Method for selecting therapeutic approach to female patients with oligomenorrhea and obesity
SUBSTANCE: blood serum fasting adiponectin and leptin concentrations are measured in the morning in the female adolescents diagnosed with oligomenorrhea and obesity. An adiponectin/leptin ratio is derived. If the ratio is 0.6 or less, insulin resistance is stated in the female patients suffering oligomenorrhea and obesity, and the therapy is started with prescribing metformin, an insulin sensitiser. The adiponectin/leptin ratio of more than 0.3 enables diagnosing the absence of insulin resistance and prescribing hormonal contraceptives with drospirenone.
EFFECT: effective treatment of oligomenorrhea and obesity by selecting the adequate treatment taking into account the carbohydrate metabolism status.
1 tbl, 3 ex
The invention relates to medicine, namely to gynecology, and will use in deciding the choice of treatment of ovarian insufficiency, manifested by oligomenorrhea and amenorrhea in adolescent girls with obesity.
It is known that with alimentary obesity in women 6 times more often than normal body weight, observed violations of the menstrual cycle due to ovarian failure (Serov V. N., Kang N. And., 2004; A. G. Rada, 2011). In the Genesis of ovarian insufficiency in obesity play a major role insulinrezistentnost (IR) and hyperinsulinemia (L. A. Cassis, English V. L., 2003).
In adolescent girls with disorders of the menstrual rhythm and obese to regulate the menstrual cycle, reduction of hyperandrogenism traditionally used combined oral contraceptives (COCS). So how COC can have a negative effect on insulin sensitivity, there are theoretical concerns their use in patients with insulinrezistentnost (IR).
A similar error is the stimulation of ovarian function without correction of IR and obesity treatment. During prolonged stimulation of ovulation without weight loss may develop the syndrome of premature depletion of ovarian (Marine Norman et al., 1991).
To increase the sensitivity of tissues to insulin use Metformin (D. E. Shilin. With�ngram polycystic ovary syndrome: role of insulin resistance and its correction / - Petrozavodsk: INTELTEC E, 2004. - 52 p.; Shubina, A. T., Demidova I. Yu., Chernov N. And., Karpov Yu. a. Metabolic syndrome: potential use of Metformin / Russian medical journal. - 2001. - Vol. 9, No. 2. - S. 77-99.; Manukhin I. B. Androgens and insulin resistance / I. B. Manukhin, M. A. Gevorkyan, N. B. CAGI // problems of reproduction. - 2005. - No. 2. - P. 27-31). This drug is indicated for use when a set of IR. This indicates the need for diagnostic measures aimed, first, to identify the IRA, and in its confirmation on the appropriateness of the use of sensitizers to insulin. For a choice of tactics of treatment you must first develop a clear differential diagnostic criteria, on which basis it is possible to establish the presence of IR. Data on the high prevalence of IR in the population suggests that its diagnosis is currently a priority issue. Given the cogency of the role of IR as a key element in the development of metabolic syndrome, polycystic ovary syndrome (SGIA) and cardiovascular diseases, there is a need for accurate and reproducible method to measure in vivo (Diamond V. A., 1999; Belyaev, O. D., 2009).
In the formation of metabolic disorders associated with obesity, IR and ofnormogonadotropic ovarian insufficiency, an important rol� play a major adipocytokine - adiponectin and leptin.
An increase in the secretion of leptin is accompanied by an increase in the secretion of insulin by the pancreas with the further development of IR as a compensatory mechanism (Pankov Yu. a., 2000). In recent studies (Miller, K. K., Parulekar M. S., 1998) identified a correlation between the level of plasma leptin and disorders in the reproductive system. The results of the study Miller K. K., Parulekar M. S., Schoenfeld E. at al. (Decreased leptin levels in normal weight women with hypothalamic amenorrhea: the effects of body composition and nutritional intake. // JClinEndocrinolMetab. 1998 Jul; 83 (7): 2309-12.), studying the role of leptin as a regulator of reproductive function. It is assumed that the resistance of the normal activity of granulosa cells in persons with excess body weight may have an increased leptin level above the critical level.
It is known that adiponectin concentration has a positive correlation with insulin sensitivity in adults. Low levels of adiponectin in the blood precedes the development of insulin resistance (Berg, A. H., Combs, T. R., Scherer P. E. TIBEB 30 / adiponectin: an adipokine regulating glucose and lipid metabolism. Trends Endocrinol. Metab. - 2002; 13: 84-89; Stefan N., B. Vozarova, Funahashi T. Plasma adiponectin concentration is associated with skeletal muscle insulin receptor tyrosine phosphorylation, and low plasma concentration precedes a decrease in whole-body insulin sensitivity in humans. Diabetes. - 2002; 51: 1884-1888; Weyer, C., Funahashi, T., S. Tanaka Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia. J. Clin. Endocrinol. Metab. - 2001; 86 1930-1935).
When WA�attachment secretion of adiponectin and leptin changed characterized by a decrease in adiponectin levels (Weyer S., T. Funahashi, S. Tanaka, 2001), increased serum leptin (Livshits G. Pantsulaia I., L. M. Gerber, 2005) and insulinrezistentnost (Weyer C, Funahashi, T., Tanaka S., 2001; Reinehr T, Roth S., Menke, T., 2004).
In the works of Inoue M, Maehata, E., Yano, M. (2005), J. Zaletel, Barlovic D. P., Prezelj J. (2010) there are indications about the indirect determination of IR in patients with diabetes mellitus type 2 by the ratio of adiponectin/leptin (A/L) (Inoue M, Maehata, E., Yano, M., Taniyama, M., Suzuki S. Correlation between the adiponectin-leptin ratio and parameters of insulin resistance in patients with type 2 diabetes. J. Metabolism. 2005 Mar; 54 (3): 281-6).
The method chosen for the prototype of the claimed invention.
The disadvantages of this method include the fact that the ratio A/L was studied only in elderly patients with diabetes mellitus type 2, and both sexes. The calculated values of the indicator And/L not indicated, the control group (healthy subjects) participated in the study were not adopted, the regulations of the ratio of the work presented.
Despite the clear research recommendations for the treatment of adolescents with oligomenorrhea and obesity depending on the severity of IR in the modern scientific and medical literature. No single point of view on the feasibility and timing of the appointment of hormonal contraceptives to adolescents with ovarian insufficiency and obesity �bukowsical the need to develop a method of choice of treatment tactics in this category of patients. For a choice of tactics of treatment it is necessary to develop a clear differential diagnostic criteria by which one can predict the further course of the disease - that is, to determine whether spontaneous recovery of the menstrual cycle only on the background diet and rational physical exercise or it is necessary to use a certain type of drug therapy. The claimed invention allows to solve this problem.
Object of the invention is the provision of an accurate differential approach and the definition of further tactics of treatment of adolescent girls with oligomenorrhea and obesity.
The solution to this problem is achieved in that in adolescent girls by examining blood by ELISA to determine the levels of adiponectin and leptin, calculate the ratio of adiponectin/leptin, and if this indicator is less than/or equal to 0.3, this indicates the presence of insulin resistance - the treatment is started with the appointment of drugs that increase the sensitivity of peripheral tissues to insulin - sensitizers to insulin (Metformin). When values of adiponectin/leptin greater than 0.3 - IR no - therapy combined oral contraceptives with drospirenone.
The technical result achieved by the claimed invention is that the inventive method allows us to PT�th evidence-based medicine to objectify the choice of tactics of treatment of adolescent girls with oligomenorrhea and obesity.
Based on the accurate diagnostic criterion IRA, allowing a differentiated approach to the management of these patients is time to apply etiopathogenetic therapy (sensitizer to insulin) and avoid polypharmacy. When using indicator A/L significantly increased the diagnostic accuracy and reduced time of implementation that is necessary at an early stage of the disease, when it is possible effective and adequate therapy. The method is simple enough, does not cause complications and is available for widespread use.
To develop the indicator for early diagnosis of IRA that allows you to objectify the choice of tactics of treatment of adolescent girls with oligomenorrhea and obesity, as well as to clarify the role of a true adipocytokines in the Genesis of oligomenorrhea and insulin resistance in adolescents, we examined indicators of leptin and adiponectin in 54 adolescent girls with primary and secondary oligomenorrhea (N91.3, N91.4 ICD-10) and obesity (E66.0). The body mass index (BMI) of patients, on average, amounted to $ 32.6 (34,8; 30,2) kg/m2.
These patients constituted the main group according to the inclusion criteria: age 18 or under; the absence of acute or exacerbation of chronic infectious diseases, chromosomal or monogenic pathology; normal plasma levels of prolactin�. Were excluded from the investigation of a patient suffering from cancer and severe somatic pathology, and diseases, which may contribute to the violation of folliculogenesis (diabetes type 1 diabetes, hypercortisolism, hyperprolactinemia); previously taking hormonal contraceptives, drugs that affect steroidogenesis in the ovaries or adrenal glands, as well as the drugs side effect which is anovulation.
The control group included 30 healthy adolescent girls without menstrual disorders with normal BMI=18,4 (20; 18,1) kg/m2. All groups of examined patients were matched for age, which on average was 15 (17; 14,75) years.
The results of the study are presented in table 1.
An increase in the secretion of leptin is accompanied by an increase in the secretion of insulin by the pancreas with the further development of IR as a compensatory mechanism (Pankov Yu. a., 2000). Consequently, hyperleptinemia in patients of group I can be associated with IR.
The function of adiponectin is to reduce blood glucose levels and intracellular triglycerides. These effects contribute to increasing the sensitivity of tissues to insulin (Wickham, E. R. III, K. I. Cheang, Clore J. P. B., et al., 2011; Schwartz V., 2009). Your levels of adiponectin are reduced in obesity (Kiec-Klimczak M., Soave�., 2008; Weyer C, Funahashi, T., Tanaka, S., et al, 2001; Yasar L., Ekin M., Gedikbasi A. et al., 2011). In the work of A. Bottner et al. (2004) showed that the decrease in the level of adiponectin in the dynamics of puberty is associated with elevated concentrations of androgens serum - Ts and DHEAS. It is known that when hyperandrogenism your levels of adiponectin are reduced due to the inhibitory effect of Ts on the synthesis of adiponectin (S. T. Page, et al., 2005; Sharifi F., Hajihosseini R., Mazloomi S., et al., 2010; Olszanecka-Glinianowicz M., D. Kuglin, et al., 2011). The data presented indicate the influence of ovarian hormones on the secretion of adiponectin.
In patients of group I, the adiponectin level was 1.2 times lower than in healthy adolescents from the control group (p=0,018475). These data confirm the importance of adiponectin in the pathogenesis of ovarian dysfunction in the presence of obesity and insulin resistance. The involvement of adiponectin in the pathogenesis hyperandrogenic ovarian dysfunction, which manifests itself in adolescents with oligomenorrhea obesity, proven relationship hypoadiponectinemia with hyperandrogenism and insulin resistance. Consequently, the level of the ratio A/L is possible to evaluate not only metabolic status, but also to predict its influence on the functional state of the ovaries in adolescents.
Currently in a number of foreign and domestic works suggested the need to develop a more accurate measure of quantitative assessment of IR that �predstavljaet of great importance for epidemiological, clinical and basic research and, ultimately, can be used in clinical practice (N. Oda, S. Imamura, T. Fujita,et al, 2008; J. Zaletel, Barlovic D. P., Prezelj J.,et al, 2010). Some studies indicated that the ratio A/L is a more effective indicator of ER than single definition of adiponectin, leptin, or HOMA-IR in patients with diabetes mellitus type 2 (J. Zaletel; D. apartments pongrac Barlovic; J. Prezelj. Adiponectin-leptin ratio: a useful estimate of insulin resistance in patients with Type 2 diabetes. Journal of endocrinological investigation, 2010, Vol: 33: No. 6, pp. 414-121).
Based on the role of insulin in regulation of ovarian function and insulinzawisimoy secretory function of adipocytes, as well as the multifunctionality of adiponectin and leptin, interesting, in our opinion, was the study of the ratio A/L and looking for his diagnostic threshold, which could be used to predict recovery/menstrual irregularities, selection of treatment strategy and assess its effectiveness in patients with oligomenorrhea against obesity. Analysis of our results revealed a significant decrease of A/L in group I - 4.3-fold compared with the control group (p=0,000001) (PL. No. 1).
With the aim of developing differentiated schemes of treatment of adolescent girls with oligomenorrhea and obesity, we have developed an algorithm that allows to predict the violation/restore menstrual cycle � to choose the best tactics of these patients.
Body of experimental and clinical data scientific and medical literature led to the conclusion about the necessity of differential treatment of adolescents with oligomenorrhea and obesity depending on the presence and severity of IR, and that there is no currently available and objective method for early preclinical diagnosis of IR, characterized by the availability performance and high accuracy in comparison with the known. The claimed invention allows to solve this problem.
We found that adolescent girls with regular menstrual cycles, normal BMI and normal insulin sensitivity values of the ratio A/L>0,3. When oligomenorrhea, obesity and insulin resistance in adolescents the value of this index is ≤0,3 - in this case, therapeutic approach should include drug therapy - sensitizer to insulin (Metformin). At values of A/L>0.3 the presence of IL is not confirmed, treatment tactics can include the appointment of combined oral contraceptives with drospirenone.
The diagnostic accuracy of this classification model was 94.2%, sensitivity - 93,33%, specificity - 94,44%.
Detailed description of the method and examples of its specific implementation
In adolescent girls with an established diagnosis of oligomenorrhea (N91.3; N91.4; N91.5 ICD-X) and obesity (E66.Po ICD-X) in the morning, fasting determine the concentration of adiponectin and leptin in the serum by ELISA using test systems Human Adiponectin ELISA (BioVendor, CzechRepublic) and Human Leptin Platinum ELISA (Bender Med Systems, Austria). Calculate the ratio of adiponectin/leptin, and if this indicator is less than/or equal to 0.3, the presence of IL-likely with a high degree of certainty, the treatment should start with the purpose of sensitizers to insulin (Metformin), and when values of adiponectin/leptin than 0.3 IR is not confirmed, the appointment of sensitizers patient does not need treatment tactics is the use of COCS with drospirenone or may be limited to diet and exercise.
Analyzing the indicators of adiponectin/leptin in patients of group I, we found that the values of this parameter, 94.4% of patients were below the established diagnostic threshold, indicating a high diagnostic accuracy of this method. For us, this conclusion is very significant because for the treatment of patients with oligomenorrhea and identified IL (on the basis of models of the HOMA-IR index and Caro), even with a normal BMI, is often used sensitizer to insulin, including Metformin, the testimony to which children and adolescents are limited. Using a diagnostic model And/L patient selection for this treatment will be more thorough, h�about will help to avoid polypharmacy and improve the treatment strategy.
The performance of the proposed method is confirmed by the following clinical examples.
Example No. 1
Patient C-VA, 17. Case history No. 690/321 from 11.08.2012 G. was Admitted to the hospital for examination and treatment. From the anamnesis installed: menstrual cycle since the age of 12, irregular menarche, delay previously reached 4-5 months, in the last 6 months of amenorrhea. The girl is overweight since childhood, in the last 6 months gained weight 12 kg.
First visit and hospitalization 6 months ago, when the conduct of clinical and laboratory investigations revealed normal serum indicators of gonadotropins (LH = 4,6 mIU/l, FSH = 6,5 mIU/l), the decrease of estradiol and progesterone in serum (estradiol - 23 PG/ml, progesterone - 2.1 nmol/l). Weight = 90 kg, height 174 cm, BMI = 29.7 kg/m2. Were investigated adiponectin and leptin - their serum level amounted to 4.56 ng/ml and 15.2 ng/ml. the Ratio A/L = 0,3. Clinical diagnosis: "Oligomenorrhea I (N91.3 ICD-X). Ofnormogonadotropic ovarian hypofunction (E 28), obesity (E66.0)".
Was assigned to Metformin therapy at a dose of 500 mg 2 times a day for 3 months and also a low-calorie diet. Menstruation resumed after 2 months of starting treatment with the decline in body weight at 6 lbs. in 3 months of starting treatment loss in ve�e was 9 kg, indicator A/L = 0,26. Metformin cancelled. It was recommended that the diet and rational physical exercise. After 9 months of starting treatment weight decreased by 3 kg and reached standards - 78 kg, menstrual cycle is regular.
Example No. 2
The patient And society, 16. Case history No. 52/15 of 27.01.2013. was Admitted to the hospital with complaints of absence of menstruation for 3 months. From the anamnesis and objective results of the study found no sexual contacts, inflammatory diseases of the external and internal genital organs, and acute exacerbation of chronic infectious and somatic diseases. From the anamnesis it is also established that in the last 3 years gained weight 15 kg, BMI currently amounts to 31.4 kg/m2that corresponds to the diagnosis of obesity I degree. Weight to a set of body weight - 78 kg, height 172 cm (BMI=26.4 kg/m2), weight currently 93 kg (BMI=31,4 kg/m2). When conducting clinical and hormonal studies hold normal levels of gonadotropins (LH = 7,4 mIU/l, FSH = 4,9 mIU/l) and prolactin (345 mIU/l), the decrease of estradiol and progesterone in serum (estradiol - 29 PG/ml, progesterone - 3.1 nmol/l). Clinical diagnosis: "Oligomenorrhea I (N91.3no ICD-X). Ofnormogonadotropic ovarian hypofunction (E 28), obesity (E66.0)". Serum �sledovani adiponectin (13,92 ng/ml), leptin (48 ng/ml) calculated the ratio of adiponectin/leptin = 0,29. The HOMA-IR was also defined, its values were within the regulations. Despite normal values of HOMA-IR =1,9 (normally up to 2), an endocrinologist and was prescribed Metformin at a dose of 500 mg daily, dosed physical activity, diet with a daily caloric content of not more than 1200 kcal/day. After 6 months of starting treatment, the patient was seen again, with anthropometric examination revealed: height 172 cm, weight 75 kg (BMI = 25,34 kg/m2), the menstrual cycle is normalized in 2 months from initiation of Metformin. In the serum of the studied indicators of adiponectin, and leptin: adiponectin = 6,96 ng/ml, leptin=31 ng/ml. the Ratio A/L = 0,22. Indicators of gonadotropins, estradiol, and progesterone met the standards. Further appointments: supervision of a gynecologist and an endocrinologist 1 time in 6 months, to continue the diet and reduce physical activity. The duration of treatment was 6 months. The effectiveness of therapeutic interventions proved by normalization of height and weight ratio, the resumption of the menstrual cycle.
Example # 3
Patient T-Ko, 17 years old. Case history No. 321/124 from 16.05.2013 G. was Admitted to the hospital with complaints of menstrual cycle from menarche - delay menstruation for 2-3 months, okuneye Myung�of troici and their absence in the last 2 months. From the anamnesis and the results of objective examination showed the absence of acute exacerbation of chronic infectious and somatic diseases, as well as the absence of pregnancy. Physical examination: weight 91 kg, height 174 cm, BMI = 30 kg/m2. When conducting clinical and hormonal studies hold normal levels of gonadotropins (LH = a 5.6 mIU/l, FSH = to 4.5 mIU/l), the decrease of estradiol and progesterone in serum (estradiol 21 PG/ml, progesterone and 1.1 nmol/l). In the investigated serum adiponectin = 11,85 ng/ml leptin = to 15.2 ng/ml. the values of A/L was 0.38. Clinical diagnosis: "Oligomenorrhea I (N91.3 according to ICD-X). Ofnormogonadotropic ovarian hypofunction (E 28), obesity (E66.0)". Treatment of the patient was performed using a COC containing 30 mcg ethinyl estradiol and 3 mg drospirenone in a period of 6 months.
Re-examined after 6 months. Treatment effect - the menstrual cycle is normal, BMI currently is 26 kg/m2. The level of adiponectin, 4,185 ng/ml leptin to 13.5 ng/ml, And/L=0,31 indicators of gonadotropins and sex hormones in the normal range.
These results have indicated the correct choice of treatment tactics and its effectiveness.
Thus, the claimed method allows us from the standpoint of evidence-based medicine to objectify the diagnosis insole�resistance, on what basis to choose the treatment tactics of adolescent girls with obesity, ofnormogonadotropic ovarian hypofunction and oligomenorrhea, which will also allow you to avoid polypharmacy. The diagnostic accuracy of this classification model was 94.2%, sensitivity - 93,33%, specificity - 94,44%.
Method of choice of tactics of treatment in adolescent girls with oligomenorrhea, ofnormogonadotropic ovarian hypofunction and obesity was tested on a large clinical material and can be widely used in gynecological hospitals, and in clinics for gynecological appointment.
Method of choice of tactics of treatment of patients with oligomenorrhea and obesity by examining blood, characterized in that in adolescent girls determined by ELISA the levels of adiponectin and leptin, calculate the ratio of adiponectin/leptin, and if the given index is less than or equal to 0.3, the treatment is started with the appointment of sensitizer to insulin, Metformin, and for values of the ratio of adiponectin/leptin than 0.3 treatment tactics include the appointment of hormonal contraceptives with drospirenone.
SUBSTANCE: gastric content pH is dynamically estimated with the use of a nasogastric tube; the total gastric content pH is measured and the efficacy of the antisecretory preparations is estimated for one day, or a longer period of time if needed, every 3 hours. The pH value is measured by means of an analogue display unit on an analogue scale at a pitch of 1.0 within 1.0 to 12.0 for 15 s as shown by discolouration, with matching to the analogue scale. The acid production suppression is considered to be effective at pH of more than 4.0 after planned surgeries, and more than 6.0 after emergency surgeries. If the acid production suppression is found to be ineffective, the antisecretory preparation is supposed to be changed or increased in dose.
EFFECT: method enables measuring the gastric content pH and estimating the efficacy of the antisecretory preparations in the patients in need thereof over a short period of time.
2 dwg, 2 tbl, 3 ex
SUBSTANCE: analyser comprises a body with a case having a compartment for diagnostic strips or test strips used for the analysis and having a zone for a biological fluid, and contact elements for transmitting a signal to a processor of an analysing unit. The analysing unit comprises a slot-like receiver for the diagnostic or test strip used. The analyser also comprises an indicator unit displaying at least one analysis result. The case or diagnostic or test strips in the case have electronic elements including lot identification and calibration parameters data. The body comprises a responder reading out the above parameters from the electronic elements and transmitting them to the processor of the analysing unit. The case is configured as a covered drop of the back wall of the body forming a flat surface with projections separating the flat drop surface on compartments for the diagnostic strips or test strips arranged in parallel as at least a single row. The case can be configured as a parallelepipedic box attached to the drop surface of the back wall of the body or to the back part of the body. The covered box has some projections separating the box bottom on the compartments for the diagnostic strips or test strips arranged in parallel as at least a single row. The case can be also presented as a parallelepipedic box integrated into a cavity provided in the body and having a loading port connected to the side or back wall and covered. This box has some projections separating the box bottom on the compartments for the diagnostic strips or test strips. The body comprises a short-range transmitter/receiver unit capable to receive signals from the responder and the processor of the analysing unit to transmit and receive the data in the wireless mode to the medical equipment provided with a transmitter/receiver unit or a computer-assisted system, or a mobile communication device, or a mobile phone.
EFFECT: effective space usage of the portable analyser, provision of simple operation of the supplied diagnostic strips and simple storage thereof inside the device.
SUBSTANCE: invention represents a method for the prediction of placental insufficiency in the second trimester of pregnancy by the enzyme immunoassay of pregnant women's blood, differing by the fact that a known ultrasound procedure is used to determine the foetus's gender; pregnant women's venous blood angiogenic factors and cytokines are measured; if observing an increase of IL-12 of more than 3.2 pg/ml, the epidermal growth factor of more than 310 pg/ml, a decrease of the placental growth factor of less than 40.0 pg/ml in the pregnant women carrying the male foetuses, and an increase of ET-1 of more than 0.42 pg/ml, IL-1β of more than 17.6 pg/ml, TNF-α of more than 6.5 pg/ml in the pregnant women carrying the female foetuses, the above pregnant women are predicted to develop placental insufficiency.
EFFECT: higher prediction accuracy of placental insufficiency in the second trimester of pregnancy taking into account the foetus's gender.
SUBSTANCE: menstrual discharge supernatant in an amount of 0.2 ml is applied drop-shaped on the slide surface, covered with a cover glass, dried at a room temperature; the produced samples are microscopically analysed; if observing parallel structures therein, fast-growing hysteromyoma is diagnosed, whereas transient forms show simple hysteromyoma. The invention simplifies the differential diagnosis of simple and fast-growing hysteromyoma with normal endometrial structure, over a short period of time with using small amounts of biological fluids and minimum material inputs.
EFFECT: simplifying the differential diagnosis of simple and fast-growing hysteromyoma with normal endometrial structure.
2 dwg, 2 ex
SUBSTANCE: invention represents method of estimating degree of local cold injury in early reactive period, including separation of peripheral blood lymphocytes, estimation of expression of injury of plasma membrane of lymphocytes in state of blebbing by means of phase-contrast microscopy counted per 100 cells, calculation of index of lymphocyte blebbing ILB by formula:
EFFECT: simplification and increase of objectivity of determining degree of local cold injury in early reactive period.
1 dwg, 1 tbl, 3 ex
SUBSTANCE: spontaneous glow, an induction period and a fast flash amplitude over a period of 5 minutes of recording are measured, and an adaptation risk ratio (ARR) is calculated by formula: ARR=Cn-A/π, wherein: ARR is the adaptation risk ratio; Cn is the spontaneous glow; A is the fast flash amplitude; π is the induction period. If the ARR is 0.066-3.85 standard units, the adaptation is considered to be satisfactory, or compensated; the ARR falling within the range of 3.88-6.5 standard units stands for an adaptation tension; provided the ARR ranges 6.6-9.5 standard units, the adaptation is stated as unsatisfactory, whereas the ARR of 9.6 standard units and more shows an adaptation failure.
EFFECT: more accurate assessment ensured by determining adaptation-based grouping criteria.
1 tbl, 8 ex
SUBSTANCE: method of neurosyphilis diagnostics includes the microscopic analysis of cerebrospinal fluid samples, with carrying out edge dehydration of the cerebrospinal fluid samples, and their microscopic analysis being carried out in a polarised light; in case of the detection of anisotropic structures in the form of dendrites or spherulites inside which oval-shaped formations, containing lipids, are located, an early form of neurosyphilis is diagnosed; and in case of the detection of a multitude of ovals, aggregated in the form of balls, included in the anisotropic structures and/or located separately, late meningovascular neurosyphilis is diagnosed. The invention task is to obtain objective criteria for the diagnostics of neurosyphilis, provision of early, including pre-clinical diagnostics of the disease, reduction of the terms for obtaining data, reduction of costs for carrying out analyses.
EFFECT: in a number of cases the method is the only one which makes it possible to obtain the valid criteria for diagnostics in the form of a picture of the brain structures destruction, which makes it possible to diagnose neurosiphilis confidently and prescribe specific therapy in due time.
4 dwg, 3 ex
SUBSTANCE: invention refers to medicine, namely to a method for the prediction of acquired myopia in school children. The substance of the method consists in measuring blood haemoglobin concentrations in 6-8-year-old school children to detect haemoglobin deficiency as shown by the difference of an optimum haemoglobin concentration specific for the above age and an actual haemoglobin concentration in a child. If observing no haemoglobin deficiency at the age of 6-8 years old, a low risk of acquired myopia is predicted. The haemoglobin deficiency to 1.7 g/l enables predicting a risk of acquired low myopia. If the haemoglobin deficiency is 1.7 g/l and more, a high risk of progressive myopia to be developed into moderate or high myopia is predicted.
EFFECT: using the declared method enables developing the reliable and accessible method for the prediction of myopia in the 6-8-year-old children.
2 tbl, 1 dwg, 6 ex
SUBSTANCE: invention represents a method for determining a probability of preserving the myocardium following infarction by creating an admission examination-based data array of 7 peripheral blood parameters, 11 biochemical analysis parameters and 6 parameters of standard 12-lead electrocardiogram in 200 patients with the Q-myocardial infarction and 200 patients without the myocardial infarction. The parameters are stratified with respect to 7 intervals, wherein values related to the probability of preserving the myocardium following infarction are derived by calculating a ratio of the patients without myocardial infarction to all the patients with acute coronary syndrome. The probability is evaluated in a specific patient by analysing the above parameters, searching the respective intervals and values related to the probability of preserving the myocardium in the data array. Summing up the derived values enables calculating an integrated index, which is normalised, and a dimension from 0 to 100% is reduced.
EFFECT: invention enables increasing the prediction accuracy of preserving the myocardium in the patients with acute coronary syndrome.
1 tbl, 2 ex
SUBSTANCE: group of inventions relates to surface hydrophilisation and immobilisation of antibodies on the surface of a cycloolefin copolymer. Disclosed method of making a capillary-action analytical device, which includes steps of: a) providing a capillary substrate, b) changing the hydrophilic property of the surface, c) mixing a matrix and immobilised molecules in solution form to obtain a solution which includes immobilised molecules covalently bonded to the matrix, and d) depositing the solution on a well defined region in at least one storage area. Also a capillary-action analytical device made using said method is described.
EFFECT: enabling change of the substrate by chemical treatment of the surface and depositing immobilised molecules in an optimum matrix on given regions, with less consumption of matrix material, which enables to use several different matrix material in the same chip.
33 cl, 3 dwg
FIELD: medicine, psychiatry.
SUBSTANCE: one should isolate DNA out of lymphocytes of peripheral venous blood, then due to the method of polymerase chain reaction of DNA synthesis one should amplify the fragments of hSERT locus of serotonin carrier gene and at detecting genotype 12/10 one should predict the risk for the development of hallucino-delirious forms of psychoses of cerebro-atherosclerotic genesis.
EFFECT: more objective prediction of disease development.
FIELD: medicine, urology.
SUBSTANCE: one should conduct subcutaneous prevocational tuberculin test and, additionally, both before the test and 48 h later it is necessary to perform the mapping of prostatic vessels and at decreased values of hemodynamics one should diagnose tuberculosis. The information obtained should be documented due to printing dopplerograms.
EFFECT: more reliable and objective information.
1 ex, 1 tbl
FIELD: molecular biology.
SUBSTANCE: the suggested innovation deals with the fact that nucleic acids should be isolated directly out of the sample without pipetting stage but with the help of interconnected reservoirs being prepared beforehand. The above-mentioned vessels should be applied either separately or being interconnected according to standard microtitrating format. The sample should be mixed with a lyzing buffer and nucleic acids are bound with matrix in closed system including, at least, two interconnected reservoirs. Forced movement of sample's mixture and buffer back and forth from one reservoir into another one for several times through narrow passage provides their thorough intermixing. The method provides quick and safe isolation of nucleic acids.
EFFECT: higher efficiency.
44 cl, 4 dwg, 1 ex
FIELD: medicine, phthisiology, microbiology.
SUBSTANCE: diagnostic material is poured preliminary with chlorohexidine bigluconium solution, homogenized, kept at room temperature for 10-12 h and centrifuged. Precipitate is poured with Shkolnikova's liquid medium, incubated at 37oC for 3 days, supernatant part of Shkolnokova's medium is removed, fresh Shkolnikova's medium is added, and precipitate is stirred and inoculated on the dense cellular egg media. Sensitivity of the strain is determined in 3 weeks by the presence of growth in the control tube only. Invention provides enhancing precision and reducing time for assay. Invention can be used in assay for medicinal sensitivity of tuberculosis mycobacterium.
EFFECT: improved assay method.
FIELD: medicine, biotechnology, pharmacy.
SUBSTANCE: invention relates to agents used for treatment of pathological states associated with disorder of synthesis of neuromediating substances. Method involves the development of pharmaceutical composition and a method for it preparing. Pharmaceutical composition represents subcellular synaptosomal fractions: synaptic membranes, "light" synaptosomes and "heavy" synaptosomes prepared from gray matter of cerebral hemispheres from experimental animals based on the goal-seeking modification of humoral mediators of nerve endings transformed to synaptosomes in development and regression of malignant processes. The composition provides inhibiting the growth of tumor cells, to elevate span-life of patients with ascite Ehrlich's sarcoma, breast adenocarcinoma Ca-755, Wolker's carcinosarcoma-256.
EFFECT: valuable medicinal and anti-tumor properties of composition.
12 cl, 3 tbl, 3 ex
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.
FIELD: medicine, clinical toxicology.
SUBSTANCE: at patient's hospitalization one should gather the data of clinical and laboratory values: on the type of chemical substance, patient's age, data of clinical survey and laboratory values: body temperature, the presence or absence of dysphonia, oliguria being below 30 ml/h, hemoglobinuria, erythrocytic hemolysis, exotoxic shock, glucose level in blood, fibrinogen and creatinine concentration in blood serum, general bilirubin, prothrombin index (PTI), Ph-plasma, the state of blood clotting system. The state of every sign should be evaluated in points to be then summed up and at exceeding the sum of points being above "+20" one should predict unfavorable result. At the sum of "-13" prediction should be stated upon as favorable and at "-13" up to "+20" - prediction is considered to be doubtful.
EFFECT: higher accuracy of prediction.
2 ex, 3 tbl
FIELD: medicine, juvenile clinical nephrology.
SUBSTANCE: disease duration in case of obstructive pyelonephritis should be detected by two ways: either by detecting the value of NADPH-diaphorase activity, as the marker of nitroxide synthase activity in different renal department and comparing it to established norm, or by detecting clinico-laboratory values, such as: hemoglobin, leukocytes, eosinophils, urea, beta-lipoproteides, lymphocytes, neutrophils, the level of glomerular filtration, that of canalicular reabsorption, urinary specific weight, daily excretion of oxalates, arterial pressure, and estimating their deviation against average statistical values by taking into account a child's age.
EFFECT: higher efficiency of detection.
7 dwg, 1 ex, 6 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.
FIELD: medicine, biology.
SUBSTANCE: invention relates to nutrient medium used for accumulation of cells for the following cytological and/or immunocytochemical analysis carrying out. Invention relates to medium containing salts NaCl, KCl, anhydrous CaCl2, MgSO4 x 6 H2O, MgCl2 x 6 H2O, Na2HPO4 x 2 H2O, KHPO4, NaHCO3, and also glucose and Henx's solution, 10% albumin solution and polyglucin taken in the ratio 1:1:1. Invention provides enhancing the preservation of cells.
EFFECT: improved an valuable properties of nutrient medium.