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Background Patients with celiac disease present with not only gastrointestinal symptoms but also extraintestinal manifestations such as anemia, osteopathy, dermatitis herpetiformis, and celiac neuropathy. Despite a fairly wide range of celiac neuropathies, we report a case of the acrodystrophic variant of celiac polyneuropathy, which has not been previously described. Case presentation A 41-year-old Ukrainian male suffered from symmetric, sensorimotor axonal polyneuropathy and encephalopathy associated with celiac disease, which is characterized by severe trophic disorders in the lower extremities (trophic ulcers, hyperkeratosis, and anhidrosis). Acrodystrophic changes in the lower extremities were due to both neurogenic and direct immunoinflammatory damaging effects. Clinical–electrophysiological dissociation was also noted, which was represented by a gross axonal lesion with the preservation of muscle strength. The absence of enteropathic manifestations was accompanied by the pronounced histological changes in the duodenal mucosa by IIIb stage of Marsh. A gluten-free diet in combination with membrane plasma exchange and intravenous pulse methylprednisolone was prescribed to reduce the severity of sensory disorders and regression of encephalopathy within 7 months. Conclusion Celiac disease may be a potential cause of neuropathy and encephalopathy in adult patients. Further immunosuppressive treatment protocols for both intestinal and extraintestinal manifestations of celiac disease are required.

To investigate the diagnostic value of biomarkers in assessing the severity of sclerotic and atrophic lesions in primary glomerulopathies.One hundred patients were included in the study, according to the results of kidney biopsy in 9 (9%) cases minimal change disease was diagnosed, in 28 (28%) focal segmental glomerulosclerosis, in 26 (26%) membranous nephropathy and in 37 (37%) IgA nephropathy. The clinical course of nephropathy was evaluated, standard laboratory tests were performed, and urinary excretions of cystatin C, 1-microglobulin, 2-microglobulin and NGAL were measured. The degree of glomerulosclerosis was assessed quantitatively, tubulointerstitial sclerosis and tubular atrophy semiquantitatively.According to the results of linear correlations and ROC-analysis, urinary excretion of cystatin C and 1-microglobulin had diagnostic value for early degree of tubulointerstitial sclerosis (cut-off value 319.9 and 10.94 mg/day, respectively). Urinary excretion of 2-microglobulin reflected the initial degree of tubalar atrophy (cut-off value of 0.224 mcg/day), as well as tubulointerstitial sclerosis of various degrees of severity (cut-off value 0.224 and 0.240 mkg/day). NGAL urinary excretion was the only marker of early degree of glomerulosclerosis with its excretion of more than 1445.4 ng/day and tubular atrophy, with a severity of 50% or more (cut-off value 4897.8 ng/day).A comprehensive assessment of sclerotic and atrophic lesions in the renal parenchyma, can be performed using a panel of traditional (GFR, proteinuria) and specific biomarkers (1-, 2-microglobulins, cystatin C, NGAL) to implement a comprehensive, personalized approach, as well as to assess the prognosis of nephropathy. In addition, the evaluation of the panel of different biomarkers can be used in those clinical situations where kidney biopsy can not be performed.Цель. Изучить диагностическую значимость биомаркеров в оценке степени выраженности склеротических и атрофических процессов в почечной паренхиме при первичных гломерулопатиях. Материалы и методы. В исследование включены 100 пациентов. В 9 (9%) случаев выявлена болезнь минимальных изменений, в 28 (28%) фокально-сегментарный гломерулосклероз, в 26 (26%) мембранозная нефропатия, в 37 (37%) иммуноглобулин А-нефропатия. Проведены оценка клинического течения нефропатии, стандартные лабораторные исследования, определена суточная экскреция с мочой цистатина С, 1-микроглобулина, 2-микроглобулина и липокалина, ассоциированного с желатиназой нейтрофилов (NGAL). Степень выраженности гломерулосклероза оценивалась количественно, тубулоинтерстициального склероза и атрофии канальцев полуколичественно. Результаты. По результатам как линейного корреляционного, так и ROC-анализа экскреции цистатина С и 1-микроглобулина с мочой обладали диагностической значимостью в отношении ранних признаков тубулоинтерстициального склероза (пороговые уровни 319,9 и 10,94 мг/сут соответственно). Экскреция 2-микроглобулина отражала начальные проявления атрофии эпителия канальцев при пороговом значении 0,224 мкг/сут, а также склероз тубулоинтерстиция различной степени выраженности (пороговый уровень 0,224 и 0,240 мгк/сут). NGAL мочи являлся единственным маркером ранних проявлений гломерулосклероза при его экскреции более 1445,4 нг/сут и атрофии эпителия канальцев выраженностью 50% и более (пороговый уровень 4897,8 нг/сут). Заключение. Комплексная оценка наличия склеротических и атрофических повреждений в почечной паренхиме может проводиться с использованием набора традиционных (скорость клубочковой фильтрации, уровень суточной протеинурии) и специфических биомаркеров (1-, 2-микроглобулины, цистатин С, NGAL). Кроме того, оценка панели различных маркеров может быть использована и в тех клинических ситуациях, когда проведение нефробиопсии затруднено.

Antimicrobial properties are traditionally evaluated by the seeding technique, which is laborious, time-consuming, and rather imprecise. We studied the possibility of using microscopy and spectrophotometry methods for evaluation of cytotoxic activity of breast milk serum against opportunistic microbes. Activity of 50 breast milk samples obtained from healthy women at different lactation stages was tested against opportunistic yeast C. albicans. Microscopy showed that incubation of cell suspension with lactoserum led to destruction of cell walls and cytoplasmic membranes with the formation of vesicular debris that absorbed the dye from the medium. Spectrophotometric measurement of the dye remained in the medium revealed a dose-depended effect of the lactoserum on C. albicans cells and strong inverse correlation between the lactation period and cytotoxic activity of the lactoserum (r=-0.948). These methods can be used in veterinary and food processing for estimation of biological activity of milk.

Large porous particles are becoming increasingly popular as carriers for pulmonary drug delivery with both local and systemic applications. These particles have high geometric diameters (5-30μm) but low bulk density (~0.1g/cm3 or less) such that the aerodynamic diameter remains low (1-5μm). In this study salbutamol and budesonide serve as model inhalable drugs with poor water solubility. A novel method is proposed for the production of dry powder inhaler formulations with enhanced aerosol performance (e.g. for salbutamol-glycine formulation the fine particle fraction (FPF≤4.7μm) value is 67.0±1.3%) from substances that are poorly soluble in water. To overcome the problems related to extremely poor aqueous solubility of the APIs, not individual solvents are used for spray freeze-drying of API solutions, but organic-water mixtures, which can form clathrate hydrates at low temperatures and release APIs or their complexes as fine powders, which form large porous particles after the clathrates are removed by sublimation. Zwitterionic glycine has been used as an additive to API directly in solutions prior to spray freeze-drying, in order to prevent aggregation of powders, to enhance their dispersibility and improve air-flow properties. The clathrate-forming spray freeze-drying process in the multi-component system was optimized using low-temperature powder X-ray diffraction and thermal analysis.

High requirements for macro- and micronutrients of the organism of a pregnant woman living in the Far North are associated with the influence of extreme factors of high latitudes, and the needs of the mother and the growing fetus. Only the products of the unique food culture of the Arctic people - the Nenets, make it possible to meet the emerging needs.

Aim. To assess the significance of the serum uromodulin (Tamm-Horsfall protein - THP) concentration (Sumo) as an early biomarker of tubular atrophy (TA) and interstitial renal fibrosis (IF) in patients with glomerulopathies. Materials and methods. 84 patients with glomerulopathy and 11 practically healthy persons (control) were examined. Uromodulin concentrations in serum and urine (Uumo) were measured, renal excretion of this protein and the estimated glomerular filtration rate (eGFR) were established. A semi-quantitative assessment of nephrobioptates was performed. Results and discussion. Sumo decreases with a minimum expression of tubular atrophy (TA) or interstitial fibrosis (IF), when the values of eGFR still remain normal. Variations of such excretory parameters of THP as Uumo, daily excretion, and ratio: urinary uromodulin / urinary creatinine, did not manifest a similar trend. Conclusion. Sumo is promising as an early biomarker of fibrotic and atrophic renal damage. The parameters of renal excretion of THP do not seem to have this property. The reason for the delay in the decline of Uumo in the progression of CKD as compared to the decrease in Sumo seems to be the need to maintain a sufficient Uumo to counteract urinary tract infection and stone formation.

The article contains results of a continuous prospective investigation of the normal course of the major duodenal papilla stenosis in 167 patients. It was revealed that the course of the disease was benign, pain syndrome became inconsiderable in the course of time, the degree of changes in biochemical analysis of blood was not significant. The development of complications (choledocholithiasis, acute pancreatitis, jaundice) was noted in 6-14% of the patients, depending on the presence or absence of GID. The data obtained allow suggestion of an algorithm of managing the patients.

The article presents data dynamics of adaptive immune responses of people for a long time living in adverse environmental conditions caused by pollution of the environment by industrial toxic waste. It is shown that in the process of adaptation to adverse environmental factors, changes in the immune system are in the phase fluctuations of immunological parameters that are accompanied by changes in the structure of immunodependent pathology. Most sensitive to prolonged exposure to toxic compounds are the cellular mechanisms of immune protection. Violations of the structural and quantitative and functional parameters of the link of the immune system are leading to the formation of immunopathological processes.

We have developed a simple method for fast analysis of single nucleotide polymorphisms and identification of target clones from cloned complex PCR products. The method utilizes Kamchatka crab duplex-specific nuclease and universal fluorescent probe and is alternative to laborious screening procedures using radioactive probes, restriction analysis followed by gel electrophoresis or expensive sequencing. The method efficacy was demonstrated in several model experiments.

Authors studied the level of cytotoxic activity of natural killer lymphocytes (NKCA) and the effect of monocytes, serotonin, rate of serotonin reuptake by lymphocytes and psychotropic therapy on NKCA levels in 59 male patients, aged 18-30 years, with the first episode of attack-like progressive schizophrenia (33 patients) and schizoaffective psychosis (26 patients). All patients were examined at baseline, 4 and 8 weeks after the beginning of treatment with haloperidol and clozapine. Before the treatment, the decrease of NKCA was found in a half of patients compared to controls. In other patients, the NKCA levels were high and did not differ from those in controls. The treatment resistance was estimated as 70,6% in patients with schizophrenia with initially low NKCA levels and 30,8% in patients with schizoaffective psychosis with initially low NKCA levels. During the treatment, the initially high NKCA level decreased while the initially low level increased but remained lower compared to controls. These changes suggest the active reaction from the immune system of the patient to treatment with neuroleptics. The changes of NKCA values during the treatment were reciprocally related to the maximal rate of serotonin reuptake by lymphocytes. Serotonin added to the cell culture in vitro normalized the NKCA level in cultures with- and without monocytes. This effect was revealed in both pathologies only in responders, regardless of the presence or absence monocytes, that may be explained by the presence of active serotonin receptors on the NK cell surface in these patients.

Structural analysis of human and rat gastrointestinal microbial communities revealed their general similarity. The structure of microbial biocenosis in ileum parietal mucin appears to be highly sensitive to nutritional factors. Inadequate nutrition leads to destruction of microbial microassociations in parietal mucin, a calcium-deficient diet has similar effect in feces. Fiber-rich diets stimulates build-up of indigenous communities while artificial nutrients and calcium-enriched diets promote formation of mixed indigenous-transient microbial associations. Bacteria themselves prove to be weak modifiers of the observed effects.

The article is devoted to analysis of pathogenic and diagnostic significance of Candida and Saccharomyces co-existence in diabetic patients. These transient fungi are known to be present in fecal microbiocenosis of both healthy subjects and patients with diabetes mellitus. However, their overall occurrence is significantly increased in the disease and the structure of the biocenosis undergoes alteration. These data confirm the role of yeast-like fungi in pathogenesis of diabetes. The diagnostic value of detection of monospecific and mixed populations of Candida and Saccharomyces spp. is not very high, but their presence in feces, especially in women, may be regarded as a sign of disturbed carbohydrate metabolism.

Population heterogeneity of Candida spp. in feces of patients with diabetes mellitus (DM) demonstrated in our earlier studies prompted to focus on the persistence of candidial infection depending on demographic characteristics of the patients and clinical features of DM. We examined 64 patients with DM and 40 practically healthy subjects aged 20-60 yr. The seeding rate (%) of short-lived (emerged on day 0 or 1) and long-lived (emerged on both days 0 and 1) of Candida spp. cultures was determined. The short-lived fraction of microorganisms most frequently occurred in patients below 50 yr without clinico-laboratory signs of DM and the history of candidiasis (coincidence rate 75.0%, p0.001). The long-lived fraction was characteristic of patients with the history of candidiasis having DM of less than 5 yr in duration and glycated hemoglobin over 7.8 mmol/l without complications taking oral hypoglycemic agents (80%, p0.001). Candida spp. were totally absent in patients with late diabetic complications, duration of disease over 5 yr, glycated hemoglobin level below 7.8%, and candidiasis-free history. It is concluded that clinico-laboratory characteristics and demographic factors determine persistence of Candida spp. in feces of DM patients.

Effects of substrate phase state and time factor on variability of human fecal microbiota were studied. It was shown that microecological system of native feces was characterized by marked time-dependent variability. It is unstable and begins to destruct after 24 hours of cultivation. The most sensitive elements of the system were bifidobacteria and Escherichia coli. Change of phase state of biotope eliminated the effect of factor limiting the microecosystem development, which allowed species of obligate and transitory microflora to freely colonize the growth substrate and interact with each other. The mentioned facts demonstrate that fecal microbiota exists in the environment of excess of growth substrate, which colonization is limited by cluster structure of biotope of native feces. It was concluded that phase state of growth substrate and duration of cultivation are important factors determining the population variability of fecal microbiota.

Changes in the parameters of innate immunity in patients with schizophrenia are observed already in the first episode. The study was performed to find out whether these changes take place prior to disease manifestation, and what role do they play in the pathogenesis of schizophrenia.Thirty-five male nonpsychotic patients at high risk of psychosis, aged between 17 to 23 years, were examined. Phagocyte activity (PA) of neutrophils in the blood serum was evaluated by the number of active neutrophils, i.e. phagocytic index (PhI), and phagocytic number (PhN), which was determined by counting latex particles absorbed with a single phagocytic cell. Cytotoxic activity of natural killer lymphocytes (NK CA) was evaluated by the number of cell targets K-562, which remained non-degraded after the contact with natural killer cells. The influence of monocytes on NKCA was determined as well.Compared to controls, patients had the lower PhI level (p0.001) which was compensated by the increase in PhN levels, and the lower NK CA level which was increased due to the influence of monocytes. Negative correlations between PhI and PhN (r= -0.83, p0.01) and between the level of NKCA and PhI (r= -0.83, p0.05) as well as the positive correlation between PhN and SOPS scores (r=0.69, p0.01) were found. After treatment, there was the decreasein the severity of mental disorders (p0.001). The level of PhAN was normalized in 61.9% of patients compared to 36.7% before treatment. After treatment, the proportion of patients with normal levels of NK CA was the same as before treatment (40 and 35%, respectively). The immune disturbances revealed in the study may play a role in the pathogenesis of the disease and have predictive value for schizophrenia.Цель исследования. Изменения показателей врожденного иммунитета выявляются у больных шизофренией уже на стадии первого приступа заболевания. Целью исследования было выяснить, предшествуют ли указанные изменения манифестации болезни и какую роль могут играть в ее патогенезе. Материал и методы. Обследовали 35 больных мужского пола в возрасте от 17 до 23 лет с непсихотическими психическими расстройствами, отражающими высокий риск развития шизофрении. В сыворотке периферической крови больных и здоровых (контроль) определяли: фагоцитарную активность (ФА) нейтрофилов по пропорции фагоцитирующих клеток (ФИ) и фагоцитарному числу (ФЧ), которое рассчитывали по среднему количеству латексных частиц, абсорбированных единичной фагоцитирующей клеткой; цитотоксическую активность лимфоцитов натуральных киллеров (ЦА НК), которую оценивали по количеству оставшихся недеградированными после контакта с НК лимфоцитами клеток-мишеней К-562, изучали также влияние моноцитов на уровень ЦА НК. Результаты и заключение. У больных до лечения было отмечено снижение по сравнению с контролем уровня ФИ (p0,001), которое сопровождалось увеличением значения ФЧ (p0,05), а также снижение уровня ЦА НК (p0,001), которое компенсировалось за счет влияния моноцитов. При этом были выявлены отрицательные корреляции между ФИ и ФЧ (r= –0,83, p0,01) и между ЦА НК и ФИ (r= –0,83, p0,05), а также положительная - между значением ФЧ и степенью выраженности психических расстройств по шкале SOPS (r=0,69, p0,01). После лечения имело место снижение выраженности психических расстройств (p0,001). Нормальный уровень ФА нейтрофилов был отмечен в 61,9,% случаев (до лечения - в 36,7% случаев). Пропорция больных с нормальным уровнем ЦА НК после лечения оставалась такой же низкой, как до лечения, и составляла 40 и 35% соответственно. Выявленные иммунологические нарушения могут играть определенную роль в патогенезе заболевания и иметь предикторное значение в отношении развития манифестных форм шизофрении.Цель исследования. Изменения показателей врожденного иммунитета выявляются у больных шизофренией уже на стадии первого приступа заболевания. Целью исследования было выяснить, предшествуют ли указанные изменения манифестации болезни и какую роль могут играть в ее патогенезе. Материал и методы. Обследовали 35 больных мужского пола в возрасте от 17 до 23 лет с непсихотическими психическими расстройствами, отражающими высокий риск развития шизофрении. В сыворотке периферической крови больных и здоровых (контроль) определяли: фагоцитарную активность (ФА) нейтрофилов по пропорции фагоцитирующих клеток (ФИ) и фагоцитарному числу (ФЧ), которое рассчитывали по среднему количеству латексных частиц, абсорбированных единичной фагоцитирующей клеткой; цитотоксическую активность лимфоцитов натуральных киллеров (ЦА НК), которую оценивали по количеству оставшихся недеградированными после контакта с НК лимфоцитами клеток-мишеней К-562, изучали также влияние моноцитов на уровень ЦА НК. Результаты и заключение. У больных до лечения было отмечено снижение по сравнению с контролем уровня ФИ (p0,001), которое сопровождалось увеличением значения ФЧ (p0,05), а также снижение уровня ЦА НК (p0,001), которое компенсировалось за счет влияния моноцитов. При этом были выявлены отрицательные корреляции между ФИ и ФЧ (r= –0,83, p0,01) и между ЦА НК и ФИ (r= –0,83, p0,05), а также положительная - между значением ФЧ и степенью выраженности психических расстройств по шкале SOPS (r=0,69, p0,01). После лечения имело место снижение выраженности психических расстройств (p0,001). Нормальный уровень ФА нейтрофилов был отмечен в 61,9,% случаев (до лечения - в 36,7% случаев). Пропорция больных с нормальным уровнем ЦА НК после лечения оставалась такой же низкой, как до лечения, и составляла 40 и 35% соответственно. Выявленные иммунологические нарушения могут играть определенную роль в патогенезе заболевания и иметь предикторное значение в отношении развития манифестных форм шизофрении.

The antimicrobial activity and microenvironmental safety of poly- and oligoguanidine antiseptics were compared. E. coli and St. aureus test strains were found to be more sensitive to chlorohexidine bigluconate (CHB) upon a long (24 hour) exposure and to polyhexamethylene guanidine derivatives on short (30-second) contact. It is concluded that unlike polyguanidine antiseptics, CHB is more ecologically dangerous; when used for rapid disinfection, it can provoke impairment in the microenvironmental balance outside the area of application. The findings show it expedient to assess the microenvironmental safety of antimicrobial agents in order to prevent ecological catastrophes.

To ascertain the effects of transcatheter repair of the secondary interatrial defect (IAD) with Amplatzer occluder on heart remodeling in respect to the patient's age.Transcatheter repair of the secondary IAD was made in 64 patients. Two groups were formed by the patients' age: group 1--age under 16 years (mean age 9 +/- 0.6 years) and group 2--age over 16 years (mean age 32 +/- 1.8 years). The control group consisted of 30 healthy subjects matched by age. Echocardiography measured size and volumes of the heart chambers, intracardiac hemodynamics before treatment of the defect and 24 hours, 1, 3, 6, 12 and 24 months after it.The indexed diameter of the defect in group 1 was 16.5 +/- 1.6 mm/m2, in group 2--13.7 +/- 0.7 mm/m2 (p0.05). The size of the occluder, in relation to the surface area, was 20 +/- 1.5 and 16 +/- 0.8 mm/m2, respectively (p0.05). 24 hours after the defect repair the right ventricle volume reduced by 29% in group 1 and by 21%--in group 2. The right atrium volume reduced significantly also. Mean pulmonary arterial pressure (PAP) in both groups diminished from 22 +/- 0.7 to 19 +/- 0.7 mmHg and from 24 +/- 1.0 to 20 +/- 0,8 mmHg, respectively. The left atrium decreased by 34 and 32%, respectively (p0.001). Remodeling reduced RV-LV in both groups by 22 and 23% (p0.001), respectively. 3 months after the defect repair all the indices reached control values. 12 months after the correction hemodynamics in the patients was the same with the healthy examinees. The time and degree of reduction of the right heart were similar in the groups, the volumes diminished by about 50%. 12 months after the repair in 4 of 18 patients of group 2 (22%) the right atrium and ventricle were larger than in healthy subjects though less than before the repair.Transcatheter repair of the secondary IAD with Amplatzer catheter leads to early noticeable reduction of the right heart. The type of the changes is similar in both age groups and does not depend on the size of the implanted occluder. Not all the patients over 16 years of age achieve normal sizes of the RV and RA 12 months after the defect correction.

The paper presents the technique of extensive systemic transperineal TRUS-guided cor biopsy of the prostate. Some aspects of the patients' safety and quality of biopsy cores are considered. The analysis of TNM stages of the detected cancers (55 cases out of 142 patients who have undergone systemic biopsy) showed 65.4% of local cancer (T1-2). The quality of cores was adequate for histological examination in 92.8% cases. None serious complications was reported. Only in two of ten patients subjected to radical prostatectomy stage T2 was changed to stage T3 in the absence of metastases to regional lymph nodes and distant metastases.

A study of human fecal microbiocenosis using experimental in vitro modeling of constipation was carried out. The study revealed certain dynamics of the incidence, proportion and ratio of microorganisms isolated from the feces at various stages of cultivation. The character of the changes of these parameters depended on the type of the microorganism. According to the results of the experiment, transitory flora (staphylococci; candidas) begins to disappear within the first day of cultivation. If intestinal evacuation is retarded for more than 2 or 3 days, distortion of the microbiological characteristics of the residential microflora, bifidobacteria and escherichiae, is possible. These processes may lead to a false positive result of dysbiosis analysis. The authors conclude that dysbiotic changes in constipation are caused by fecal retention. That is why correct diagnostics of dysbiosis is possible only after regular everyday stool is reestablished.

A comparison of the adhesive properties of lactobacteria and escherichiae in different divisions of human gastrointestinal tract under normal and pathologic conditions was conducted. The study shows that the population changeability of the adhesive properties of lactobacteria and escherichiae is determined by localization of the strain in the gastrointestinal tract, and morphofunctional condition of the intestinal wall. Bacteria's adhesiveness to glycocalix of intestinal epithelial cells is higher in the left half of the colon than in the right one, and is still higher in feces. Their co-adhesiveness changes in the reverse order. Bacteria localized in the parietal mucin of inflamed segments, possess low capability of forming microcolonies, and high adhesiveness to glycocalix. The results of the study demonstrate that the choice of therapeutic probiotic bacterial strains should depend on the anatomic localization of the lesion and the character of gastrointestinal pathology.

A new modification of the single nucleotide polymorphism (SNP) analysis (DSNP, duplex-specific nuclease preference) method using the duplex-specific nuclease from the king crab was proposed. The method was used to study SNPs in the following human genes: kRAS, nRAS, hRAS, and p53, the genes of blood coagulation factor V, methyltetrahydrofolate reductase, prothrombin, and apolipoprotein E and a deletion in the BRCA1 gene. DSNP was shown to be useful for the estimation of the mutant allele content in DNA samples. A system for the simultaneous identification of several adjacent single-nucleotide polymorphisms in the kRAS gene was proposed. The approaches could be used to develop test systems for the detection of SNPs in human genes. The English version of the paper: Russian Journal of Bioorganic Chemistry, 2005, vol. 31, no. 6; see also http://www.maik.ru.

Human ectoparasites, such as itch mites and the follicular mites Demodex brevis and D. folliculorum are notified on the territory of Moscow. The bird and rodent mites Ornythonyssus bacoti and the larvae of harvest mites may attack human beings indoors. The ticks Ixodes ricinus and I. persulcatus begin to inhabit the tree belts and environs of Moscow and other cities and towns. In the cities and towns of more southern regions of the Russian Federation, the red hen-mites Dermanyssus gallinae are also encountered and the ticks Rhipicephalus sanguineus and Ornithodoros papillipes begin to inhabit urban structures. A differential system of their controlling measures is proposed in relation to the habitats of mites and ticks on the urban territories and the results of use of a number of currently available disinfectants are presented.

The species composition of fleas attacking man in Moscow, the time course of changes in their size, and the efficiency of disinfecting measures against them have been studied. The basement premises are the commonest habitat of fleas. The absolute predominant species in these biotopes are Cetenocephalides felis (Boushe) whose feeders are dogs, synanthropic rodents, and humans, other than cats. Micropopulations of the fleas have been existed in some structures for more than 5 years (a follow-up period). A mathematical analysis of the factors that influence the efficiency of disinfestation has established that the most influential factors were the factors associated with the poor state of basement premises (the presence of a substrate for the breeding and shelter of fleas, the possibility of homeless animals and rodents, the feeders of fleas, to penetrate there) that reduce the residual effect of insecticides. Out of 15 applied insecticides, those based on chlorpyrifos, cypermethrin, and fenvalerate showed the highest efficacy. The combined use of liquid and powered insecticides is most effective in disinfestation. The treatments made in the periods when the number of fleas is small in the basements (April-May and August-September) provide the most prolonged residual effect.

The lumen and parietal biotopes of the human gastrointestinal tract were investigated, i.e. the antibiotic sensitivity of strains E. coli and Enterococcus faecalis residing in them were comparatively analyzed. Certain isolation degrees not only of the parietal and fecal biotopes but also of certain micro-regions in the intestine wall were detected. The obtained data confirm a previously made assumption on the cluster distribution of microorganisms in the parietal mucin. The distinct strain differences between the parietal and fecal biotopes are not enough to completely extrapolate the available characteristics of the lumen microflora on the parietal microbiocenose. The above stated underlines the necessity in purpose-oriented research of parietal microbe populations of "internal" biotopes.

Microbiological examinations of the human-colon parietal mucin were made in different sections of the human gastrointestinal tract (GIT). Biopsy samples of the human colon mucus tunic were used as the research material. Convincing data were found by research on the importance of the anatomic-and-morphological factor in shaping-up of microbiocenosis of the colon-wall parietal mucin. It was established that, depending on a GIT section, not only the quantitative and qualitative composition of normal microflora but also the nature of inter-microbe interactions are subject to changes. In particular, biopsy materials of the small-intestine parietal mucin are much different from that of the colon. The colon section from the ascending colon to the sigmoid colon has, with some exceptions, an identical microbial composition. At the same time, the rectum is significantly different from other colon sections. The results are suggestive of the below cluster-type pattern of parietal biological material: microorganisms are clustered as small domains with certain specific and quantitative compositions. It was established that, although feces and parietal mucin have a similar species composition of microorganisms, still, there is a number of essential differences between them in as far as the frequency ratio and the microorganism concentration are concerned, which signifies a certain degree of isolation of the above biopsy materials. Finally, a certain isolation degree of the feces biopsy materials and of the parietal ones was established.

An original technique was used to investigate the human colon mucin in different pathologies of gastrointestinal tract. The microbial pattern of the biotope in question was found to be dependable on a morphological-and-functional condition of the intestinal wall. It is noteworthy, that not only its quantitative and qualitative composition but also the nature of the inter-microbe relations and the "specific content" of microbes are subject to changes. A correlation was established between the studied characteristics of the human parietal gastrointestinal biotope and the biochemical blood parameters. The results revealed a new chain in the pathogenesis of disbiotic processes occurring in the colon mucous tunic. The diagnostic value of microbiological parameters of the human colon mucous tunic is under discussion.

To analyze action of digoxin and some non-digitalis drugs (beta-blockers, verapamil, amiodarone, d,l-sotalol) and their combinations on electrical activity of atria, frequency and structure of ventricular rhythm in patients with permanent atrial fibrillation.One hundred patients with permanent atrial fibrillation and heart rate at rest above 80 bpm were divided into 9 treatment groups. High-resolution orthogonal Frank lead ECG was recorded before and after allocated treatment. Analysis included construction of ff-waves periodograms, histograms of RR interval, cardiointervalograms and application of autocorrelation function.It was demonstrated that frequency and form (structure) of ventricular rhythm was determined not only by the state of AV conduction but also by value of basic period of ff-waves. The mechanisms of ventricular rate deceleration by investigated drugs were not identical. beta-blockers and verapamil directly slowed AV conduction without changing parameters of ff-waves and differed from each other only in action on parameters of concealed conduction in AV node. Action of digoxin in patients with ff-waves period equal to or exceeding 0,15 s was biphasic. During phase I shortening of ff-wave period (by 0.025+/-0.012 s) occurred. This was associated with increase of their concealed conduction through AV node. The latter phenomenon represented independent mechanism of ventricular rhythm deceleration. During phase II of digoxin action direct inhibition of AV conduction took place. Amiodarone and d,l-sotalol increased basic ff-waves period. This facilitated their conduction through AV node. Greater heart rate slowing effect of d,l-sotalol was attributed to its ability to augment concealed conduction. Due to their antiarrhythmic qualities amiodarone and d,l-sotalol slowed heart rate in patients with peak RR duration in the region of 0.28-0.46 s. These patients often had bi- and tri-modal structure of interval RR histogram. Changes of ventricular rhythm structure during use of various drugs were different. Action of digoxin was most whilst that of beta-blockers least favorable.Choice of a drug for treatment of permanent atrial fibrillation should be conducted with consideration of ff-waves periodicity, parameters of RR interval histogram, and characteristics of ventricular rhythm structure.

The modified method of the microbiological study of parietal mucin has been developed. The proposed method makes it possible to evaluate the parietal microflora of the intestine. The advantages of using physiological saline and Hanks' solution as medium ensuring the storage and self-thinning of mucin have been proved. The optimum time of making the microbiological study of intestinal mucin has also been determined.

To study influence of different rate-reducing medicine groups on atrial electrical activity and ventricular thyrhms structure in chronic atrial fibrillation (CAF) and thus to optimize treatment.57 patients with CAF treated with digitalis, beta-blockers, their combinations, verapamil, amiodaron and sotalol were studied. Repeatedly highly-resolution ECG analysis was made.Atrial fibrillation is characterized by ff-waves basic period from 0.12 s to 0.20 s. Ventricular characteristics were determined both by AV conduction and basic ff-waves periods. The reducing of basic ff-period is the leading mechanism of digitalis rate-reducing actions in typical cases. The direct AV block appears on the late stage of therapy and is moderate.Combined therapy by medicines with different mechanisms of rate-reducing actions is the most efficient. The choice of the drug and its doses is determined by basic ff-waves periods value and the ventricular rhythm structure.

Tuberculous meningitis (TM) develops more frequently in unvaccinated or inadequately vaccinated infants (28 cases of 34), in contact infants (26 of 34 cases). Within the first year of life TM is especially aggressive. Late diagnosis and treatment leave significant residual neurological changes or result in lethal outcomes.

The diagnosis of bulky formations of the parathyroid glands (PTG) has become possible since current high-resolution techniques of visualization, such as ultrasound study (USS), computed tomography (CT), magnetic resonance imaging (MRI), were introduced into practice. The presence of clinical and/or laboratory signs of hyperparathyroidism (HPT) is a signal to initiate a goal-oriented search for abnormal PTG formations. The complex diagnosis of HPT involves the methods of detecting osteoporosis ranging from routine X-ray study of the hand and foot to more in-depth techniques: dichromatic X-ray absorptiometry (DXA) and quantitative CT (QCT). USS is an excellent method for screening if abnormal PTC changes are suspected; however, negative USS results in the presence of clinical and/or laboratory signs of HPT should not stop a diagnostic search. CT with intravenous contrast bolus specifies the site and structure of an formation, has some advantage in detecting retrosternal tumors. Due to its high tissue contrast, three-dimensional images, none ionizing radiation and osseous structural artefacts, MRI becomes a preferable tool for studying PTG when they are typically or atypically located. Needle biopsy is required when noninvasive methods cannot characterize the pattern of an abnormal PTG formation properly or their results are contradictory.

To elucidate clinical value of 24-h ECG monitoring followed by analysis of cardiac rhythm structure in patients with perpetual cardiac fibrillation (CF).24-h ECG monitoring has been performed 163 times in 142 patients aged 33-82 years. Interval histograms and cardiointervalograms of R-R intervals were performed.24-h ECG monitoring has shown the phenomena which can be used for perfection of the diagnosis and treatment: features of 24-h changes in heart rate; features of ventricular ectopy; periods of asystole; preclinical signs of hyperdigitalization; frequency-related shift of ST segment.24-h ECG monitoring in patients with perpetual CF provides valuable diagnostic information. Therefore, it should be conducted in all of them irrespective of subjective state and routine ECG data, especially in deciding on antiarrhythmic therapy.

In 140 patients with essential hypertension effectiveness of hypotensive treatment was assessed clinically by the results of single measurements of arterial pressure (AP) vs results of 24-h AP monitoring. According to 24-h monitoring, effectiveness of hypotensive treatment was clinically overestimated because night AP lowering was not sufficient and plasm sodium levels were relatively high. In 20.0% of the patients treatment results were, on the contrary, underestimated as shown by marked pressor reactions and relative hypopotassemia. Thus, single measurements of AP provide wrong results of antihypertensive treatment in one-third of the patients. Plasma levels of sodium and potassium can predict the error.

Antituberculosis antibodies and mycobacterial antigens were detected in 74 young and preschool children suffering from tuberculosis by using enzyme immunoassay (EIA). They were found in 75.7% and 68.9% of children, respectively. The highest levels of antibodies were significantly greater in patients with active disseminated processes than in those with active restrictive processes. There were no great differences in the levels of antigens between the patients having different activities of a tuberculosis process. Follow-up indicated that there was a reduction in the levels of antibodies and antigens at 6-month treatment. The use of enzyme EIA in children ill with tuberculosis may serve an additional criterion for diagnosis of tuberculosis, evaluation of its activity and course.

The paper outlines the results of following up 50 infants and preschool children who had contacts on their families. The major sources of infection were equally both their mother and their father. The children were found to have pronounced active processes. The most severe types of tuberculosis were common in infants in whom general, military tuberculosis and tuberculous meningitis along with complicated types in intrathoracic lymph node tuberculosis were detected. There was more commonly a phase of dissemination and decay in infants. Severe types of tuberculosis were encountered in the families having a combination of many unfavourable factors, both medical and social ones. Among the children who had fallen ill, 32% were detected on their visits to polyclinics of upon admissions to general hospitals.

As shown by clinical, electrophysiological and hormonal examinations of 34 patients with chronic inflammation of the uterine appendages and control subjects, the disease treatment with intensive low-frequency current has no negative effects on cardiovascular and endocrine systems, improves function of the reproductive system. Intensive low-frequency currents are believed to be a useful modality in management of chronic genital inflammation.

2500 records of cardiointervalograms and 24-h ECG monitoring for 1530 arrhythmic patients have been analysed. This complex approach to analysis of cardiac arrhythmia allowed a more accurate differential diagnosis, more detailed visualization of rhythmic abnormalities, more advanced analysis of neurovegetative background of developing rhythmic shifts.

The paper is a fragment of a comparative clinico-economic study of two models of organizational forms of psychiatric services in Moscow and Kaluga with special reference to schizophrenic patients (386 and 531 patients, respectively). The authors describe the results of computing expenditures on patients depending on the sex, age, disease pattern and social factors including educational and skill levels, family status, and family structure. The values of "direct" and "indirect" expenditures on schizophrenic patients are fairly variable. There are definite significant relationships between the magnitude of these expenditures and clinico-psychopathological and social factors as is their certain stability in both patients' populations examined. The adequately designed psychiatric services, scientifically based financing of the appropriate treatment and social rehabilitation programs may have a noticeable effect on the magnitude and character of losses on the part of the state, connected with schizophrenic patients, decrease expenditures on them as well as markedly improve their social functioning.

The authors describe part of the results of a comparative clinico-economic analysis of the functioning of two models of organizational forms of psychiatric services with special reference to Moscow and Kaluga. The purpose of the given research fragment was to make a comparative analysis of expenditures on schizophrenic patients depending on the system of psychiatric services organization on the whole and between different types of services; to specify approaches to optimization of their functioning with the use of a clinico-economic approach. Based on a comparative investigation of the representative groups of schizophrenic patients (386 patients of a mental health center in Moscow and 531 patients of the Kaluga regional psychiatric hospital No. 1), it has been established that as a result of the proper organization and financing of psychiatric services in Kaluga, the "direct" expenditures on one schizophrenic patient per year could be 20% as reduced and the losses of the national income could be lowered more than 2-fold. It should necessarily be mentioned that the financing of extra hospital services in Kaluga exceeded that in Moscow more than 3-fold, reaching about 20.3% of all the expenditures on schizophrenic patients. Apparently, the organizational and financial experience gained in Kaluga with the design of the common complex and many-staged system of psychiatric services may turn fairly instrumental in elaborating approaches to optimization of the functioning of psychiatric services.