Modern medical technology

Analysis of the body composition of rats with experimental diabetes mellitus type 1 and its correction

Yu. M. Kolesnyk — 2024-12-27

The aim was to determine the body composition of rats with experimental type 1 diabetes mellitus and its correction with amino acids using bioimpedance analysis.

Material and methods. Diabetes mellitus was modeled by the injection of streptozotocin. On the 6^th week the rats were divided into 3 subgroups: DM1-1 – without correction, DM1-2 – correction with L-arginine and DM1-3 – correction with N-acetyl-L-cysteine for 2 weeks. Body composition was determined by the Vet BIS1 impedance analyzer with a study of total water volume in the body, extracellular and intracellular fluid, fat and fat-free body mass.

Results. Weight of rats in DM1 group at the 6^th week was 40 % less than in control, with a 63 % reduction in fat and 22 % decrease of fat-free body mass. The development of hyperglycemia in week 6 caused general dehydration, with a decrease in absolute values of both fluid volumes. On the 7^th and 8^th weeks, body weight, fat and fat-free body mass in the subgroups DM1-1, DM1-2, and DM1-3 did not differ statistically. Both amino acids caused a decrease in glucose concentration, but this did not affect existing total dehydration with a decrease of both fluid volumes.

Conclusions. The development of streptozotocin-induced type 1 diabetes mellitus in rats in 6 weeks resulted in a statistically significant loss of body weight, mostly due to fat mass decrease with a violation of its ratio to fat-free mass. Persistent hyperglycemia already in the 6^th week of experimental diabetes mellitus causes general dehydration due to loss of extracellular and intracellular water, with a predominance of intracellular dehydration. Two-week correction of diabetes with L-arginine and N-acetyl-L-cysteine at 8^th week significantly reduces glucose concentration in subgroups, but does not affect the progressive reduction of body weight, fat and free-fat mass, and fluid volumes.

Predictors of severe community-acquired pneumonia associated with coronavirus infection

S. S. Avhaitis — 2024-12-27

Aim of the study. To determine the predictors of severe community-acquired pneumonia associated with coronavirus infection.

Materials and methods. To achieve the aim and solve the problems, an open, prospective observational study was conducted: from January 2021 to February 2022, 102 patients with community-acquired pneumonia (CAP) aged 40 to 65 years with a positive test for SARS-CoV-2 were observed in the outpatient department of the Kherson City Clinical Hospital named after Athanasius and Olga Tropinin of the Kherson City Council. Determination of interleukin-6, interleukin-10, and high-sensitivity C-reactive protein (hs-CRP) was performed in blood plasma by enzyme-linked immunosorbent assay using standardized kits: “hs-CRP-ELISA-Best”, “IL-6-ELISA-Best”, “IL-10-ELISA-Best” in accordance with the attached instructions.

Results. The analysis of univariate logistic regression models showed that such indicators as patient age, heart rate and SpO₂ were not important in the occurrence of severe CAP. Indicators such as vital capacity of the lung, blood glucose, C-reactive protein, IL-6 and IL-6 / IL-10 ratio were predictors of severe CAP according to the results of logistic regression analysis. Blood glucose, IL-6, and the IL-6 / IL-10 ratio lost their prognostic power in multivariable logistic regression models of severe CAP. According to the results of multivariate regression analysis, the predictors of severe CAP were the volume of lung lesions on computed tomography (CT) and the level of hs-CRP. Multivariate logistic regression analysis showed that independent predictors of severe CAP were the volume of lung lesion more than 20 % on CT (OR = 1.28, 95 % CI OR 1.11–1.48), and the level of hs-C-reactive protein >13.50 mg/L (OR = 2.22, 95 % CI OR 1.50–3.31). In terms of predicting the development of severe CAP, hs-CRP has an advantage over the standard model (AUC = 0.92 vs AUC = 0.72, p < 0.05).

Conclusions. According to multivariate logistic regression analysis, the following independent predictors were most significant for the occurrence of severe community-acquired pneumonia associated with coronavirus infection: lung lesion volume on CT and high hs-CRP. These indicators also had the largest areas under the ROC curve among those analyzed. Determining the level of C-reactive protein by a highly sensitive method is important for patients with moderate pneumonia associated with coronavirus infection to assess the risk of severe disease.

Predictors of radiological progression of rheumatoid arthritis while receiving conventional synthetic disease-modifying antirheumatic drugs

O. B. Iaremenko — 2024-12-27

The aim of the work is to study the predictors of rheumatoid arthritis (RA) radiological progression while using conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

Materials and methods. 163 patients with RA who were prescribed csDMARD were included in the study. Most of them were female 141 (86.5 %); mean age was 50.1 ± 12.0 years, disease duration 37.5 ± 56.3 months. Rheumatoid factor (RF) was detected in 53.3 % of patients, and antibodies to cyclic citrullinated peptide (ACCP) – in 54.0 %. Logistic and linear regression were used to analyze independent risk factors for radiological progression of RA and results were expressed as odds ratio (OR). Statistical processing was carried out using SPSS 29.0 software.

Results. During 2 years of study, radiological progression according to the OMERACT 4 criteria was observed in 104 patients (63.8 %): in 97 patients (59.5 %) according to the total van der Heijde’s Sharp score (SHS); 53 (32.5 %) – erosion scale; and 99 (60.7 %) – narrowing scale. The dynamics of the average values of the total SHS and its components (erosive and narrowing scales) were 11.50 ± 14.20 (р < 0.001), 3.29 ± 5.86 (р < 0.01) and 8.30 ± 15.90 (p < 0.001) respectively. The mean increase in total SHS was 5.75 per year, while 41 patients (25.2 %) had radiological remission. In multivariate and ROC analyses, higher titers of ACCP (OR 0.06 [0.05; 0.09]) and RF (OR 0.01 [0.002; 0.02]), as well as the patient’s global assessment by visual analogue scale (OR 0.15 [-0.02; 0.33]) were independently associated with the risk of radiological progression of RA.

Conclusions. The radiological progression of RA is observed in 63.8 % of patients with undergoing csDMARDs therapy. Only one in four patients achieves radiological remission. Independent predictors of radiographic progression in patients with RA are higher titers of ACCP, RF and higher values of patient’s global assessment by visual analogue scale at baseline.

Use of intraoperative luminescent methods for detecting affected lymph nodes in patients with complicated forms of colon cancer

M. A. Kubrak — 2024-12-27

The issue of the volume of lymphatic dissection in patients with complicated forms of colon cancer and the possibility of using methods of intraoperative visualisation of the affected lymph nodes remains controversial.

The aim of the study – to analyse the results of using the intraoperative luminescent method of detecting affected lymph nodes in patients with complicated forms of malignant diseases of the large intestine.

Materials and methods. The study group included 109 patients with complicated forms of colon cancer. In the gender structure, female patients predominated – 57 (52.29 %), there were 52 (47.71 %) men. The average age of the patients was 69.78 ± 16.37 years. Contrasting of regional lymph nodes was carried out using a 10 % sodium fluorescein solution.

Results. According to the results of the fluorescence examination, in 67 (61.47 %) patients, lymph nodes were visualized in the regional lymphatic outflow: in 39 (58.21 %) cases, the visualized lymph nodes were located in the area of epi- and paracolic nodes (lymphodissection D1), in 23 (34.33 %) of patients – in the zone of mesocolic lymph nodes (lymphodissection D2) and in 5 (7.46 %) – in the zone of apical lymph nodes (3^rd level of lymph drainage). A total of 268 lymph nodes were detected in 109 patients, which was an average of 2.46 lymph nodes per 1 patient. These nodes were marked and sent for histological examination separately from the main preparation. In total, a pathohistological examination of 1436 lymph nodes from the regional zone of lymph drainage from colon cancer was carried out, which was an average of 13.17 lymph nodes per 1 patient.

Conclusions. The use of a 10 % solution of sodium fluorescein as a preparation for photoluminescence examination made it possible to visualize lymph nodes in the regional lymphatic outflow zone for the tumor in 67 (61.47 %) patients. The use of photoluminescence made it possible to determine the optimal volumes of lymphatic dissection without unjustified expansion in the case of surgical interventions for complicated forms of colon cancer. The levels of sensitivity and specificity of the photoluminescent method of detecting affected lymph nodes using a 10 % solution of sodium fluorescein had quite high results and amounted to 72.41 % and 93.28 %, respectively.

Clinical effectiveness of complex differentiated rehabilitation of patients with vertebral thoracic pain due to degenerative-dystrophic pathology of the thoracic spine

O. Ye. Alypova — 2024-12-27

The aim of the study. To determine the effectiveness of complex differentiated rehabilitation in patients with degenerative-dystrophic pathology of the thoracic spine (DDPS) and thoracic back pain syndrome depending on the indicators of vertebrodynamics.

Materials and methods. Rehabilitation measures were carried out in 124 patients with DDPS complicated by thoracalgia syndrome at the post-acute stage of rehabilitation. The age of the patients was from 18 to 54 years. There were 51 (41.2 %) women, 73 (58.8 %) men. The duration of the disease was from 2 to 23 years. A rehabilitation examination was carried out with an assessment of vertebrodynamic disorders indicators according to the A. Stoddard method. All patients had functional block of the 2^nd degree in the vertebral-motor segments of the thoracic spine. Patients were divided into 2 groups, comparable in age and disease severity. The first group (n = 56) received a basic complex of rehabilitation: massage, personalized sets of therapeutic exercises, physical methods of treatment (magnetotherapy, ultrasound therapy) against the background of drug treatment (nonsteroidal anti-inflammatory drugs, muscle relaxants, analgesics). Patients of the second group (n = 68) were prescribed, in addition, sessions of post-isometric and post-reciprocal muscle relaxation, mobilization techniques according to K. Lewit, R. Maigne, V. Gubenko, as well as the original methods of kinesiotherapy developed by us depending on the indicators of vertebrodynamics. The outpatient rehabilitation cycle lasted 14 days.

Results. The developed comprehensive scheme of of patients examination based on neurological, manual, instrumental studies, assessment of pain syndrome, insomnia and affective disorders allows early diagnosis of the disease, as well as dynamic monitoring during treatment. The developed and tested complex kinesiotherapeutic treatment method with the use of manual therapy leads to a faster regression of neurological symptoms, restoration of the lost range of motion in the thoracic spine, reduction of pain and the risk of DDPS exacerbation, shortening the time of treatment and rehabilitation of patients, and improving their quality of life.

Conclusions. The comprehensive differentiated rehabilitation with the use of manual therapy developed and researched in the work has confirmed its effectiveness, which allows recommending its use in clinical and rehabilitation practice, and provides significant economic effect in the treatment of this contingent of patients.

The results of many years of complex use of cycle- and power-ergometry in determining the physical capacity of young athletes

M. F. Khoroshukha — 2024-12-27

Aim of the work: to assess the results of a complex use of cycle- and power-ergometry in determining the aerobic and anaerobic-aerobic performance in young athletes for the selection of criteria in predicting athletes’ sports abilities and performance results at competitions in certain sports.

Materials and methods. Young athletes aged 15–16 (n = 636) took part in the study in which they represented two groups of athletes according to a training process direction: group A (n = 260) – speed-power sports (boxing, freestyle wrestling); group B (n = 376) – endurance sports (athletics, skiing, cycling, swimming). According to the results of their performance at competitions, all athletes were additionally divided into two groups: 1) a group of people who won prize places at competitions in their chosen sports – winners, 2) a group of their peers who unsuccessfully performed at competitions – outsiders. Physical working capacity was determined using two methods: cycle ergometric test PWC₁₇₀ and power-ergometric test PWC₁₇₀. Submaximal ergometric test PWC₁₇₀ (Physical Working Capacity, PWC) is a method based on the determination of physical working capacity (load capacity) upon reaching a heart rate of 170 beats·min^-1.

Results. The fact of possible prediction of sports results at competitions of adolescents in sports chosen by them, depending on the nature of changes in indicators of aerobic and anaerobic-aerobic performance PWC₁₇₀, was established. Examples of the performance of young athletes at competitions are given. Statistically significant differences were found in the indicators of aerobic (cycle-ergometry) and anaerobic-aerobic performance (power-ergometry) of athletes-winners and outsiders.

Conclusions. A complex use of cycle- and power-ergometry allows to determine the level of contribution of each type of energy potential separately – aerobic (aerobic performance PWC₁₇₀) and anaerobic-aerobic (anaerobic-aerobic performance PWC₁₇₀) to the general physical working capacity (PWC). In our opinion, the level of aerobic and anaerobic-aerobic performance PWC₁₇₀ (according to PWC index proposed by us) may be one of the criteria in predicting athletes’ sports abilities and performance results at competitions in certain sports.

Micro- and ultramorphological features of the leaf cells of Myrtus communis L. as a parameter for the standardization of medicinal plant syrup are the basis for new herbal remedies

V. M. Odyntsova — 2024-12-27

In the context of war, developing and standardizing new medicinal plants, such as Myrtus communis L., can significantly enhance the availability and effectiveness of medicinal products. The micro- and ultramorphological features of the leaf cells of this species could become crucial parameters for their identification and standardization, thereby facilitating the introduction of new, effective medications into practice.

The aim of the work is to study the morphological and anatomical structure and determine the general diagnostic microscopic features of leaves and the structure of meristem cells of common myrtle.

Materials and methods. Microscopic analysis of temporary leaf preparations of Myrtus communis L. was carried out using a Carl ZEISS “AxioStar Plus” and “Primo Star” microscopes with a photographic attachment for work in both direct and reflected light. The ultrastructure of leaf cells was additionally studied using transmission electron microscopy methods. Ultra-thin sections, 60 nm thick, were obtained on a Reichert Om 43 ultramicrotome. Sections were contrasted with a 1 % solution of uranyl acetate and lead citrate for 2 minutes in each solution at room temperature. Ultrathin sections were studied using a PEM-100-01 electron microscope at an accelerating voltage of 75 kV.

Results. The external features of common myrtle (Myrtus communis L.) leaves are described, including their shape, color, and type of veining. Anatomical features of the leaf include the presence of convoluted epidermal cells, anomocytic stomata located on the abaxial surface of the leaf, calcium oxalate crystals and druses, simple hairs on the midvein, and schizolysigenous secretory receptacles. The ultrastructure study of common myrtle leaf cells revealed characteristic structural components of various cell types, including a nucleus with a nucleolus, chloroplasts with plastoglobules and starch grains, a Golgi complex with numerous dictyosomes, endoplasmic reticulum, mitochondria, lysosomes, oil droplets, and myrtle characteristic storage inclusions such as amyloplasts. During electron microscopy, mature secretory receptacles were observed, with visible remnants of cells in the lumen. They are surrounded by cells with a high metabolic rate, as well as senescent cells that appear darker, with low organelle definition and tortuous walls.

Conclusions. The leaves of Myrtus communis L. have a hypostomatic leaf type, with the lower epidermis containing a significant number of uniformly arranged stomata of the anomocytic type. Simple unicellular hairs are present only on the central vein. Shared anatomical features with other species in the Myrtaceae family include the presence of druses and prismatic calcium oxalate crystals, along with schizogenous secretory receptacles that produce lipophilic substances. The ultrastructure of meristem cells and cells adjacent to the secretory receptacles in Myrtus communis includes cell membrane, cytoplasm, nucleus, mitochondria, vacuoles, chloroplasts, Golgi complex with numerous dictyosomes, endoplasmic reticulum, lysosomes, oil droplets, and amyloplasts, which are starch-storing inclusions characteristic for the species. Mature secretory receptacles were found, within which cell remnants are surrounded by metabolically active cells and senescent, darker cells with poorly defined organelles and convoluted walls. Recommended parameters for the standardization of Myrtus communis L. medicinal plant material: microscopic indicators include the anomocytic type of stomatal apparatus with hypostomatic placement, simple hairs, the presence of druses and prismatic calcium oxalate crystals, and schizogenous secretory receptacles. Ultramorphological indicators include cell membrane, cytoplasm, nucleus with nucleolus, chloroplasts with plastoglobuli and starch granules, Golgi complex with numerous dictyosomes, endoplasmic reticulum, mitochondria, lysosomes, oil droplets, characteristic storage inclusions (amyloplasts), and the presence of secretory receptacles.

Ultrafine industrial aerosol as an occupational risk factor for sintering industry workers

L. P. Sharavara — 2024-12-27

Aim. Assessment of the physicochemical characteristics of suspended particulate matter of the ultrafine range present in the air of the working area of the sintering factory of a metallurgical plant.

Materials and methods. The assessment and analysis of the physicochemical parameters of ultrafine particles were carried out in different areas of the sintering factory of the metallurgical plant. The parameters were measured using a portable scanning spectrometer Nanoscan 3910 (USA). The chemical composition of the suspended particulate matter was determined by the method of optical emission spectrometry with inductively coupled plasma (OES-IZP) using the device “Ortima 2100 DV” (PerkinElmer, USA).

Results. It was estimated that the concentration of suspended particulate matter of ultrafine size in the main part of the sintering machine ranged from 3.02 × 10⁴ to 3.12 × 10⁴per cm³, in the tail part of the sintering machine – from 5.09 × 10⁴ to 7.59 × 10⁴per cm³, in the sintering machine control room No. 1 – from 2.06 × 10⁴ to 2.38 × 10⁴ per cm³, in the workers of the control group – from 1.43 × 10⁴ to 1.73 × 10⁴ per cm³. The quantitative concentration of suspended particulate matter by individual sizes at all workplaces of the sinter plant workers compared to workers of the control group had a significant difference. Values of the total surface area and surface volume of suspended particulate matter of the nano-sized range had their maximum in the tail part and near the head of the sintering machine, the lowest values were recorded around the control room and among the employees of the plant management department. The highest mass concentration of ultrafine particles was recorded in the tail part of the sintering machine (22.55 μg/m³ to 508.35 μg/m³), which is associated with a significant amount of suspended particulate matter of a larger size (≥115.5 nm). The chemical composition of the particles of the ultrafine range included aluminum, calcium, iron, magnesium, manganese, silicon, and phosphorus, which is explained by the specifics of the technological process, and the exceeding of the hygienic standard was observed for calcium, silicon and phosphorus.

Conclusions. It was established that during the sintering of the agglomerate in the agglomeration compartment, many suspended particles of the ultrafine range are formed. They included aluminum, iron, manganese, magnesium, silicon, phosphorus, and calcium. Significantly higher values of the number, mass concentration, surface area and surface volume of suspended particulate matter were determined at the workplaces of sintering factory workers, which had a statistically significant difference compared to the workers of the control group.

Inhibitory potential of probiotic spore formers grown as mono- and mix-cultures under conditions of different nutrient availability

O. V. Knysh — 2024-12-27

In many clinical cases, the use of probiotic microorganisms is a safer alternative to antibiotic therapy. Spore-forming probiotics, due to their high resistance to damaging environmental factors, stand out among other beneficial microorganisms and, therefore, deserve special attention. Determining the conditions that enhance the inhibitory potential of probiotic bacilli is an important step towards increasing their effectiveness against pathogenic bacteria and pathobionts.

The aim of this study was to determine whether the inhibitory potential of spore-forming probiotic species: Alkalihalobacillus clausii (previously known as B. clausii), Heyndrickxia coagulans (formerly B. coagulans) and B. subtilis increases under conditions of co-cultivation or nutrient depletion (starvation).

Materials and methods. The commercial strains of bacilli from three probiotic preparations: Enterogermina (A. clausii), Lactovit forte (H. coagulans) and Subalin (B. subtilis) were used in this study. The ability of mono- and mix-cultures of the studied probiotic species cultured on conventional and semi-starvation nutrient media to affect the growth of indicator bacteria-pathobionts (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa) was investigated by the agar block method (using 1.5 % nutrient agar) and the spot-on-lawn assay with wells (using 0.7 % nutrient agar).

Results. Inhibitory activity against indicator bacteria-pathobionts was characteristic of both mono- and mixed probiotic test cultures. Using the agar block method, probiotic monocultures grown on nutritive agar demonstrated moderate inhibitory activity against S. aureus and P. aeruginosa, but weak inhibitory activity against E. coli. Probiotic monocultures grown on “semi-starvation” agar and mix-cultures regardless of the culture medium showed pronounced inhibitory activity against S. aureus and P. aeruginosa, but moderate inhibitory activity against E. coli. Co-cultivation and cultivation on semi-starved media were accompanied by an increase in the number of isolated colonies of probiotic bacilli (disseminates) in the transparent zone of no growth and the pathobiont growth zone. Using spot-on-lawn assay revealed moderate inhibition of staphylococcus growth by both mono- and mixed probiotic cultures, regardless of their cultivation conditions. However, the inhibition indicators of probiotic mix-cultures were statistically significantly higher than those of monocultures. The inhibitory activity of probiotic monocultures against E. coli and P. aeruginosa was moderate, while probiotic mix-cultures had a pronounced inhibitory effect on these gram-negative bacteria.

Conclusions. The inhibitory activity and dissemination ability of spore-forming probiotic species: A. clausii, H. coagulans and B. subtilis increases under conditions of co-cultivation or nutrient depletion (starvation). The demonstrated effect of increasing the inhibitory potential of probiotic spore-forming bacteria by co-cultivation and application of nutrient depletion conditions requires further study and clarification of the underlying molecular mechanisms.

Multiple acute complications of transarterial chemoembolization of liver metastases

R. N. Abu Shamsia — 2024-12-27

The aim of the work: to describe a clinical case of treatment of multiple acute complications after transarterial chemoembolization of liver metastases in a patient with pancreatic cancer.

Materials and methods. Patient M., 52 years old, sought medical help at the “DIEVO” Medical Center for Surgical Solutions. He had previously been treated for pancreatic cancer in other medical institutions.The patient’s anamnestic data, features of his previous treatment, including transarterial chemoembolization of liver metastases, were studied. The patient underwent a clinical examination, laboratory and instrumental studies, as a result of which multiple acute complications were diagnosed. The council of specialists made a decision to optimize the treatment tactics.

Results. On the 24^th day after hospitalization, the patient, after completing treatment at the medical center, was discharged from the clinic in a satisfactory condition for further outpatient treatment and observation by an oncologist at his place of residence. For timely diagnosis of purulent-septic complications after transarterial chemoembolization of liver metastases, in addition to ultrasound, computer, magnetic resonance imaging, careful clinical monitoring of the patient and a comprehensive assessment of his health are required.

Conclusions. Careful clinical observation of the patient, comprehensive laboratory and instrumental examination of the patient with ultrasound, computer, magnetic resonance imaging, etc. are important prerequisites for timely diagnosis of possible purulent and septic complications after transarterial chemoembolization of liver metastases.