The article raises a question about the possible and effective kidney transplantation in elderly patients with various severe comorbidities. The analysis is based on an example of successful kidney transplantation from a deceased donor when a 67-year-old patient had severe concomitant background: obesity, diabetes mellitus, and cardiovascular disturbances. Despite unfavorable prognosis and further unpredictable illnesses such as COVID-19, candidal esophagitis, coronary attack, and pneumonia, the patient has not develop graft injury or rejection and kept sufficient kidney function. The research was mainly focused on coexisting illnesses and their influence on kidney transplantation consequences. Following disease groups were discussed regarding their impact on transplantation outcomes and prognosis: arterial hypertension, cardiac disorders, diabetes mellitus, and obesity. Patient’s age, previous interventions, and comorbidities were observed for association with outcomes and risk of graft rejection. A review of available publications compared approaches for recipient selection in different clinical centers as well.
UDC 616.12.331.1+616.379-008.65):616-008.9:616.36-003.826]-006-002.64-092.19
Abstract. Background. Lack of information about proinflammatory interleukins (IL) and tumor necrosis factor alpha (TNFα) levels in case of metabolic-associated liver steatosis (MALS) and their roles in its progression to steatohepatitis are key reasons for the relevance and actuality of our study. The purpose: to evaluate proinflammatory interleukins 2, 6, and TNFα levels in concomitant liver steatosis. Materials and methods. Thirty- five patients with hypertension stage II–III, type 2 diabetes mellitus were examined. All of them were treated on an outpatient basis according to the guidelines of the Ministry of Health of Ukraine and the Declaration of Helsinki. Participants were divided into the main group with MALS (n = 24, males 45.8 %, females 54.2 %; average age 55.83 ± 0.89 years) and the control group without steatosis (n = 11, males 54.5 %, females 45.5 %; average age 53.00 ± 1.55 years). In addition to standard parameters, levels of IL6, IL2, TNFα, selectin, resistin, insulin, C-peptide, glycated hemoglobin, non-esterified fatty acids were evaluated, and some indexes were calculated, including triglyceride-glucose index and Castelli indexes I and II. Results were processed statistically, with significance level of р < 0.05. Results. Although MALS is not followed by qualitative differences in proinflammatory IL2, IL6 and TNFα compared to no steatosis, the risk of TNFα elevation was 5 times higher in patients with MALS (odds ratio 5.08; 95% confidence interval 1.02–25.17). An increase in IL2 and TNFα is unfavorable for patients with MALS, it can be considered as a marker of steatosis progression to steatohepatitis, as it is associated with transaminase activation, endogenous intoxication, lipid distress and glucose intolerance. IL6 was rather lower in patients with MALS compared to those without steatosis, but its growth was exponential and proceeded simultaneously to IL2 and TNFα. Conclusions. MALS was not associated with significant changes in IL2, IL6 and TNFα compared to no steatosis, but their elevation can be criteria for transformation into steatohepatitis due to the activation of transaminases, inflammation, endogenous intoxication, lipid distress, glucose intolerance.
Keywords: diabetes mellitus; interleukin-2; interleukin-6; tumor necrosis factor alpha; metabolic-associated liver steatosis
UDC 616.716.1/.3-001.5-089.168.1-036.82
Purpose of the study. The aim of this research was to compare the effectiveness of transcranial electrical
stimulation to normalize the regulatory functions of the CNS in the postoperative period of treatment of patients
with bone injuries of the middle face. Research methods. The study was performed in 47 patients with combined
mid-facial trauma, characterized by the presence of mild traumatic brain injury (concussion, brain contusion
of mild severity) and severe injuries of the facial skeleton – 1, 3, 4, 7 classes according to the Yu.I. Bernadsky
classifcation. After surgical treatment, all patients were divided into two groups. Conservative treatment
according to the traditional scheme described above was used for rehabilitation of patients in the control group
(22 patients). The same scheme was used for the treatment of patients of the main group (25 patients), but it was
supplemented by a course of transcranial electrical stimulation, which was performed using a low-frequency
electrotherapy device “Radius-01 FT”. The parameters of transcranial electrical stimulation were established
according to the literature of similar studies [20; 21; 22], and were DPS = 5%, 70 Hz, 0.11 ms with a session
duration of 35 minutes 1 time per day with a course of treatment of 10 days. The 7th and 14th days were
chosen as the terms of observation of the effect of its influence on the body’s resistance to stress factors, while
hematological studies were selected as indicators to determine the content of β-endorphins, ACTH and cortisol,
and to calculate the Garkavi stress index. Scientifc novelty. Studies have shown that the use of transcranial
electrical stimulation helped to normalize the tone of anti-stress defense mechanisms, stimulated endodorphic
structures of the brain and reduced the intensity of pain in patients with combined mid-facial trauma. Already on
the 7th day, the content of stress-limiting hormones β-endorphins in the plasma of the main group patients was
higher compared to that of the control (15.4 ± 1.8 pg / ml to 12.73 ± 1.6 pg / ml with g > 0.05), Conclusions.
The obtained data indicate a positive therapeutic effect of transcranial electrical stimulation on the stress-limiting
endogenous opiate system.
УДК: 618.193-006-076.4
Aim. Establishing the surface characteristics of ductal breast cancer of different degree of differentiation and different histological structure of the invasive component in scanning electron microscopy.
Material and Methods. The results of the study of invasive ductal breast cancer using light and scanning electron microscopy were analyzed. The degree of malignancy was determined according to a modified scheme of P. Scarff, H. Bloom and W. Richardson. Electron microscopic features of the cell surface of invasive ductal breast cancer during this study were compared in each case with its histological structure and degree of malignancy G.
Results and Discussion. Histologically, tubular, trabecular, solid, alveolar structures and discrete (single) groups of tumor cells were diagnosed in the infiltrative component of invasive ductal breast carcinoma. In terms of the surface configuration of tumor cells, we have identified three cell variants. The first variant was characterized by the presence in most tumor cells numerous asymmetric microvilli with diffuse or focal distribution on the cell surface and was prevailed in the tubular structures of the infiltrative component of ductal breast carcinoma of G1 grade (p<0,05). The second variant of the surface configuration was characterized by a small number of asymmetric microvilli scattered throughout the cell surface and was diagnosed in a solid
and trabecular invasive component of malignancies G2 and G3 grades. The third variant was characterized by the absence of microvilli on the surface in most tumor cells and was prevailed in the alveolar structures of the invasive component of G2 and G3 grades. It was found that the decrease in the grade of histological differentiation of invasive ductal breast cancer is associated with a decrease or absence of asymmetric microvilli on the cell
surface. Tumors classified as G2 showed a wide range of surface configurations of cancer cells; in 75% [27,96-99,89] of cases G3 carcinoma was characterized by the absence of microvilli on the surface in most tumor cells, i.e., there was a III variant surface configuration of cells.
Conclusions. Scanning electron microscopy makes it possible to provide information in a nanometer scale about the surface features of tumor cells, and the identification of phenotype features between tumor cells can be prognostically important in the course of breast cancer.
Obesity can cause respiratory disorders inflicted by adipose tissue accumulation and the numerous cytokines adipocytes produce. Smoking is, first of all, associated with a wide range of lung diseases characterized by diffuse changes in the lung tissue and a decrease in the respiratory volume of the lungs. The study aimed to investigate the ultrastructural changes in the lungs of sexually mature male rats under conditions of experimental obesity and smoking. The total sample of experimental animals consisted of 120 rats, divided into four groups: the control group (n=30) – conditionally healthy rats fed on a standard diet; a group of rats subjected to isolated exposure to tobacco smoke (n=30); a group of experimentally obese rats (n=30) and a group of experimentally obese rats simultaneously exposed to tobacco smoke (n=30) – feeding using a high-fat diet with exposure to a chamber with tobacco smoke. The revealed ultrastructural features of the lungs in the group of rats with experimental obesity and the group of rats with experimental obesity that were simultaneously exposed to tobacco smoke did not differ qualitatively, which indicates that pathological changes in the ultrastructure of the lung tissue developed regardless of the presence or absence of a direct damaging effect on the lung tissue of passive smoking.