Background. The course of lymphoproliferative diseases, in which the proliferation of a malignant clone is accompanied by the secretion of paraproteins, is often complicated by kidney damage. Perhaps kidney damage is associated with the physicochemical properties of monoclonal proteins.The objective of the study was to determine the relationship between the type of monoclonal paraprotein, its level of secretion, and kidney damage in lymphoproliferative diseasesMaterials and methods. A retrospective analysis of the data of 108 patients with lymphoproliferative diseases accompanied by paraproteinemia and kidney damage was performed. The age of the patients was 31–86 years (median 62.5 years). 78 out of 108 patients were diagnosed with chronic kidney disease (CKD). CKD was diagnosed in accordance with the clinical guidelines of KDIGO 2012.Results. In patients with multiple myeloma, stage III CKD was diagnosed in 28 (35.9 %) cases, stage IV – in 14 (17.9 %), stage V – in 19 (24.4 %). High risk group for CKD included 10 (9.3 %) of 30 patients without CKD. 91 patients were diagnosed with concomitant diseases predisposing to the development of kidney damage. In the group of patients with paraproteinemic hemoblastosis in combination with CKD, the vast majority were patients with the presence of IgGκ and IgGλ blood paraproteins, free light chains (FLC), and Bence-Jones protein (BJ) in the urine. At the same time, patients with the secretion of IgDλ, IgAλ, IgAκ and IgMκ paraproteins were much less common. The highest level of pathological Ig of all classes and their structural components and fragments was observed in patients with stage III CKD, which is also characteristic of other laboratory markers in CKD. A negative correlation of glomerular filtration rate (GFR) with FLCκ in the blood (r = –0.21), GFR with BJκ (r = –0.35), GFR with FLCλ in the blood (r = –0.13), GFR c BJλ, which indicates a tendency to damage the kidneys of FLC and protein BJ.Conclusion. In patients with lymphoproliferative diseases accompanied by monoclonal secretion of paraprotein and kidney damage with the development of CKD, in most cases IgGκ, IgGλ, FLCκ and FLCλ were determined in the blood, and protein BJ in urine. IgAκ, IgAλ, IgMκ, IgMλ, IgDλ paraproteins were determined much less frequently in serum. The highest level of pathological Ig and their structural components was observed in patients with stage III CKD. No association with quantitative level, type of paraprotein, and kidney damage was found. The role of FLC and BJ protein in the development of nephropathy is noted. The results of the study also show that with the development of the disease and kidney damage with subsequent progression of the stage of CKD in patients with lymphoproliferative diseases and proteinemia, there is a tendency to a temporary decrease in proteinuria and a compensatory increase in the number of paraproteins in the blood. This can be considered as one of the compensatory pathophysiological mechanisms of the protective function of the kidneys.
The article is devoted to the use of reflexotherapy techniques in the treatment of transient post-vaccination reactions after the use of the vaccine "Sputnik V" against COVID-19.
The review on the use of traditional and new methods of laboratory diagnostics of fat embolism syndrome - a complication that in some cases asymptomatically accompanies severe concomitant trauma is presented. The main currently used laboratory diagnostic methods are described: traditional methods and new markers (interleukin-6, neuroglial protein S100B, surfactant protein SP-D). A review of the literature data in terms of assessing the pathogenetic and diagnostic significance of some methods of laboratory diagnosis of fat embolism syndrome, the relationship between the dynamics of the considered laboratory parameters, the clinical picture and inflammation. Own observation is presented. The results show the importance of integrating the whole range of available methods in the diagnosis of fat embolism syndrome.
Асташина Н. Б., Казаков С. В., Рогожникова Е. П., Горячев П. С. ФГБОУ ВО «Пермский государственный медицинский университет имени академика Е. А. Вагнера» Минздрава России, г. Пермь, Россия АннотацияПредмет. За последнее десятилетие резко возрос интерес врачей-стоматологов к применению различных видов лечебно-профилактических аппаратов (индивидуальных шин и капп) для лечения хронического генерализованного пародонтита. В статье отражены конструкционные особенности и клинико-лабораторные этапы изготовления новой лечебно-профилактической назубной шины, изготовленной из термопластического материала на основе полиоксимети-лена «Dental D» Quattro Ti (Италия). Представлены показания к применению назубной съемной шины из термопласта на этапах лечения хронического генерализованного пародонтита легкой степени тяжести.Цель -повышение эффективности комплексного лечения хронического генерализованного пародонтита на основе разработки и внедрения новой конструкции лечебно-профилактической назубной шины, изготовленной из термопла-стического материала «Dental D».Материалы и методы. Термопластические материалы на основе полиоксиметилена обладают высокими пластиче-скими свойствами, устойчивостью к усталостным нагружениям, низкими показателями износа, биологической инерт-ностью, отсутствием токсичности и канцерогенности, а также доступностью для использования в повседневной сто-матологической практике.Одной из разновидностей термопластов является материал стоматологического назначения «Dental D» -орга-нический технополимер, аналог металла, обладающий малой степенью упругой деформации, физико-механические характеристики которого обеспечивают возможность использования его в качестве конструкционного материала для шинирования зубов.Результаты. В ходе исследования были изучены физико-механические характеристики термопластического материала «Dental D», подтверждена целесообразность его применения в качестве конструкционного материала для изготовления съемных шин и разработана новая конструкция индивидуализированной неинвазивной лечебно-профилактической назубной шины.Выводы. За счет уникальных свойств термопластического материала «Dental D» существенными преимуществами применения шины является сохранение физиологической подвижности зубов, комфортность в использовании и, как следствие, короткий срок адаптации. Применение данной конструкции на начальных стадиях заболеваний пародонта обеспечит стабилизацию состояния и будет способствовать снижению риска утяжеления патологии.Ключевые слова: пародонтит, шинирование зубов, шинирующие конструкции, термопластические материалы Авторы заявляют об отсутствии конфликта интересов. The authors declare no conflict of interest. Ортопедическая стоматология Orthopaedic Dentistry -56 -56 Адрес для переписки:Correspondence address:Евгения Павловна Рогожникова аспирант кафедры ортопедической стоматологии, Пермский государственный медицинский университет, Пермь, Россия rogozhnikova_ep@mail.ru 614045, Россия, г. Пермь, ул. Луначарского, д. 74Б-525 Тел. +7 (992) 230-00-63 Evgenia P. Rogozhnikova
Microflora of the oral cavity forms a biofilm that induces response of immune system at the mucous membranes. Transition to periodontal lesion is provided by certain classes of resident mucosal immune cells and inflammatory/immune cells migrating to the periodont. In periodontal diseases, Th1, Th2, Th17, Treg are detected. T regulatory cells (Tregs) are proven to comprise the main anti-inflammatory cell population. Th17 cells and Treg cells play an important role in osteoclast differentiation. IL-17 secreted by Th17 cells affects osteoclastogenesis and may induce macrophages to enhance the local inflammatory response. In this regard, the aim of our work was to identify the local immune cells in oral cavity which are associated with severity of chronic generalized periodontitis. The oral cavity cells from 58 persons aged 38-65 years of both sexes in their mature age with a diagnosis of «chronic periodontitis» were examined by means of flow cytofluorometry. When determining levels of CD64+CD16+CD14- neutrophils in the patients with periodontitis of different severity, a statistically significant increase of this cell population was revealed upon development of this disease. In mild cases of periodontitis, a significant increase of relative CD64+CD16+CD14- neutrophil contents was revealed (Me = 36.16%, p < 0.05) compared to the control group (Me = 7.7%, Q0.25 = 2.4%, Q0.75 = 12%). When assessing relative numbers of CD14+ monocytes in periodontitis of various severity, we revealed a significant increase in the number of these cells in severe cases. When studying levels of regulatory T lymphocytes (CD4+CD25+CD127low) in periodontitis of different severity, we revealed significantly decreased amounts of this cell population during development of the disease. In mild cases of periodontitis, a decreased level of CD4+CD25+CD127low cells (p < 0.05, Me = 1356 cells/ml) was revealed, as compared with control group (Me = 10666 cells/ml). Although the concentration of CD4+CD25+CD127low (Me = 4709 cells/ml) in the patients with moderate periodontitis was higher than the values in milder cases, the range of the main values was comparable and lower, than in control group. In severe periodontitis, a significantly decreased concentration of regulatory T lymphocytes was revealed (Me = 2637 cells/ml). These results confirm the anti-inflammatory regulatory function of Tregs. Understanding the osteo-immune mechanisms of bone remodeling control will help to understand the pathophysiology of accelerated bone loss observed in severe chronic periodontitis.
Новая коронавирусная инфекция COVID-19 осложняет лечение и ухудшает прогноз у пациентов с заболеваниями системы крови. Проанализировав опыт одного гематологического стационара, оценили влияние новой коронавирусной инфекции COVID-19 на течение заболеваний системы крови и исходы. В период с февраля 2020 г. по март 2021 г. всего в гематологическом стационаре лечилось 1150 пациентов, каждый из которых получал 3-4 курса полихимиотерапии. Общее число инфицированных новой коронавирусной инфекцией составило 186 пациентов (16,7%). Летальных исходов от общего числа получавших лечение составило 24,7%. Результаты клинических и гематологических исследований показали преимущественно неблагоприятное течение новой коронавирусной инфекции COVID-19 у пациентов с заболеваниями системы крови, а также неблагоприятный исход во всех исследуемых нозологических группах пациентов с COVID-19, находившихся на амбулаторном и стационарном лечении. Необходимо углубленно исследовать иммунный статус для выявления взаимосвязи с исходом заболевания. The new coronavirus infection COVID-19 complicates treatment and worsens the prognosis in patients with diseases of the blood system. After analyzing the experience of one hematological hospital, the impact of the new coronavirus infection COVID-19 on the course of diseases of the blood system and outcomes was assessed. In the period from February 2020 to March 2021, 1150 patients were treated in the hematology hospital; each patient received 3-4 courses of polychemotherapy. The total number of the infected with the new coronavirus infection was 186 patients (16.7%). The number of deaths from the total number of those receiving treatment was 24.7%. The results of clinical and hematological studies showed a predominantly unfavorable course of the new coronavirus infection COVID-19 in patients with diseases of the blood system, unfavorable outcome in all studied nosological groups of patients with COVID-19 who were on outpatient and inpatient treatment. It is necessary to investigate the immune status in depth to determine the relationship with the outcome of the disease.
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