CC BY
13стемы санитарно-авиационной эвакуации. Разработаны Техническое задание на оказание услуг воздушного транспорта, оборудованного медицинским оборудованием и типовая документация на проведение аукциона на право заключить государственный контракт на оказание услуг воздушного транспорта, оборудованного медицинским оборудованием; Разработан типовой государственный контракт на оказание услуг воздушного транспорта для плановых и экстренных эвакуаций, а также проекты таких нормативных документов как Порядок медицинской эвакуации и Порядок экстренной консультативной медицинской помощи.
Таким образом, приоритетами поступательного развития организации экстренной медицинской помощи в Российской Федерации являются совершенствование нормативно-правовой базы и создание адекватных условий для выбора оптимальной модели финансирования данной службы.
СПИСОК ЛИТЕРАТУРЫ:
1. Федеральный закон «Об основах охраны здоровья граждан в Российской Федерации» от 21.11.2011 N 323-ф3 (последняя редакция). [Электронный ресурс]. Режим доступа: https://www.consultant.ru/document/cons doc LAW 121895/. . - Загл. с экрана.
2. Приказ Минздравсоцразвития России № 500н от 5 мая 2012 г. «Об утверждении перечня федеральных государственных учреждений, осуществляющих медицинскую эвакуацию». [Электронный ресурс]. Режим доступа:
http://www.minzdravkk.ru/pages/proizdorovie/npd/det ail.php?ELEMENT ID=3290. - Загл. с экрана.
3. Методические рекомендации «Развитие системы санитарной авиации в Российской Федерации в 2013-2015 гг.»
4. Воздушный кодекс Российской Федерации от 19.03.1997 № 60-ФЗ (ред. от 31.12.2017) (с изм. и доп., вступ. в силу с 04.06.2018) [Электронный ресурс]. - Режим доступа: https://www.consultant.ru/document/cons doc LAW 13744/. - Загл. с экрана.
5. Топорков М.Г., Лучников Э.А. Авиа-меди-цинская эвакуация в отечественных и зарубежных силовых структурах в военных конфликтах и в мирное время // Медико-биологические и социально-психологические проблемы безопасности в чрезвычайных ситуациях. -№ 2. -2012. - С. 29-38.
6. Концепция создания санитарной авиации в Российской Федерации [Электронный ресурс]. - Режим доступа: http://docplaver.ru/29226022-Koncepciva-sozdaniva-sistemv-sanitarnov-aviacii-v-rossiyskoy-federacii.html. - Загл. с экрана.
7. А.В. Попов. Проблемы санитарной авиации в Российской Федерации. Доклад Всероссийского центра медицины катастроф «Защита» Минздрава РФ международной конференции «Эффективное здравоохранение: инновационный путь развития», Москва, РАНХиГС, 30.10.2012. [Электронный ресурс]. - Режим доступа: http://www.viablehealthcare.ru/events/mezhdunarodna va-konferentsiva-effektivnoe-zdravookhranenie-innovatsionnvv-put-razvitiva/. Загл. с экрана.
CLINICAL MARKERS OF PREMATURE AGING AMONG WOMEN WITH UNDIFFERENTIATED
CONNECTIVE TISSUE DYSPLASIA
Kononova N.
Candidate of Medical Sciences, General Director - Chief Physician, JSC Sanatorium "Metallurg",
Izhevsk, Russia Smetanin M.
Candidate of Medical Sciences, Doctor of ultrasound diagnostics, Budgetary health care institution of the Udmurt Republic "Republican clinical diagnostic center of the Ministry of health of the Udmurt Republic".
Department of ultrasound diagnostics.
Chernyshova T.
Doctor of medical Sciences, Professor of the Department of General practitioner and internal medicine with the course of emergency medical care Budgetary health institution of the Udmurt Republic "City clinical
hospital №9 of the Ministry of health of the Udmurt Republic"
Pimenov L.
Doctor of medical Sciences, Professor, head of the Department of General practitioner and internal medicine with the course of emergency medical care Budgetary health institution of the Udmurt Republic
"City clinical hospital №9 of the Ministry of health of the Udmurt Republic"
Abstract
The article discusses the problem of early diagnosis of undifferentiated connective tissue dysplasia as a possible predictor of premature aging in ontogenesis. External signs of undifferentiated connective tissue dysplasia can testify the presence of pathological modification of proteins of connective tissue (elastin and collagen), which leads to premature aging of skin. This signs should be diagnosed by any doctor during the first consultation. Such patients are in need of an early esthetic prophylactic correction with the help of the most effective methods.
Keywords: premature aging, undifferentiated connective tissue dysplasia, anthropometric study
According to the national recommendations (2015) of Russian scientific medical society of therapists in treatment and rehabilitation of patients with connective tissue dysplasia (CTD), depending on peculiarities of etiological agents, it is relevant to distinguish hereditary disorders of connective tissue (differentiated or monogenic diseases) and connective tissue dysplasia (undifferentiated forms). Differentiated (syn-dromic) forms include diseases of a single-factor type with identified gene defect, well-known type of inheriting and, as a rule, with an explicit and clearly defined clinical semiology. A classic example of syndromic forms of CTD are Marfan and Ehlers-Danlos syndromes, osteogenesisimperfecta and other rare genetic syndromes. Undifferentiated forms of CTD (UCTD) occur as a result of a large number of gene mutations in various combinations and of an impact of diversified environmental factors. Clinical manifestations of UCTD do not fit into any of the known differentiated hereditary diseases, although they may resemble them. It is possible to isolate the Marfanoid, Eleerside and MASS-like phenotypes, assuming a single genetic essence of these states [7]. The morphologic basis of UCTD is the reduction of certain types of collagen or the imbalance among them, that leads to the reduction of strength of connective tissue in many organs and systems [2, 13, 14]. The external manifestations of UCTD are the so-called «stigmata of disembryogenesis», which can be manifested in both apparent deformities and unspectacular signs [1, 2, 3, 16]. Since the skin is the largest organ of human body containing a numerous amount of various connective tissue cells, it is reasonable to presume that the first signs of UCTD, which are manifested mostly in poorly expressed heterogeneous symptoms and syndromes, can be identified more likely than others, while carefully examining the cutaneous integument. As it is known, up to 35% of healthy people have UCTD of a different degree of manifestation, whereas 70% of them are women [1, 3], who are worried about their appearance. The slightest signs of ageing, especially at a young age, cause mental discomfort, affect interpersonal skills, create a social disadaptation. Therefore, detecting the first signs of ageing is the most relevant.
The objective of this work is to reveal markers of premature ageing among women with UCTD while assessing patterns of facial esthetic features.
Materials and methods: 119 women who underwent medical survey, treatment and rehabilitation in both 'Metallurg' sanitarium and therapy unit of Izhevsk clinical hospital №9 participated in a study. All patients' predictors of UCTD [7, 11] with an emphasis on skin signs wereassessed[6]. Six and more signs of UCTD were diagnosed among 67 women, who formed
the experimental group, other patients who had five and less signs of UCTD formed the control group (n=52). Criteria for the inclusion are: women agedbetween 24 and 45 with body mass index between 17 and 25 and skin phototype of I - IV. Excluded from the study: pregnant, lactating women, women going through the menopause to exclude the influence of hormonal changes on study results; patients who had wrinkles correction with the use of fillers or botulinum toxin type A. Average age withinexperimental group was 38,6±6,7, within control group —39,4±5,6. Inside each group, anamnesis was collected, physical examination wasperformed and leading clinical syndromes of UCTD were defined with the use of electrocardiography, echocardiography, abdominal organs ultrasonography, esophagogastrodu-odenoscopy in the presence of complaints, assessment of biological age using method by V.P. Voitenko. — Tokar A.V. — Chebotarev D.F. [10], morphometry (transverse headwidth, morphological face height, greatest face width, altitude and length of the eye orbit, distance between canines, width of a dental arch) [8]. From this datathe following average values were defined: physiognomic height of the face, ear height, nose width, width between nasolabial folds, filter width, mouth width, height and length of the eye gap, head and facial index [8]. To identify the degree of manifestation of skin changes occurring in the result of ontogenesis, visual estimation of macromorphology of skin and wrinkleswas used. Visual method presumed registering locations of wrinkles, as well as identification of their type, depth and degree of expression using the Lem-perle assessment scales [15]. Statistical processing of data was handled with«Statistica 6,0» software («Star-soft», version 6, USA) using the Shapiro-Wilk test. Distribution of the anthropometric indicators was in line with the norm, the data was submitted in the form of average values and confidence intervals, mean values were compared using Student's t-test. Differences were considered statistically significant ifp<0,05. Correlation between two quantitative traitswas determined by Spearman rank-order correlation coefficient. The following criteria were applied to the correlation coefficient: |r|<0,20 - very weak correlation; 0,2<|r|<0,5 -weak correlation; 0,5<|r|<0,7 - mean (moderate) correlation; 0,7<|r|<0,9 - strong correlation; 0,9<|r|<1,0 -very strong correlation. Differences and relationships between indicators were considered statistically significant if the significance level p for the corresponding statistical criterion did not exceed 0,05.
Results and discussion: according to thethe physical examination, bone and muscle-joint deformities occurred in 54% of caseswithin the experimental group and only in 9% of cases within the control group. Visceral signs of UCTD are presented in the Table 1.
Table 1.
Visceral manifestations of UCTD in experimentaland control groups, (quantity,%)
Trait Trait frequency, quantity (%)
Experimentalgroup (n=67) Control group (n=52)
Mitral valve prolapse 1st and 2nd degree 36 (53,7) 4 (7,7)
Myxomatous degeneration of valvular structures 8 (11,9) 0 (0)
Abnormal chords of the left ventricle 18 (26,9) 3 (5,8)
Ptosis of the abdominal cavity organs 30 (44,8) 6 (11,5)
Kidney Duplication 1 (1,5) 0 (0)
Bend of the gallbladder, S-shaped gallbladder 56 (83,6) 15 (28,8)
Myopia, astigmatism 20 (29,9) 18 (34,6)
Varicose veins of lower extremities 14 (20,9) 8 (15,4)
Esophageal Diverticula 2 (3) 0 (0)
From Table 1 it can be seen that patients from Skin manifestations of UCTD and facial dysmor-
theexperimental group were more often diagnosed with phia also prevailed in the experimentalgroup, as seen in visceral manifestations of UCTD and gallbladder dis- Table 2. eases, as well as ptosis of the abdominal cavity and small heart abnormalities.
Table 2.
Frequency of skin signs of UCTD,%_
Trait Trait frequency, %
Experimental group (n=67) Control group (n=52)
Increased skin extensibility (more than 3sm) 81,8 44,0
Thin translucent skin 22,7 9,9
Loose skin with reduced tone 80,7 22,0
Scars thin 10,2 4,4
broad atrophic 79,5 29,7
"tissue-paper" -type 36,4 11,0
keloid/hypertrophic/pathological 9,1 2,2
Striae single 10,2 2,2
multiple 77,3 20,9
Vulnerable skin 98,9 63,7
Receding chin 8,4 2,1
Antimonogloid eye incision 13,4 3,0
Dental crowding 15,9 5,1
Table 2 shows that the dominant trait within the experimental group was vulnerable skin. Increased skin extensibility (more than 3sm) was twice more common, andloose skin with reduced tone was 4 times more com-moninside the experimental group than inside the control group. Compared to the control group, patients in the experimental group had frequent cases of single and multiple striae (unrelated to pregnancy), receding chin, antimonogoloid eye incision and dental crowding.
Premature aging of the patients of the experimental group was confirmed by a large gap (about 8 years) between their calendar and biological age and
between median biological age in both groups (about 9 years, p <0,05).
According to the analysis of the main anthropo-metric indices, the patients of the experimental group were significantly higher (p <0,05), had lesser weight (p <0,05) and were diagnosed with dolichostenomelia (p <0,05) - lengthening of limb sizecompared to their height (significant difference between "arm span -height"; "brush / height" ratio higher than 11%; "foot / height" ratio higher than 15%).
During the anthropometric study of face differences were obtained using the following indices, as shown in Table 3.
Table 3.
Mean indicesfor the anthropometric study of face, mm
Index Experimental group (n=67) Control group (n=52) p
Morphological height of face 124,0±2,5 118,0±1,6 p<0,05
Zygomaticdiameter 136,3±0,9 138,8±0,8 p<0,05
Transverseheaddiameter 140,1±0,7 142,2±0,7 p<0,05
Verticalheaddiameter 187,5±2,1 178,1±2,0 p<0,05
Widthbetweencanines 38,5±1,7 40,0±1,3 p>0,05
Widthofdentalarch 48,1±2,6 51,0±2,2 p>0,05
Orbitheight 30,3±1,2 30,2±1,3 p>0,05
Orbit length 34,7±1,5 35,3±1,7 p>0,05
Table 3 shows that within the experimental group zygomatic diameter and transverse head diameter are lesser compared to the control group, while the morphological height of face and vertical head diameter are significantly larger.
After calculating average anthropometric parameters using the regression equations, the following data was obtained: the difference between the mean indices is only significant regarding physiognomic height of face - 188.5 ± 1.7mm inside the experimental group versus 184.0 ± 1.4mm inside the control group (p <0,05).
Within the experimental group, dolichocephalic shape of head predominated (76%), while in the control group it wasthe mesocephalicshape (73.6%). As for the face shape, the patients differed drastically, with the predominance of leptoprozopic shape (64%) inside the experimental group and mesoprozopic (68,4%) shape inside the control group.
Within theexperimental group, significant differences in the severity of dysplasia were revealed, compared to the control group(Me = 12; LQ = 8; UQ = 18) (p <0.05). The most pronounced manifestations of CTD were defined under combination of dolichocephalic shape of head and leptoprozopicshape of face (Me = 33; LQ = 29; UQ = 39). Average indices for anthropometric study of face were minimal (Me = 28, LQ = 19, UQ = 32), except for the physiognomic height. These differences were statistically significant (p <0,05). Correlation between severity of dysplasia and age was not revealed (r = 0,07; p = 0,18).
Conclusion:the most significant diagnostic markers of UCTDare the following anthropometric values: height, weight, dolichostenomelia. Dolichocephalic shape of head orleptoprozopicshape of face are the signs of premature aging. This signs should be diagnosed by any doctor during the first consultation to prevent the age-related skin changes as soon as possible, using early aesthetic prophylactic correction methods. That would reduce the risk of complications connected with invasive procedures, as well as the duration of the recovery period, while maintaining a high degree of patient satisfaction.
REFERENCES:
1. Dedova, V.O. Rasprostranennost' displaziisoedinitel'nojtkani (obzorliteratury) / V.O. Dedova, N.YA. Dotsenko, S.S. Boev, I.A.
SHekhunova, L.V. Gerasimenko L.V. // Meditsina i obrazovanie v Sibiri. — 2011. — № 2. — S. 6-8.
2. Kadurina, T.I. Displaziyasoedinitel'nojtkani / T.I. Kadurina, V.N. Gorbunova. - SPb. :EHlbi," 2009. -714 s.
3. Klemyonov, A.V. Klinicheskoe znachenie nedifferentsirovannoj displazii soedinitel'noj tkani: Avtoref dis. ... dokt. med. nauk. — M., 2005, 18.
4. Kononova, N.YU. Analiz pokazatelej kachestva zhizni u patsientov s nedifferentsirovannoj displaziej soedinitel'noj tkani / N.YU. Kononova, T.E. CHernyshova, I.A. Ivanova // Arkhiv" vnutrennejmeditsiny.-2015. - T. 5. - N3(23). - S. 23-26.
5. Kononova, N.YU. Kosmetologicheskie problem displazii soedinitel'noj tkani: kliniko-ehksperimental'noe obosnovanie perspektiv mezoterapii / N.YU. Kononova, T.E. CHernyshova, E.G. Butolin, O.V. Danilova // Spravochnikvrachaobshhejpraktiki. - 2014. - № 10. - S. 59-61.
6. Lyakhovetskij, B.I. Displazii soedinitel'noj tkani v praktike vracha-dermatologa I kosmetologa: Uchebno-metodicheskoe posobie dlya sistemy poslevuzovskogo professional'nogo obrazovaniya vrachej / B.I. Lyakhovetskij, L.K. Glazkova, T.F. Peretolchina, YU.M. Bochkarev - Ekaterinburg: UGMA, 2012. - 48s.
7. Natsional'nye rekomendatsii rossijskogo nauchnogo meditsinskogo obshhestva terapevtov po diagnostike, lecheniyu I reabilitatsii patsientov s displaziyami soedinitel'noj tkani. Vserossijskoe nauchnoe obshhestvo terapevtov // Meditsinskij Vestnik Severnogo Kavkaza. - 2016. - №1. - S.2-76.
8. Obshhestvennoe zdorov'ei zdravookhranenie: uchebnik / V.A. Medik, V.K. YUr'ev. - 3-eizd.,pererab. idop. - M. :GEHOTAR-Media, 2015. - 288 s. :il.
9. Perspektivy metoda organotkanevoj terapii v ehsteticheskoj meditsine /Tezisy XI S"ezda dermatovenerologov I kosmetologov 09.11-12.11// Ekaterinburg, 2010.
10. CHebotaryov, D.F. Prezhdevremennoe (uskorennoe) starenie: prichiny, diagnostika, profilaktikailechenie / D.F. CHebotaryov, O.V. Korkushko,
V.B.SHatilo//http://socion.net.ua/med_journal/articles/ gerontology/chebotarev. htm
11. SHlyakhto, E.V. Nasledstvennye narusheniya soedinitel'noj tkani. Problemy I vozmozhnosti ikh
resheniya. / E.V. SHlyakhto, EH.V. Zemtsovskij // Klinicheskayameditsina. - 2010. - №5. - S.63-65.
12. EHrnandes, E.I. Metod yehsteticheskoj meditsiny v kosmetologii: in"ektsionnye metody ehsteticheskoj korrektsii, pilingi / E.I EHrnandes, E.I. Gubanova, E.Z. Parsagashvili, I.V. Ponomarev, S.V. Klyuchareva M.: OOO «ID «Kosmetikaimeditsina», 2010. - 320s. ISBN 978-5-901100-32-5.
13. Cole W.G. Collagen genes: mutations affecting collagen structure and expression // Prog. Nucleic. Acid. Res. Mol. Biol. 1994. Vol. 47. P. 29-80.
14. Flavell S.J., Hou T.Z., Lax S., et al. Fibroblasts as novel therapeutic targets in chronic inflammation //
British. J. Pharmacology.— 2008.— Vol. 153.— S. 241-246.].
15. Lemperle G., Holmes RE., Cohen SR, Lem-perle SM. A classification of facial wrinkles // Plast. Reconstr. Surg. 2001 Nov; 108(6):1735-50; discussion 1751-2.
16. PersicovA.V., Brodsky B. Unstable molecules form stable tissues // Proc. Natl. Acad. Sci. 2002. Vol. 99(3). P. 1101-1103.
17. Nechaeva G. I., YAkovlev V. M., Konev V. P. Displaziya soedinitel'noj tkani: osnovnye klinicheskie sindromy, formulirovka diagnoza, lechenie // Lechashhijvrach. — 2008. — № 2. — S. 22-28.
DETERMINATION OF LEFT VENTRICULAR SYSTOLIC DYSFUNCTION PROGRESSION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND TYPE 2 DIABETES MELLITUS
TAKING INTO ACCOUNT OF TENASCIN C
Koteliukh M.Y
Candidate of Medical Sciences, Department of internal medicine № 2, clinical immunology and allergology, Kharkiv National Medical University, Kharkiv, Ukraine
Kravchun P.
Doctor of Medical Sciences, Department of internal medicine № 2, clinical immunology and allergology,
Kharkiv National Medical University, Kharkiv, Ukraine
Ryndina N.
Doctor of Medical Sciences, Department of internal medicine № 2, clinical immunology and allergology, Kharkiv National Medical University, Kharkiv, Ukraine
Kreis I.
1 head of cardiology department Kharkiv hospital railroad №1
Zaikina T.
Candidate of Medical Sciences, Department of internal medicine № 2, clinical immunology and allergology, Kharkiv National Medical University, Kharkiv, Ukraine
Borzova-Kosse S.
Assistant of Department of internal medicine № 2, clinical immunology and allergology,
Kharkiv National Medical University, Kharkiv, Ukraine
Abstract
At present the role of tenascin C in patients with acute myocardial infarction and type 2 diabetes mellitus has remained unclear.
The aim of the study - construction of a model prediction of left ventricular systolic dysfunction in patients with acute myocardial infarction and type 2 diabetes, taking into account the level of tenascin C.
Methods. The content of tenascin C was determined by the immunoassay method using a set of "Human Tenascin-C Large (FNIII-C)" reagents (Immuno-Biological Laboratories Co. Ltd. (IBL), Takasaki-Shi, Japan ).
The results. The study showed that over time the content of tenascin C at the 10-14th day decreased in patients with acute myocardial infarction and type 2 diabetes mellitus compared with patients with AMI without type 2 DM. It has been established practical to elaborate a model taking into account tenascin C to predict of development of left ventricular systolic dysfunction in patients with acute myocardial infarction and type 2 diabetes mellitus. Consideration of tenascin C, creatinine, BMI and diastolic blood pressure indices in one model makes it possible to increase the specificity to 77% in high sensitivity of 89%.
Conclusion. This suggests that diabetes may be associated with exhaustion of tenascinemia. Tenascin C are found the prediction properties of development of left ventricular systolic dysfunction in patients with acute myo-cardial infarction and concomitant type 2 diabetes mellitus.
Keywords: acute myocardial infarction, tenascin C, diabetes mellitus type 2, left ventricular systolic dysfunction.
Ischemic heart disease (IHD) is ranked first among cardiovascular diseases and is the leading cause of mortality worldwide and in Ukraine [3; 7]. The course and prognosis of IHD depends on the presence of comorbid pathology. Type 2 diabetes mellitus (type 2 DM) is a significant factor that predisposes an unfavorable course of coronary artery disease [2].
Currently, 347 million people are suffering from diabetes, 90% have type 2 DM [6]. The prevalence of diabetes mellitus in Ukraine is 1264500 individuals. Thus, type 2 diabetes is a global problem not only in Ukraine but also in the world [3; 6].
