A scientific journal devoted to the systematic informing of doctors and scientists about the latest advances in medicine, the experience, and perspectives of diagnosis, treatment, and prevention of major diseases; coverage of the latest data on the etiology and pathogenesis and experimental research. It joins efforts of Ukrainian scientists and physicians in developing and implementing new methods of diagnosis, treatment, and prevention. The journal is included in the list of periodicals issued by the State Attestation Commission of Ukraine, contains articles recommended for publishing that include dissertational materials. ISSN 2415-8798 (Online), ISSN 1681-276X (Print)
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EFFICIENCY OF TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION AND COMORBID STATES IN REAL CLINICAL PRACTICE
The recommendations of the last 5 years underline the need to control concomitant risk factors in patients with arterial hypertension (АН) of high and very high risk. Antihypertensive (AHT) and prognosis-modifying therapy (PMT) in patients with AH should be prolonged and continued. One of the factors hindering this is poor patient‘s adherence to treatment. The clinical aspects of poor adherence include the polymorbid status of patients, which in connection with polypharmacy negatively impacts to persistence in following the recommendations of the doctor. The aim of the study – to evaluate the effectiveness and identify the factors of ineffective treatment of patients with AH and comorbid conditions in real clinical practice for the further development of methods for their correction. Materials and Methods. As а part of the research work “Detection of molecular genetic markers for selection, evaluation of the effectiveness of personalized pharmacotherapy for primary arterial hypertension with comorbid pathology” (state registration number 0114U007015, 2015–2019), 370 patients with AH of 1–3 grades, 31–88 years old, 164 (44 %) – men, 206 (56%) – women. At the inclusion of patients, it was assessed what AHT and its doses were prescribed, whether PMT was prescribed (statins, antiplatelet drugs), and their effectiveness. Charlson comorbid index was calculated. Results and Discussion. The clinical portrait of a patient with hypertension in the study was determined by multiple vascular and metabolic comorbidity. More than 3 concomitant pathological conditions had 90.5 % of patients, which was the cause of polypharmacy. Five or more medications were taken daily by 21.2 % of patients. However, 7.8 % of patients at the time of inclusion had controlled hypertension only. Uncontrolled blood pressure, low rate of PMP prescription (rennin-angiotensin system inhibitors – 63.5 %, statins – 35.1 %, antiplatelet drugs – 59.5 %), and the inappropriate intensity of the therapy with statins contributes to the complicated course of hypertension in comorbid patients. Conclusions. The strategies to improve adherence to the complex therapy of hypertensive patients with concomitant conditions and its individualization while coordinating the clinical pharmacologist are required to be developed.
STUDY OF ACTIVITY OF BIOCHEMICAL INDICATORS OF BONE METABOLISM IN MANDIBLE AFFECTED BY RADICULAR CYSTS IN PATIENTS WITH DIFFERENT MINERAL METABOLISM STATUS
In response to growing compression of the increasing volume of radicular cysts from adjacent bone tissue of the jaws, compensatory reorganization of the morphological structure of the spongy substance occurs – its consolidation, which is a morphological manifestation of the local adaptive reaction of the organism. However, in the case of violation of mineral metabolism (osteoporosis) in the bone tissue, morphological changes occur. In postmenopausal women, the expression of alkaline phosphatase decreases on the background of estrogen deficiency, the inhibitory activity of this hormone on osteoclasts is reduced, which is accompanied by an increase in the activity of acid phosphatase and, consequently, an increase in bone resorption. The aim of the study – to carry out a comparative assessment of the activity of biochemical parameters of bone metabolism in the regions of the mandible affected by radicular cysts in patients with a different state of mineral metabolism. Materials and Methods. All patients with radicular cysts of the mandible, depending on the state of mineral metabolism, were divided into two clinical groups: clinical group 1 included 21 patients (13 men and 8 women), in which no age-related violations of mineral metabolism were detected; clinical group 2 included 19 patients (14 women and 5 men), in whom age-related violations of mineral metabolism were detected – osteoporosis. Patients were determined the mineral density of bone tissue by using bone ultrasonic densitometry. On orthopantomograms of the facial skeleton localization and size of radicular cysts were revealed. The state of mineral metabolism in the lower jaw was evaluated on X-ray images by using the mandibular – cortical index (MCI) by Klemetti E. and co-authors. Materials for biochemical studies (determination of activity of alkaline and acid phosphatases, index of mineralization) were obtained by taking bone fragments from regions adjacent to the shells of the radicular cysts of the mandible during cystectomy operations. The statistical processing of the obtained research results was carried out using the statistical program of statistical calculations "Statistica 8". Results and Discussion. In patients with no mineral metabolism disturbances, in bone biopsy samples taken from sites affected by radicular cysts of the mandible, statistically significant (p <0.05) increase in alkaline phosphatase activity (ALP) was found, which directly correlated with the size of these tumorous formations. A statistically significant increase in the activity of acid phosphatase (AP) in these sites was also observed. For radicular cysts of large size, the activity of AP was the highest – (0.82±0.09) IU / g (p<0.005). However, the process of osteogenesis prevailed over bone resorption. The index of mineralization in the jaw regions undergoing chronic compression from tumor-shaped neoplasms increased in comparison with the intact bone. In patients with osteoporosis in the mandibles the processes of resorption over osteogenesis prevail. In the affected areas of the mandibles there was a statistically significant increase of the activity of the AP. In bone tissues exposed to large-sized radicular cysts, the activity of this enzyme increased by 2.4 times compared with intact bones – (1.27±0.13) IU / g (p <0.001). ALP activity also increased, but less intensive in comparison with similar clinical cases in patients without violations of mineral metabolism. The mineralization index of bone tissue increased only in the regions of the mandibles, adjacent to the radicular cysts of small sizes. In bone tissues adjacent to odontogenic cysts of medium to large size, this indicator progressively decreased from (14.60±1.33) units of account to (11.84±1.27) units of account, which, in our opinion, indicates an inadequate level of adaptive potential in jaw bones of patients with broken mineral metabolism. Conclusions. 1. In patients without violations of mineral metabolism in the bone tissues of the mandible, in response to the destructive effect of radicular cysts, there is a compensatory activation of the osteogenesis process (statistically significant increase in the activity of alkaline phosphatase), which is a local manifestation of the adaptive reaction of the organism in this disease. 2. In patients with osteoporosis in the jaw bones there is a decrease in the process of osteogenesis, under the influence of radicular cysts, resorption processes progress, and the activity of acid phosphatase increases statistically significantly, which correlates directly with the size of these tumor-like neoplasms.
EXPRESSION OF MARKERS OF EMOTIONAL-PAIN STRESS AFTER REMOVAL OF IMPACTED LOWER THIRD MOLARS IN PATIENTS WITH DIFFERENT INDIVIDUAL PSYCHOLOGICAL FEATURES
After removal of impacted lower third molars in patients there are pathophysiological changes in the organism, inflammatory (immune) reactions induced by an operating trauma. Acute inflammatory reaction in the maxillofacial area is accompanied by pain syndrome, edema of soft facial tissues, trismus, sensory disorders of the functions of the lower alveolar and/or lingual nerves. The appearance of the above clinical symptoms of damage of the tissues of the maxillofacial area often causes them psycho-emotional stress, reactive anxiety. Their severity depends on the individual-typological characteristics of each patient. The fundamental psychological feature of personality is neuroticism. The aim of the study – to learn the expression of markers of emotional-pain stress (reactive anxiety and content of cortisol and prostaglandin E2 in oral liquid) in patients with different individual psychological features (neuroticism) after removal of impacted lower third molars. Materials and Methods. In 30 patients aged 18–30 years (16 men, 14 women), atypical removal of the retained third molars was performed according to orthodontic indications (high surgery complication level according to Pederson scale). The level of neuroticism in patients was evaluated by their testing according to G. Eysenck's method. The postoperative reaction of the patients was evaluated for the severity of the pain syndrome, the swelling of the facial soft tissues, the degree of inflammatory-muscular contracture of the masticatory muscles according to H. Eysenck method, for a qualitative assessment of the pain, we used the McGill pain questionnaire. The degree of damage of the lower alveolar nerve was detected by measuring the electrical excitation of the pulp of the fang on the corresponding side of the mandible and the electrical potentials of the facial skin in the projection of the mental aperture. The determination of cortisol and prostaglandin E2 in the oral liquid of patients was performed in the preoperative period and for 1st and 5th days of the postoperative period by the method of ELISA. In order to determine the probability and correlation strength, Pearson correlation coefficient (χ2) was determined. Results and Discussion. It was found that patients, regardless of their level of neuroticism, in assessing the nature of acute pain, according to the McGill questionnaire, descriptors from the sensory scale prevail. In addition, patients with expressed level of neuroticism to characterize the pain sensation were also selected by descriptors from the affective scale. An increase in the content of prostaglandin E2 in the oral liquid was detected as inflammatory changes develop. Significant decrease of local clinical manifestations of acute inflammatory response directly correlated (χ2 = 26.53, р < 0.001) with a significant decrease in the oral liquid content of this biochemical marker of inflammatory response. The content of cortisol in the oral liquid of the patients was influenced not only by the severity of acute inflammatory reaction and the intensity of pain, but also by psycho-emotional factor. Conclusions. After removal of impacted lower third molars in the majority of patients with manifestations of neuroticism under the influence of severe acute inflammation and nociceptive pain appears psycho-emotional stress (reactive anxiety). Patients regardless of their level of neuroticism in assessing nociceptive pain predominate descriptors of sensory questionnaire McGill, to characterize neuropathic pain patients with high levels of neuroticism also use descriptors of affective scale. The level of prostaglandin E2 and cortisol in the oral liquid of patients depends on the severity of the acute inflammation and intensity of the pain syndrome in them. The level of cortisol in the oral liquid is also influenced by the level of neuroticism in patients.
THE PECULIARITIES OF PSYCHOLOGICAL DISADAPTATION OF PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE
The article presents up-to-date data concerning psychosomatic problem in medicine, in particular world experience of studying disorders of psychological of adaptation in patients with gastroesophageal reflux disease (GERD), as well as own researches data. When using psychological tests, detection rate of anxiety and depression in patients with GERD was 100 and 91.2 % respectively. The research studies revealed that presence of psychological dysadaptation in patients with GERD makes it impossible to achieve a stable remission of the underlying disease and necessitates appropriate correction. The aim of the study – to determine the specificity of psychological dysaptation of the patients with gastroesophageal reflux disease. Materials and Methods. 45 patients with GERD were under our supervision. To verify the diagnosis we used an endoscopic examination of the upper gastrointestinal tract that was performed using flexible Olympus-type fibrogastrostocks according to the generally accepted technique. Results and Discussion. Among 45 patients there were 31 women and 14 men, the age of patients varied from 19 to 70 years, the mean age was (45.67±2.32) years. The anamnesis showed that the duration of the disease varied from 7 months to 20 years. At the same time a history of 1 to 5 years showed more often: in 51.1 % of the patients. The average duration of illnesses of the examined patients was (7.77±1.35) years. Conclusions. According to MRI, changes in the psychological status of the examined patients with GERD were detected in 76.7 %. The most significant of them were: depression (63.3 %), hypochondria (43.3 %) and psychasthenia (20.0 %).
NEUROVASCULAR VIOLATIONS, MEDIATORIAL-VASCULAR INFLUENCES AT NEUROCONDUCTIVITY OF SPINAL RADIXES, ASPECTS OF THEIR CORRECTION
Spondylogenic compression of the spinal cord roots (SCR) leads to impaired blood flow in the epidural vascular plexus (EVP), blood stasis, edema, and local vascular inflammation with impaired endothelial function. In this process, ET-1, nitric oxide, interleukins, coagulation factors, and mediators of EVP violation are of great importance. They bind to specific receptors on the membranes of smooth muscle cells, cause dysfunction of the vascular endothelium, induce vasoconstriction, which is one of the mechanisms of the development of ischemia in the SCR. The aim of the study – to determine mediators of damage at the compression of epidural-vascular plexus (EVP) and to study opportunities of influence of choline alfoscerate at the process of neuroconductivity of spinal radixes. Materials and Methods. In 31 patients with chronic form of compression EVP on the background of common therapy and in 27 patients with acute compression EVP on the background of common therapy with including choline alfoscerate and in 29 practically healthy people who were included to the group of control, before and after treatment determined the changes of indexes of endotheline-1, metalloproteinase-1, informative molecules and molecules of adhesion sVCAM-1 і sICAM-1. Results and Discussion. Intercommunication was educed between the change of indexes of endotheline-1, increase of level of metalloproteinase-1, informative molecules and molecules of adhesion, that testified to immune-vascular inflammation that is one of mechanisms of compression of EVP. Under influence of choline alfoscerate there was marked the improvement of the state of patients, reducing pain intensity and restoring neuroconductivity. Conclusions. In the acute form of compression of EVP there was an increase in endotheline-1 and the expression of sVCAM-1 and sICAM-1, matrix metalloproteinase-1, interleukin-1β and tumor necrosis factor-α. The high level of these indicators, especially sICAM-1 and matrix metalloproteinase-1, may indicate an activity of vascular inflammation EVP and give opportunity to increase effectiveness of treatment. Clinical-laboratory changes verify restoration of neuroconductivity under the effect of choline alfoscerate in patients with compression of spinal radixes.
FEATURES OF STRUCTURAL RECONSTRUCTION OF ARTERIES OF THE TONGUE AT DESQUAMATIVE GLOSSITIS
Desquamative glossitis is often found in the clinic, and its diagnosis is not easy. At glossitis the structure of the tongue is changing and the important role of arterial bed plays in it which in this pathology is not investigated enough. The aim of the study – to learn morphometric age characteristics of structural reconstruction arteries of the tongue at desquamative glossitis. Materials and Methods. The research was conducted on 60 sexually mature male rats, which were divided into 4 groups. The group 1 consisted of 15 intact animals at the age of 8 months, group 2 – 15 rats at the age of 24 months, and group 3 – 15 animals aged 8 months with desquamative glossitis, group 4 – 15 animals aged 24 months with desquamative glossitis. Euthanasia of animals was carried out by bloodletting in conditions of thiopental anesthesia 2 weeks after the beginning of the experiment. Histological micropreparations were made from the tongue. The morphometry of the arteries of the middle (51-128 μm) and small (26-50 μm) calibers was conducted, measuring external, internal diameters, thickness of the media and adventitia, height of endothelial cells, diameter of their nuclei, determining the Kernogan index, the relative volume of damaged endothelial cells. Quantitative indicators were processed statistically. Results and Discussion. It was found that the arteries of the small caliber of the tongue at desquamative glossitis changed in a greater degree compared with the arteries of the middle caliber. The average diameter of the arteries of the middle caliber in the group 3 of rats decreased by 8.8 %, and in the group 4 – by 11.9 % (p <0.001), the thickness of the media increased by 7.8 % and 8.2 % (p <0.001), and the thickness of adventitia – by 25.6 % and 68.1 % (p <0.001). The Kernogan index of small caliber arteries at desquamative glossitis decreased by 21.6 % in the observations of the group 3, and in the experimental animals of the older age group by 26.7 % (p <0.001). The narrowing of the lumen of these arteries, the thickening of their walls, the pronounced reduction of the Kernogan index showed a significant decrease in the throughput of the examined vessels and deterioration of the blood supply to the organ. At desquamative glossitis, the height of the endothelial cells of the artery of the tongue of small caliber in animals of group 3 decreased by 4.6 %, and in the group 4 of rats – by 5.6 % (p <0.01). The diameter of the nuclei of the studied cells in these experimental conditions was almost unchanged, but they were violated by nuclear-cytoplasmic relations. Thus, in the group 3 of observations, the indicated morphometric parameter increased by 8.9 %, in the group 4 – by 12.6 % (p <0.05). It should be noted that changes in the nuclear-cytoplasmic relations in the endothelial cells of the arteries indicated a violation of structural cellular homeostasis. In the group 3 of observations, the relative volume of damaged endothelial cells with a significant statistically difference (p <0.001) increased by 6.6 times, and in the group 4 – by 7.36 times (p <0.001). The performed researches and the received results testify that desquamative glossitis leads to the expressed structural reconstruction of tongue arteries, which is characterized by thickening of their walls, narrowing of lumen, decrease in bandwidth, violation of cellular structural homeostasis and increase of relative volumes of damaged endothelial cells. More pronounced structural changes at desquamative glossitis were found in small caliber tongue arteries and in animals of the older age group. Conclusions. Desquamative glossitis in laboratory white male rats is accompanied by pronounced structural rearrangement of the arteries of the tongue, characterized by thickening of their walls, narrowing of the lumen, decreased vascular capacity, cellular structural homeostasis, endothelial cell damage, endothelial dysfunction, and stroke of blood supply to the organ. More pronounced structural changes at descquamative gloslitis are detected in small caliber tongue arteries and in experimental animals of the older age group.
IMPACT OF METFORMIN ON THE EXPRESSION OF α- AND β-MHC GENES AFTER MYOCARDIAL INFARCTION IN MICE
Type 2 diabetes is diagnosed in more than 65 % of patients who die as the result of cardiovascular disease. Metformin is a drug of choice for the treatment of type 2 diabetes which exerts cardioprotective effects. However, the molecular mechanisms of cardiomyocyte protection remain unclear and require further study. Hypertrophy of cardiomyocytes plays a leading role in the development of heart failure and is considered to be the result of imbalance between prohypertrophic and antihypertrophic factors and their mechanisms which control cell growth. In case of heart failure and hypertrophy, dysfunction of α-MHC and β-MHC genes occurs. Normally, α-MHC is a dominant isoform, however, when cardiac dysfunction occurs, the β-MHC gene is upregulated. The aim of the study – to investigate the effects of metformin on hypertrophy of cardiomyocytes and the expression of α-MHC and β-MHC genes after myocardial infarction in mice. Materials and Methods. C57BI/6J type mice were exposed to ischemia/reperfusion injury. To assess the translational potential of metformin study was designed to determine whether treatment with metformin in a dose of 5 mg/kg/day, initiated 15 minutes after the onset of reperfusion and maintained for 14 days induced cardioprotection in mice subjected to cardiac I/R. Cardiac sections were stained with hematoxylin and eosin. The evaluation of cardiac structural alterations was performed using ImageJ software. α-MHC and β-MHC expression levels were measured using quantitative RT-PCR analysis. Results and Discussion. Ischemia/reperfusion injury caused hypertrophy of the cardiomyocytes. Histological analyses of cardiac sections stained with hematoxylin and eosin demonstrated a significant decrease in myocyte hypertrophy in metformin-treated mice as compared with vehicle-treated mice. In addition, ischemia/reperfusion induced β-MHC upregulation, although there was no significant change in α-MHC expression. It was found that metformin has no effect on the expression of α- and β-MHC genes. Conclusions. Metformin protects cardiomyocytes from hypertrophic remodeling after myocardial infarction in mice. This cardioprotective effect is provided independently of α- and β-MHC pathways.
FEATURES OF ANGIOARCHITECTONICS OF LIVER VEINS IN RATS AND REMODELING WITH POISONING BY ACETYLSALІCYLІС ACID
The problem of development of toxic liver damage, in recent years has become more actual. Increasingly, there is a phenomenon of medicinal (toxic hepatitis), which develops as a result of receiving a single large dose of the drug or prolonged use, both under the supervision of a doctor and without him. Nonsteroidal anti-inflammatory drugs (NSAIDs) is a pharmacological group that, along with antimicrobial agents, appears massively in the prescriptions of doctors around the world. Among them, acetylsalicylic acid is one of the most widespread substance, which can be found in many drugs that can be purchased or obtained without prescription. The aim of the study – to learn, describe and illustrate the peculiarities of the spatial organization of liver veins in intact, sexually mature rats and their reorganization when poisoned with acetylsalicylic acid. Materials and Methods. Experiments were performed on 42 white laboratory mature male rats. Among them, 6 animals were a control group. 6 rats were given once intragastric acetylsalicylic acid at a dose of 500 mg per 1 kg of body weight for the simulation of severe toxicity. Another 30 rats received intragastric acid acetylsalicylic acid per day at a dose of 150 mg per 1 kg of body weight for the simulation of chronic intoxication. Results and Discussion. In the simulation of severe toxicity in the first day of the experiment, all animals died. At the same time, on their contrasting radiographs, significant changes were observed in the angioarchitectonics of liver veins. They were manifested by the pronounced enlargement of the lumen of the veins of all contrasted orders, which was visually confirmed by the strengthening of the vascular pattern due to the deeper contrast of the small branches, as well as the results of their quantitative analysis. Conclusions. Major changes occur when take place acute poisoning with high doses of acetylsalicylic acid. In chronic poisoning, the changes are less pronounced and are in several stages. The obtained quantitative indices of hepatic veins and venous collectors can form the basis for comparing and determining the degree of changes in the liver of rats in the experimental modeling of pathological processes.
CHANGES OF LIPID PEROXIDATION AND ANTIOXIDANT DEFENSE OF HIGH AND LOW-RESISTANCE TO ACUTE HYPOXIC HYPOXIA IN RATS OF DIFFERENT SEX IN IMMOBILIZATIONAL STRESS
Determining the mechanisms of damaging the influence of stress on the heart in persons with different reactivity can contribute to the development of individual methods of correction. The aim of the study – to determine the effect of immobilization stress on changes in peroxide lipid oxidation and antioxidant defense in rats of different sex with high and low resistance to hypoxia (HR, LR). Materials and Methods. Stress was modeled 4 times by an hour immobilization of rats on a back down with an interval of 24 hours. In the heart, the diene and triaene conjugates, schiff bases, TBA-active products, superoxide dismutase (SOD), catalase activity in heart and ceruloplasmine and activity of peroxides were determined. Results and Discussion. In control males with high resistance to hypoxia, in comparison with LR, lower activity of lipid peroxidation, higher activity of SOD, concentration of ceruloplasmine, blood peroxides were observed; in HR-females, in comparison with LR, more diene and triene conjugates, schiff bases, SOD, ceruloplasmine and activity of peroxides; less TBA-active products and catalase activity. Immobilization led to an increase in all investigated products of lipid peroxidation (in all groups of animals the TBA-active products increased the most intensively). The females also significantly increased the schiff bases. This indicates the development of oxidative stress, which is more pronounced in males than in females. In females, lipid peroxidation products metabolize faster, than in males. At the same time, the antioxidant link was activated: the superoxide dismutase activity (more in low resistance to hypoxia animals) and catalase activity (more in high resistance to hypoxia individuals) increased maximally in the females, and in males, the concentration of ceruloplasmin (most notably in low resistance to hypoxia animals). The peroxidase activity of blood decreased in all observed groups of animals. Conclusions. Immobilization of rats leads to oxidative stress in the heart, but the mechanisms of their development, adaptation and compensation depend on resistance to hypoxia and sex.
PECULIARITIES OF ATRIAL CARDIOMYOCYTES’ ULTRASTRUCTURAL REORGANIZATION AT EXPERIMENTAL THERMAL INJURY AND IN CONDITIONS OF APPLICATION OF LYOPHILIZED XENOGRAFT SUBSTRATE
In developed countries burn injury is one of the most common type of damage in peacetime. Treatment of burns is determined by complexity and multiplicity, thermal trauma – is one of the most dangerous, it leads to the destruction of complex proteins – the basis of cells and tissues of organs. The cardiovascular system plays a key role in the development and pathogenesis of burn disease, which develops after a thermal injury of the third degree. The aim of the study – to establish ultrastructural reorganization of atrial cardiomyocytes after severe thermal trauma and the combined application of lyophilized xenograft substrate. Materials and Methods. Burns of the third degree were applied under ketamine anesthesia with copper plates heated in boiling water to a temperature of 97–1000C. Euthanasia of animals was perfomed after ketamine anesthesia, by decapitation. The size of the lesions was 18–20 % of the guinea pigs epilated body surface. For electron microscopic examination, atrial pieces were taken, fixed in a 2.5 % glutaraldehyde solution, postfixed with 1 % osmium tetraoxide solution in phosphate buffer. Further processing was carried out according to the standard technique. Ultrathin sections made on LKB-3 ultramicrotome were contrasted with uranylacetate, lead citrate according to the Reynolds method and studied with a PEM-125 K electron microscope. Results and Discussion. During experiment submicroscopic changes of atrial cardiomyocytes after severe thermal trauma under condition of early necrectomy and the combined application of lyophilized xenograft substrate to cover the burn wound were investigated. It was established that after burning of the III degree there are significant ultrastructural changes in atrial cardiomyocytes, the damage degree of which increased in the dynamics of the experiment. In the stages of burn shock and early toxemia adaptive-compensatory processes are developing in the structures of the heart, and in the stages of late toxemia and septicotoxemia there are deep irreversible destructive changes. It was proved that the application of lyophilized xenograft substrate after the early necrectomy of damaged tissues prevents the development of destructive changes in the components of the heart in the early stages of the experiment, activates the regenerative processes of the contractile and endocrine atrial myocytes at the late stages of the experiment. Conclusions. The use of lyophilized xenograft substrate has a positive effect on the course of regenerative processes and improves the state of the atrial ultrastructure in the dynamics of the experiment. In the early stages of the experience of using lyophilized xenoskin, the degree of damage to the cytoplasmic membranes of atrial cardiomyocytes is reduced, and regeneration processes in the cells are activated.
MORPHOLOGICAL CHANGES IN THE SMALL INTESTINE OF RATS WITH ACUTE GENERALIZED PERITONITIS
The main cause of mortality in acute generalized peritonitis (AGP) is the development of multiple organ insufficiency. The intestine is the organ where the first changes develop in this pathology. The aim of the study – to research and evaluate the morphological changes in the small intestine wall of animals with experimental AGP. Materials and Methods. 32 white rats were used in this study. Acute peritonitis was modeled by introduction of 10 % fecal suspension in the dosage of 0.5 ml per 100 g of the animal's weight into the abdominal cavity of rats by puncture. The terms of observation: the 1st, 3rd and the 7th days from the beginning of the peritonitis modeling. For histological study the intestinal tissue was taken. The resulting pieces of the organ were fixed in a 10 % neutral formalin solution, which were then stained with hematoxylin and eosin. Results and Discussion. On the 3rd day of the experiment in animals with a modeled AGP, vascular changes were manifested first of all by the rounding (retraction) of endothelial cells or their desquamation and the appearance of defects, that allow plasma proteins and the formed elements of blood to leave circulation boundaries of the vascular bed. On the 7 th day in animals with a modeled AGP increased vascular permeability of the mucous membrane of the small intestine was accompanied by a significant edema of the stroma of the villi and by focal hemorrhages. Conclusion. Consequently, the distinct inflammatory changes in all terms of the injury were seen in the wall of the small intestine at the simulated AGP. The significant expansion of the capillaries and venules against the background of inflammatory infiltration in the stroma of the glandular component of the small intestine was noted on the 1st day from the beginning of the experiment. An increase in the height of intestinal villus and a crypt with retraction and desquamation of endothelial cells in the wall of vessels, which caused platelet adhesion in the areas of destruction was observed on the 3rd day. The areas of focal necrosis of the superficial epithelium, which were accompanied by multiple hemorrhages per diapedesis in the perivascular space of the mucous membrane, were seen in the wall of the small intestine of animals with a simulated AGP on the 7th day.
FEATURES OF CLINICAL COURSE OF ACUTE CORONARY SYNDROME CAUSED BY THE CORONARY SLOW FLOW PHENOMENON (REVIEW OF LITERATURE AND DESCRIPTION OF THE CLINICAL CASE)
The coronary slow flow phenomenon (CSFP) – is a microvascular injury, which consists in delayed coronary blood flow (movement of contrast agents) in coronary arteries without their significant stenosis. The main causes of CSFP are structural and functional disorders in the system of coronary microcirculation due to endothelial dysfunction, diffuse calcification or non-obstructive atherosclerosis, hibernation of the hypoxic myocardium. The lack of clear criteria for diagnosis and adequate treatment programs justify expediency of accumulation of clinical material and research of mechanisms of its development. The aim of the study – to analyze the clinical case of the development of acute coronary syndrome in a patient with angiographically diagnosed coronary slow flow phenomenon, to investigate the features of the clinical course of coronary syndrome Y and optimize its treatment and prevent the development of complications. Results and Discussion. The introduction of diagnostic coronary angiography makes it possible to conduct a differential diagnosis of microcirculatory disturbances of coronary blood flow, as well as to assess the adequacy of the proposed treatment. The given clinical case is characterized by the typical clinical symptomatology of acute coronary syndrome in the absence of an angiographic atherosclerotic changes in coronary arteries, patient – woman 66 years old. The proposed treatment with Nebivolol, Rosuvastatin and the combined metabolic drug – Levocarnitine and Arginine gave a rapid clinical effect, which was manifested by the disappearance of symptoms of ischemia and the absence of chest pain. Conclusions. Thus, microcirculatory disturbances, in particular the coronary slow flow phenomenon, play a significant role in the pathogenesis of acute coronary syndrome, which should be taken into account in the diagnostic algorithm for the management of such patients. The main differential diagnostic criterion in such cases is coronary angiography, and in the complex treatment it is necessarily to include beta-blockers, statins and metabolically active agents – Levocarnitine and Arginine, which have endothelial normalizing and energy-myocardiocyte protective properties.
CONCOMITANT ISCHEMIC HEART DISEASE AS A FACTOR OF REDUCED QUALITY OF LIFE IN PATIENTS WITH CHRONIC PANCREATITIS
The urgency of the problem of chronic pancreatitis is increasing due to the fact that in 15.5 % of patients with diseases of the gastrointestinal tract, including pancreatitis, there is coronary heart disease. The high medical and social significance of both chronic pancreatitis and coronary heart disease is determined by their significant contribution to the pathology of people of social active age, high costs of diagnosis and treatment, decreasing the quality of life. The aim of the study – to learn and compare the quality of life of patients with chronic pancreatitis regarding patients with comorbi­dity of chronic pancreatitis and coronary heart disease. Materials and Methods. The study included 52 patients with chronic pancreatitis with coronary heart disease and 30 patients with isolated chronic pancreatitis. The quality of life of all patients were evaluated by using a common medical questionnaire – the Medical Outcomes Study 36-Item, and a specialized gastroenterological questionnaire the Gastrointestinal Symptom Rating Scale. Results and Discussion. During the study, a significantly lower quality of life in patients with comorbidity of chronic pancreatitis and coronary heart disease as a psychological and physical component of health (according to the questionnaire SF-36) was established (p<0.05). Analyzing the data of the patients in the main group using the GSRS specialized gastroenterology questionnaire, it was established that the leading place in the clinic of the disease is pain, dyspepsia and diarrhea syndromes (p<0.05). Conclusion. Рatients with chronic pancreatitis concomitant with coronary heart disease had a significantly lower level of quality of life scores on all scales as by a questionnaire Medical Outcomes Study 36-Item and by gastroenterological questionnaire the Gastrointestinal Symptom Rating Scale in regarding to the group of patients with isolated chronic pancreatitis.
FUNCTIONAL STATE OF AUTONOMOUS NERVOUS SYSTEM IN YOUNG WOMEN
Determination of heart rate variability is considered affordable, non-invasive, relatively simple and relatively inexpensive for autonomic nervous system evaluation today. Most researchers consider it as an integral marker that reflects the state of all regulatory systems of the body. Changes in the vegetative balance in the form of activation of the sympathetic link are considered as a non-specific component of the adaptive reaction in response to various stress actions. In recent years, the number of people with reduced adaptive capabilities of the organism has increased – with the disadaptation of the regulation of functional systems, which leads to the disruption of the corresponding mechanisms. The aim of the study – to evaluate the status of the autonomic nervous system in female foreign-born junior students of medical faculty. Materials and Methods. The study involved 20 female non-native female students of the 2–3rd year of the medical faculty at the age of 18–22 years. Registration of the heart rate variability was carried out in conditions of physiological rest, after a 10-minute rest, and in conditions of active orthostatic test according to the well-known method with the help of the computer diagnostic complex "CardioLab" ("KhAI-Medika", Ukraine). Results and Discussion. The results of the analysis of heart rate variability in a state of physiological rest indicate that the students are characterized by the values ​​of cardiac rhythm variability for healthy individuals, and in response to orthostatic test, the probable increase in the activity of the sympathetic link of the autonomic nervous system LF is (261±187) ms, LF % to (12.6±0.6) % (p <0.05) and decreased parisympathetic effects: RMSSD by (9.4±12.7) ms, pNN50 % by (21.1±5.1) %, HF by (481±83) ms (p <0.01), and HF % by (14.2±2) % (p <0.05) on the cardiac rhythm. The sympathic-vagal balance indicator has increased by (3.04±2.5). Conclusions. The functional status of the autonomic nervous system in young female students of foreign countries is characterized by a balanced activity of all its units. The use of orthostatic test in the study of heart rate variability allows better analysis of the state of vegetative tone and to detect hidden disorders of autonomic nervous system functions.
IMPLEMENTATION OF "FAST TRACK SURGERY" PRINCIPLES INTO URGENT SURGERY OBSTRUCTIVE OBSTRUCTION OF THE COLON OF TUMOR GENESIS
One of the potential directions for improving the direct results of treatment of patients with obstructive obstruction of blastomatous genesis is the integration of modern achievements of planned colorectal surgery in the form of concepts "Fast track surgery" or ERAS into surgical protocols of emergency care to patients with this pathology. The aim of the study – to improve the results of surgical treatment of patients with obstructive obstruction of the colon of blastomatous genesis by introducing the principles of "Fast track surgery" in the algorithms of treatment of patients with this pathology. Materials Methods. The results of treatment of 127 patients with obstructive obstruction of the colon of tumor genes undergoing treatment at the surgical clinic No. 3 for the period of 2009–2018 were analyzed. The patients were subjected to urgent surgical interventions with the attraction of the multimodal program "Fast track surgery". Results and Discussion. The efficiency of the application of separate elements of the "Fast track surgery" multimodal program in the urgent surgical treatment of the specified pathology in the pre-, intra- and postoperative period is presented and proved. Thus, the use of Ultracision ultrasound scissors (Ethicon) and Liga Sure (Covidien) and EC-300 M1 welding electrodes allowed shortening the operating time intervals from (3.5±0.2) to (1.5±0.4) hours. The average bed day of the recovered patients was (13.4±2.7) days. There were no deaths among the group of patients who had been surgically interrupted in a timely manner. The average bed-day was (8.3±1.8) days, while in the group of patients, who were used during the treatment of laparoscopic technology, the average bed-day was (5.4±1.3) days.
THE USE OF STRESS-TEST DURING SONOGRAPHY IN THE EARLY DIAGNOSTIC OF THE INJURY OF THE LATERAL GROUP OF LIGAMENTS WITH THE INVERSION TRAUMA OF ANKLE JOINT
The acute damage to the connective apparatus of the ankle joint is one of the most common types of injuries in the musculoskeletal system. In this type of damage mainly involves the lateral ligamet complex which includes the anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament. The ultrasound has a number of advantages over additional research methods such as CT and MRI to rate the condition of the ligament apparatus of the joints, mainly its ability to assess the state of the relationship with the use of stress tests in real time. The aim of the study – to evaluate the possibilities of ultrasound research using stress tests at various degrees of damage to the lateral group of ligaments of ankle joint due to acute inversion trauma. Materials and Methods. The study involves 43 patients, aged from 19 to 48 years with a severe inversion traumatic involvement of the ankle joint, of whom 26 (60.47 %) men and 17 (39.53 %) women. The average age of the patients was (26.3±4.8) years. The examination in most cases was carried out on 4–6 days from the moment of injury after primal examination of the orthopedic traumatologist. The tests were conducted by Aloka SSD 2000 and Acuson Antares (Siemens) using high-frequency broadband sensors with a working frequency of 7–12 MHz. In the course of clinical and sonographic examination the following results were obtained: Ligament damage of I degree was detected in 12 (27.90 %) patients. Partial communication gap (II degree), was found in 26 (60.47 %). Damage of the III degree (severe) is a complete break of the connection with significant pain, edema and hematoma was found in 5 (11.63 %) people. Conclusions. Sonography using stress tests is a valuable method of diagnosing different degrees of damage to the lateral group of ligaments of ankle joint in acute inversion trauma in real time. The obtained results require further research and technological improvement of the stress test method in case of damage to the lateral ligaments group of the ankle joint. The obtained results require further research in order to develop technological equipment and improve the method of conducting a stress test, which will improve the quality of the results of sonography of the lateral group of lagaments with acute inversion trauma of the ankle joint.
MORPHOLOGICAL FEATURES OF UTERINE POLYPS IN FEMALES OF REPRODUCTIVE AGE
According to modern views based on evidence-based medicine, the concept of "poly-endometrium" is defined as a benign, exophytic nodophilic formation of the uterine mucus that consists of glands and stroma, predominantly fibrous, containing a "tangle" of thick-walled blood vessels. The aim of the study – to learn the morphological features of tissues of polyps of the body of the uterus and endometrium with the establishment of the role of inflammatory factor in the pathogenesis of hyperproliferative changes in women of reproductive age. Materials and Methods. The article presents the results of a survey of 62 patients of reproductive age with polyps in the body of the uterus. The presence of the glandular component in 79.03 % of cases, fibrotic polyps – 12.9 %, and micro-polyps – 8.06 % were determined, respectively. The combination of polyps with non-atypical endometrial hyperplasia was detected in 80 % of patients with micro-polyposis, in 63.6 % of women – with glandular-cystic polyps of the uterine body, in 44.4 % of the examined – with glandular-fibrous endometrial polyps and in 37.5 % of patients – with fibrous polyps. Immunohistochemically, CD138 expression was detected both in the tissues of the polyps of the uterus and adjacent endometrial tissues in 43.5 % of cases, which became a marker of the chronic endometritis in the part of the surveyed, which formed the basis of the pathogenetic approaches in the treatment of such a pathology. For processing data standard procedures using Microsoft Excel were used. The research was conducted in the Laboratory of Pathomorphology of the Department of O. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the National Academy of Medical Sciences of Ukraine, head of the department – Corresponding Member of the National Academy of Medical Sciences of Ukraine, Professor T. Zadorozhna. Results and Discussion. In clinical analysis of complaints of polyps of the body of the uterus, clinical manifestations in the form of menstrual cord disturbance were 13 (20.97 %) patients, in 11 (17.74 %) patients there were no complaints about the desired pregnancy, at the same time as 38 (61.29 %) women were asked to carry out a preventive examination, which does not contradict the results of other researchers. During the morphological study, we established the following features of the polyps of the body of the uterus in women of reproductive age: the most frequently tested polyps of the body of the uterus, which had the glandular component – in 49 (79.03 %) cases, of which the glandular-cystic structure was found in 22 (35.48 %) of patients, the glandular-fibrous structure was in 27 (43.55 %) patients, approximately the same values ​​were found in fibrous polyps of the body of the uterus – 8 (12.90 %) of women and micropolymers of endometrium – in 5 (8.06 %) cases respectively. We found that in all groups of patients with polyps in the body of the uterus, there were signs of non-atypical hyperplasia of the endometrium. It should be noted that, according to literature, endometrial polyps larger than 15 mm were associated with hyperplasia. The above data is an important indication that the unidirectional determination of the positive expression of the CD138 inflammatory marker, both in the tissue of the polyp of the uterus and in the endometrial tissue, indicates the unity of the inflammatory factor in the pathogenesis of hyperproliferative processes and proves the significant role of the inflammatory process in the development of its pathological conditions and justifies the necessity take into account this fact in approaches to the tactics of patient management. Conclusions. The results of the conducted morphological and immunohistochemical research indicate that the basis of the formation of polyps of the body of the uterus is the inflammatory process, which is confirmed morphologically with the presence of chronic endometritis and a positive reaction to CD138. The study of pathogenetic mechanisms for the formation of endometrial pathology is a key factor in the development of methods for correction of these pathological processes, which thus allows to increase the efficiency of treatment and preserve reproductive health.
ASSESSMENT OF THE POSSIBILITY OF SHORT-TERM STORAGE OF PLACENTA EXPLANTS FOR REGENERATIVE MEDICINE
Placental cells, tissues and biologically active substances are promising objects for an effective treatment of pathological conditions of the endocrine, immune and nervous systems. For clinical use of placental derivatives it is necessary to develop methods for their short-term storage and transportation from the clinic to the biotechnological laboratory and in the opposite direction. The aim of the study – to determine the possibility of subnormothermic (+20°C) and hypothermic (+4°C) storage of placenta explants. Materials and Methods. Explants were obtained from placentas after a cesarean section. Explants were stored in culture medium under hypothermic and subnormothermic conditions for 96 hours. Explants structure was histologically evaluated every 24 hours, as well as metabolic characteristics of explants according to the tests for the recovery of resazurin, MTT and glucose consumption test. Results and Discussion. Under subnormothermic conditions placenta explants were found to retain structure, viability and metabolic characteristics for 48 hours; under hypothermic conditions the term of storage is reduced to 24 hours. Typical lesions of placenta explants are reduction of the villi and intervillous spaces, and trophoblast detachment. Recommendations for the short-term storage of placenta explants were developed. Conclusions. Thus, it was defined that finding (transporting) placenta explants in subnormothermic conditions for up to 48 hours in culture medium ensures the safety of their properties and determines the effectiveness of their clinical use.
MORPHOLOGICAL RESEARCH OF PLACENTA IN WOMEN WITH PRETERM LABOR
Preterm labor is one of the most current problems of modern medicine. Preterm labor is defined as the birth of a child in the gestation period less than 37 full weeks of gestation and is the second most common cause (after congenital anomalies) of neonatal mortality [3]. The highest percentage of morbidity and mortality occurs in children born to gestational age less than 32 weeks, although the proportion of these newborns is 16 % of all preterm infants [4]. Preterm labor is a polyetiology problem that depends on many factors. One of the major problems is the formation of placental dysfunction, which manifests itself by morphofunctional changes in the placenta associated with violation of uterine-placental circulation. The aim of the study – to obtain the peculiarities of placentas’ histological condition in women with burdent anamnesis and preterm labor with different Apgar point scale of newborn. Materials and Methods. A total of 19 placentas of women with preterm labor were observed in Maternal Hospital No. 5 of Odesa, Ukraine. We studed their residence areas, obstetrical and gynacology anamnesis, current pregnancy and labor anamnesis. We exa­mined the ultrasound datas of the newborns, studied their anthropometric, Apgar scale and histology of placentas’ datas. All interviewed women were devided into two groups: less than 35 years old – 12 women of the group 1 and more than 35 years old – 7 women, it was the group 2. The average age of the examined groups was 31.3 years old. Statistical datas processing was carried out by using the Fisher angular transformation. The degree of probability (P) between two comparative values was considered to be statistically valid when P<0.05. The research results showed that all elder women were married, lived in ecoregions of the city, had more often revolved to artificial reproductive technologies, had singleton gestation compared to younger group of patients. Newborns of women afer 35 had better points of Apgar scale and no one had IUGR compared to newborns of the younger women. Signs of placenta dysfynction were detected in placentas of both groups of women. Conclusions. In our investigation the women of different age groups with preterm labor had signs of placenta dysfunction but women after 35 years had better datas of newborn babies according to Apgar scale and absence of IUGR. Probably, it is connected with residency, official marriage and better preconceptional preparation in this group.
HEALTH MONITORING BY FUNCTIONAL INDICATORS WITH SENSORS ASSISTANCE IN REHABILITATION MEDICINE: SYSTEMATIC REVIEW
At present, people’s need for rapid and effective rehabilitation processes is growing significantly. People with limited functional capabilities need sensor devices that are used for rehabilitation in order to improve human health and to return to a decent standard of living. Sensory devices are used for the health monitoring system of people that are divided into portable and movable. After all, rehabilitation treatment requires patients of different age groups with cardio-pulmonary pathology, neurological disorders, orthopedic disorders, etc. The article covers electromechanical, electric, optical and thermal sensors, acoustic signal transducers or sensitive sensors, sensors and their application at different stages of rehabilitation. The aim of the study – to conduct an analysis of modern domestic and foreign literature on types of sensors in rehabilitation medicine. Materials and Methods. The study used biblio-semantic and analytical methods in the following electronic databases: Science Direct, PubMed, Scopus and Google Scholar. When looking for an article, annotations are analyzed. Inclusion criteria were: (1) physical and medical rehabilitation and / or auxiliary system supported by sensors and computer, (2) systems developed for the human body, and (3) documents written in English. If the expected criterion was found, the full text was reviewed. Results and Discussion. During the study, a systematic review and analysis of recent publications, mainly foreign scientific medical, biological and technical literature on the types, principles of work, development and the possibilities of using sensors in rehabilitation medicine was conducted. Sensory technologies continue to be fully developed and offer convenient opportunities to use to improve the functional state of health. A wide range of studies included and reflected in this review included various types of sensors. To date, devices used to monitor physical activity are divided into sensors that measure biological parameters such as pressure, heart rate, respiratory rate - pulse meter, tonometer, spirometer and motion sensors – pedometers, accelerometers, trackers of activity. Some of the most commonly used sensors used in rehabilitation are electromyography, galvanic skin reaction, electrocardiography, electroencephalography and sensory sensors and systems that control motor and physiological activity of a person. The article for examples considered: 1 – a typical algorithm for the operation of devices for monitoring the functional state of human health, 2 – diagnostic tool ALLADIN with sensors, which includes nine components. In the electronic databases: Science Direct, PubMed, Scopus and Google Scholar, no previously published work was found whereby the authors synthesized a combination of sensors with hardware, robotic, computer, and rehabilitation systems for patients of different ages. Conclusions. In the analysis of modern domestic and foreign literature on types of sensors in rehabilitation medicine, the development and application of sensor devices in physical and medical rehabilitation has been studied and described. All publications indicate that sensory sensors are attached to devices that allow measuring functional performance of a person's health. Therefore, sensory technologies in rehabilitation medicine continue to develop in a comprehensive manner and are frequently used to diagnose, assess and monitor the health of a person.
OCCULT HCV-INFECTION (LITERATURE REVIEW)
Occult HCV infection, a form of infection that is defined as the presence of RNA in hepatocytes with the presence of HCV RNA in serum or plasma, in the presence or in the absence of HCV antibodies using usual laboratory tests. Detection of RNA in mononuclear cells of peripheral blood and/or liver tissue, today, is considered the gold standard in the diagnosis of occult HCV infection. This article provides an overview of currently available literature data on the prevalence, clinical characteristics, study of risk factors for occult HCV infection in patients with treatment experience who have achieved a sustained virological response. Presented studies that have learned the relationship of the occult form of HCV-infection with lymphoproliferative diseases and cryoglobulinenia. Practical recommendations are given regarding the search for an occult HCV infection as a possible cause of the progression of liver disease in certain groups of patients. The aim of the study – to improve the diagnosis of cryptogenic hepatitis, by exclusion occult HCV infection, as a possible cause of liver damage. Numerous literature data indicate the presence of the occult form of hepatitis C. The occult form of hepatitis C should be excluded as a possible cause of liver damage, especially in patients with disease progression: in patients with spontaneous clearance of hepatitis C virus, in patients, who received antiviral treatment for chronic hepatitis C and achieved a sustained virological response, however, have clinical and/or laboratory signs of liver disease progression; in patients with cryptogenic liver disease, after excluding possible causes of both viral (HCV, HBV, EBV, CMV, etc.) and non-viral etiology. Research is needed for further long-term study of this form of the disease, since a number of authors deny the existence of an occult form of hepatitis C.
PATHOGENETIC SUBSTANTIATION OF PREVENTION AND CORRECTION OF REPERFUSION-REOXYGENATIVE SYNDROME AT REVASCULARIZATION OF THE ARTERIAL BED IN CONDITIONS OF CHRONIC CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES
The article indicates the prevalence of occlusive-stenotic lesions of the arterial lumen of the lower extremities and the frequency of postoperative complications after revascularization in the form of reperfusion-reoxygenative syndrome (RRS). The pathogenetic mechanisms and processes of RRS development that can be suspended or their manifestation can be significantly reduced in the application of a set of measures, which should be aimed at: a) reducing the activity of neutrophils; b) normalization of the state of endothelial cells; c) elimination of vasoconstriction; d) normalization of microvascular permeability; e) restoring the prooxidant-antioxidant balance. For prophylaxis and correction of RRS it was proposed to use infusion of prostaglandin E1, prolonged epidural anesthesia, polyclonal antineutrophil serum, monoclonal antibodies, L-selectin, leukapheres, statins, beta-blockers, angiotensin-converting enzyme inhibitors, indoleacetic acid derivatives, catalase, mannitol, allopurinol, alpha- tocopherol, corvitin, L-arginine. The aim of the study – pathogenetical substantiation of reperfusion-reoxygenative syndrome prevention in the revascularization of the arterial bed in conditions of chronic critical ischemia of the lower extremities. Materials and Methods. The material for the work were data from literature over the past 5–10 years on the issue of critical ischemia of the lower extremities and revascularization of the arterial line to find out the current trends and views on the causative factors of reperfusion-reoxygenative syndrome development. Results and Discussion. The results of researches testify that the basis of RRS is the arrival of oxygenated blood in the arterial channel of the ischemic lower limb. The formed RRS prolongs ischemia of lower limb tissues and promotes the progression of dystrophy, which exhibit generalized depressive effects on organs and systems. For prophylaxis and correction of RRS it is proposed to use infusion of prostaglandin E1, prolonged epidural anesthesia, polyclonal antineutrophil serum, monoclonal antibodies, L-selectin, leukapheres, statins, beta-blockers, angiotensin-converting enzyme inhibitors, indoleacetic acid derivatives, catalase, mannitol, allopurinol, alpha- tocopherol, corvitin, L-arginine. Conclusions. The starting factor of the complex of pathogenetic mechanisms and processes of development of RRS is the discrepancy between the amount of oxygen in the blood entering the arterial system of the lower limb during a revascularizing operation and its ability to be consumed by reoxygenated ischemic tissues. The indicated pathogenetic mechanisms and processes of RRS development may be suspended or their manifestation can be significantly reduced by applying a set of measures that should be directed to: a) decrease of activity of neutrophils; b) normalization of the state of endothelial cells; c) elimination of vasoconstriction; d) normalization of microvascular permeability; e) restoration of prooxidant-antioxidant equilibrium.