Method for assessing efficacy of nutritional support accompanying ulcerative colitis

FIELD: medicine.

SUBSTANCE: marker used is a soluble form of adhesion molecules of the family ICAM - sICAM-1, sICAM-2, sICAM-3. If observing sICAM-1 decrease from 29-37.2 to 23-24, sICAM-2 decrease from 19.1-21.1 to 13-14, sICAM-3 decrease from 23-30.7 to 14-17, the nutritional support is considered to be effective.

EFFECT: method enables increasing the assessment accuracy of the efficacy of the nutritional support accompanying ulcerative colitis.

3 ex

 

The invention relates to the field of gastroenterology and in particular to methods of evaluating the effectiveness of nutritional (nutritional) support in ulcerative colitis.

The known method of diagnostics of the effectiveness of enteral nutrition in postoperative disorders of motor-evacuation function of the gastrointestinal tract based on data auscultation, ballinagree, inominate, direct myography as well as the use of special probes (1 - Pankov V. I. Prevention and treatment of postoperative dynamic motility of the gastrointestinal tract. Abstract of Diss. Dr. med. Sciences. Ryazan, 1980).

The disadvantages of the known methods is the low efficiency and the information content that does not provide the possibility of determining the optimal volume of enteral nutrition in abdominal sepsis, as well as the high cost, the need for special training of staff, the painfulness for the patient, complications and side effects.

The known method of evaluating the effectiveness (usefulness) of enteral nutrition in patients with abdominal sepsis. The essence of the method lies in the fact that, initially, empty stomach, and then injected into the stomach of the marker, which is used acetaminophen. 15-40 min determines its concentration in the blood plasma, which Oprah�elaut possible effectiveness of enteral nutrition in abdominal sepsis (2 - RF patent №2484467, G01N 33/48, 2012). This method is adopted for the prototype.

The aim of the invention is to improve the accuracy of evaluating the effectiveness of nutritional support in ulcerative colitis.

The technical result is achieved in that a marker using a soluble form of adhesion molecules ICAM family - sICAM-1, sICAM-2, sICAM-3, and by reducing the level of sICAM-1, 29-37,2 to 23-24, sICAM-2 from 19.1 21.1 per to 13-14, sICAM-3, 23-30,14-17 7 to consider nutritional support is effective.

The method is implemented as follows.

At admission, patients complain of weakness, loss of weight 8-15 kg in 2-3 years, loose stools up to 9-15 times a day, occasionally blood in the stool, a false urge to defecate.

From history we know that you are sick within 2 to 7 years, when I first noted loose stools up to 8-15 times a day, increased body temperature to 37-40,5°C, weight loss. With sigmoidoscopy is observed on the mucous membrane multiple erosions, contact bleeding, "grit", vascular pattern is blurred or missing due to edema of the mucosa, indicating the presence of peptic proctosigmoiditis. By barium enema, left - sided colitis. In the blood - iron deficiency anemia - HB - 75-110 g/l ESR - 45-90.

Diagnosed with ulcerative proctosigmoiditis, first identified iron deficiency anemia 1 tbsp. consider taking metronidazole, sulfasalazine a dose of 3 g/day, prednisolone 25-40 mg/day, sorbifer.

During exacerbation of diarrhea, low-grade fever, decreased serum iron.

ECG - half-upright position of the electrical axis of the heart. Sinus rhythm correct. HR - 76-110. Endoscopy: esophageal lumen is not deformed when air insufflation good deals. The mucosa of the esophagus pink, smooth, shining, in the lower third of the esophagus determined by linear erosion length of up to 2.0 cm, in the epithelialization phase. The outlet of the cardia closes completely. Cardiac folds of the stomach are at the level of hiatal. The lumen of the stomach is not deformed when air insufflation easily crushes. In the lumen of the stomach on an empty stomach moderate amount of mucous content. Gastric mucosa is moderately hyperemic on the peaks of the folds in the antrum has a speckled appearance, the walls are defined submucosal hemorrhages. The folds are medium sized, crimped, longitudinally oriented. Peristalsis is satisfactory, symmetrical. The angle of the stomach is not changed. Gatekeeper rounded, closed, pass. The bulb 12 duodenal ulcer is medium in size, edematous mucosa, moderately hyperemic. The output of the bulbs are loose. Postbulbarnye divisions: mucous duodenum 12 pale pink, active peristalsis, BDS in a typical place, with checks�e apparatus with the end location of the optics are not visually changed. Urease test - negative. Conclusion: reflux esophagitis. Antral gastritis with a hemorrhagic component. Bulbit.

Colonoscopy - examination before the dome of the cecum mucosa of the descending colon and rectum hyperemic, edematous, with a touch of fibrin, it is noted contact bleeding.

Objectively admission: General condition of moderate severity, asthenic physique. Growth - 160-175 cm, weight 45-55 kg. Peripheral lymph nodes were not enlarged. Auscultation vesicular breathing, wheezing no. BH min. 14-16 in auscultation of the heart tones are muffled, rhythmic, heart rate - in 65-75 min. BP 110/75-130/80 mm Hg.PT. Zev clean, tongue moist, coated at the root of the white coating. The belly of the correct form, participates in the act of breathing, palpation is soft, painful in the course of the colon. Liver at the edge of the costal arch. The gallbladder is not palpable, the gallbladder symptoms negative. The spleen is not enlarged to palpation. Chair - unformed, up to 5-15 times, without pathological impurities. Urination painless. There is no swelling.

The final clinical diagnosis: ulcerative colitis, a total lesion of the colon, high degree of activity in the stage of ulcers, recurrent continuously heavy currents, pseudopolyps. Chronic iron deficiency anemia of moderate severity.

Chronic gastroduodenitis, about�friction. Reflux esophagitis.

Recommended parenteral antibiotics, local treatment focaccina. He was treated with medications 5-ASA at a dose of 3 g/day, iron supplementation, prednisolone, the treatment marked slowing of the chair. Fluorography: without pathology.

Examination.

General clinical blood analysis - iron deficiency anemia, increased erythrocyte sedimentation rate. Biochemical analysis of blood - decrease in total protein, decreased serum iron, increased C-reactive protein.

Blood group b(III), Rh - positive, Kell - negative.

General urine analysis: Rel. the density of 1,016-1,025, the reaction of 5,5-7, protein 0.15 to 0.45, and no glucose, leukocytes 50-85 in p/Zr, erythrocytes - negative.

In the coprogram reaction for occult blood positive cells, plant cells and starch ++. The calprotectin in feces - 930-1350 µg/g.

ANCA - Outout to the neutrophils were not detected.

AT the saccharomycetes have not been identified. YEAH and ATTTG - negative.

EMA: hypermotor dyskinesia of the stomach and the descending part of the colon. The frequency of slow waves of the stomach of 9.6 and 10.3 min, the amplitude of 0.11 to 0.14 mV. The frequency of spikes is 3.8 to 4.4, the amplitude of 0,02-0,04 mV. The frequency of slow waves of the descending part of the colon 8,0-11 in min, the amplitude of 0.11-0.15 mV. The frequency of spikes - 4,0-5,3, amplitude of 0.02-0.05 mV.

Treatment: corticosteroids (metipred, topically in the form of rectal enemas). Azathioprine,/in carabo�, the metrogyl, fluconazole. Cosmofer, sorbifer, bifidum bacteria, omeprazole, CREON.

Conducted drug treatment modules in the dose at a dose of 25-30 g 2-3 times on the first day of appointment of the drug, 35-40 g three times on the second day, 45-50 g three times a day from the third to the thirtieth day of treatment.

Evaluate the effectiveness of nutritional support is carried out with the help of molecules sICAM-1, sICAM-2, sICAM-3, and by reducing the level of sICAM-1, 29-37,2 to 23-24, sICAM-2 from 19.1 21.1 per to 13-14, sICAM-3, 23-30,14-17 7 to consider nutritional support is effective.

The treatment has a positive dynamics: improving General well-being, relief of pain, slowing of the chair, the normalization of its consistency. The patient is discharged in a satisfactory condition. The forecast for gastroenterological pathology positive.

The method is further illustrated by examples of its implementation.

Example 1

The patient W-n, 1975 Complaints when applying for loose stools up to 10 times a day, occasionally admixture of blood in the stool, a false urge to defecate with the discharge of gases, weakness, weight loss of 12 kg in 2 years.

History: Considers himself ill for 5 years when I first noted loose stools up to 10 times a day, increased body temperature to 37-38°C, weight loss. With sigmoidoscopy conducted in polyclinic in a residence - multiple mucosal erosions, contact to�autocephaly, "grit", absent vascular pattern, inspection of 20 cm Conclusion: ulcerative colitis of the rectum 1 article by barium enema, left - sided colitis. In the blood - iron deficiency anemia - HB - 75 g/l ESR - 89.

Diagnosed with ulcerative colitis, first identified with left-sided lesions of the colon, iron deficiency anemia 1 tbsp. consider taking metronidazole, sulfasalazine at a dose of 3 g/day, prednisone 40 mg/day, sorbifer.

The patient took the medication for 6 months, then did not accept. In 2013, notes the deterioration is frequent loose stools, low-grade fever, sent to inpatient treatment, when examined in the analyses, there was a reduction of serum iron, TPHA dysentery, salmonellosis, arsines - negative.

Ultrasound bio - without features, colonoscopy - examination before the dome of the cecum, mucous from the anus to the hepatic angle hyperemic, edematous, with a touch of fibrin, it is noted contact bleeding.

Endoscopy - subatrophic gastritis. Diagnosed with ulcerative colitis, recurrent, with left-sided lesions, reactive hepatitis, chronic pancreatitis. Iron deficiency anemia (IDA) approved the appointment of metipred 40 mg, azathioprine 100 mg, mesalazine 4 g/day. After discharge, the patient took a metipred with gradual withdrawal once a week on 1 tab., azathioprine patient �animal, disability group not issued. The present deterioration since July, more frequent stools 6-7 times; the deterioration was treated, during examination: anemia, thrombocytosis, leukocytosis with stab shift (33 p/I), accelerated erythrocyte sedimentation rate, biochemical analysis of blood - decreased serum iron, HIV-negative.

Objectively admission: General condition of moderate severity, asthenic physique. Height - 165 cm, weight - 52 kg. Peripheral lymph nodes were not enlarged. Auscultation vesicular breathing, wheezing no. BH 16 V min. auscultation of the heart tones are muffled, rhythmic, heart rate is 75 / min. blood pressure 110/70 mm Hg.PT. Zev clean, tongue moist, coated at the root of the white coating. The belly of the correct form, participates in the act of breathing, palpation is soft, painful in the course of the colon. Liver at the edge of the costal arch. The gallbladder is not palpable, the gallbladder symptoms negative. The spleen is not enlarged to palpation. Chair - unformed, up to 5 times, without pathological impurities. Urination painless. There is no swelling.

The final clinical diagnosis: ulcerative colitis, a total lesion of the colon, high degree of activity in the stage of ulcers, recurrent continuously heavy currents, pseudopolyps. Chronic iron deficiency anemia of moderate severity.

Chronic gastroduodenitis, aggravation. Refl�COP esophagitis.

Performed colonoscopy - examination to the splenic angle, mucous sharply hyperemic, edematous, more in a down division, a lot of the cast surface erosion, severe contact bleeding, folding smoothed due to the swelling of the mucous.

Recommended parenteral antibiotics, local treatment focaccina, antiseptic ointments. He was treated with medications 5-ASA at a dose of 3 g/day, iron supplementation, prednisolone, on the background of treatment, there is a decrease in frequency of stool, reduce the appearance of the rash. Fluorography: without pathology.

Examination.

ECG - half-upright position of the electrical axis of the heart. Sinus rhythm correct. HR - 85. Endoscopy: esophageal lumen is not deformed when air insufflation good deals. The mucosa of the esophagus pink, smooth, shining, in the lower third of the esophagus determined by linear erosion length and 1.8 cm in the epithelialization phase. The outlet of the cardia closes completely. Cardiac folds of the stomach are at the level of hiatal. The lumen of the stomach is not deformed when air insufflation easily crushes. In the lumen of the stomach on an empty stomach moderate amount of mucous content. Gastric mucosa is moderately hyperemic on the peaks of the folds in the antrum has a speckled appearance on the wall� defined submucosal hemorrhages. The folds are medium sized, crimped, longitudinally oriented. Peristalsis is satisfactory, symmetrical. The angle of the stomach is not changed. Gatekeeper rounded, closed, pass. The bulb 12 duodenal ulcer is medium in size, edematous mucosa, moderately hyperemic. The output of the bulbs are loose. Postbulbarnye divisions: mucous duodenum 12 pale pink, active peristalsis, BDS in a typical place, during the inspection apparatus with the end location of the optics are not visually changed. Urease test - negative. Conclusion: Erosive esophagitis. Antral gastritis with a hemorrhagic component. Bulbit.

General clinical blood analysis

dateNVEritr.No.TromLake.P/IWith/IEosinLymphsMunozESR
05.09.8,24,1826,862415970 116441
09.09.8,13,99265748,5658229541
18.09.9,64,42Is 31.13598363228412
26.09.10,8A 4.6434,82118,137012157

Biochemical analysis of blood

Indicator05.09 11.0924.09Norm
Total protein65,966,963,866,0-83 g/l
Albumin35,235-52
Bilirubin total139,620,23-4-21 µmol/l
Glucose3,834,274,064,1-6,4 mmol/l
Urea5,38Of 4.541,7-8,3 mmol/l
Cholesterol4,42Of 5.75The 6.251,4-5,2 mmol/l
Creatinine105,772,480,274-110 µmol/l
Alkaline phosphatase155,4 Of 116.863,530-120 units/l
ACTOf 33.522,313,15-35 u/l
ALT64,143,630,45-45 u/l
Amylase48,767,8127,128-100 u/l
Iron2,814,110,212,5-32,2 mmol/l
Potassium4,454,235,31A 3.5-5.1 mmol/l
Sodium136,8140,4Of 143.2136-146 mmol/l
GGTPAt 86.489,266,4About 7-56 u/l
Chlorine98To 100.6104,7 98-106 mmol/l
DRR127,2410,10-5 mg/l
Fibrinogen3,562-4 g/l
ACTV32,825-35 sec
MHO1,290,9-1,2
Prothrombin73,170-130%
Prothrombin time18,5h

HbsAg, a-HCV - negative.

At. to HIV negative. The reaction of the RMP is negative.

Blood group 0(1), Rh - positive, Kell - negative.

General urine analysis: Rel. the density of 1,023, the reaction of 5,5, protein 0,2, no glucose, leukocytes - 75 in p/Zr, erythrocytes - negative.

General urine analysis: Rel. the density of 1.014, reaction of 7.0, protein - no, no glucose, leukocytes neg., erythrocytes-negative.

Coprogram

IndicatorThe resultNorm
ConsistencyLiquid
FormNeoform.
ColorBrown
SmellNormal
The reaction for occult bloodPut.Negative.
YeastNoNo
Idolina floraNoNo
StarchNoNo
LeukocytesModeratelyNo
Muscle fiberSlightly
ProtozoaFo�hidden Not found
Vegetable fiberModerately
EpitheliumSlightlyNo
Red blood cellsSlightlyNo
Helminth eggsNot foundNot found

The fecal occult blood - negative, the calprotectin in feces - 950 µg/g. ANCA - AutoIt to neutrophils was not detected. AT the saccharomycetes have not been identified. YEAH and ATTTG - negative. Bacteriological analysis: inoculation of wound discharge on flora and sensitivity to antibiotics - growth of organisms have been identified.

EMA: hypermotor dyskinesia of the stomach and the descending part of the colon. The frequency of slow waves of the stomach 9.6 min, the amplitude of 0.11 mV. The frequency of spikes is 3.8, the amplitude of 0.02 mV. The frequency of slow waves of the descending part of the colon 8.0 min, the amplitude of 0.11 mV. The frequency of spikes - 4,0, amplitude of 0.02 mV.

Treatment: Corticosteroids (metipred 40 mg, topically in the form of rectal enemas). Azathioprine 100 mg per day, in/capable 1000 mg 2 times a day. In/in of metrogyl 250 mg 2 times a day, fluconazole 50mg 1 TA�. 2 times a day. In/in cosmofer 2,0 No. 5, then sorbifer on 1 tab. 2 times a day, bifidum-bacterin 5 doses 3 times a day, omeprazole 20 mg 2 times a day, CREON 10 thousand units, 3 times a day, local treatment of skin antiseptics.

Conducted drug treatment modules in the dose at a dose of 25 g 2-3 times on the first day of appointment of the drug, 35 g three times on the second day, 45 g three times a day from the third to the thirtieth day of treatment.

Evaluating the effectiveness of nutritional support to produce the level of molecules sICAM-1, sICAM-2, sICAM-3 in serum. The level of sICAM-1 decreased from 37.2 to 24, sICAM-2 from 21.1 to 14, sICAM-3 from 30.7 to 17. On this basis, consider nutritional support is effective.

On the background of treatment noted positive dynamics: the chair 2 times a day, poluoformlennaya, without pathological impurities, the pain syndrome was arrested, there is a regression of cutaneous manifestations.

The patient is discharged in a satisfactory condition. The forecast for gastroenterological pathology is questionable.

In connection with severe ulcerative colitis patient recommended the passage of the ITU.

Recommended:

1. The diet №4 and diet.

To continue taking: Metipred 4 mg (36 mg - 9 table.) morning - 6 tab., day - 3 tab., with a gradual reduction until full repeal.

On the whole reception metipred to take omeprazole 20 mg 2 times a day, drugs calcium DZ Nycomed, azatioprina 50 mg 1 tab. 2 times a day for a long time. Only a blood test 1 time per month, iron supplements under control of biochemical parameters (serum iron blood) and OAK 1 time per month, probiotics (Bifidobacterium-bacterin 5 doses 3 times a day) for 1 month, microclysters with prednisolone 30 mg 2 times a day for 1 month, enzymes, containing bile acids, 1 tab. 3 times a day for 1 month.

To continue the treatment of cutaneous manifestations antiseptics.

2. Gastroenterologist supervision in the community. The control endoscopy in a month. Control b/x blood tests (amylase, total protein, CRP, GGT, ALT, AST, ALP).

Example 2

Patient B-to 1958, when a complaint is received on a periodic aching epigastric pain, intermittent pain in right side and stomach and lower abdomen, aggravated by defecation. The watery stools up to 8 times a day, without any admixture of mucus and blood.

Final diagnosis: Ulcerative colitis, first identified a total defeat, moderate activity, acute phase subsides. Gastroesophageal reflux disease in the stage of esophagitis. Chronic gastroduodenitis, non-associated with MS in remission. Iron deficiency anemia of moderate severity. Hypolactasia severe.

History of present illness: Considers herself a patient since 2002, when it was first diagnosed as an ulcer 12 PHE�STN intestine, the treatment provided. In 2008, with complaints of pain in the epigastric region appealed to the gastroenterologist on m/f.

The conducted research: endoscopy: Hernia hiatal. Scar-ulcer deformation of a bulb 12 duodenal ulcer. Chronic ulcer of the duodenal bulb in the initial stage. Treatment: diet, omez 20 mg 1 t 2 p/d, motilium 10 mg 1 t for 30 minutes before eating, fromilid 500 mg 2 R/d 7 days, then Linex 2 drops 3 times/d, eglonil 50 mg 2 R/d Treatment with a positive effect: pain stoped. Endoscopy - chronic ulcer of the bulb 12 duodenal ulcer in the stage "red" scars. Since 2011 began periodic episodes of loose stools up to 7-8 times a day, a mushy stool without mucus and blood. Ultrasound bio: Diffuse changes of the liver and pancreas. Deformity of the gallbladder. Calcification of the walls. In b/x blood GGTP - 52,8. Prescribed treatment: diet 5, enzymes demand, Linex 1 cap 3 times/d, Hylak Forte 30 drops 3 times/d (reception at the beginning of the meal) - 1 month, hepatoprotectors the course of a month. Treatment with a positive effect. During routine examination in the clinic in m/f b/x blood: iron 3,9 mmol/l, SGS to 64.6 μmol/l was prescribed duralex 1 tab. 2 p/D. Patient self-hosted furazolidone 1-2 tablets in the morning during the month, after taking the drugs notes the decrease of the chair. Also, the patient connects the acceleration of the chair when page�CCE. The photo x-rays are normal.

At the initial examination: the General condition satisfactory, normal food. Heart sounds clear, rhythmic. Heart rate is 78 BPM vesicular breathing in the lungs, no wheezing. Belly swollen, palpation soft, painful in the epigastric region and along the colon.

The results of the survey:

ECG: is semi horizontal position EOS. Sinus rhythm, right, heart rate 92 per minute Expressed diffuse changes of a myocardium.

Ultrasound of abdominal organs: Liver: enlarged, CWR right lobe 126 mm (normal up to 150 mm), the thickness of the left lobe 57 mm (normal up to 60 mm). Heterogeneous echostructure. Echogenicity is increased. Vascular pattern is significantly depleted. Portal vein 10 mm (norm up to 14 mm), the lumen is free. Bile ducts are not dilated. Additional education was not detected. Choledoch 3 mm in diameter, free. Gall bladder: the shape is not changed, the sizes are not increased to 5.4×2.1 cm.; Wall thickened to 3 mm (normal up to 3 mm). The contents are homogeneous. Concretions no. The perivesical region is not changed. The pancreas is typically smooth contours, indistinct. Dimensions: head 22 mm (normal up to 30 mm), the body is 10 mm (normal up to 20 mm), tail 20 mm. Echostructure homogeneous. Virunga duct 1.0 mm. Spleen: normal location, contours equal, precise. Capsule is not changed. The sizes are not increased. Echostructure one�DNA. Echogenicity average. The splenic vein is not dilated to 6 mm. Kidneys: are typically, contours equal, precise. The right kidney is 99×44 mm, left kidney - 99×44 mm. Corticomedullary differentiation is not changed. PCS is not extended, no concretions. Free fluid in the abdominal cavity is not revealed. Free fluid in the abdominal cavity is not revealed. Conclusion: signs of fatty liver, chronic cholecystitis.

Endoscopy: the lumen of the esophagus is freely pass. The mucosa of the esophagus pale pink, in the lower third swollen, cardia closes not fully visualized HH. The stomach of the usual form, in the stomach a moderate amount of mucous content of bile. Folds of medium height, elastic, the angle of the stomach is not changed, the mucosa is pink, edematous, sometimes moderately hyperemic, in the antrum, has a mottled appearance. Peristalsis is satisfactory, the gatekeeper rounded, marked duodeno-gastric reflux. Duodenum: medium onion. The mucous membrane of the bulb 12 duodenal ulcer pale pink, sometimes white. Postbulbarnye divisions: the area of the papilla of Vater papilla without pathological changes. Jejunum: pale pink with whitish mucus. HP - negative.

Conclusion: the HH. Moderate reflux esophagitis. Chronic gastroduodenitis. Do�Deno-gastric reflux.

Propria with weak lymph plasmocytomas infiltration. Conclusion: Chronic mild duodenitis.

Rapid diagnosis of lactase deficiency: a study of lactase activity in one biopsy of the mucosa of the small intestine. Lactase test is positive, corresponding to a severe hypolactasia.

Colonoscopy: an Endoscope held in the ileum 10 cm of small intestine Mucous membrane pink with the presence of vascular pattern. Peristalsis it active. Bauhinia flap polypoid shape, closed, oriented in the dome. The mucosa of the colon throughout hyperemic, edematous. Vascular pattern is absent. Are defined by multiple submucosal hemorrhages, multiple ulcers of point and polygon shape, covered with fibrin. Contact bleeding is moderate. The folds are not defined. The intestine is short, looks in the form of a tube. The intestine is moderately narrowed due to the swelling. For further diagnosis of the mucosa of the sigmoid colon biopsies (in which there is a marked density). Conclusion: ulcerative colitis. Total defeat. The activity is moderate.

Biopsy: microscopic examination of the surface and crypts lined with goblet cells. Private plate with the�erenkoy lymph plasmacytomas and eosinophil infiltration. Fibrosis of the stroma and vascularization. Conclusion: moderate colitis. Healed scars of erosion.

Sigmoidoscopy: examination of the back passage defined by the collapsed external hemorrhoids is bleeding at the time of inspection. Anal sphincter tone is increased. The proctoscope introduced on 15 see the Mucosa of the colon on the visible areas hyperemic, edematous. Vascular pattern is absent. Define multiple hemorrhages, ulcers polygonal shapes. Contact bleeding is moderate. Conclusion: ulcerative colitis.

TPHA: Anti-Shigella flexneri (I-V, VI and Anti-Shigella sonnei - not found.

Ultrasound of lower limb veins: Conclusion: varicose NC. ULTRASOUND signs of valvular insufficiency veins NC. In the Lumina of veins NC additional formations are not revealed.

EMA: hypermotor dyskinesia of the stomach and the descending part of the colon. The frequency of slow waves of the stomach of 10.3 per minute, the amplitude of 0.14 mV. The rate of spikes and 4.4, the amplitude of 0.04 mV. The frequency of slow waves of the descending part of the colon 11 min, amplitude of 0.15 mV. The frequency of spikes is 5.3, the amplitude of 0.05 mV.

Counseling in TB clinic: fluorography of the chest - without pathology. DST - negative. Conclusion: current data for pulmonary tuberculosis have not been identified.

Common blood test

Indicator03.09.201313.09.2013NormHemoglobin11,111,612-16 g/DLRed blood cells3,954,353,8-5,3·106/mm3Platelets374429150-400·103/mm3Leukocytes7,98,94-9·103/mm3P/nuclear221-6%With/nuclear556447-72%Eosinophils32Of 0.5-5%Lymphocytes342819-39%Monocytes6 43-11%ESR54321-20 mm/h

Biochemical analysis of blood

IndicatorNorm
ALT9,55-34 u/l
Amylase28,428-100 u/l
ACT175-31 units/l
Protein77,166-87 g/l
Bilirubin total8,43,4-21 µmol/l
GGTP347-38 units/l
Iron6,610,7-32,2 mmol/l
PotassiumWith 4.86A 3.5-5.1 mmol/l
Calcium2,44Of 2.2-2.7 mmol/l
71,110,7-32,2 mmol/l
Urea3,011,7-8,3 mmol/l
Sodium141,5136-146 mmol/l
Triglycerides1,410-1,7 mmol/l
Chlorine104,798-106 mmol/l
Cholesterol5,641,4-5,2 mmol/l

Immunological study

HBsAg is not detected, HCV is not detected.

Wassermann reaction negative, HIV - negative.

Coagulation: Fibrinogen is 3.59 (2-4 g/l); ACTV - 29 (25-35 sec); MHO - 1,06 INR (0,9-1,2); Prothrombin - 92,8 (70-130%); Prothrombin time of 15.6 seconds.

General urine analysis: Rel. the density of 1,015, transparent, colorless, the reaction of 5.0, glucose, red blood cells, ketones are absent. Leukocytes - 500.

Analysis of feces: consistency of liquid, unformed, brown, yeast - no. The reaction for occult blood - positive, helminth eggs - not detected. Muscle fibers, vegetable fibers digestible - slightly. Leukocytes, erythrocytes - in moderation. The epithelium is moderately.

�romedenne treatment: table 4, ercefuryl, omez, Mezim, white clay, ferrum Lek, sulfasalazine, microclysters with prednisolone, metrogyl, modules, sorbifer.

Conducted drug treatment modules in the dose at a dose of 30 g 2-3 times on the first day of appointment of the drug, 40 g three times on the second day, 50 g three times a day from the third to the thirtieth day of treatment.

Evaluate the effectiveness of nutritional support to determine the level of molecules sICAM-1, sICAM-2, sICAM-3. The level of serum sICAM-1 decreased from 29 to 23, sICAM-2 from 19.1 to 13, sICAM-3 from 23 to 14. On this basis, consider nutritional support is effective.

On the background of therapy the patient's condition is improving, pain is partially docked. Dyspeptic syndrome is absent. Stools 1-2 times a day, decorated, without any admixture of mucus and blood. The patient will be discharged under the supervision of a gastroenterologist at the place of residence. The prognosis of the disease (gastroenterology) questionable, requires followup. Works.

Tested the proposed method on 61 ill. Tests confirmed the achievement of the objectives of the invention - improving the efficiency of nutritional support. An additional advantage of this method is the reduction of complications.

Sources of information:

1. Pankov V. I. Prevention and treatment of postoperative dynamic motility of the gastrointestinal tract. Auth�Ref Diss. Dr. med. Sciences. Ryazan, 1980.

2. RF patent №2484467, G01N 33/48, 2012.

A method of evaluating the effectiveness of nutritional support in ulcerative colitis by biochemical studies, characterized in that as a marker using a soluble form of adhesion molecules ICAM family - sICAM-1, sICAM-2, sICAM-3, and by reducing the level of sICAM-1, 29-37,2 to 23-24, sICAM-2 from 19.1 21.1 per to 13-14, sICAM-3, 23-30,14-17 7 to consider nutritional support is effective.



 

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2 dwg, 1 tbl

FIELD: test equipment.

SUBSTANCE: invention refers to material test methods. Essence of the invention: a sample is first strained to the maximum set deformation, held in this deformation for a given time, compressed to the initial unloaded state, left in it for a given time, with further cyclic deformation with delays in each deformation stage of compression and tension, where at each tension cycle the set deformation is less than at the previous cycle, and the set deformation at each unloading cycle is larger than in the previous cycle.

EFFECT: more information on material properties from a sample test, new information represented by equilibrium stress-strain curve, dissipation loss, material softening after each tension/compression cycle, and relaxation curves together with material structure recovery curves for various deformations.

2 cl, 1 dwg

FIELD: measurement equipment.

SUBSTANCE: invention relates to measurement equipment, in particular, to devices for measurement of profile of surfaces of low-modular viscoelastic sheet materials of light industry, namely, man-made and natural leathers, etc. A device to detect profile of materials in deformed condition, comprising a base, a counting unit, a locating element, installed as capable of rotation around its axis, differing by the fact that the locating element is made in the form of a semi-cylinder with a hollow semi-cone and two limiting plates to fix a sample; the device comprises an additional counting unit fixed on the semi-cylinder, to detect bending radius of the investigated sample, arranged in parallel to the semi-cone guide, at the same time the main counting unit is made as combined, capable of displacement along the axis of rotation of the locating element and comprises a strain gauge motion sensor and a digital optical microscope.

EFFECT: device makes it possible to study hidden defects of natural leather and man-made materials, to determine variation of material relief under bending deformation.

2 cl, 1 dwg

FIELD: chemistry.

SUBSTANCE: disclosed is a method of determining the glass-transition point of tetrazole-based polymer composite materials based, according to which the glass-transition point is determined from the change of slope of a curve of temperature versus the inverse of dielectric constant 1/ε'=f(T).

EFFECT: high accuracy and reliability of determining the glass-transition point of tetrazole-based polymer composite materials.

4 dwg, 1 tbl

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology, and can be used for recognising synchronous multifocal colorectal carcinoma. Substance of the invention consists in measuring preoperative blood follicle-stimulating hormone both in male and female patients suffering from colorectal carcinoma. If its concentration falls within the range of 26.01 to 60.91 IU/l in the females and of 2.71 to 5.67 IU/ml in the males, a single tumour is diagnosed in the patients, and if the hormone concentration is from 2.70 to 5.50 IU/ml in the females and from 12.88 to 52.04 IU/l in the males, the presence of synchronous colorectal new growths are stated. The method can be implemented at the preoperative stage; it is easily reproducible in the oncology hospital environment.

EFFECT: stating the presence of synchronous multifocal colorectal carcinoma.

6 ex

FIELD: chemistry.

SUBSTANCE: invention relates to field of producing carbon-carbon composite materials for various purposes, and is intended for comparative characteristic of impregnation of carbon fibre (CF) braids with melts of pitches, and can be used in improvement of technologies of producing carbon-carbon composite materials, possessing various properties, by modification or replacement of pitch binder and/or carbon fibre, for instance, in research laboratories, in particular, in carrying out laboratory work. To determine degree of impregnation of carbon fibre braids with pitches, carbon fibre braid is placed into glass tube in such a way that the end of braid protrudes from glass tube, and carbon fibres in braid are oriented along glass tube axis, with braid thickness being selected in such a way that it tightly fits glass tube, protruding end of carbon fibre braid is brought in contact with melted pitch and keep in such position, after which carbon fibre braid is extracted from tube and height of impregnation of carbon fibre braid with pitch is determined.

EFFECT: simplification and acceleration of determination are achieved.

1 ex, 3 dwg

FIELD: chemistry.

SUBSTANCE: method involves cutting a sample for analysis and analysing its chemical composition, from which the rubber brand is determined. The sample is cut such that it has pre-decomposition zones. Chemical composition is analysed from a fracture in the sample by X-ray spectral technique on a scanning electron microscope with an energy-dispersive spectrometer. The obtained data on chemical composition of the sample are compared with chemical composition of a known rubber brand or a rubber brand used as a reference.

EFFECT: high accuracy and objectivity of determining a rubber brand.

3 ex, 1 tbl, 2 dwg

FIELD: chemistry.

SUBSTANCE: method involves titration of a suspension with a solvent which is soluble in water and dissolves the suspended resin-like substance until reducing light scattering, which is determined either visually or using optical devices which enable to measure the amount of light passing through the liquid.

EFFECT: rapid estimation of the amount of resin-like substance suspended in water.

3 dwg

FIELD: physics.

SUBSTANCE: apparatus has a clamp mechanism for holding material, an indenter for loading with possibility of measuring its displacement and recording information into a processor. A sensor is built into the indenter, said sensor being sensitive to the spectrum of acoustic emission generated by a sample upon change of deformation characteristics thereof. The clamp mechanism is in form of two coaxially placed cups with built-in heating elements with a controlled temperature range and a sensor for said temperature.

EFFECT: broader technological capabilities of the apparatus and high measurement accuracy.

2 dwg

FIELD: chemistry.

SUBSTANCE: before testing in a heat chamber, samples of polymer materials are activated with UV radiation in the 248-365 nm wavelength range for 3-30 minutes with radiation power density of 1-15 mW/cm2. Analysis of volatile organic compounds is carried out while comparing the obtained chromatograms of gas samples collected from the heat chamber when testing samples of polymer materials with selected additives based on nanostructured bentonite powder and nanostructured bentonite powder intercalated with metal ions - magnesium (Mg2+ ), scandium (Sc3+), chromium (Cr3+), manganese (Mn2+), iron (Fe2+), cobalt (Co2+), nickel (Ni2+), copper (Cu2+), zinc (Zn2+), tin (Sn2+), cerium (Ce3+) or a mixture of bentonite powders intercalated with ions of said metals. The results of comparing chromatograms of gas samples are used to evaluate the effect of nanocomponents on the predicted sanitary-chemical properties of the designed polymer materials.

EFFECT: realisation of the present invention widens technological capabilities and increases reliability of results of evaluating the effect of modifying mineral nanocomponents on predicted sanitary-chemical properties based on release of volatile organic compounds from the designed polymer materials.

8 cl, 7 ex, 2 tbl, 4 dwg

FIELD: fur industry, in particular, method for evaluating pickling quality of leather web in tanning of fur and sheepskin raw material.

SUBSTANCE: method involves providing testing on parallel groups of fur sheepskin after pickling on three topographic portions of sheep skin surface: skirt, spine and neck portions; processing samples of each group with acid-salt solution for 24 hours; withdrawing sheepskins of each group from acid-salt solution in predetermined time intervals; removing excessive liquid; placing said samples into tensile testing machine and stretching lengthwise of spine line by 40% relative to initial length thereof; holding samples in stretched state for 1 min and withdrawing from tensile-testing machine; leaving samples in free state for 10 min; determining residual elongation value in mm.

EFFECT: reduced time for determining quantitative pickling characteristic of skin web.

2 tbl, 2 ex

FIELD: fur industry, in particular, method for evaluating pickling quality of leather web in tanning of fur and sheepskin raw material.

SUBSTANCE: method involves determining quantitative pickling characteristic of leather web of semi-finished product by using time of solving thereof in alkaline solutions, said time depending on number and kind of intermolecular bindings destructed during pickling. Solving of collagen in alkaline solutions depends upon nature of preliminary acidic preparing procedure. Solving is provided in aqueous solution of potassium hydroxide having concentration of 150 g/l and temperature of 18-20 C. Derma solving time is found after preliminary thermal processing at temperature of 60-65 C during 1.5 hours. Method may be employed both in production of fur and sheepskin products and in fur processing.

EFFECT: wider operational capabilities and reduced time for determining quantitative pickling characteristic of skin web.

1 tbl, 1 ex

FIELD: methods and devices for determination of an alcohol concentration in solutions.

SUBSTANCE: the invention presents a method of determination of an alcohol concentration in solutions (versions) and a device for its realization (versions). The first version of the method provides for placement of a bath with the reference and investigated solutions on the path of the optical beam, measuring and introduction into the memory of the computation unit of intensity of the light absorption by the reference solutions, measuring of the intensity of the light absorption of radiation of the investigated solution, processing the data of the measurements of the light absorption. The investigated solution is transilluminated within the range of the wavelengths of 1250-1350 nanometers. Simultaneously with the measurement of the light absorption by the investigated solution measure the concentration of alcohol in it. In compliance with the received values determine a concentration of alcohol in the investigated solution. The second version of the method provides for placement of a bath with the reference solutions and investigated solutions on the path of the optical beam, measurement and introduction into the memory of the calculation device of intensity of the light absorption of radiation by the investigated solution, processing of the received values of the measurements of the light absorption. The investigated solution is transilluminated within the range of the wavelengths of 1250-1350 nanometers, measure the values of density of the reference solutions and the investigated solution, using which determine the concentrations of alcohol and sugar in the investigated solution. The device for the first version contains a computation unit, a conjunction unit, optically coupled a radiating unit, a bath for solution, a measuring photoreceiving device, the output of which is connected through the conjugation unit with the computation unit and the input of which is optically connected through the bath with the radiating unit. The device for measurement of a concentration of sugar in a solution consists of a beam splitter plate and an additional photoreceiving device, the output of which is connected through the conjugation unit with the computation unit. The input of which is optically connected through the beam splitter plate mounted at Brewster's angle to a axis of radiation and the bath with by a radiation unit. And the radiation unit has the wavelength of radiation laying within the range of 1250-1350 nanometers. The device for determination of a concentration of alcohol in the solutions consists of the computation unit, the conjugation unit, the optically connected radiation unit, the bath for solution, the measuring photoreceiving device, output of which is connected through the conjugation unit with the computation unit, the density gage connected with the bath by means of the pipe duct. The output of the density gage is connected through the conjugation unit with the computation unit. The radiation unit has the wavelength of radiation laying within the range from 1250 to 1350 nanometers. The invention allows to improve accuracy of measurements.

EFFECT: the invention ensures an improved accuracy of measurements.

12 cl, 5 dwg

FIELD: agriculture, in particular, dairy farming.

SUBSTANCE: method involves determining tightening of teat cup liner before it is inserted into teat cup; acting upon teat cup liner by suspending weight for determining tightening of teat cup liner; providing expansion by introducing internal gauge into teat cup liner which is positioned within teat cup casing. Method allows extent of teat cup liner tightening to be visually detected at any time of machine milking process. Tightening of teat cup liner manufactured integral with milk pipe as well as separately therefrom is determined during operation of milking units.

EFFECT: increased efficiency and reduced milking time.

1 dwg

FIELD: technologies for researching durability properties of packing washer materials for collapsible oil pipelines.

SUBSTANCE: in the method for determining remaining resource of rubber compacting curves utilized in oil pipeline junctions, preparation of samples of given geometrical shape is performed, measurement of source hardness conditions for stretching, relative elongation during tearing, Shore hardness, temperature fragility limit, comparison of aforementioned values to given values, culling of washers, sample coefficients of which do not correspond to given values. Remaining samples are exposed to oil product after extraction from oil product samples are thermostatted, cooled down to normal room temperature, and then the same physical-mechanical coefficients are measured again with limit values. Before preparation of samples with given geometrical shape, washers are organized in batches of same manufacturing plant and production year, additionally measured are external d1 and internal d2 washer diameters for each batch, relative compression Ecp deformation of same washers. Their deviation from standard is calculated and culling of aforementioned washer batches is performed on basis of allowed values Δd1, Δd2 and Ecp, while as allowed values Δd1, Δd2 ≤ 3%; 25% ≤ Ecp ≤ 70%. After that remaining rings with least values of relative compression deformation Ecp are utilized to prepare geometrical samples of given geometrical shape. Remaining resource ΔT is determined from following formula: years, where ki - coefficient, characterizing alteration of remaining resource ΔT dependently on climatic zone input of operation of rubber packing washers, is taken as i - climatic zones I1 - II12, additional information, T - average lifetime of rubber packing washers until removal from operation in accordance to technological characteristics provided by manufacturing plant and/or operation instructions, in years, Tn - period of operation of rubber packing washers since production year - marking of manufacturing plant, until moment of determining ΔT, years, f=9,4 MPa - minimally allowed value of conditional hardness for stretching after thermostatting of sample, MPa.

EFFECT: reliable trustworthiness of results of estimation of remaining resource under dynamic conditions of rubber packing washers in oil pipeline junctions with simultaneous increase of ecological safety due to decreased risk of emergency spilling of oil products.

4 dwg

FIELD: investigating or analyzing materials.

SUBSTANCE: method comprises preparing specimens of polymeric materials of specified mass, exposing the specimens to the hostile fluid at a given temperature, and determining informative characteristic from a formula proposed.

EFFECT: enhanced reliability.

2 dwg, 7 tbl, 2 ex

FIELD: weighing equipment; chemical mechanical engineering.

SUBSTANCE: method can be used for measuring content of binder in reel-up composite material produced by preliminary soaked thread. Method is based upon weighing. The constant values are determined according to the method as length of thread for specific type of items and value of linear density averaged for any reel before and after soaking by binder and reeling it up onto frame. Weighing is performed for item before reeling it up with soaked thread and after reeling-up and final polymerization of composite material to determine mass of composite. Basing upon the data received, content of thread is determined which value is subsequently used for finding mass content of binder in composite from relation of C=(M-LxT/M)x100%, where C is content of binder in composite, in mass percent; M is mass of composite, g; L is length of thread consumed for item, km; T is average arithmetic meaning of values of linear density of thread and its rests at any reel before and after impregnation, g/km.

EFFECT: higher stability of performance measures.

1 ex

FIELD: light industry.

SUBSTANCE: method comprises recording response of the material to be tested that represents an amplitude-frequency characteristic, calculating deformation characteristics, and determining the value of distributed mass of the vibrating part of the material. The response representing two amplitude-frequency characteristics is recorded for the same part of the material to be tested for various masses of two bodies that cause deformation. The deformation characteristics are calculated from equations of vibration theory for viscoelastic bodies.

EFFECT: enhanced precision and reliability.

FIELD: investigating or analyzing of materials.

SUBSTANCE: method comprises investigating threshold capabilities of the multi-layer polymeric material and determining maximum permeability of oil product and time period required for reaching the maximum permeability.

EFFECT: enhanced reliability.

1 dwg, 1 tbl

FIELD: investigating or analyzing of materials.

SUBSTANCE: method comprises preliminary conditioning of rubber specimens in paraffin hydrocarbon with 12-16 atoms of carbon in the atmosphere of neutral gas and in the fuel to be tested at a temperature of 130-150°C for 3-5 hours.

EFFECT: enhanced reliability.

1 dwg, 2 tbl, 1 ex

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