Московский государственный медико-стоматологический университет им. А.И. Евдокимова Россия, 127473, Москва, ул. Делегатская, 20/1 В обзорной статье обсуждаются современные данные о влиянии патофизиологических характеристик хронической обструктивной болезни легких (ХОБЛ) на ремоделирование сердца при отсутствии сопутствующих сердечно-сосудистых заболеваний, факторов сердечно-сосудистого риска и хронической легочной гипертензии. Вопреки традиционным представлениям о преимущественном вовлечении в патологический процесс правых камер сердца у больных ХОБЛ результаты ряда исследований, проведенных в последние годы, свидетельствуют о непо-средственном участии легочной гиперинфляции и эмфиземы в нарушениях диастолического наполнения и морфологических параметров левого желудочка (ЛЖ). Основным механизмом диастолической дисфункции ЛЖ у больных ХОБЛ с выраженной гиперинфляцией и эмфи-земой является снижение преднагрузки на фоне ремоделирования легочного сосудистого русла, механическая компрессия камер сердца, которая повышает ригидность миокарда. Интересными, малоизученными и противоречивыми остаются вопросы гипертрофии миокарда ЛЖ у больных ХОБЛ без сопутствующей кардиальной патологии -легочная гиперинфляция, повышение жесткости сосудистой стенки и ак-тивация симпатоадреналовой системы рассматриваются в качестве возможных факторов ее развития. Применение спекл-трекинг эхокар-диографии позволяет выявлять субклинические нарушения систолической функции ЛЖ у больных ХОБЛ уже при умеренной степени брон-хиальной обструкции и без сердечно-сосудистых заболеваний. К значимым патофизиологическим механизмам формирования систолической дисфункции относятся саркопения, обусловленная активацией системных воспалительных реакций с развитием нарушений энергетического обмена, и хроническая гипоксия. Современная бронходилатирующая терапия ХОБЛ позволяет уменьшать выраженность легочной гипер-инфляции, в связи с чем необходимо активное изучение возможности воздействия фармакологической редукции легочных объемов на за-медление развития и прогрессирования дисфункции миокарда.Ключевые слова: хроническая обструктивная болезнь легких, диастолическая дисфункция, систолическая дисфункция, левый желудочек, эмфизема, легочная гиперинфляция, саркопения. The paper aimed to present evidence of the effect of some pathophysiological features of chronic obstructive pulmonary disease (COPD) on cardiac remodeling in patients free of overt cardiovascular diseases, traditional cardiovascular risk factors and pulmonary hypertension. Contrary to traditional beliefs that cardiac abnormalities in COPD have been mainly associated with the right ventricle, several recent studies have shown an independent effect of pulmonary hyperinflation and emphysema on left ventricular (LV) diastolic filling and LV hypertrophy. Pulmonary hyperinflation and emphysema cause intrathoracic hypovolemia, low preload, small end-diastolic dimension and mechanical compression of LV chamber which could worsen end-diastolic stiffness. Interestingly, that the presence of LV hypertrophy in COPD...
Study objective. To assess the association between intracardiac hemodynamics and airway obstruction with pulmonary hyperinflation in patients with chronic obstructive pulmonary disease.Materials and methods. Ninety-six patients with chronic obstructive pulmonary disease, aged 40 to 75 years, without concomitant cardiovascular disease, were examined and divided into 4 groups according to the severity of the disease. The patients underwent general clinical examination, spirometry, 24-hour pulse oximetry and echocardiography with assessment of linear and volumetric parameters, as well as diastolic function of left and right ventricles.Results. Linear and volumetric parameters of the left ventricle, LV myocardial mass and geometry in the examined patients with chronic obstructive pulmonary disease matched threshold values. The progression of the severity of chronic obstructive pulmonary disease was accompanied by decrease of the end-diastolic size of the left ventricle, ratio of peak early to late diastolic filling velocity for the left ventricle (E/A) without significant changes in the left ventricle isovolumetric relaxation time (IVRT). Moderate correlations of the inspiratory capacity with the end-diastolic size of the left ventricle (r=0.612; p=0.001) and the left ventricle E/A (r=0.464; p=0.001); forced expiratory volume in 1 second (FEV1) with the left ventricle E/A (r=0.600; p=0.011) were established. As a result of the logistic regression performed, the predictor value of the inspiratory capacity was confirmed (Wald χ2 — 5.795; р=0.024). Impairment of left ventricular diastolic function of grade I was revealed in 12 (31.6 %) patients in group 2, in 7 (24.1 %) patients in group 3, and in 9 (56.2 %) patients in group 4.Conclusion. Airway obstruction severity and pulmonary hyperinflation progression in patients with chronic obstructive pulmonary disease and without concomitant cardiovascular disease is associated with a decrease of left ventricular size and diastolic filling, contributes to the development of the left ventricular diastolic dysfunction, predominantly due to the decrease in filling velocity parameters.
One of the main problems of modern medicine is cancer, which is the second leading cause of death after cardiovascular disease. Malignant neoplasms have been known for a long time; however, their study still presents significant difficulties. Modeling of malignant processes in animals allow researchers to study tumors and the main patterns of malignant growth characteristic of animals and humans. The main cause of death in malignant neoplasms is the process of metastasis formation, which remains to be understood in detail. The study of metastatic processes is one of the most important tasks of oncology. To this end, various models of tumor metastasis are created. The article reviews literature data on the most popular models of metastasis in experimental conditions. The advantages and disadvantages of the main approaches to modeling metastasis are evaluated.
Despite significant successes in the development of medical sciences, the study of oncopathology issues still occupies a leading place due to the identification of a large number of advanced cases of the disease. Firstly, this may be due to the rapid growth of a malignant tumor, for example, against the background of immunodeficiency. Secondly, with late treatment of patients, when they already have distant metastases. The success of treatment of any oncological process primarily depends on the timing of the diagnosis: the earlier the tumor is diagnosed, the greater the chance of a positive outcome and an increase in the life expectancy of the cancer patient. The most formidable complication of oncopathology and the main cause of death from it is metastasis, which often reduces to zero all the effects of therapy. Metastasis remains a mystery today. So, despite the large number of various theories, the question of the spread of the tumor throughout the body has not yet been resolved. There is no definite answer to the question: do metastases metastasize? The mechanisms of the influence of hormones on the processes of metastasis have not been fully studied. Difficulties in diagnosis are associated with the lack of clinical manifestations before the appearance of metastases, the inability to track and compare changes in tissues and organs in vivo, the non-specificity of the results of available research methods, and the lack of control of the spread of metastases throughout the body. Experimental studies on laboratory animals can provide answers to these and many other questions. In a review of the literature, a study of the main issues of metastasis is conducted.
Mast cells play an important role in many processes occurring in the human body. These include inflammation, allergic reactions, parasitic infections, carcinogenesis and others. Therefore, the detection of mast cells plays an important role in the diagnosis of pathological conditions. The purpose of the study is to summarize data on imaging methods of mast cells. Materials and methods. Review of available literature sources published in Elibrary and PubMed. Results. There are several major groups of methods for finding mast cells: histochemical, enzyme-linked histochemical and immunohistochemical. All are based on the ability to detect specific substances contained in mast cell granules. Histochemical methods include Unno, alcian blue and safranin staining of mast cells and others. The most modern method is mast cell visualisation using immunohistochemical reactions based on antigen-antibody reactions. Conclusion. This review presents the most common methods of mast cell staining, differing in difficulty of performance, specificity in relation to mast cells and staining cost.
The adrenal gland is one of the first organs to respond to external influences. Cortisol, with its important properties affecting the immune system, proliferation and apoptosis in various tissues, is a significant indicator of such a pathological process as malignant growth. Selenium is a powerful antioxidant having an immunomodulatory action and exhibiting anticarcinogenic effects. In this paper, we investigate adrenal morphofunctional changes under experimental carcinogenesis against the background of urethane and selenium administration by determining blood cortisol concentrations and studying the aggregate morphometric index of adrenal glands. The study revealed that carcinogen introduction imitates the adaptation syndrome stages in the organism and is accompanied by changes in the cortisol level and aggregate morphometric index. Maximal values of the studied parameters were detected after 1 month of exposure to carcinogen, which indicated the development of the alarm phase. A further decrease in the indices after 2 and 3 months down to the intact level indicates the development of the resistance stage. A sharp decrease in the indices after 6 months shows the exhaustion stage. An isolated course introduction of selenium leads to a reliable decrease in the aggregate morphometric index practically in all terms that indicates the stress-relieving influence of the microelement. The combined effects of selenium and carcinogen revealed a dropout of the alarm stage, but rapid elimination of the micronutrient from the body could not prevent the development of the exhaustion phase after 6 months.
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