Changes of the endothelium in cardiovascular pathology in the elderly. Part I. Signal molecules and endothelial functions

The review discusses the issue of the interaction between the endothelium and numerous biologically active substances, secreted by endotheliocytes and their environment--the so called signal molecules - in the most prevalent pathology in the elderly. In the elderly, signal molecules are synthesized by endothelial cells less intensively by comparison to young and middle-age people because a range of morphological features of endotheliocytes at elderly age: a hyperchromic nucleus; a smaller number of ribosomes, which leads to the inhibition of protein synthesis; a bigger number of lysosomes; structural changes in myofibrils; alterations in the mitochondrial structure such as crista death as well as the swelling and destruction of some organellas, which disturb the process of energosynthesis. At the same time, the main regulatory functions of the endothelium--vasomotor, antithrombocyte, anticoagulatory, thrombolytic, antiinflammatory, antioxidative, and antiproliferative ones--are the same in the healthy elderly and at earlier stages of ontogenesis. Disturbances in one or another endothelial function, especially at elderly age when the peculiarities of endothelial functioning under normal conditions are formed together with age-related morphological changes, result in fast development and progress of cardiovascular diseases.     

Revealing of tuberculosis in an infectious diseases hospital of a megalopolis

The advisory work of the phthisiatrician in an infectious diseases hospital was analyzed; the analysis revealed that in 2005 tuberculose changes of various degrees of activity had been revealed in 42.5% of examined patients, and 32.1% of them were subjects in whom tuberculosis of diferent localizations had been revealed for the first time. In 43.2% of the latter subjects, the reasons for hospitalization were "clinical masks" of tuberculose process (influenza, acute respiratory viral disease), while 48.6% were hospitalized for gastrointestinal infections and viral hepatitis. In 20.7% of cases tuberculosis was combined with HIV infection. In the infectious diseases hospital, 16.2% of patients with active tuberculosis died. Among the patients treated in the infectious diseases hospital during one year, the proportion of patients with active tuberculosis was 1.44%, the proportion of those in whom the process was revealed for the first time, was 0.75%. In Botkin infectious diseases hospital, there were approximately 6% of patients in whom tuberculose process was revealed for the first time in Saint Petersburg. The peculiarities of this group of patients in an infectious diseases hospital require not only tuberculose alertness, but also reinforcement of phthisiatric, radiological, and laboratory services.     

Endothelial changes in cardiovascular pathology in the elderly. Part 2. Signal molecules and the pathogenesis of atherosclerosis

This article is a continuation of the review on the issue of the interaction between the endothelium and numerous biologically active substances, secreted by endotheliocytes and their environment--the so called signal molecules--in the most prevalent cardiovascular pathology in the elderly. For example tumor necrosis factor plays a pathogenetic role as an immunomodulator, possesses anti-inflammatory and pro-atherogenic properties, provokes endothelial dysfunction, and stimulates the expression of other pro-inflammatory cytokines. Other signal molecules are described as well. The article also presents data from studies directed towards the perfection of atherosclerosis therapy via affecting signal molecules: depression of the expression of interleukins and their receptors, inhibition of atherogenic interleukins, neutralization of pro-inflammatory interleukins, and introduction of interleukin receptor antagonists.     

Umbilical blood is a source of hemopoietic stem cells for transplantation

AIM: To develop and introduce into practice scientifically validated methods of collection, testing and storage of hemopoietic stem cells of umbilical blood (UB) for non-relative transplantations. MATERIAL AND METHODS: UB and UB concentrate of 1004 mature newborns were studied with morphological, immunocytometric and cultural methods. RESULTS: The established reference values of the number of leukocytes and hemopoietic stem cells (HSC) are essential for examination whether UB is useable for production of the transplantation material. Obtained with the procedure of UB concentration based on sedimentation of erythrocytes due to hydroxyethylstarch, transplantation material has volume 20.0 ml, contains 39.0 +/- 0.48 x 10(6)/ml leucocytes and 1.37 +/- 0.029% CD34+cells and does not differ from umbilical blood by percentage of basic subpopulations of leucocytes and HSC. Assessment of efficacy of leucoconcentration procedure in different pregnancy courses, delivery and technological stages of UB collection gives grounds to consider the methods optimal for use in UB bank, while testing is thought adequate for examination of the material for transplantation fitness. CONCLUSION: Introduction of the study results into practice optimizes the work of stem cell banks and allows production of effective transplantation material.     

Acute porphyrias: problem of primary diagnosis in Russia and CIS countries

AIM: To analyse manifestations and experience in primary screening diagnosis of acute porphyrias which are rarely encountered and little known by general practitioners. MATERIAL AND METHODS: The data on 100 patients with the diagnosis acute porphyria have been analysed. Porphyrin metabolism in differential diagnosis was estimated according to standard techniques. RESULTS: Analysis of primary diagnosis of acute porphyria hepatica in Russia (region-related prevalence, duration of diagnosis, complications because of late pathogenetic treatment) demonstrates the importance of screening diagnosis of acute porphyria at the level of municipal clinics. CONCLUSION: Early diagnosis prevents severe complications of acute porphyria and reduces cost of examinations in search of accurate diagnosis.     

Informative value of orthogonal electrocardiogram in the diagnosis of the left ventricular hypertrophy

AIM: To estimate the informative value of orthogonal ECG parameters for the diagnosis of left ventricular hypertrophy (LVH). MATERIALS AND METHODS: The study comprised 142 apparently healthy individuals and 125 patients with arterial hypertension (AH) and LVH (left ventricular mass index more than 125 g/m2 for males and more than 110 g/m2 for females). Characteristic curves (ROC curves) were used to describe and compare the informative value of vectorcardiographic, demapping criteria for L VH with the informavalue of the Sokolov-Lyons criterion, the Cornelian index, and the Cornelian product. RESULTS: The informative indices of orthogonal ECG were Rx + Sz and IADIM: the area under the ROC curve was 0.89 +/- 0.02 and 0.88 +/- 0.02, respectively, which was significantly higher than with the Sokolov-Lyons criterion (0.64 +/- 0.04; p < 0.05) and similar to the Cornelian product (0.84 +/- 0.03). Of great informative value is the angle phi (area under the ROC curve was 0.88 +/- 0.04) in males and the area of QRS loop in the horizontal plane (area under the ROC curve was 0.89 +/- 0.03) in females. With 96% specificity, the male sensitivity of IADIM was 80%, Rx + Sz--73%, which was significantly higher than that of the Cornelian index (56%; p < 0.05) and the Sokolov-Lyons criterion (27%; p < 0.05). With 96% specificity, the female sensitivity of IADIM was 73%, Rx + Sz--84%, SQRSxz--70%, which was significantly higher than that of the Cornelian index (49%; p < 0.05), the Cornelian product (55%; p < 0.05), and the Sokolov-Lyons criterion (30%; p < 0.05). CONCLUSION: The threshold values of the most informative indices of orthogonal ECG are presented, which could provide the optimum sensitivity-specificity ratios. These values allow cardiac lesions to be detected in hypertensive patients with normal 12-lead ECG.     

Routine and new risk factors for cardiovascular diseases in patients with ankylosing spondylitis (Bechterev's disease)

AIM: Analysis of standard and new risk factors (RF) to develop cardiovascular diseases (CVD) in patients with ankylosing spondylitis (AS). MATERIAL AND METHODS: Examination of 96 patients with a documented diagnosis of AS has detected symptoms of CVD (arterial hypertension--AH, ischemic heart disease -IHD) and conventional CVD RF (smoking, hyper- and dyslipidemia, overweight, hereditary predisposition, diabetes mellitus). The SCORE scale assessed the risk of CVD complications within 10 years of ischemic heart disease. The following RF were also studied: the levels of C-reactive protein, fibrinogen, platelets, von Willebrand factor activity, total fibrinolytic plasma activity, left ventricular hypertrophy (LVH) according to echocardiography, intima-media complex thickness of the common carotid artery by USI. RESULTS: Prevalence of AH in the examinees (34.4%), IHD (4.2%) was within population values. Total risk for IHD calculated with consideration of conventional RF in AS patients (6.3 +/- 5.0%) did not differ much from mean populational (6.8 +/- 4.4%) while in the absence of hypertension it was lower (4.1 +/- 2.5 and 5.4 +/- 3.5%, respectively, p < 0.05). The risk for lethal CVD complications proved not high (1.46 +/- 1.34%). However, AS patients have high risk for thrombosis due to elevated levels of prothrombogenic factors (fibrinogen, von Willebrand factor, platelets) and subnormal fibrinolytic blood activity. AS patients also demonstrate frequent LVH (overall 51% and 42.9% in normotensive AS patients). CONCLUSION: Higher risk of CVD death in AS patients than in general population may be caused by additional RF missed at conventional stratification.