirin 75-162 mg/day and statins - not more than 10 mg/day, monitoring of lipid profile performed at least 1 time in 6 months, and excretion of albumin in urine and measure creatinine blood - 1 time in 12 months; if the amount is below 14 points determine the presence nor the who risk and in patients receiving standard therapy it is also prescribed aspirin 75-162 mg/day, monitoring of blood lipid spectrum spend 1 time in 12 months, and excretion of albumin in urine and measure creatinine blood - at least 1 time in 12 months.



 

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3 tbl

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to sampling body fluid for the analysis, that is for determination of tested substance concentration. In particular it relates to devices and systems for obtaining a small sample of body fluid by puncturing subject's (person's or animal's) skin by means of disposable puncture element, which has tip for skin puncturing, suitable for creating a small wound, from which fluid is sampled. Described is device for sampling body fluid for analysis by skin puncturing by means of puncturing element, which has tip for skin puncturing. Claimed device has case, drive for puncturing, pressure ring and device for pressure force control. Drive for puncturing is located inside case for connection to puncturing element and for driving puncturing element, connected to it, in puncturing movement, during which puncturing element after trigging puncturing movement moves in direction of puncturing until it reaches point of maximal displacement, and in opposite direction after it reaches point of maximal displacement. Pressure ring surrounds opening for contact with skin and is made with possibility of pressing to skin. Opening for contact with skin has area of opening corresponding to circle with diameter, at least, 1.5 mm, but not larger than 4 mm. Device for pressure force control for controlling pressure force between pressure ring and skin at the time of triggering puncturing movement, which must be equal, at least, 3 H, preferably, at least, 4 H, and the most preferably, at least, 5 H. In the second version of implementation device for sapling body fluid has pressure ring, which has surface region in form of narrow ring, surrounding opening for contact with skin and transferring at the time of practical device application, at least, 70% of forces, acting between device and skin. Ring is on, at least, part of its circumference length, not more than 1.5 mm wide, preferably, not more than 1.2 mm wide, the most preferably, not more than 1 mm wide. System for obtaining body fluid sample for analysis by skin puncturing contains one of above mentioned manual devices for multiple use and puncturing element, made with possibility of connection with possibility of replacement to device drive.

EFFECT: technical result of invention consists in simplicity of application, minimal pain and minimal volume, weight and production cost.

23 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: group of inventions refers to medical equipment. A sampling instrument comprises a body, an in-built cutting element drive for actuating the cutting element attached thereto after puncture, a support ring surrounding a skin contact hole and formed to be pressed against skin so that skin represents a bump towards the hole for stimulation of body fluid expression. The skin contact hole has an area shaped as a circle of the diameter of at least 3 mm, and at most 8 mm. The instrument comprises a compression force control unit for adjustment of compression force between the support ring and skin when actuating puncture which is equal to at least 3 N and at most 8 N. What is disclosed is a version of implementing the instrument differing by implementing the puncture actuators, and the system for body fluid sampling for analysis using said instruments.

EFFECT: provided reproduction of tissue penetration depth.

3 cl, 325 dwg

Catheter // 2457871

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, namely a catheter, particularly a catheter for collection of a number of samples inside a blood vessel along its length, and related methods, particularly a method for creating a data profile for one or more biomarkers recovered from a blood vessel wall, a method for profiling a length of the blood vessel for determination of the pathological or physiological state of the blood vessel wall, and a method for blood sampling in vivo from the blood vessel. A catheter comprises an elongated central body, at least one collection portion limited along the elongated central body for sample collection in the central portion of the blood vessel, and at least one mixer presented radially outside the elongated central body. Said body is introduced in the blood vessel and arranged along it. At least one mixer extends around said body circumferentially substantially in all radial directions. The mixer is presented to serve as an blood flow obstruction along the blood vessel to create a blood flow from a layer bordering the blood vessel wall along the whole periphery of the blood vessel in said body so that to enable said at least one collection portion collecting samples from the bordering layer.

EFFECT: invention provides improved better result consistency and closer correlation of the actual positions of biomarker sources and the positions in which such biomarkers are initially collected.

23 cl, 25 dwg, 1 tbl

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to oncology, and can be used in treatment of patients with non-small cell III stage lung carcinoma (NSCLC). For this purpose, first laboratory estimation of initial cortisol production is performed and in case of its normal indices carried out is pre-medication that includes intramuscular introduction of dexamethasone in accordance with the scheme: 20 mg 13 hours, 10 mg 7 hours and 10 mg 2 hours before carrying out chemical therapy with taxanes. Cortisol level is determined repeatedly immediately before infusion of taxanes and after operation. In case if level of peak cortisol secretion in post-operation period in early morning hours drops lower than 300 nmole/l drug correction with glucocorticosteroids is carried out additionally until normalisation of indices.

EFFECT: method allows to reduce number of post-operation complications in said category of patients due to preventive drug correction of possible adrenal insufficiency with simultaneous prevention of hypersensitivity responses to introduction of taxanes.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and can be used in cardiology, endocrinology, functional diagnostics and can find application in diagnostics and selecting a therapeutic approach to ischemic heart disease. The following risk factors are detected in the patients suffering from diabetes mellitus accompanied by cardiovascular disorders: blood plasma glucose, glycated haemoglobin (HbAlc), total blood plasma cholesterol, blood plasma low density lipoprotein cholesterol, blood pressure, load St segment depression, signs of carotid wall thickening, an ankle-brachial index and brachial endothelium-dependent vasodilatation as shown by the Doppler ultrasound, duration of diabetes mellitus; the derived values are scored. The derived scored values are summed up, and a risk of coronary artery atherosclerosis is stated to be low, moderate, high or very high.

EFFECT: method enables determining the risk of coronary artery atherosclerosis in the patients suffering from diabetes mellitus accompanied by cardiovascular disorders by assessing the clinical laboratory values and conducting instrumental tests, including electrocardiography, Doppler ultrasound and coronary angiography.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to marine medicine. The nervous and cardiovascular functional characteristics are measured 30 minutes before and 30 minutes after a 30-metre chamber immersion to stay there for 1 hour and following 63-minute decompression. That is followed by determining an index of resistance to decompression disease (DD) in females at 20-30 years of age (IRDDF20-30) by original formula. If the derived value of the index of resistance is less than 1, a high degree of resistance to DD is stated, and the value falling within the range of 1 to 1.8 shows a moderate degree, while a low degree of resistance to DD is stated if observing the related value exceeding 1.8.

EFFECT: method enables providing the more accurate detection of the degree of individual resistance to decompression disease in females and the differentiated assessment of resistance to decompression disease in the females of a specific age by taking into account the nervous and cardiovascular characteristic values.

3 ex

FIELD: medicine.

SUBSTANCE: device for non-invasive glucose measurement in an individual comprises a single external unit, which is provided with the first part and the opposite second part for receiving the individual's body par in between. The first and second ultrasonic piezoelectric elements are mounted on the first and second parts respectively, and comprise the first and second coating membranes respectively for measuring the glucose content by ultrasound. The first and second membranes form the first and second capacitor plates respectively with a connected self-excited glucose measuring device using electromagnetic measurements. A heater and a thermal detector are mounted on the first part and separated from the first piezoelectric element for measuring glucose by the thermal characteristics.

EFFECT: using the invention enables providing the more accurate glucose measurement by a combination of the ultrasonic, electromagnetic and thermal measurement methods.

8 cl, 17 dwg

FIELD: medicine.

SUBSTANCE: invention concerns determining a degree of severity of psychosomatic disorders in patients with discirculatory encephalopathy. That is ensured by a standard therapeutic, neurologic, instrumental examination. That is added with measuring primary anti-S100B protein antibody (AT) titres in blood serum. If the measured titre is up to 150, they should be taken into account in stating degree 3 discirculatory encephalopathy with cognitive disorders reaching moderate or severe dementia accompanied by severe affective and behavioural disorders.

EFFECT: higher specificity, accuracy, sensitivity and reliability of the molecular diagnostic technique.

FIELD: medicine.

SUBSTANCE: diagnostic technique for the ischemic heart disease is implemented by stating risk factors, symptoms and ECG findings, diagnostic characters (DC) of which are distributed into groups and assigned with certain numerical scores. Conditional probabilities of the presence or absence of IHD in a specific patient are calculated. The findings are used to establish the diagnosis of IHD or not.

EFFECT: technique enables providing establishing the more accurate diagnosis of IHD by taking into account a complex of various DCs, the records of which are processed by a mathematical model.

2 ex

FIELD: measurement equipment.

SUBSTANCE: method to train a user how to use a set for analyte (such as glucose) detection in a body fluid sample (for instance, a whole blood sample) includes activation of an analytical meter of a set, besides, the analytic meter includes a training module on the basis of a display. Besides, the display-based training module includes a user interface with a visual display, a memory module, where the training program is saved, and a microprocessor module made as capable of control and coordination in respect to the user interface and memory module. Besides, the training program saved in the memory module has sections, besides, each section comprises one or more training images illustrating use of the set. Besides, the user interface, the microprocessor module and the memory module are functionally connected and configured for event-controlled display on the basis of the section of training images for the user on the visual display. The method also includes training of the user on how to use the set by display of section-based training images in the event-controlled manner.

EFFECT: method improvement.

10 cl, 33 dwg

FIELD: medicine.

SUBSTANCE: clinical-laboratory and functional methods are used to determine diagnostic criteria and to calculate a prognostic index. A complex of the following diagnostic criteria is determined in a patient: anthropometric - a Quetelet index, a lipid metabolism - an atherogenic index of apoprotein, a functional hepatic state - alanine aminotransferase, lipid peroxidation - a relation of malondialdehyde to the antioxidant activity, central haemodynamic values - a systolic arterial blood pressure and cardiac index. A predictive index determining a degree of manifestation of metabolic disorders is the prognostic index as the total value of the diagnostic criteria determined by clinical-laboratory and functional methods and calculated by formula. The value derived from formula is used to predict no risk of metabolic syndrome, a low risk, a moderate risk and a high risk of metabolic syndrome.

EFFECT: method enables predicting the manifestation of metabolic syndrome by assessing the diagnostic criteria and conducting timely therapy for the purpose of preventing metabolic syndrome and cardiovascular complications.

3 tbl, 2 ex

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