Saratov JOURNAL of Medical and Scientific Research

Puchinyan D.M.

Saratov Scientific Research Institute of Traumatology and Orthopedics, Deputy Director of Science, Doctor of Medical Science, Professor

Hemostasis test parameters in patients requiring revision knee arthroplasty

Year: 2018, volume 14 Issue: №2 Pages: 266-271
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Girkalo M.V., Shakhmartova S.G., Shpinyak S.P., Mandrov A.V., Kozadaev M.N., Puchinyan D.M.
Organization:
Summary:

Objective: comparative analysis of the blood coagulation system in patients requiring revision arthroplasty of the knee joint in connection with the developed infectious and aseptic complications after total arthroplasty. Material and Methods. 37 patients with complications of total knee replacement were examined. Patients were divided into 2 groups: 1st — with signs of suppuration (n=19); 2nd — withsigns of aseptic instability of the endoprosthesis components (n=18). The control group consisted of 22 conditionally healthy people. Studied screening coagulation: activated partial thromboplastin time, prothrombin time, fbrinogen concentration, thrombin time, antithrombin III, protein C, the content of soluble fbrin-monomer complexes and D-dimers. Results. There was an increase in activated partial thromboplastin time in patients of group 2, prothrombin time — in patients of groups 1 and 2 compared with the data obtained in the control group (p<0.001). An increase in the content of soluble fbrin- monomer complexes and D-dimers was recorded in the blood plasma of patients of the 1st and 2nd groups compared to their level in the control group (p<0.001). Conclusion. The data of local coagulogram tests in patients requiring revision arthroplasty of the knee joint refect the signs of maladaptation in the hemostatic system at the preoperative stage of examination. It is worth noting the lack of information content of the screening coagulogram, as its basic tests do not refect changes in the whole system of homeostasis, the search for new informative research methods remains relevant today.

Keywords: -
AttachmentSize
2019_02_266-271.pdf1.45 MB

The capacity of the thrombin generation test in the diagnostics of hemostasis system disorders in patients with osteoarthritis

Year: 2018, volume 14 Issue: №3 Pages: 602-606
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shakhmartova S.G., Vorobyova I.S., Puchinyan D.M.
Organization:
Summary:

Aim: to determine the diagnostic significance of thrombin generation test parameters in the diagnostics of hemostatic disorders in patients with osteoarthritis of large joints in preoperative period. Material and Methods. 137 subjects have been investigated, among whom there were 115 hip and knee osteoarthritis patients, submitted for primary arthroplasty (68) and re-prosthetics (47); control group — 22 conventionally healthy blood donors. All subjects underwent plasma hemostasis study and thrombin generation test with two activators — RB (TF 2 pmol/ml) and RC-low (TF 5 pmol/ ml). Osteoarthritis patients were divided into two groups according to the results of thrombin generation test. The 1st group included patients with an adequate response to the stronger activator (t-lagR >t-lag ow, tt-peak^tt-peak^^), the 2nd —with an inversion response (t-lagRBlow). Results. In trie control group and group 1 patients, the thrombin formation process is more pronounced when using an activator with a high TF(RC-low) content than when using an activator with a lowTF (RB) content, which is regarded as an adequate reaction of thrombin formation to the action of a stronger agonist. Patients of the 2nd group inresponse to the action of the activator with a high content of TF was observed inhibition of the reaction of formation of thrombin, which was reflected in the slowdown in the speed of the generation of this enzyme and reduce its quantity. Conclusion. The use of two activators with different concentrations of tissue factor in the test of thrombin generation allows the nature of the response of the hemocoagulation system to initiate the process of thrombin formation to identify patients with adequate and inadequate response.

AttachmentSize
2018_3-1_602-606_1.pdf258.03 KB

The history of the development of national traumatology on the example of medical and scientific activities of Saratov Research Institute of Traumatology and Orthopedics (SarNIITO) (1950-1980)

Year: 2018, volume 14 Issue: №3 Pages: 596-602
Heading: Traumatology and Orthopedics Article type: Short message
Authors: Ulyanov V.Yu., Grishin S.E., Puchinyan D.M., Fedonnikov A.S., Chibrikov G.l., Norkin I.A., Ilyina E.S., Skobelkina A.V.
Organization: Saratov Socio-Economic Institute of G. V. Plekhanov Russian University of Economics
Summary:

We outlined and described basic directions of national traumatology development at the period of 1950-1980 illustrated by the example of Saratov traumatological school, estimated the contribution of SarNIITO traumatologists into this development at the abovementioned period, depicted syna — one of the founders of acute trauma clinics.

AttachmentSize
2018_3-1_596-602.pdf1.01 MB

Growth factors of fibroblasts and vascular en-dothelium in the early stages of knee osteoarthritis

Year: 2018, volume 14 Issue: №3 Pages: 583-586
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Puchinyan D.M., Gladkova E.V., Karyakina E.V., Romakina N.A., Belova S.V.
Organization:
Summary:

Aim: to compare and study the relationship between the maintenance of vascular endothelial growth factor and acidic fibroblast growth factor in individuals with the initial clinical and radiological manifestations of the degeneration of the hyaline cartilage of the knee joints and healthy people. Material and Methods. 27 women with initial symptoms of knee osteoarthritis (main group, average age

AttachmentSize
2018_3-1_583-586.pdf258.28 KB

The state of the hemocoagulation system and endothelial dysfunction in benign and malignant skeleton neoplasms

Year: 2018, volume 14 Issue: №3 Pages: 574-578
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Ponamarev I.R., Puchinyan D.M., Gladkova E.V., Korshunov G.V.
Organization:
Summary:

Aim: to study the functional status of the vascular endothelium and the activity of the hemocoagulation system, as well as the relationship between some indicators characterizing their state in patients with benign and malignant skeleton neoplasms. Material and Methods. 62 patients with benign (45) and malignant (17) bone neoplasms and 10 healthy individuals of the control group were examined. The coagulation properties of blood plasma and the content of vascular endothelial growth factor (VEGF), intercellular adhesion molecules of sICAM and adhesion molecules of vascular endothelium (sVCAM) in blood serum were investigated. Results. In patients with benign bone tumors, prothrombinase formation mechanisms were activated, the concentration of soluble fibrin-monomer complexes (FSC) was

AttachmentSize
2018_3-1_574-578.pdf255.69 KB

The role of pro- inflammatory cytokines and the enzyme element of antioxidant system in the destruction of hyalin cartilage at the early stages of primary gonarthrosis

Year: 2018, volume 14 Issue: №3 Pages: 545-549
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Karyakina Е.М., Gladkova Е.М., Puchinyan D.M., Romakina N.A., Belova S.V.
Organization:
Summary:

Aim: comparative assessment of the state of joint (hyaline) cartilage, pro-inflammatory component of cytokine profile and enzyme element of blood antioxidant system in healthy individuals and patients at the early stages of gonarthrosis. Materials and Methods. The content of cartilage oligomeric matrixprotein (COMP), superoxide dismutase-2 (mitochondrial) (SOD-2) and interleukin-1 (3 (IL-1 (3) was studied in 34 individuals with initial signs of gonarthrosis (main group) and in 20 conventionally healthy individuals (control group) in blood serum by ELISA. Results. In the serum of patients with GA, the content of COMP (Me=20.67 pg/ml; 25% quartile 14.70; 75% quartile 27.15) and IL-1(3 (Me=4.74 pg/ml; 25% quartile 3.93; 75% quartile 5.90) was statistically significantly higher (p<0.05) than in the control group: COMP (Me=15.27 pg/ml; 25% quartile 8.86; 75% quartile 20.76 and IL-1(3 (Me=3.59 pg/ml; 25% quartile 2.75; 75% quartile 3/83). A correlation analysis in the control group revealed a positive strong correlation between COMP and IL-113 (r=+0.70; p=0.01) and a tendency toward a negative moderate association between COMP and SOD2 (r=-0.43; p=0.08); in the main group between these indicators, the connections were weak, statistically insignificant. Conclusion. Patients in the early stages of primary GA compared with healthy individuals confirmed the presence of destructive processes in the articular (hyaline) cartilage and the activation of the proinflammatory element of the cytokine profile and the enzyme level of the antioxidant system of the blood. The correlation analysis revealed a decrease in the strength of functional links in patients with GA, between the indicators of COMP — IL-1 (3 and COMP — SOD2, which indicated a change in the regulatory effects of proinflammatory cytokines and the enzyme element of the antioxidant system of the blood on the structural-metabolic state of the articular (hyaline) cartilage in the initial stage process.

Professor I.Ya. Livshits and his contribution to the development of national neurosurgery

Summary:

The article traces the professional path of Professor Lev Yakovlevich Livshits, assesses his scientific contribution to the development of national neurosurgery. The concept of minimally invasive surgical treatment of trigeminal nerve neuralgia, developed by L. Ya. Livshits, allowed developing an original method of puncture surgical treatment of pain syndrome by directed hydrothermal destruction of the sensitive trigeminal root. The concept of "growing radicalism" created by Professor L. Ya. Livshits allowed his students elaborating algorithms for treating severe chronic pain syndromes of any localization and etiology.

AttachmentSize
2018_3_466-469.pdf449.07 KB

Prognostic opportunities for infectious inflammatory complications in primary endoprosthesis of large joints

Year: 2017, volume 13 Issue: №3 Pages: 715-719
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Belova S.V., Mamonova I.A., Puchinyan D.M., Babushkina I.V., Gladkova E.M., Adilov R.G.
Organization: Saratov State Medical University
Summary:

The aim: to study prognostic and diagnostic opportunities for infectious inflammatory complications of primary endoprosthesis of hip and knee joints on the basis of cellular immunity indices. Material and Methods. 174 patients with large joint osteoarthrosis aged 61 ±13 yrs which had undergone total joint replacement were enrolled into the study. The experimental group consisted of 22 patients with infectious inflammatory complications emerging from 6 up to 12 months postsurgically. The comparison group included 152 patients with favorable postsurgical period. We carried out WBC differentiation by subpopulations (lymphocytes, monocytes, granulocytes) and their immunophenotyping. 40 conventionally healthy individuals comprised the control group. The outcomes were estimated using the worked-out score system. Results. In patients with favorable postsurgical period total value of indices equaled not more than 4-6 points. In all the other cases the risk of infectious inflammatory complications is significantly higher and reaches its maximal values in patients with 10-12 points. Conclusion. The assessment of laboratory indices reflecting immune response of the body allows estimating the risk of infectious inflammatory postsurgical complications and diagnosing them in III grade large joint osteoarthorisis patients after total replacement.

AttachmentSize
2017_03-2_715-719.pdf256.93 KB

Concentration of MMP-9, TNF-a and IL-6 in patients with tumors and tumor-like bone lesions

Year: 2017, volume 13 Issue: №3 Pages: 506-510
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Puchinyan D.M., Pavlenko N.N., Korshunov G.V., Galashina E.A., Gladkova EV.
Organization: Scientific Research Institute of Traumatology Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky
Summary:

Aim: to determine the concentration of MMP-9, TNF-a and IL-6 in blood serum of patients with benign and malignant bone tumors and feasibility of cytokine data use for differential diagnostics of the neoplastic process nature. Material and Methods. Levels of matrix metalloproteinase-9 (MMP-9), tumor necrosis factor-a (TNF-a) and interleukin-6 (IL-6) in blood serum were determined by the immunoenzyme method in 64 patients with bone tissue neoplasms (fibrous dysplasia, osteocystoma, giant-cell tumor, osteosarcoma, chondrosarcoma, bone metastases, multiple myeloma). Re-sults. MMP-9 level was heightened in patients suffered from chondrosarcoma and multiple myeloma. TNF-a and IL-6 expression was increased in cases with bone metastases. MMP-9, TNF-a and IL-6 levels were higher in cases with malignant bone neoplasms than in cases with benign bone tumors. Conclusion. MMP-9, TNF-a and IL-6 participate in the neoplastic process pathogenesis directly. Nevertheless it is too early to speak about the diagnostic value of the cytokines in cases with tumorous bone affection.

AttachmentSize
2017_03_506-510.pdf297.36 KB

Biomarkers content in blood serum of patients with osseous neoformations

Year: 2016, volume 12 Issue: №3 Pages: 358-361
Heading: Clinical Laboratory Diagnostics Article type: Original article
Authors: Korshunov G.V., Pavlenko А.А., Puchinyan D.M., Shakhmartova S.G.
Organization:
Summary:

The aim of the study was the estimation of several biomarkers in differentiation diagnostics of tumour diseases in osseous system. Material and methods. 160 patients with benign (115) and malignant (45) osseous neoformations were investigated. Neopterine, tumour necrosis factor (TNF-а), interleukin-6, adhesion molecules of vessel endothe-lium (sVCAM-1) and vascular endothelial growth factor (VEGF) levels were identified by ELISA solid-phase test and compared with the levels of 20 apparently healthy individuals. Tumor verification was fulfilled by X-ray, CT, MRI and histomorphological essay. Results. Both benign and malignant osseous tumour patients showed increased levels of neopterine, TNF-а and interleukin-6 being more significant with malignant processes. The level of sVCAM was decreased in patients of both groups and VEGF level corresponded to the control, these indexes did not show any differences between the groups. The assessment of diagnostic value of these cytokines indicates that positive results for TNF and neopterine give the ground for the final diagnostic decision while the same results for interleukin-6 give moderate basement for diagnostic decision. Conclusion. Increased TNF-а and neopterine levels allow substantiating the difference between benign and malignant osseous tumours and improving diagnostic quality.

AttachmentSize
2016_03_358-361.pdf249.81 KB