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In the majority of our patients with CP the clinical symptoms werenon-specific with laboratory findings typical for CP (elevation of serum lipase and amylase). The most common clinical and laboratory findings were: malegender, overweight, an enlarged head of the pancreas and elevated serum levels of glucose and lipase and amylase. The normal function of the immune system is based on the balanced regulatory cytokine production. In patients with CP the serum levels of IL-2R, IL-6, TNF-a, and INF-y were elevated compared to the control group. High levels of TNF-a and INF-y in serum ofpatients with CP indicate a shift towards the production of pro-inflammatory cy-tokines. Thus, a vicious circle develops through the action of reactive oxygen species and pro-inflammatory cytokines. In addition to the above factors, insulin also stimulates the synthesis of TNF-a through the expression of TNF-receptors in adipose and muscle tissues [4; 7]. Pro-inflammatory cytokines, including TNF-a, may participate in the mechanism of insulin resistance. How TNF-a is involved in this process is not completely understood, but insulin receptors (IRS-1) are important targets for TNF-a [3; 4].
Conclution. The results of our study indicate that cytokines are involved in the pathogenesis of CP. This study has demonstrated that PSCs have the capacity to respond to cytokines known to be up regulated during pancreatitis. Persistent activation of PSCs by cytokines during acute pancreatitis may be a factor involved in the progression from acute pancreatitis to chronic pancreatic injury and fibrosis [8]. The inflammatory IL-6 is often expressed by multiple cell types within the tumor microenvironment. IL-6 produced in the bone marrow microenvironment to bone metastasis and this cytokine has a strong pro-tumorigenic activity due to its multiple effects on bone metabolism, tumor cell proliferation and survival, angiogenesis, and inflammation. Supporting the role of IL-6 in human cancer is the observation of elevated serum levels of IL-6 and sIL-6R in patients with bone metastasis and their association with a poor clinical outcome. Thus, IL-6 emerges as a key player at all stages of the pathogenesis of pancreatic diseases, including carcinogenesis, and a potential molecular therapeutic target [2; 3; 6].
References:
1. Schultz N.A., Christensen I.J., Werner J., Giese N., Jensen B.V., et al (2013). Diagnostic and prognostic impact of circulatingYKL-40, IL-6, and CA 19-9 in patients with pancreatic cancer. PLoS One 8: e67059.
2. Matsuo Y., Takeyama H., Guha S. (2012) Cytokine network: new targeted therapy for pancreatic cancer. Curr Pharm Des 18: 24162419.
3. Zhang Y., Yan W., Collins M.A., Bednar F., Rakshit S et al (2013). Interleukin-6 is required for pancreatic cancer progression by promoting MAPK signaling activation and oxidative stress resistance. Cancer Res 73: 6359-6374.
4. Guo Y., Xu F., Lu T., Duan Z., Zhang Z. (2012).Interleukin-6 signaling pathway in targeted therapy for cancer. Cancer Treat Rev 38: 904-10.
5. Talukdar R., Saikia N., Singal D.K., Tandon R. (2006).Chronic pancreatitis: Evolving paradigms. Pancreatology 6: 440-9.
6. Tasnim Ara, T. Declerck Y.A. (2010). Interleukin-6 in bone metastasis and cancer progression. Eur J Cancer 46: 1223-1231.
7. Talukdar R., Tandon R.K. (2008). Pancreatic stellate cells: New target in the treatment of chronic pancreatitis. J Gastroenterol Hepatol 23:34-41.
8. Apte M., Phillips P., Fahmy R. (2008). Alcohol directly stimulates rat pancreatic stellate cells. Gastroenterology 118: 780. - 94.
Zufarov Aziz Alimdjanovich, CMS, Assistant of the Department of Propaedeutics of children's diseases,
Tashkent Pediatric Medical Institute E-mail: [email protected]
Acute respiratory syndrome and spectral characteristics of cardiac rhythm in children and its cause-effect interrelations
Abstract: For the age peculiarities of the children with manifestations of ARS there was determined link with all spectral ranges of CR. From one side it determines the character of organism reaction and specificities of pathologic process, and from the other side it is linked with the processes of functional development (status).
Keywords: acute respiratory syndrome, the spectral characteristics of heart rate, children.
Topicality. In the structure of morbidity among children there is prevailing of acute respiratory infections of the upper respiratory ways with various etiologies and influenzae, taking more than 90% of all registered infectious and parasite diseases in children [3; 7]. These diseases prevail all other infections with the number of cases [4; 8].
During the last three decades significant interrelations were revealed between vegetative nerve system and cardiac vascular mortality rate including sudden deaths [2].
In the modern time one of the methods of study of vegetative nerve system and its functions in the mechanisms of development of diseases is application of cardiac rhythm variability methods, es-
pecially for the states when vagosympathetic factors probably play an important role [6].
In spite of the chosen approach to the study of the regularities linked with spectral characteristics of cardiac rhythm (CR) for acute respiratory syndrome (ARS), the strategy of the study requires consideration of the revealed peculiarities by means of correlation analysis methods [5; 7]. And the basic branches of the analysis shoukd be linked with group-forming criteria such as sex, age, preliminary and clinical diagnosis.
The objective: is to study cause-effect interrelations of acute respiratory syndrome and spectral characteristics of cardiac rhythm in children.
Acute respiratory syndrome and spectral characteristics of cardiac rhythm in children and its cause-effect interrelations
Materials and methods of the study: We checked 167 children in the age from 0.2 to 6.6 years old (M±SD: 2.1±1.5 years old). Among them there were 48 children under 1 (28.7 ±3.5%), from 1 to 3 years old — 79 (47.3±3.9%) and above 3 years old — 40 (24.0±3.3%). Among the checked children the number of boys was equal to 61.1±3.8% (n=102) and number of girls — 38.9±3.8% (n=65).
At the reception to clinic the following diagnosis were determined: ARVD (laryngotracheitis) — 82 (49.1±3.9%), acute bronchitis — 42 (25.7±3.4%) and bronchial pneumonia — 43 (25.7±3.4%).
Duration of sequent cardiac intervals and calculation values of CRV was determined with the help of program-apparatus complex "Rhythm" (PAC «Rhythm», Republic of Uzbekistan «ALEN»). RR-intervals were registered for 5minutes with 0.001 sec accuracy. The study was performed in compliance with all recommended conditions [1; 2] in "sitting" position. All time indicators of cardiac rhythm variability were calculated with the help of standard methods [1], and the value of pMo was expressed in part (%) of RR-intervals of corresponding area of mode (Mo±10 ms).
Absolute values of spectral density were achieved with the help of Furie's method (complete conversion of singular series in compliance with «Hamming» variant). And the following limits of frequency ranges were accepted: HF — >0.150 Hz, LF — 0.1500.040 Hz, VLF — 0.040-0.015 Hz, ULF — <0.015 Hz, HF-1-0.150-0.300 Hz, HF-2-0.300-0.450 Hz, HF-3 — >0.450 Hz.
For the common characteristics we used standard methods of descriptive (parametric) statistics — calculation of means (M) and extensive values (P), its variation characteristics (standard mistake of extensive value — mp, standard deviation — SD, confidence interval — DI).
Results of the study: in the performance of correlation analysis we considered rank assessments of spectral sub-ranges. Taking into account spectral characteristics of cardiac rhythm, sex, and the data of preliminary and clinical diagnosis we presented quality indicators for assessment of correlation link using Spirmen's non-parameter method (Rs) and gamma (Rg).
Conversion of spectral assessments from absolute values first to relative ones (extensive) and then to rank provided widening ofthe capabilities of the study by means of increase of functional descrip-tiveness. In fact using that kind of approach in the study of cause-effect interrelations of spectral characteristics of CR in ARS, we dealt not only with the common regularities ofpathogenetic mechanism, but also detected characteristics linked with the possibility of differential diagnostics performance.
Results of correlation analysis showed that sex of the children with manifestations of ARS had statistically reliable correlation with rank characteristics of low voltage sub-ranges LF-12 (Rg=+0.242, with p=0.04) and LF-17 (Rg=+0.346, with p< 0.001). And the direction of the link was direct (positive). At the same time correlation link of the sex with rank assessments of spectral sub-ranges of CR had both negative and positive character or direction.
So with rank characteristics of spectral sub-ranges HF-2-28 (Rg=-0.278, with p=0.001) and HF-3-2 (Rg=-0.273, with p=0.001) correlation dependence was negative, whole for subrange HF-3-5 it had direct direction (Rg=+0.256, with p=0.002).
The age of the examined children correlated with all sub-ranges of CR spectrogram, but for the first high frequency subrange HF-1 these links had a character of tendency existence, low power, threshold level of reliability or were not determined by standard methods of correlation analysis at all.
Results of correlation analysis of the children's age with rank assessments of spectral sub-ranges of CR showed existence of statistically reliable links with positive (direct) direction with ultra low (ULF: Rs=0.187, with p=+0.016), very low (ULF: Rs=+0.205, with p=0.008) and low frequency (LF: Rs=0.303, with p< 0.001) ranges. For the second and third of high frequency ranges with sex indication in the children we determined statistically reliable negative correlation dependence (HF-2: Rs=-0.230, with p=0.003; HF-3: Rs=-0.314, with p=0.001).
For every low frequency range of CR we revealed statistically reliable correlation links of age values of the children with certain sub-ranges of frequency spectrum. For the ultra low frequency area that link was determined with ULF-3 subrange (Rs=+0.154, with p=0.048), and for very low frequency one with VLF-5 subrange (Rs=-0.152, with p=0.019).
Age peculiarities among the examined children with manifestations of ARS were reflected in the alteration of the spectral density of CR in low frequency area (ULF: Rs=+0.187, with p=0.016; VLF: Rs=+0.205, with p=0.008; LF: Rs=+0.303, with p< 0.001).
The age of the children had negative correlation with the values of rank assessments of spectral density of CR in the second and third ranges HF (HF-2: Rs=-0.230, with p=0.003; HF-3: Rs=-0.314, with p< 0.001).
In compliance with the general regularity of correlation links of the age with rank assessments of CR spectrum in low frequency area a statistical reliable correlation with ULF-3 (Rs=+0.154, with p=0.048) subrange was determined, while for VLF-5 and LF-5 sub-ranges there was notable correlation feedback (Rs=-0.182, with p=0.019; Rs=-0.152, with p=0.049). The value of children's age also correlated with certain characteristics of high frequency area of spectrum of CR, and that link had various directions (HF-2-12: Rs=+0.185, with p=0.016; HF-2-24: Rs=-0.164, with p=0.015; HF-3-6: Rs=+0.167, with p=0.031; HF-3-11: Rs=-0.194, with p=0.012). The values of preliminary diagnosis (PD) had positive correlation with rank assessments of spectral density of CR in low frequency area (ULF-3: Rg=+0.304, with p< 0.001; LF-21: Rg=+0.184, with p=0.010), while for high frequency area of the spectrum there was notable existence of statistically valuable feedback (HF-2-4: Rg=-0.193, with p=0.009; HF-2-13: Rg=-0.215; with p=0.003).
It should be noted, that only for ULF-2 subrange there was feedback with clinical diagnosis (Rg=-0.303, with p< 0.001), and with ranges ULF-3 (Rg=+0.324, with p < 0.001), LF-21 (Rg=+0.274, with p< 0.001) and HF-1-3 (Rg=+0.191, with p=0.010) there was positive link.
The values of clinical diagnosis united by ARS manifestations and represented by three levels of the primary injure of respiratory system (URW, B and L) had positive correlation with rank assessments of CR spectral density in the sub-ranges HF-1-30 (Rg=+0.197, with p=0.008) and HF-2-26 (Rg=+0.261, with p<0.001), while for the sub-ranges HF-2-4 (Rg=-0.250, with p=0.001) and HF-2-13 (Rg=-0.248, with p=0.001) there was negative link.
Conclusion. Thus, for the age peculiarities of the children with manifestations of ARS there was determined link with all spectral ranges of CR. From one side it determines the character of organism reaction and specificities of pathologic process, and from the other side it is linked with the processes of functional development (status). Results of comparative analysis of rank assessments of spectral sub-ranges of CR in ARS provided evidence based isolation of more than 250 signs from which 55 were the most valuable ones according to the criteria of statistic reliability and probability ofprevalence for three categories of the diagnostics.
References:
1. Analysis of cardiac rhythm variability with using various electrocardiographic systems (methodic recommendations)/ Edited by R.B. Babyevski. - M.: CMTVMHC RF, 2000. - 50 p.
2. Bayevski R.M., Ivanov G.G. Variability of cardiac rhythm: theoretical aspects and possibilities of clinical application//http://www. ecg.ru.
3. Baranov A. A., Kaganov B.S., Girelov A.V. Acute respiratory diseases in children: therapy and prophylaxis. - M., 2004.
4. Bobrov M. V. Clinical-economic basis of etiotropic therapy of respiratory viral infection in children: Abstract of doct. diss. - Volgograd, 2006. - 24 p.
5. Galeyev A.R., Igisheva L.N., Kazin E.M. Variability of cardiac rhythm in healthy children in the age 6-16 years old//Human physiology. - 2002. - V. 28, № 4. - P. 54-58.
6. Kokoulin G.S. Lebedeva A.B., Tatarinova S.V., Tatareva S.V. About the peculiarities of cardiac rhythm variability in children with tachy-arythmia//Information resource of electrocardiography (http://www.ecg.ru, 2008).
7. Slobodskaya E.R., Tataurov U.A. Vegetative regulations of cardiac rhythm and temperament in young children//Human Physiology. - 2001. - V. 27, № 2. - P. 86-90.
8. Suess P. E., Alpan G., Dulkerian S. J. et al. Respiratory sinus arrhythmia during feeding: a measure of vagal regulation of metabolism, ingestion, and digestion in preterm infants//Dev. Med. Child. Neurol. - 2000. - № 42(3). - P. 169-173.
Ibragimova Nargiza Sayfutdinovna, Assistant of the Tashkent Medical Academy E-mail: [email protected]
Effect of the type of vegetative nerve system on the quality of life of the patients with itching in old and senile age
Abstract: We established dependence of reactivity type of vegetative nerve system and life quality in elderly and old people. Expression of deterioration of life quality, over-tension state, and failure of adaptation adjustment mechanisms in the regulation system depends on the presence of skin itching.
Keywords: itching, vegetative nerve system, old and senile age, quality of life.
At the modern time it is proven that the parameters of SI of a patient have independent prognostic value and serve to be more accurate criteria for the definition of a patient' status during the therapy than values of common somatic status [7].
Aging is a final period of organism development; it is a complex ofvarious physiologic mechanisms occurring on molecular, cellular and systemic levels with alive tissue structural and functional alterations, which decrease ability of an organism to maintain its isolation and resistance [4]. In some authors' opinion the part of people elder than 65 years old to the modern time is 10-14% of the whole population [5]. Similar situation is observed in Uzbekistan.
Among various symptoms met in elderly people itching takes a prominent place. According to literature data about 50% of people above 60 have itching, often continuous and intensive, leading to depression and insomnia, and that decreases quality of patients' life
[3, 6].
Recently in literature there appear publications about influence of not only immune and endocrine systems, but also vegetative nerve system on skin [2]. It is known that activation of immune competent cells and further stage of pathologic physiologic process in allergic diseases is under the control of neural vegetative regulation. Sensitizing of skin with further dystrophic alterations in it is formed with the background functional drifts in central and vegetative nerve system [1, 8].
On the basis of the aforesaid, performance of the study of interrelation of life quality and vegetative nerve system is a topical problem in elderly and senile people suffering itching.
Thus, the objective of that research is study of the interrelation of the values of vegetative nerve system and life quality in old and senile age people with itching.
Materials and methods of the research: we checked 85 people aged from 48 to 90 years old staying clinical supervision in the CP № 2 MCO in Tashkent. Among them there were 37 (43.5%) women and 48 (56.5%) men. Patients were divided to two groups: 55 patients with skin itching (1st main group) where patients were united by prevailing in clinical picture symptom — itching and patients considered it to be intolerable; and 30 patients without skin itching (2nd group — comparison).
All patients had cardio-immunography (CIG) — test in compliance with the common method with classification according to the types ofVNS: hyper sympathetic tension, sympathetic tension, eitonia and vagotonia. Together with that we determined vegetative reactivity such as failure of adaptation-compensatory processes, over-tension, tension, prevailing of sympathetic tension and preservation of adaptation-compensatory processes.
We worked out a questionnaire about life quality among old and senile people with itching. The questionnaire provides assessment of patients' opinion about their health, especially health criteria which are significant (from the patient's point ofview) in itching. The questionnaire contains 4 scales (physical and social status, emotional status and general health) including 12 subscales. The values of the questionnaire are measured in points interval from 1 to 6. And the higher values correspond to less expressed symptoms and higher quality of life. Maximal gathered score was 110 points, and minimal score was 24.
Digital material was processes by means of variation statistics method.
Results of the study: Performed studies showed the tendency for decrease of Mo values and variation range (AX) in the patients with itching in comparison with the values of the group of patients
