Saratov JOURNAL of Medical and Scientific Research

osteoarthrosis

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.
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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.

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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.
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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

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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.
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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.

The correlation between structural changes in articular hyaline cartilage and the parameters of systemic manifestations of inflammatory reaction in the pathogenesis of early stages of primary osteoarthritis

Year: 2018, volume 14 Issue: №3 Pages: 518-523
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Gladkova Е.М., Ivanov A.N.
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Aim: to study the correlations of structural disorders of articular hyaline cartilage with changes in concentration of pro- and anti-inflammatory cytokines at the early stages of osteoarthritis. Material and Methods. Ultrasound and MRI investigations of knee joints (T2*-relaxometry) were performed to 67 females of main group aged 35-50 with initial manifestations of (0-1 stages) of primary osteoarthritis and 30 conventionally healthy individuals. The level of interleukin-1 (3 was determined in blood serum with multi-parameter system MAGPIX (Luminex Corporation), Urine CTX-II was identified in urine and YKL- 40, interleukin-4 — in blood serum of the subjects by ELISA. Results. The levels of Urine CTX-II: 32.5 (30.9; 35.1) ng/ml, interleukin-1 (3: 6.09 (4.81; 7.69) pg/ml and YKL-4064.1 (58.1; 77.0) ng/ml of main group patients were higherthan in the comparison group. The correlation force between Urine CTX-II and cartilage glycoprotein YKL-40 (R=0.7); interleukin-1 (3 and cartilage glycoprotein YKL-40 (R=0.3) was lower; and the correlation force between YKL-40 and CTX-II (R=0.4 (p<0.05)) the connection was higher. Conclusion. Early stages of primary osteoarthritis are accompanied by degenerative changes inhyaline cartilages that is verified by T2*-relaxometry results, and increased excretion of Urine CTX-II on  the background of pro-inflammatory mediators hyperproduction, more significant increase in the concentration of cartilage glycoprotein YKL-40 compared to interleukin-1 (3 which comes together with the alteration of the system of correlations between the levels of pro-inflammatory cytokines and the parameters of degenerative dystrophic changes in articular cartilage.

 

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The role of polymorphism of the genes COL1A1, MMP12, EPHX1 in osteoarthritis and cardiovascular comorbidity

Year: 2018, volume 14 Issue: №3 Pages: 373-379
Heading: Internal Diseases Article type: Original article
Authors: Kabalyk M.A., Nevzorova V.A., Sunyaykin А.В.
Organization: Pacific State Medical University
Summary:

Aim: to analyze polymorphic variants of genes of connective tissue remodeling, biotransformation and their role in the development of cardiovascular comorbidity and osteoarthritis (OA). Material and Methods. The study included 70 patients with OA. As a control group, 30 patients without OA of comparable sex and age were included in the study. All patients were assessed total (absolute) cardiovascular risk according to the SCORE scale. The pain was assessed by visual analog pain scale. The physical dysfunction was assessed on a WOMAC scale. Single-nucleotide polymorphisms of the genes COL1A1 (rs1107946), EPHX1 (rs1051740), MMP12 (rs652438) were studied by PCR-RT. Results. In patients with OA, there is a twofold increase in the frequency of the heterozygous genotype of the GT gene COL1A1. The presence of the T allele of the COL1A1 gene is a risk factor for the development of OA. Patients with OA have a fourfold increase in the frequency of genotype AG of the MMP12 gene. The patients with severe pain significantly present the difference in the distribution of allele frequencies of the polymorphic locus G1997T of the COL1A1 gene from the control sample. The frequencies of heterozygous genotypes COL1A1 and MMP12 differed significantly in patients with different cardiovascular risk. Conclusion. The results partially confirm the integration theory of the pathogenesis of OA, suggest the existence of general mechanisms of connective tissue remodeling.

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Hirudotherapy as a method of hemoreological disorders correction efficiency on osteoarthrosis

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The aim: to study the hirudotherapy effectiveness in case of osteoarthrosis as a pathogenetic therapy in view of vascular disorders in the disease pathogenesis. Material and Methods. 81 patients with ostearthrosis, predominantly gonarthrosis, aged 36 to 76 years old with a disease duration from 1 to 15 years were under observation. There were clinical and laboratory studies (generally accepted in patients with osteoarthritis), special studies included bulbar conjunctiva biomicroscopy and lower limbs rheovasography. Results. Hirudotherapy is a clinically effective method for the articular syndrome treatment in various types of osteoarthrosis. It is advisable to use the method in patients with a disease duration up to 15 years, with severe pain syndrome, concomitant peripheral veins pathology, and hypertension. Conclusion. The influence of hirudotherapy on the state of microcirculation in patients with osteoarthritis with the evaluation of the clinical effect and the rheovasography and conjunctival biomicroscopy was first studied, confirmed by instrumental methods. The greatest clinical efficacy was achieved with a high degree of local inflammatory activity, what once again emphasizes the role of microchemocirculation disorders in the development of synovitis in osteoarthritis.

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Rehabilitation after hip and knee joints replacement: several results of medical and sociological monitoring

Year: 2017, volume 13 Issue: №4 Pages: 796-799
Heading: Health Service Organization Article type: Original article
Authors: Fedonnikov A.S., Andriyanova Е.А., Erugina M.V, Norkin I.A.
Organization: Saratov State Medical University
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Aim: research of rehabilitation process problem areas after hip and knee joints replacement. Material and Methods. Program of monitoring and evaluation of medical, organizational, social and psychological components of rehabilitation was developed. Sociological study of 1175 patients who have undergone in 2015-2016 total hip and knee joints replacement was conducted. Results. It was revealed an absence of real interaction between key parties of rehabilitation processes based on significant disproportion between high level (more than 80%) of patients' satisfaction of rehabilitation organizing and low activity of health managers (9.4%). Despite of declared patients' high rehabilitation quality permanent pain noted by 45% of respondents, move freely without additional support is available only for about 50% of patients. Conclusion. Rehabilitation management and its' quality are the key values for locomotor system functional recovery. Provided study has designated main problems of rehabilitation quality evaluation after hip and knee joints replacement.

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Medical and sociological issues of rehabilitation of patients after hip and knee joints replacement

Year: 2017, volume 13 Issue: №3 Pages: 761-764
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Fedonnikov A.S., Erugina M.V., Andriyanova E.A., Norkin I.A.
Organization: Saratov State Medical University
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The aim: research of medical and social issues of rehabilitation after hip and knee joints replacement. Material and Methods. Sociological study of 1175 patients who have undergone in 2015-2016 total hip and knee joints replacement was conducted. Results. Within the scope of medical surveillance after the surgery 69.8% of patients made regular visits to orthopedic specialists after joint replacement, but only 9.4% of surveyed patients confirm the practice of active monitoring of rehabilitation on the part of health services. There had been determined a high level of declared patients satisfaction (more than 80%) with weak health managers activities argue considerable informational gap between the key parties of rehabilitation. Conclusion. Provided study has designated problem areas of patient and health system communication in rehabilitation after hip and knee joints replacement.

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The peculiarities of bone and cartilage tissue remodeling in patients after hip joint replacement

Year: 2017, volume 13 Issue: №3 Pages: 723-727
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Gladkova Е.М., Karyakina E.V., Tsareva Е.Е., Persova Е.А., Belova S.V.
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The aim: to study the peculiarities of structural and metabolic state of bone and cartilage tissue in patients in the first 12 months after total hip replacement with respect to their immune state and lipid peroxidation activity. Material and Methods. Significant laboratory predictors of initial signs of aseptic instability were singled out allowing estimating the peculiarities of bone tissue remodeling as well as humoral and cellular immunity state. Results. The obtained results demonstrated that impairments in T-lymphocyte system in patients with initial signs of aseptic instability of en-doprosthesis were accompanied by reduction of its total number (CD3+), among that due to the population of cytotoxic (CD3+CD8+) cells with simultaneous increase of T-helpers (CD3+CD4+) number. Activation of serum proosteoclasto-genic factors (TNF-a and IL-1(3) was noticed on the background of anti-inflammatory humoral immunity failure (IL-10). Conclusion. The estimation of cellular immunity state, content of pro- and anti-inflammatory cytokines in blood serum combined with the bone tissue state markers and indexes of lipid peroxidation and antioxidant system as well as dual-energy absorptiometry allows identifying patients with high risk of further development of aseptic instability in hip joint implant in the period of up to 12 months postsurgically which can be useful while planning prevention management of implant or its components instability.

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The characteristics of cellular element of immunity before and after endoprosthesis of large joints

Year: 2016, volume 12 Issue: №2 Pages: 182-185
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Mamonova I.A., Gladkova Е.М., Uljanov V.Yu., Babushkina I.V., Belova S.V., Puchinyan D.M., Kuzmin E.S., Bezrokov L.Kh.
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The aim of the research is to study the indices of cellular immunity in patients before and after hip joint endoprosthesis. Materials and methods. The indices of cellular element of immunity (quantitative and qualitative composition of T-lymphocytes (CD3+), T-helpers (CD3+CD4+), cytotoxic T-lymphocytes (CD3+CD8+), B-lymphocytes (CD3-CD19+), natural killers (CD3-CD16+CD56)) in 20 patients with post-traumatic osteoarthrosis of III grade preoperatively and in the dynamic follow-up on the 3rd, 7th and 21st day post-surgically. Results. Patients with osteoarthrosis showed expressed immunological impairments both before and after endoprosthesis mostly affecting T-cellular immunity element and manifesting in immunoregulatory subpopulations imbalance as well as in T-suppressors decrement, T-helpers increment and NK-cells enlargement in patients after endoprosthesis. Conclusion. Patients with osteoarthrosis showed expressed immunological impairments both before and after joint endoprosthesis. Surgical intervention resulted in the aggravation of the pre-surgical disturbances in immunodeficiency.

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