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Immunity state on the background of osteotropic therapy with medicine calcium D3 in endoprosthesis of the knee joint
References:
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3. Aliev M. A., Mamadaliev M. A. The diagnostic importance of the computer and magnet-resonance tomography in posttraumatic cerebral arachnoiditis. Materials of 8th Asian Congress of Neurological Surgeons, 2010, Kuala Lumpur, Malaysia, - P.194.
4. Aliev M. A. The importance endolumbal ozone and nootropic insufflation during the postoperative period after evacuation of posttraumatic arachnoidal cysts. Abstract book of European Association of Neurosurgical Societies' Young Neurosurgeons Meeting, Innsbruck, Austria, 2011., - P.40.
5. Bolg'ayev A. B., Madiyarov S. D. (1977). Treatment of chronic arachnoiditis via introduction of ozone in the subarachnoid space. Journal of Neurology and Psychiatry, Moscow, № 2. - 227-231, in Russian.
6. Gaevaya M. A. (2000). Features vegetovascular paroxysms of posttraumatic cerebral arachnoiditis different localization. - (The dissertation of candidate of medical sciences)./Kharkiv Medical Academy of Postgraduate Education. - Kharkiv, Ukraine, in Russian.
7. Dubrovina Y. A. (2007). Endolyumbal introduction of ozone-oxygen mixture in the treatment of traumatic brain injury and its complications: Clinical and neurophysiological evaluation (The dissertation of candidate of medical sciences), Kazan, Russian Federation, in Russian.
8. Konovalov A. N., Likhterman L. B., Potapov A. A. (1998, 2002). Clinical guidelines for traumatic brain injury. Volume № I and III. Moscow, “Antidor", in Russian.
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10. Konovalov A. N., Likhterman L. B., Potapov A. A. Neurotraumatology: directory. - M.: Medicine, 1994. - 415 p, in Russian.
11. Madyarov S. D. (1988). Pathogenesis, diagnosis and surgical treatment of cerebral arachnoiditis. (The dissertation of doctor of medical sciences). - Kiev, Ukraine, in Russian.
12. Madyarov S. D., Bolgaev A. B. Modification method of introducing ozone into the subarachnoid space/Rat. Offer № 127 of04/19/78, issued by the summit in Russian.
13. Mamadaliev A. M. (1988). Predicting outcomes of traumatic brain injury in the acute period (The dissertation of doctor of medical sciences), Burdenko Neurosurgery Institute, Russian Federation, in Russian.
14. Mamadaliev A. M., Agzamov M. K. (1993). A method for treating severe traumatic brain injury in the acute period (The patent for the invention of the Russian Federation № 5042297/14/023170 on 07/21/93)., in Russian.
15. Mamadaliev A. M., Aliev M. A. (2009). The Importance of the Duration Disorders of Consciousness to Prognosis of the Outcome of Cranio-Cerebral Trauma. In Black P. (Eds)., Proceedings of XIV WFNS Congress, Boston, USA.
16. Macheret E. L., Samosyuk I. Z., Garkusha L. G. Cerebral arachnoiditis. - K.: Health Protection, 1985.- 168 p., in Russian.
17. Firsching R. Early magnetic resonance imaging and CT ofbrain-stem lesions after severe injury//J. Neurosurg. - 1998/ - V. 89 (5). - P. 707-712.
18. Zlader J., Boguslawaka-Staniaszezyk R. Comparadility of CT-tomography and EEG in the evaluation of posttraumatic sequelae (pol-ish)//Neurologia I neurochirurgia polska. - 1993. - Mar. - Apr. - 27 (2). - P. 175-180.
Alimov Aziz Pulatovich, Scientific Research Institute of Traumatology and Orthopedics, Ministry of Health of the Republic of Uzbekistan Kamalov Zaynitdin Sayfutdinovich Iinstitute of Immunology Academy of Sciences of the Republic of Uzbekistan
Azizov Mirhakim Javharovich, Scientific Research Institute of Traumatology and Orthopedics, Ministry of Health of the Republic of Uzbekistan Aripova Tamara Uktamovna Iinstitute of Immunology Academy of Sciences of the Republic of Uzbekistan E-mail: [email protected]
Immunity state on the background of osteotropic therapy with medicine calcium D3 in endoprosthesis of the knee joint
Abstract: The clinical-immunologic examinations were performed in 44 patients with degenerative-dystrophic changes of knee joint (DDCKJ), of them 21 patients — before treatment (group 1), 23 patients — received preparation Calcium D3, and 20 were healthy volonteers of comparable age. There were studied features of changes of the cellular and humoral immu-
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nity including such oarameters as number of lymphocytes CD3+, CD4+, CD8+, CD16+, CD19+ markers, activation markers CD25+ (carrying receptors to the IL-2 а-chain) and CD95+ (carrying receptor for Fas dependent apoptosis), concentration of immunoglobulins (IgA, IgM, IgG) and cytokines — interleukins of immune system (IL-1 and IL-4). It has been revealed that during treatment with preparation Calcium D3 in the patients with DDCKJ before and after operation there has been normalized only total number o leucocytesand lymphocytes, CD3+, CD8+ and IgM. However, as it is seen from the given data, the other studied changed parameters of immunity have not undergone to restoration up to control parameters.
Keywords: immunity, lymphocytes, immunoglobulins, interleukins, osteotropic therapy, endoprosthesis.
The reason of aseptic instability of the endoprosthesis is connected to mechanical instability of the components or is caused by reaction of the tissues to the foreign body, due to wearing out and appearance of fragments of implant rubbing [1; 4; 5]. The development of aseptic flail components of endoprosthesis has multifactor character, thus the particles of wearing out require the leading role. It is considered, that the recognition of the particles of deterioration is fulfilled by macrophages at phagocytosis of the small particles. Resistance of these particles to enzymatic digestion forms the pathological answer resulting in aggressive osteolysis.
Activation of neutrophils by cytokines which occur as a result of local response to the foreign body, probably, is the initiating factor of a chronic inflammation around the implant leading to the aseptic instability [1; 3; 6; 9].
Under the conditions of primary defectivity of the bone tissue, at presence of accompanying osteoporosis, the problem of instability rises especially sharp in connection with probable development of periproshesis microfractures [2; 7; 8]. Therefore preoperative me-dicamentous providing of the balanced progressing of the processes of osteolysis and remodelling in the bone bed is obviously important element of early and long-term prevention of the aseptic flail components of the endoprosthesis of the knee joint [7; 10].
The dynamic of blood parameters reflects the developing processes among which the changes of immune status on the background of orthotropic therapy performed appeared the most important.
Hence, the revealing of early signs of osteolysis on the basis of the methods of evaluation of immune status and medicamentous effect will allow studying of resorption processes in the periprosthesis bone on the background of the osteotropic therapy before and after arthroplasty performed of the knee joint.
The purpose of our research was to study efficacy of the influence of medicamentous correction with preparation calcium D3 on the processes of remodelling of the bones forming a knee joint before and after endoprosthesis in comparative aspect with use of the methods of the immune status estimation.
The results of complex research of cellular and humoral immunity before and after operation of the total endoprosthesis of knee joint on the basis of use of medicines of the orthotropic effect are presented in this report.
Material and methods
The clinical-immunologic examinations were performed in 44 patients with degenerative-dystrophic changes of knee joint (DDCKJ), of them 21 patients — before treatment (group 1), 23 patients — received preparation Calcium D3, and 20 were healthy volonteers of comparable age. There were studied features of changes of the cellular and humoral immunity including such oarameters as number of lymphocytes CD3+, CD4+, CD8+, CD16+, CD19+ markers, activation markers CD25+ (carrying receptors to the IL-2 а-chain) and CD95+ (carrying receptor for Fas dependent apoptosis), concentration of immunoglobulins (IgA, IgM, IgG) and cytokines — interleukins of immune system (IL-1 and IL-4).
For estimation of the state of immune system the following methods were used: isolation of the lymphocytes from peripheral
blood (Boyum, 1968) on a gradient phycoll-verografin, phenotype of immuno-competent cells was defined with use of monoclonal antibodies of the manufacture ООО Sorbent (Russia). The contents of immunoglobulins were measured with method of radial immunodiffusion by Manchini (1969) with use of monospecific serums against IgA, IgM, IgG (Russia, Institute of microbiology and immunology named after Gamaleya N. F.).
Concentration of interleukins (IL-1ß, IL - 4) in the blood serum was determined with use of method ofsolid phase of immuno-enzymatic analysis with use of test-systems of ZAO “Vector — Best” (Russia). The research was carried out in the Institute of Immunology of the Academy of Science of the Republic of Uzbekistan. The quantitative estimation of the results was performed by method of the construction of calibrate curve or with use of the commercial computer program “Microplate manager”, reflecting dependence of optical density on concentration for a standard antigen and allowing comparison with it of studied samples. Sensitivity of a method was 5-30 pg/ml.
The received data underwent statistical processing on the personal computer Pentium-4 under the programs developed in the package EXCEL, with use of library of statistical functions, with calculation of arithmetical mean (М), mean square-law deviation (u), standard mistake (m), relative values (frequency,%), Student's criterion (t), with calculation of probability of a mistake (P). The distinctions of mean values were considered to be reliable at the level P<0,05. These procedures were performed on the basis of recommendations on the statistical processing of the results of clinical and laboratory examinations (Zaytcev V. M., et al, 2003).
Results and discussion
During study of the state of immune system in the patients with degenerative-dystrophic diseases of knee joint (DDDKJ) before endoprosthesis at admission to the clinic the immunological investigation revealed relative leucocytosis in the first group in relation to the control (7,3±0,29 thousand cells/mcl against 5,6±0,20 thous. cells/mcl), Р<0,001. In the first group it was also marked lempho-cytosis (41,9±0,73% against 30,8±0,71%) (Table 1).
The study of the contents of Т-lymphocytes (CD3+-cells) in th peripheral blood in healthy volunteers of control group showed fluctuation from 41 up to 58% with the average contents 51,4±1,04%, that 1,2 times is higher than meanings received in the first group (45,1±0,87% with individual fluctuations from 38 up to 53%) (P<0,001). The more accurate estimation of the contents of Т-lymphocytes is achieved at study of absolute parameters. So, in the peripheral blood in control group the contents of Т-lymphocytes accounted 890,4±50,75 cells/mcl, that was reliably lower, than data in the first group (1394,8±72,79 cells/mcl).
In our researches the relative quantity of Т-helpers/inductors in the peripheral blood in control group, was in limits from 26 up to 46% with average meaning 35,1±1,04%. And the absolute value was 609,9±31,83 cells/mcl in a big way of individual fluctuations from 314 up to 857 cells/mvl. In the first group the relative quantity was reduced and reliably differed from values of control group (P<0,001) and accounted, on the average, 26,9±0,75%, in a big way
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Immunity state on the background of osteotropic therapy with medicine calcium D3 in endoprosthesis of the knee joint
of individual fluctuations from 22 up to 34%. The contents of absolute number was also reliably (P>0,001) differed from control group, that was connected with leucocytosis in the first group, and accounted, on the average, 834,0±51,33 cells/mcl.
Study of another immune regulating population of cells — Т-suppressors/cytotoxic lymphocytes (CD8+-cells), capable to suppress too strong and too delayed immunological responses, i. e. regulating force and the duration of reaction to antigen, has shown, that the relative quantity of CD8+-cells, on the average, contains in the blood of control group 22,5±0,72% in a big way of individual fluctuations from 17 up to 29%. The absolute mean of these cells has made, on the average, 392,1±23,05 cells/mcl. The quantity of CD8+-cells in the peripheral blood in the first group was reliably higher (P<0,001) than in control and accounted, on the average, 28,4±0,43% with individual values from 24 up to 32%. The absolute value was also reliably higher, than in control group and was in limits from 878,0±43,95 cells/mcl.
Reduction of the quantity of Т-helpers/inductors and the increase of quantity of CD8+-cells in the first group resulted in reliable decrease of immune regulating index, which accounted 0,9±0,03 against control 1,6±0,06 (Р<0,001).
The work of B — system of immunity was estimated under the quantitative contents of the general pool of B-lymphocytes -CD19+-cells.
Our researches have shown, that the relative and absolute quantity of CD19+- cells in the peripheral blood of the first group reliably raised and accounted, on the average, 30,5±0,56% and 935,2±40,01 cells/mcl (Р<0,001).
In healthy volunteers the relative quantity of CD19+-lympho-cytes accounted, on the average, 24,2±1,24% with fluctuations from 15 up to 34% and absolute — 417,8±29,92 cells/mcl with individual fluctuations from 246 up to 829 cells/mcl.
The study of IgG level has shown, that in the serum of peripheral blood of control group, on the average, it contents was 1146,0±27,19 mg/%, with fluctuations from 960 up to 1400 mg/%, while in the first group the average value of IgG has made 1420,5±37,58 mg/% with individual fluctuations from 1080 up to 1680 mg/%, that reliably differed from parameters of control group (P<0,001).
The contents of IgA in the serum of peripheral blood from the control group changed from 120 up to 170 mg/% with mean value 140,1±3,13 mg/%, that reliably differed in comparison with value of the first group — 230,0±6,65 mg/% with individual fluctuations from 175 up to 280 mg/% (P>0,05).
The concentration of IgM in the serum of peripheral blood in healthy individuals of control group, on the average, was 125,3±3,51 mg/%, and in the patients of the first group, the mean value of which was 128,5±5,76 mg/% with fluctuations from 95 up to 190 mg/%.
In the healthy volunteers in the peripheral blood circulates from 10 up to 19% of CD16+-cells with mean value 14,8±0,59%. The absolute values of this parameter were, on the average, 261,2±20,47 cells/mcl in a big way of individual means from 154 up to 492 cells/mcl.
The analysis of results of the researches performed has revealed reliable reduction 1,4 times of the relative level of CD16+-cells in the peripheral blood of the first groups and accounted, on the average, 10,4±0,39% in a big way of individual fluctuations from 8 up to 14% (P<0,001). And the absolute indications in the first group were 1,2 times higher than parameters of control group — 317,3±14,84 cells/mcl (P<0,05).
The analysis of activation markers in the first group has shown reliable increase ofrelative values ofCD25+molecules to a-receptor of IL-2 (35,1±0,55% against 27,1±0,71%) and CD95+--marker of apopto-
sis (30,9±0,49% against 24,1±1,20%), and their absolute means were also reliably differed with the control group (1078,6±47,35 cells/mcl against 469,1±23,50 cells/mcl and 954,6±47,65 cells/mcl against 418,5±28,22 cells/mcl, respectively, Р<0,001).
In our research at definition of proinflammatory (IL-1ß) and anti-inflammatory (IL-4) cytokines there were revealed reliable differences in their levels. In the first group there was found significant rising in levels of IL- 1ß and IL-4 (158,3±18,27 pg/ml and 120,7±7,04 pg/ml against 19,7±0,86 pg/ml and 20,4±1,11 pg/ml) in comparison with control.
Thus, during studying of the main parameters of immunity in the peripheral blood of the patients with DDCKJ at admission on the basis of leuco- and lymphocytes there were revealed changes in the cellular and humoral immunity which were manifested by decrease of relative CD3+, CD4+ and CD16+ cells and IRI, increase in relative CD19+, CD25+, CD95+ lymphocytes and increase of their absolute number, as well as increase in concentration of pro- and anti-inflammatory cytokines.
The following stage of researches is the study of immune system state in the patients DDCKJ before and after operation, treated by a preparation Calcium D3. The researches were performed in three groups, the patients before operation — the second group, patients after operation TKR (2-3 weeks after operation) — third group, patients TKR through 2-2,5 months — fourth group.
The first group (group of comparison) includes the patients at admission to the clinic who did not receive any preparations (see above).
We surveyed in dynamics 23 patients. The analysis of results has shown the following ambiguous changes of the parameters of cellular and humoral immunity before and after operation.
The results of immunologic investigations showed that use of preparation Calcium D3 иммунологических of researches have shown, that the application of preparation Calcium D3 promoted change of the investigated parameters of the immune system in the patients.
The analysis of results has shown the following interesting changes of the parameters of cellular and humoral immunity in the patients with DDCKJ treated with preparation Calcium D3. The relative quantity of leucocytes in the patients before operation tended to decrease (6,8±0,20 thous.cells/mcl against 7,3±0,29 thous.cells/mcl in the first group, Р>0,05), and then in dynamics in 2-3 weeks after (group 3) leucocytes reliably dropped (6,4±0,23 thous.cells/mcl, Р<0,05), and by the end of research (group 4) the results did not differ by reliability from the control. There was observed in dynamics reliable decrease of relative (group 2-37,4±1,01%, Р<0,001; group 3-33,6±1,15%, Р<0,001; group 4-31,5±0,58%, Р<0,001 against group of comparison) and absolute (group 2-2576,6±125,52 cells/mcl, Р<0,05; group 3-2162,9±101,55cells/mcl, Р<0,001;group4-1865,2±99,23cells/mcl, Р<0,001, against group of comparison) number of lymphocytes (at the control 30,8±0,71% and 1747,0±93,53 cells/mcl). There was also noted reliable increase in relative and absolute number of CD3-lymphocytes in the first two periods after operation (Р<0,001), which achieved the control parameters to the end of researches (Tab.1).
There was also revealed reliable increase of the relative and absolute number of T-helper CD4+ cells (group 3-30,2±0,55%, 654,8±33,99 cells/mcl, Р<0,01 came to light also; 4-group —
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Section 6. Medical science
32,2±0,80% and 598,3±33,25 cells/mcl, Р<0,001 against group of comparison) in the first two terms after operation. However, the relative numbers to 2-2,5-months were still below than level of appropriate control (32,2±0,80%, Р<0,05 at the control 35,1±1,04%) parameters.
Also there was registered reliable reduction of the relative and absolute (accordingly by groups Р<0,01, Р<0,001 and Р<0,001 against group of comparison) number of T-suppressor cytotoxic (CD8) cells to the end of researches.
Reliable increase in the contents of helper and some decrease in the number of suppressor lymphocytes have resulted in the essential changes of immunogerulatory index in comparison to those in group of comparison (group 2-1,1±0,03, Р<0,001; group 3-1,2±0,04, Р<0,001; group 4-1,4±0,04, Р<0,001 against 0,9±0,03 in groups of comparison). These parameters were still reliably below the level of control (1,6±0,06) parameters.
In the patients with DDCKJ treated with preparation Calcium D3 the relative quantity of natural киллеров tended to increase, but has not achieved a level of the control (Р<0,05), and their absolute contents was within the limits of the control (P>0,05).
The analysis of results of study of the quantitative contents of B-lymphocytes in the patients has shown, that the application of preparation Calcium D3 did not promote decrease of number CD19+ cells up to the end of researches.
The concentration of immunoglobulins of classes A and G at application of Calcium D3 tended to decrease to the end of research remaining, thus, is reliably higher the control indications. The level of IgM, raising in the first term after operation, was normalized by the end of researches.
The realization of treatment with inclusion of preparation Calcium D3 in the patients did not promote reliable decrease of quantity
of markers of early activation of CD25+-lymphocytes and carrying a marker of apoptosis — CD95+ cells.
There was noted, that the relative and absolute parameters of CD25 and CD95 lymphocytes had the tendency to the decrease in relation to the group of comparison, but were still reliably higher than level of control parameters.
Concentration of IL-1ß and IL-4 in the patients after the therapy performed in dynamics have decreased. So, reliably raised production of IL- 1ß and IL-4 by the end of treatment was reduced in 2,8 and 2 times in relation to the parameters of group of comparison, respectively, but remaining reliably higher than control.
Thus, in the patients with DDCKJ before and after operation, treated by Calcium D3 there were normalized only total quantity of leucocytes and lymphocytes, CD3, CD8 and IgM. However, the results showed that there has not been achieved restoration of the changed parameters of immune system to their control values.
Conclusions:
1. Is established, that in the patients with DDCKJ at admission to the clinic there were revealed changes in the cellular and humoral immunity in the serum of peripheral blood on the basis of leuco- and lymphocytosis, which were expressed by decrease in relative CD3+, CD4+ and CD16+ cells and IRI, increase in relative CD19+, CD25+, CD95+ lymphocytes and increase in their absolute numbers as well as by increase in concentration of pro- and antiinflammatory cytokines.
2. It has been revealed that during treatment with preparation Calcium D3 in the patients with DDCKJ before and after operation there has been normalized only total number o leucocytesand lymphocytes, CD3+, CD8+ and IgM. However, as it is seen from the given data, the other studied changed parameters ofimmunity have not undergone to restoration up to control parameters.
Table 1. - Dynamics of the parameters of cellular and humoral immunity in the patients with DDCKJ before and after operation treated with Calcium D3
Immunologic parameters Healthy volunteers (Control) (n=20) At admission (n=21) Before operation (n=23) In 2-3 weeks after (n=23) In 2-2,5 months after (n=21)
Leucocytes, g/l 5,6±0,20 7,3±0,29 6,8±0,20 6,4±0,23 5,9±0,26
Lymphocytes,% 30,8±0,71 41,9±0,73 37,4±1,01 33,6±1,15 31,5±0,58
Lymphocytes, (abs) 1747,0±93,53 3082,6±139,79 2576,6±125,52 2162,9±101,55 1865,2±99,23
CD3+,% 51,4±1,04 45,1±0,87 46,4±0,59 47,3±0,66 49,9±0,61
CD3+ (abs) 890,4±50,75 1394,8±72,79 1182,4±52,51 1026,3±53,08 930,5±50,32
CD4+,% 35,1±1,04 26,9±0,75 28,4±0,93 30,2±0,55 32,2±0,80
CD4+ (abs) 609,9±31,83 834,0±51,33 741,0±47,42 654,8±33,99 598,3±33,25
CD8+,% 22,5±0,72 28,4±0,43 26,1±0,70 24,9±0,54 23,2±0,45
CD8+ (abs) 392,1±23,05 878,0±43,95 683,7±46,71 539,5±28,88 435,1±26,07
CD16+,% 14,8±0,59 10,4±0,39 11,4±0,49 12,8±0,50 13,0±0,57
CD16+ (abs) 261,2±20,47 317,3±14,84 297,7±21,68 280,0±18,87 244,0±17,04
IRI (CD4+/CD8+) 1,6±0,06 0,9±0,03 1,1±0,03 1,2±0,04 1,4±0,04
CD19+,% 24,2±1,24 30,5±0,56 30,0±0,86 30,2±0,72 27,1±0,57
CD19+ (abs) 417,8±29,92 935,2±40,01 778,5±45,95 654,5±36,89 508,1±30,38
IgG, mg% 1146,0±27,19 1420,5±37,58 1380,4±34,91 1460,4±38,14 1256,2±34,38
IgA, mg% 140,1±3,13 230,0±6,65 220,0±3,81 198,2±2,26 180,5±2,69
IgM, mg% 125,3±3,51 128,5±5,76 126,4±2,25 142,1±4,00 130,1±2,60
CD25+,% 27,1±0,71 35,1±0,55 32,0±0,85 30,4±0,72 29,1±0,65
CD25+ (abs) 469,1±23,50 1078,6±47,35 831,7±50,55 626,2±44,59 537,1±25,48
CD95+,% 24,1±1,20 30,9±0,49 30,3±0,67 29,4±0,86 27,1±0,62
CD95+ (abs) 418,5±28,22 954,6±47,65 778,6±38,57 637,6±37,45 506,9±30,23
Il-1ß 19,7±0,86 158,3±18,27 149,3±9,76 118,5±3,74 55,9±4,54
Il-4 20,4±1,11 120,7±7,04 110,9±3,86 78,6±3,26 58,1±3,66
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Etiology, clinical forms and methods of the sensorineural hearing loss treatment (review of the literature)
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2. Syggelos S.A., Giannopoulou E., Gouvousis P.A., Andonopoulos A.P., Aletras A.J. Panagiotopoulos E. In vitro effects of non-steroidal anti-inflammatory drugs on cytokine, prostanoid and matrix metalloproteinase production by interface membranes from loose hip or knee endoprostheses.//Osteoarthritis Cartilage. 2007 May;15 (5): 531-42. Epub 2006 Dec 22.
3. St'ovickova J, Hulejova H, Pesakova V, Spacek P, Klezl Z, Trc T, Adam M. Relation between cytokines, adhesive immunoglobulins and matrix metalloproteinases in osteoarthritic joints//J. Rheumatol. 2009 Aug; 36 (8):1618-25. Epub 2009 Jun 16.
4. Klett R., Kordelle J. Stahl U., Khalisi A., Puille M., Steiner D., Bauer R. Immunoscintigraphy of septic loosening of knee endoprosthesis: a retrospective evaluation of the antigranulocyte antibody BW 250/183.//Eur J Nucl Med Mol Imaging. 2003 Nov;30 (11): 1463-6. Epub 2003 Jul 22.
5. Fuchs D., Zinman C., Lewinson D. Characterization of the biological process of aseptic loosening of joint implants in orthope-dics//Harefuah. 1998 Mar 15;134 (6): 432-5, 504, 503.
6. Toom A., Arend A., Gunnarsson D., Ulfsparre R., Suutre S., Haviko T., Selstam G. Bone formation zones in heterotopic ossifications: histologic findings and increased expression of bone morphogenetic protein 2 and transforming growth factors beta2 and beta3.//Calcif Tissue Int. 2007 Apr;80 (4): 259-67. Epub 2007 Apr 1.
7. Reznik L. B., Turushev M. A. About possible optimization of stress bone remodeling in endoprosthesis of the knee joint//Vestnik travmatologii I jhnjpedii im. N. N. Priorova, 2009, № 4. - P.19-23.
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Amonov Aminjon Shavkatovich, attending medical doctor ”Department of congenital and acquired diseases of ENT organs” Republican specialized scientific-practical medical center of Pediatrics, Uzbekistan
E-mail: [email protected]
Etiology, clinical forms and methods of the sensorineural hearing loss treatment (review of the literature)
Abstract: Sensorineural hearing loss (SHL, synonym — Neurosensory Hypoacusis) is hearing loss caused by damage of the inner ear structures, vestibulocochlear nerve (VIII), or central parts of the auditory analyzer (in the stem and the auditory cortex) [1]. It is one of the most relevant and complex medical and social problems of otorhinolaryngology. Conservative SHL treatment still remains ineffective and the searches for new efficient methods are demanded.
Keywords: hearing loss, causes, sensorineural hearing loss, classification, treatment.
According to the World Health Organization (WHO) globally hearing loss is one of the six leading factors that can impair quality of life [22]. According to WHO (2012) 360 million people (5.3% ofthe population) suffers from the auditory function violation, 328 million of this people — adults, and 32 million — children. In 80% ofpatients with acoustic disturbance the hearing loss is caused by sound-perceiving apparatus damage [3, 4, 16]. WHO stated that by 2020 the number ofpeople with acoustic disturbances increased not less than 30%.
The term hearing loss means hearing reduction which can be mild (the auditory threshold of sounds with frequency 5004000 Hz is on the level of 30-40 dB), moderate (50-60 dB) and severe (more than 60-70 dB).
In case of mild hearing loss the whisper speech comprehension is possible from the distance of 4-6 m, in case of moderate hearing loss — from 1 to 4 m, in severe — 0.25 to 1 m. The greater hearing loss is defined as deafness [1]. Sometimes, when the auditory threshold of the oral speech increases up to 70-90 dB, we can think about profound hearing loss, and over 90 dB — about the deafness.
The most common is SHL caused by the auditory receptor cell lesion. Rarely sensorineural hearing loss occurs associated with vestibulocochlear nerve (VIII cranial) or auditory brain center damage. And in very rare cases only central parts ofacoustic analyzer (usually in pathological lesions ofthe cerebral cortex temporal lobe, where the cortical center ofhearing is localized and associated) are damaged [10].
The SHL can be congenital (CSHL) or acquired (ASHL) and hereditary.
The cause of congenital SHL can be the following:
• Insufficient development (aplasia) of the cochlea, including autosomal-recessive Shaibe aplasia, autosomal-dominant Michael and Mondini aplasia.
• Syndromal (combined with the other pathological symptoms) sensorineural hearing loss caused by chromosome defects (rare).
• Congenital cholesteatoma. This is hyperplasia of the middle ear squamous epithelium, manifested as invasive tumor, which, during its growth, destroys the middle and inner ear structures with cochlea receptor apparatus damage.
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