On the basis of already published works in the field of opportunistic behavior-in general and among students-the authors tested a number of hypotheses. Econometric modeling allowed establishing the influence on students' propensity for opportunism of such factors as motivation, propensity for group work and procrastination, expectations regarding others, financial independence and a certain level of income. Thus, students who are motivated primarily to obtain knowledge (mastery) show a lesser inclination towards opportunism compared with students whose main motive is the degree (performance). The probability of behaving opportunistically is higher among students who are prone to group work and procrastination, rather than those who are inclined to work alone and solve various tasks consistently as they arrive. If a student believes that more than 70% of his classmates violate the charter of the university, the probability that the student himself will be an opportunist will be higher compared to students who think that less than a third of classmates are dishonest. In addition, students who are partially dependent on their parents are less prone to opportunism than students who do not depend on their parents at all. Finally, students who earn income in the range of twenty to thirty thousand rubles are less prone to opportunism, other things being equal, than students who have less than 10 thousand rubles a month at their disposal. Thus, on the basis of the analysis performed, it can be assumed under what conditions the student environment will be characterized by a higher propensity for opportunism and, consequently, a lower rate of accumulation of human capital.
Lifetime use of IgG replacement therapy is the standard of CVID treatment. However, full control over stabilization of chronic infection loci is not always achieved, even if this therapy is continuously applied. The purpose of this study was to carry out comparative analysis of changes in cellular component of adaptive and innate immune response, depending on effectiveness of replacement therapy of patients with infectious CVID phenotype. The observation group consisted of 15 patients with CVID who were diagnosed since early childhood in 100% of cases. They had prolonged respiratory infections followed by the development of complications requiring continuous treatment with antibiotics.After reaching mean age of 15 years old, the intensity of infection-associated antibody deficiency was 6-8 times per year. After verification of the diagnosis, the patients received replacement therapy, first at the saturation dose, and, after stabilization of IgG at the level of 7-8 g/l, at the monthly maintenance dose. The clinical course of the disease was traced during a full year of replacement therapy, and the cellular immunity indices were evaluated. In all patients, after a year of therapy corresponding to clinical guidelines, there was an improvement in quality of life indices, decreased rates of recurrent bacterial infections. At the same time, 40% of them continued to suffer, on average, 5.4±1.1 times a year and required long-term courses of antibiotic therapy. Evaluation of immune status did not reveal statistically significant differences in IgG plasma saturation between the groups of patients with different treatment efficiency: 8.7 (8-9) g/l and 9.1 (8.5-10.5) g/l, at p = 0.5. The differences related to immune cell factors in cases of smaller effect of IVIG therapy are manifested in higher relative numbers of T effectors containing lytic Granzyme B granules and CD14+CD284+ monocytes, accompanied by lower spontaneous active oxygen forms produced by neutrophils, lesser contents of CD16+ natural killers in peripheral blood.The obtained data illustrate the value of monitoring, not only serum IgG level, but also the parameters of the cellular immune response. Such analysis may be essential as a prognostic criterion for efficacy of IVIG therapy. Reduced levels of some parameters of innate immunity cells serves a basis to formulate the concept of combined treatment and usage of tools that alter functions of immunocompetent cells.
Common variable immunodeficiency (CVID) is a variant of primary immunodeficiency in which inhibition of antibody production is formed due to disorders of intercellular interaction affecting cellular elements of both innate and adaptive immune responses. A feature of CVID is the late start and variability of clinical minifestation. These arguments determine the purpose of the study: to identify the dynamics of changes in the cellular parameters of the adaptive and innate immune response depending on the duration and severity of the infectious manifestation of CVID. In this regard, a retrospective analysis of medical histories and dynamic observation of fifteen patients with CVID were carried out. Selection of specific parameters of cellular indices of factors of innate resistance and adaptive immunity was carried out on the basis of systemic-functional approach of immunodiagnostics. It is shown that in patients with CVID -mediated hypogammaglobulinemia and infectious phenotype of clinical manifestation, enhancement of quantitative and functional potentials of T-link effector cells of adaptive immunity is recorded against the background of reduction of number of regulatory T-helpers. With a more severe clinical course of the disease, the number of CD3+HLA DR + limphocytes is lower than with a more favorable version, there is a tendency to decrease the number of these cells, as well as the number of peripheral Treg with an increase in the length of the disease. Cellular components of innate immunity are characterized by a decrease in neutrophil activity, inhibition of antigen-presenting monocyte activity, the number and cytotoxicity of natural killers. At the same time, the tendency to decrease the cytolytic potential of NK with an increase in the length of illness and statistically significant differences depending on the severity of the manifestation of the infectious phenotype of CVID was recorded. The obtained results determine the importance of evaluating the cellular link of the immune system in patients with CVID, including as a prognostic criterion for the severity of the course.
Факторы, ассоциированные с вариативностью течения Х-сцепленной агаммаглобулинемииФедеральное государственное бюджетное учреждение высшего образования «Ростовский государственный медицинский университет» Министерства здравоохранения Российской Федерации, 344022, г. Ростов-на-Дону, Российская Федерация Резюме Введение. Исторически с исследования Х-сцепленной агаммаглобулинемии (Х-АГГ) берет начало развитие раздела клинической иммунологии, посвященного проблеме первичных иммунодефицитов (ПИД). Несмотря на многочисленные исследования и достижения в области диагностики и лечения Х-АГГ, далеко не все проблемы, связанные с ведением пациентов с этим вариантом ПИД, решены. Доказательство влияния белка Btk на функции не только В-лимфоцитов, но и других компонентов иммунной системы определяет интерес к комплексной характеристике клеточных факторов врожденного и адаптивного иммунного ответа.Цель исследования -определение изменений клеточных параметров иммунного ответа и их динамики в зависимости от длительности и тяжести течения Х-сцепленной агаммаглобулинемии.Материал и методы. Под динамическим наблюдением находились 12 пациентов с Х-АГГ. Дефект гена BTK подтвержден с использованием технологии секвенирования нового поколения. При иммунологическом мониторинге был использован комплекс методов, оценивающих количественные и функциональные параметры факторов врожденного и адаптивного иммунитета.Результаты исследования свидетельствуют, что у пациентов с Х-АГГ усилены процессы созревания и цитотоксичности Т-эффекторов при угнетении иммунорегуляторной супрессии, микробицидной активности нейтрофилов, функций натуральных киллеров. Показано, что более тяжелое течение Х-АГГ ассоциировано с более значимым угнетением метаболизма нейтрофилов; увеличение стажа заболевания сопряжено с ростом количества Т-эффекторов и снижением цитолитического потенциала натуральных киллеров.Заключение. Полученные результаты, без сомнения, требуют дальнейшего изучения с участием расширенной когорты пациентов. Тем не менее, данные о качестве и степени вовлеченности клеточных компонентов иммунного ответа следует учитывать при ведении пациентов с Х-АГГ в ежедневной практике.
Objective: to evaluate the effectiveness of intravenous immunoglobulins in X-linked agammaglobulinemia, to identify changes in the cellular link of the innate and adaptive immune response associated with an insufficient effect of replacement therapy. Materials and methods: 12 patients with X-AGH were under dynamic observation. BTK genetic defect confirmed using next generation sequencing technology. After verification of the diagnosis, patients received IVIG replacement therapy at a saturation dose and then at a maintenance dose. The data of prospective observation for a full year of regular IVIG therapy with an assessment of the severity of the disease, monthly monitoring of the pre-transfusion IgG level and determination of the quantitative and functional parameters of the components of the adaptive and innate immune response every three months are presented. Results: regular replacement therapy contributed to a decrease in the frequency of exacerbations of foci of chronic infection, a decrease in the frequency and duration of antibiotic therapy, however, in 30 % of cases, the frequency of exacerbations remained high, and antibiotic courses were doubled than the standard ones. A comparative analysis of the parameters of the immune system showed that with a smaller effect of IVIG, the functional potentials of T-effectors are less significant than in the comparison group and the properties of neutrophils and natural killers are more inhibited. Summary: the relationship between the severity of the clinical manifestation of XLA on the background of replacement therapy and the preservation of the functional potencies of the cellular components of the immune system provides the basis for a possible combination of IVIG therapy with drugs that affect the properties of cellular elements of the immune system.
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