Method for early prediction of cystic periventricular leukomalacia in newborns with very low or extremely low body weight
SUBSTANCE: invention can be used for the purpose of the early prediction of cystic periventricular leukomalacia (PVL) in the newborns with very low (VLBW) or extremely low body weight (ELBW). Substance of the method: the newborns with VLBW and ELBW on the 3rd-7th day of life are examined to assess the perinatal medical history, namely the presence of chorioamnionitis and amniotic fluid nature, 5th minute Apgar score, the absence of prolonged artificial pulmonary ventilation, a severity of respiratory distress syndrome, the presence of pneumonia, sepsis, convulsive disorder, anaemia, laboratory signs of the systemic inflammatory reaction, average values of carbon dioxide, anionic bicarbonate and base deficiency in capillary blood, interleukine-6 and receptor interleukine-1 antagonist in venous blood serum. Each sign is assigned with a prognostic coefficient (PC). That is followed by determining total PC, and it is expected cystic PVL that is decided for if total PC is at least (+)9.5, whereas no cystic PVL is expected if total PC is (-)9.5 or less.
EFFECT: invention provides the early (for the first 7 days of life) prediction of cystic periventricular leukomalacia in the most susceptible category of patients that are children with very low and extremely low birth weight.
6 tbl, 5 ex
The invention relates to medicine, namely to neonatology, and can be used for early prediction of cystic periventricular leukomalacia (PVL) in infants with very low (IT is) and extremely low birth weight (ELBW).
At the present time in connection with the nursing of preterm infants, including those with extremely low body weight, prevention and correction of severe neurological complications of violations is one of the most pressing health and social problems, the solution of which is aimed at reducing childhood disability and improving quality of life. The most susceptible to the action of damaging factors periventricular areas of the brain. Ensuring their circulation devoid of vasculature autoregulation mechanisms and depends on the condition of systemic hemodynamics. The consequence of these anatomical and physiological features can be the development of hypoperfusion and ischemia of the brain, up to the necrosis of the white matter with the development of cystic periventricular leukomalacia (PVL). The incidence of PVL depends on many factors, primarily on the degree of maturity of the newborn, use of aggressive methods of respiratory support, as well as duration of life of a premature baby. So, for example, the number of surviving children born before 33 weeks of gestation, anasastasy on average 4-10%, while the dead after 7 days of age, the frequency of BES at autopsy, up to 75%. According to some reports, the children who needed mechanical ventilation, frequency of BES can reach 60% in contrast to 6% of cases the development of BES in children without ALV ('chik A. B., Fedorova L. A., Monetising A. E. Neurology premature babies. M.: Medpress-inform, 2010, 342 p.). It has long been established that cystic PVL is one of the main causes of severe psychomotor retardation and cerebral palsy (CP), because the treatment of this complication and the possibility of rehabilitation are extremely difficult and sometimes ineffective (Permian J. M. White matter injury in the preterm infant: an important determination of abnormal neurodevelopment outcome. Early Hum. Dev. 1998; 53 (2): pp.99-120). In this regard, early detection of markers associated with cystic PVL, and their timely correction are particularly relevant. To date, the literature has accumulated enough information about the leading etiopathogenetic mechanisms and risk factors of BES. Proven clinical value, according to most authors, have fluctuations in blood pressure, hypotension, disturbances in the gas composition of the blood. The triggers of these conditions can be severe hypoxia/birth asphyxia, respiratory disorders, neonatal infection and sepsis (Back S. A. Perinatal white matter injury: the changing spectrum of pathology and emerging insights into athogenetic mechanisms. Ment. Retard. Dev. Disabil. Res. Rev. 2006; 12 (2): pp. 129-140, Adams-Chapman I., Stoll B. J. Neonatal infection and long-term neurodevelopmental outcome in the preterm infant. Curr. Opin. Infect. Dis. 2006; 19 (3): pp. 290-297). There is evidence, proving the continuity of PVL and cerebral palsy with chorioamnionitis in the mother and the syndrome of intrauterine inflammation of the fetus (I. Burd, V. Balakrishnan, Karman S. Models of fetal brain injury, intrauterine inflammation, and preterm birth. Am. J. Reprod. Immunol. 2012; 67 (2): pp. 87-94). There is convincing data on the role of inflammation factors and cytokine cascade in the immunopathogenesis of cystic PVL. Most studies in this area indicate an authentic dependence high levels of proinflammatory cytokines in the serum of premature infants with the development of PVL and cerebral palsy (R. S. Procianoy, R. C. Silveira Association between high cytokine levels with white matter injury in preterm infants with sepsis. Pediatr. Crit. Care Med. 2012; 13 (2): pp. 183-187, Kapitanovic Vidak H., Catela Ivkovic T., M. Jokic, Spaventi R., Kapitanovic S. The association between proinflammatory cytokine polymorphisms and cerebral palsy in very preterm infants, a Cytokine 2012; 58 (1): pp. 57-64).
Thus, the relevance of the proposed method is determined by the relatively high frequency of BES and the probability of the formation of severe motor disorders in children with IT and extremely low body weight at birth.
Modern diagnosis of BES based on the methods of neuroimaging. In routine practice, the most often used neurosonography (NSG). The diagnosis of cystic PVL, usually billed at 3-4 weeks of life and suggests the presence of characteristic�x multicyclonic cavities in periventricular areas of the brain.
In recent years the most popular and are highly specific methods of forecasting, based on immunological and neurospecific markers of the CNS.
For example, in the method for diagnosing the severity of cerebral ischemia in newborns I. N. Horikawa et al. the concentration of medium molecular peptides in the supernatant portion of the biological fluid nasopharyngeal aspirate. And when the concentration of medium molecular peptides 0,386-0,714 units of optical density of diagnosed cerebral ischemia mild. When the concentration 0,715-0,785 units of optical density - cerebral ischemia of moderate severity. But when the concentration of 0.786-0,853 units of optical density - severe cerebral ischemia severity (application for invention No. 2008137878/15 from 22.09.2008, the patent for the invention №2372620).
In another method, proposed by I. G. Loginova, poor prognostic criteria of the disease outcome in neonates with severe perinatal lesions of the CNS we used the values of serum concentration of brain-derived neurotrophic factor less than 4000 PG/ml neopterin less than 1.6 ng/ml (abstract of thesis ... candidate of medical Sciences "Clinical diagnostic and pathogenetic significance of neurospecific proteins in infants with severe� perinatal lesions of Central nervous system", Rostov-on-don, 2009, 25 p.).
In studies of N. N. Volodin, M. V. Degtyareva et al., 2000, proved the role of interleukin-1β in the Genesis and prognosis of post-hypoxic lesions of the Central nervous system in newborns. Its significant increase in the serum on the 3-4th week of life were correlated with the severity of neurological symptoms and forecast ("the Role of Pro - and anti-inflammatory cytokines in immune adaptation of newborns / N. N. Volodin, M. V. Degtyarev, A. S. Simbirtsev et al. International Journal on Immunorehabilitation. 2000; 2, (1): pp. 175-185).
These methods predict the severity of perinatal lesions of the Central nervous system was examined and tested primarily in full-term infants in the study did not include children with ELBW, data was not taken into account neonatal perinatal history, there was no specific emphasis on the morphological substrate of the nervous system, characteristic for preterm infants - BES.
The invention is aimed at reducing severe motor impairment in preterm infants due to cystic periventricular leukomalacia. The challenge is to early, in the first 7 days of life, the prognosis of cystic periventricular leukomalacia in the most susceptible to this complication category of patients - children with IT and extremely low body weight at birth.
Said technical result achieved�is the that infants with HE and ELBW at 3-7 days of life appreciate these perinatal history, namely the presence of chorioamnionitis and the nature of amniotic fluid, evaluation of the newborn Apgar at 5 minutes, no prolonged mechanical ventilation, severity of respiratory distress syndrome (RDS), pneumonia, sepsis, seizures, anemia, laboratory signs of systemic inflammatory response (SVR), the averages of carbon dioxide (pCO2), bicarbonate anion (HCO3) and deficit (BE) in capillary blood, the levels of interleukin-6 (IL-6) receptor antagonist and interleukin-1 (IL-RA) in the serum of venous blood. While each indicator is established prognostic factor (PC), namely in the presence of chorioamnionitis set PC (+)3,6; amniotic fluid in pathological PC (+)6,2; assessed by the Apgar score at 5 minutes to 7 or more points, set PC (-)4,5; in the absence of prolonged ventilator set PC (-)3,9; in the presence of moderate RDS set PC (-)2,4, severe RDS PC (+)of 2.5, pneumonia or sepsis PC (+)3,5; when convulsions PC (+)7,8; in the presence of anemia PCs (+2,5), if PC (-2,4); if there are laboratory signs of SVR install PC (+)6,6; with averages pCO2less than 30 mm Hg.PT. set PC (+)7.1, with the figures more � equal to 30 mm Hg.PT. PC (-)2,7; when indicators of HCO3less than 20 mmol/l set PC (+)4,9; when the numbers are equal and more than 20 mmol/l) PC (-)3,7; when indicators BE less than -4 mmol/l set PC (+) 2,3; when the numbers are equal or more -4 mmol/l set PC (-)2,5; when the level of IL-6 are equal and less than 25 PG/ml set PC (-)3,6; when the level of IL-RA equal and less than 550 PG/ml PC (-)5,4; then determine the sum of the PC and make a decision about the forecast in favor of cystic PVL, if the amount of the PC is not less than (+)9.5 and no forecast for the development of cystic PVL, if the amount of diagnostic ratios equal to or less than (-)of 9.5.
With this arrangement, the method provides a complex and multifactorial evaluation, it becomes possible early prediction of cystic PVL with a sensitivity and specificity of 90%.
The main group consisted of 32 children with IT and extremely low body weight at birth, formed cystic PVL. The study excluded neonates with intraventricular hemorrhage (ivh) of II-III degree. The diagnosis of PVL was based on data neurosonography (NSG) held on 3-4 weeks of life and suggested the presence of multiple cystic cavities in the periventricular areas of the brain. The comparison group were 60 children with no signs of BES. The prediction was carried out using Wald sequential analysis (Gubler E. V., Genkin A. A. Applied�e nonparametric tests statistics in biomedical research. - L.: Medicine, 1973. - 141 p.). Informative signs was calculated using information as Kullback. In the course of forecasting was used more than 40 signs, which are selected with the highest information content (not less than 0.3). As a rule, the higher the informational content of a sign is directly correlated with the value of a prognostic factor. The prediction was made on the basis of the sum of the PC and the decision was taken when the upper threshold amount for cystic PVL or lower threshold for the absence of cystic PVL. The upper and lower thresholds were determined by the level of acceptable error probability. The probability of errors of the first (view of the disease) and second kind (overdiagnosis of the disease was taken equal to not more than 10%. Method of determining upper and lower thresholds are described in the monograph of Gubler E. V., Genkin A. A. the Use of nonparametric tests statistics in biomedical research. - L.: Medicine, 1973. - 141 p. Thus, when the amount of (±)9.5 predicted probability of the event equal to at least 90%.
Prediction of events is constructed as follows:
1. Consistently summarizes the values PC corresponding to the gradation characteristic is detected in the patient. If the parameter value does not match or it is unknown, it is not in the forecast citywide.>
2. If the amount of PC is equal to or exceeds the upper threshold, the decision to refer the patient to a risk group for the development of cystic PVL. If the amount of PC is equal to or smaller than the lower threshold, the decision about the absence of risk of cystic PVL.
3. If the sum of the PC remained in the range between the lower and upper thresholds, the outcome is undefined, because there is insufficient information for a decision with a given level of reliability.
The proposed method was successfully tested in the reanimation and intensive therapy of the MUSES Clinical maternity hospital and children's city clinical hospital №1 (for newborns) Astrakhan from January 2009 to December 2011
The following are examples of building some predictive scenarios, proving the possibility of their use for early prediction of cystic PVL.
EXAMPLE 1. An extract from a case history No. 2110 child S.
The basis of the forecast. A male child born from 1st pregnancy occurring with the threat of abortion, preeclampsia, vaginitis, Smoking, chronic pyelonephritis, 1-premature birth 29 weeks, weight 1170 g, length - 37 cm, head circumference is 26 cm, Apgar score-7/7 points on 1-th and 5-th minute. Amniotic fluid is turbid, with an unpleasant odor. Condition at birth is regarded as heavy, with a negative d�Namiki, it was noted the existence of DN article 3 (score on a scale downs 7b), IVL. On the first day of life showed development of seizures, edema syndrome, decreased urine output. In the dynamics of the child's condition stabilized, underwent ALV with average parameters, convulsive syndrome was arrested, in the neurological status was most prevalent symptoms of hyperosmolality CNS. Urine output is normalized. R-logically on the 2nd day of life was determined by the signs of RDS. On the 5th day of life the child was transferred to hospital. When entering a serious condition, hardware ventilation. In consciousness. Oppressed, to inspect reacts by increased spontaneous motor activity. In the lungs listened scattered krepitiruyuschie rales on both sides. Stable hemodynamics. R-logically on the 6th day of RDS in the stage of resolution. In the blood without acute inflammatory changes, signs of anemia. Extubated on the 7th day. At NSG on the 7th day - Periventricular ischemia. DRCS 1 PT in the stage of cystic degeneration. Blood gases on the 5th day of life: pCO2- 21.9 mm Hg.CT., HCO3And 13.3 mmol/l, VE=-12,1 mmol/l On the 6th day of life taken blood for cytokines, the level of which amounted to IL-6 - 36 PG/ml, IL-1RA - 1450 PG/ml. Forecast implementation cystic PVL: the child with probability P. more than 90.0%, one should expect the development of cystic PVL. Total PC was +28, 8 (see tab. 2).
Realistically: Yes�ness of the people's Assembly on 15-th day - Suspicion on BES. Subependymal pseudocyst. Dilation W/o ventricle (d=s=6 mm), on day 21 - BES, stage cystic encephalomalacia. Dilation W/o ventricle (d=s=9 mm), the widening of the interhemispheric sulcus to 8 mm.
EXAMPLE 2. An extract from a case history No. 2246 baby K.
The basis of the forecast: a male Child born from the 3rd pregnancy (in history - honey. abortion, non-developing pregnancy) occurring with the threat of termination, on the background of chronic pyelonephritis with frequent exacerbations, 1-premature birth by cesarean section at 31 weeks. about the detachment of the placenta, weighing 1450 grams, length - 40 cm, Apgar score 3-4 score at 1st and 5th minutes respectively. Condition at birth heavy, was performed tracheal intubation, mechanical ventilation with Ambu bag, transferred to the Department of resuscitation and intensive care, C/o 20 min. at the second day his condition had stabilized, oksigenirovannym yourself through a child's oxygen tent. Clinically, it was noted the existence of DN 1-2 tbsp., retraction of intercostal spaces during respiration, the retraction of the sternum, were listened krepitiruyuschie wheezing. In the neurological status prevailed clinic oppression. R-gram of the chest on the 3rd day of life signs of RDS. Was admitted to the hospital on the 5th day of life in the office of the 2nd stage of nursing preterm infants. Noted the clinic expressed ugne� " s Central nervous system, in the form of a sharp inhibition of reflexes and muscle tone. After one day, the condition worsened, he began to give repeated prolonged apnea, therefore, translated into hardware IVL, which was within 14 days. In a study in the blood inflammatory changes in the form of hyperleukocytosis with neutrophilia, thrombocytopenia, anemia, increased levels of urea. When you request histological data of the placenta - the signs of choriodecidua. Blood gases on the 5th day of life pCO2- 44.7 mm Hg.CT., HCO3- 20,7 mmol/l, BE=-6,5 mmol/l NSG on the 7th day of life - Periventricular ischemia. DRCS 1 article On the R-gram of the chest signs of pneumonia. On the 7th day the level of IL-6 was 30 PG/ml, IL-1RA - 1020 PG/ml.
The forecast for the implementation of cystic PVL: the baby K with probability more than 90.0%, one should expect the development of BES. Total PC was+12,1 (see tab.3).
Really: on the 3rd week of life on the people's Assembly in the periventricular region was located conglomerates of various cysts, indicating the development of cystic PVL.
EXAMPLE 3. An extract from a case history No. 2218 child of J.
The basis of the forecast: female Child born from 1st pregnancy occurring with preeclampsia in the 2nd half, on the background of obesity of 2 degrees, 1-premature birth at 30 weeks. by planned cesarean section, weighing 1150 grams, length - 39 cm, with rating on Apga� 7/7 points. Condition at birth severe, clinic RDS, NAM article III (score on a scale Downes - 7 points). Was performed tracheal intubation, mechanical ventilation with Ambu bag. In the NICU continued intensive therapy, a ventilator for 5 days, after which the child is transferred to spontaneous breathing. From the nervous system prevailed symptoms of CNS depression. In light of the weakening of breath, listened scattered krepitiruyuschie wheezing. R-gram of the chest in 1st day of life signs of RDS. At NSG - increased periventricular echogenicity. Was admitted to the hospital on the 7th day of life in the NICU. Noted clinic DN-2 tbsp., CNS depression, inhibition of reflexes, muscle tone. Wheezing in the lungs are not listened to. Respiratory support using DCT. In a study in the blood without inflammatory changes, signs of anemia. At NSG on the 7th day of life - Periventricular ischemia. DRCS 1 article On the R-gram of the chest signs of RDS. The IL-6 level was 8 PG/ml, IL-1RA - 270 PG/ml. blood Gases: pCO2- 39,0 mm Hg.CT., HCO3- 22,3 mmol/l, VE=-3,6 mmol/L.
The forecast for the implementation of cystic PVL: the baby Zh with probability more than 90.0% should not expect the development of BES. Total PC amounted to 17,4 (see tab. 4).
Really: on the 3rd week of life on NSG changes have been identified.
EXAMPLE 4. Extract from history # 344 child P.
The basis of the forecast: the Rebbe�OK male born from the 1st pregnancy, proceeding with preeclampsia in the 2nd half, threatened abortion, Smoking, 1-premature birth at 30 weeks., weight 1340 g, length 40 cm, Apgar score 6/7 points. Condition at birth severe, clinic RDS, NAM article III (score on a scale Downes - 7 points). Was performed tracheal intubation, and mechanical ventilation. In the NICU continued intensive therapy, mechanical ventilation. From the nervous system prevailed symptoms of CNS depression. In light of the weakening of breath, listened scattered krepitiruyuschie wheezing. R-gram of the chest in 1st day of life showed signs of RDS. At NSG - increased periventricular echogenicity. Was admitted to the hospital on the 7th day of life in the NICU. Persisted clinic days 3 PT, CNS depression. Artificial ventilation for 24 days, followed by respiratory support through the OST. In a study in the blood signs of moderate neutrophilia, anemia, and biochemical indicators without features. Blood gases pCO2- 52.1 mm Hg.CT., HCO3- 24,8 mmol/l, VE=-3,0 mmol/l NSG on the 7th day of life - Periventricular ischemia. DRCS 1 article On the R-gram of the chest signs data for pneumonia no. The IL-6 level was 17 ng/ml, IL-1RA - 300 PG/ml. Forecast implementation cystic PVL: the child has P. with probability more than 90.0% should not expect the development of BES. Total PC amounted to 17,4 (see tab. 5).
Really: on the 3rd week of life on NSG kept�camping signs DRCS I degree. Data for cystic PVL no.
EXAMPLE 5. An extract from a case history No. 2664 child I.
The basis of the forecast: female Child born of the 4th pregnancy (a history of abortion and two miscarriages) occurring with anemia, threatened abortion, 1-premature birth at 25 weeks., weight 760 g, length - 33 cm, Apgar score 6/7 points. Condition at birth severe, clinic RDS, NAM article III (score on a scale Downes - 7 points). Was performed tracheal intubation, and mechanical ventilation. In the NICU continued intensive care, artificial ventilation for. R-gram of the chest in 1st day of life signs of RDS. At NSG - increased periventricular echogenicity. Was admitted to the hospital on the 6th day of life in the NICU. Persisted clinic 3 tbsp NAM, CNS depression. Blood work signs of anemia, moderate leukocytosis of neutrophiles, biochemical parameters were unremarkable. On the 7th day of life diagnosed with bilateral pneumonia. At NSG on the 7th day of life - Periventricular ischemia. DRCS 1 tbsp. blood Gases pCO2-38,1 mm Hg.CT., HCO3- 23,8 mmol/l, VE=-1,5, the IL-6 Level was 14 ng/ml, IL-1RA - 690 PG/ml.
The forecast for the implementation of BES: questionable (but more in favor of the absence of cystic PVL), total PCs amounted to 7.4 (see tab. 6). Really: on the 3rd week of life on NSG signs of ivh I degree. Data for cystic PVL no.
Thus, the mathematical interpretation of clinico-Anan�statistical risk factors and laboratory data creates a real opportunity to build an individual predict the formation of cystic PVL in infants with HE and ELBW. The proposed method allows targeted in the first days of a child's life to prevent, or adjust an emerging pathological conditions associated with BES, and thus prevent its development.
METHOD for EARLY PREDICTION of CYSTIC PERIVENTRICULAR LEUKOMALACIA IN INFANTS WITH VERY LOW AND EXTREMELY LOW BODY WEIGHT, namely, that at 3-7 days of life appreciate these perinatal history, namely the presence of chorioamnionitis, the nature of amniotic fluid, evaluation of the newborn Apgar at 5 minutes, no prolonged mechanical ventilation, severity of respiratory distress syndrome (RDS), pneumonia, sepsis, seizures, anemia, laboratory signs of systemic inflammatory response (SVR), the averages of carbon dioxide (pCO2), bicarbonate anion (HCO3) and deficit (BE) in capillary blood, the levels of interleukin-6 (IL-6) receptor antagonist and interleukin-1 (IL-RA) in the serum of venous blood, wherein each indicator is established prognostic factor (PC), namely in the presence of chorioamnionitis set PC (+)3,6; amniotic fluid in pathological PC +)6,2; assessed by the Apgar score at 5 minutes to 7 or more points, set PC (-)4,5; in the absence of prolonged ventilator set PC (-)3,9; in the presence of moderate RDS set PC (-)2,4, severe RDS PC (+)of 2.5, pneumonia or sepsis PC (+)3,5; when convulsions PC (+)7,8; in the presence of anemia PCs (+2,5), if PC (-2,4); if there are laboratory signs of SVR install PC (+)6,6; with averages pCO2less than 30 mm Hg.PT. set PC (+)7,1; when performance is superior or equal to 30 mm Hg.PT. PC (-)2,7; when indicators of HCO3less than 20 mmol/l set PC (+)4,9; at rates equal to and more than 20 mmol/l, PC (-)3,7; when indicators BE less than -4 mmol/l set PC (+) 2,3; while values equal to or more -4 mmol/l, set PC (-)2,5; when the level of IL-6, equal, and less than 25 PG/ml, set PC (-)3,6; when the level of IL-RA equal to and less than 550 PG/ml, PC (-)5,4; then determine the sum of the PC and make a decision about the forecast in favor of cystic PVL, if the amount of the PC is not less than (+)9.5, and the lack of guidance for the development of cystic PVL, if the amount of diagnostic ratios equal to or less than (-)of 9.5.
SUBSTANCE: interferon is measured in plasmocytoid dendrite cells at week 12 of the treatment. Its gain in adults and children twenty times as much as compared to the pre-treatment initial level, or 2.6×102 times as much in adults, and 1.2×102 as much as compared to the normal values, the stable positive antiviral treatment response is predicted.
EFFECT: method enables providing the more accurate prediction for selecting the optimum therapeutic approach in each patient.
SUBSTANCE: invention represents a method for assessing the mucosal immunity state of open cavities accompanying the prediction of the clinical course of infectious-inflammatory processes, characterised by the fact that having a pathogenetic factor established, degrees of microbiocoenosis disturbances of a specific biotope are recorded with the use of a complex of methods for estimating colonisation resistance factors, namely normal microflora, opportunistic microflora, immunoglobulins G, M, A, secretory immunoglobulin A and sc component; the mucosal immunity state is assessed according to the degree of microbiocoenosis disturbance, and the favourable outcome implying agent eradication or chronisation with agent persistence is predicted. The invention also refers to a method for correcting the infectious-inflammatory processes with the Kipferon® immunomodulator added.
EFFECT: increasing the prediction accuracy of the clinical course of the disease, extending the range of the method for correcting the infectious-inflammatory processes.
2 cl, 3 ex, 6 tbl, 1 dwg
SUBSTANCE: content of calcium and protein in oral liquid is determined before and after physical load, as well as a day after physical load. Recovery of content of calcium ions and protein in oral liquid after physical load to initial values is considered to be a criterion of total recovery of athlete's-volleyball player's organism, with evaluating time interval, required for said process.
EFFECT: invention makes it possible to determine reserve abilities of organism and its adaptability in athletes-volleyball players to physical load.
2 dwg, 4 tbl
SUBSTANCE: invention relates to the field of veterinary and can be used to diagnose the presence of a pathological effect of iron dextran on the piglets' liver. The essence of the method consists in carrying out the morphological systemic step-by-step analysis of histological liver cuts with the description of its histological structure, measurement of the average quantity of binucleate hepatocytes, apoptotic bodies and cells of the mononuclear-macrophage system. If the complex of pathognomonic morphological changes, including the presence of blood filling of sinus capillaries, oedema of the Disse's space; swelling of the vascular endothelium, granular dystrophy of hepatocytes, increase of the average quantity of cells of the mononuclear-macrophage system, including haemosiderophages by two times and more, as well as an increase of the quantity of binucleate hepatocytes and apoptotic bodies by 2 times and more, the effect of iron dextran on the piglets' liver condition is considered to be pathological.
EFFECT: invention provides an increased accuracy of the post-mortem diagnostics of the presence of a pathological effect of iron dextran on the piglets' liver.
SUBSTANCE: after thymomegalia has been excluded, tissue specimens of three-day-old mature newborns are studied to evaluate areas of inflammation changes in points in the placental umbilical cord (A), in the foetal placenta (B), in the maternal placenta (C), in extraplacental membranes (D); then thymomegalia is predicted by a discriminant equation: DE=-0.350×A-1.176×B-1.690×C-1.203×D, wherein DE is a discriminator function with a threshold equal to - 15.00. If DE is equal to or more than the threshold, the absence of thymomegalia is predicted; if D is less than the threshold, thymomegalia is predicted, whereas the score is taken at: (A) - 1 point - no inflammation, 2 points - amnionitis, 3 points - leukocytic infiltration in the Wharton's jelly, 4 points - phlebitis, 5 points - arteriitis, 6 points - a combination of two or more areas of inflammation: in blood vessels or in vessels and in the Wharton's jelly, (B) - 1 point - no inflammation, 2 points - chorioamnionitis, 3 points - villusitis, 4 points - vasculitis, 5 points - intervillesitis, 6 points - a combination of two or more areas of inflammation, (C) - 1 point - no inflammation, 2 points - villusitis, 3 points - vasculitis, 4 points - intervillesitis, 5 points - deciduitis, 6 points - a combination of two or more areas of inflammation, (D) - 1 point - no inflammation, 2 points - amnionitis, 3 points - chorioamnionitis, 4 points - deciduitis, 5 points - choriodeciduitis, 6 points - a combination of two or more areas of inflammation.
EFFECT: enabling the prediction of thymomegalia in the three-month-old mature newborns suffered prenatal influenza B complicated by placentitis.
FIELD: veterinary medicine.
SUBSTANCE: method consists in determining in the scales of concentration of Mn and/or Cu by the method of atomic-emission spectrometry. The regression equation is calculated, and on the content of Mn and/or Cu in the scales a copper concentration is determined.
EFFECT: method is accurate, atraumatic and non-invasive, simple and easy to use.
3 tbl, 1 ex
SUBSTANCE: after the ablation of the spleen, its weight is determined, the average area of a marginal zone of the spleen in histological cuts with coloration with hematoxylin and eosin is measured morphometrically. The obtained values are used to calculate the weight of the marginal zone and, if its values are ≤1.9 g, a favourable prognosis for the course of aplastic anaemia is made, if its value is >1.9 g, an unfavourable course of the disease is predicted.
EFFECT: prognosis of the aplastic anaemia course after splenectomy independent on the severity of the disease with the possibility to approach therapeutic treatment in a differential way.
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
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.
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.