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Aggregation activity of thrombocytes at patients with chronic generalized parodontitis.
Conclusions:
1. Low level of emotional empathy can be seen as a barrier to the successful restoration offamily and environmental links between drug addicts in therapeutic remission and impedes their social reinsertion.
2. Treatment and rehabilitation programs for patients with opioid dependence should include the development of empathie abilities, communication skills, ability to listen, reflect and understand the feelings of others.
References:
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Usmanova Shaira Ravshanbekovna, Hadzhimetov Abdugaffur Ahatovich, The Tashkent State Dental Institute E-mail: [email protected]
Aggregation activity of thrombocytes at patients with chronic generalized parodontitis in combination with an atherosclerosis syndrome
Abstract: To study the significance of functional activity of thrombocytes in pathogenesis of microcirculatory disturbances at patients with ChGP in combination with atherosclerosis syndrome.
Keywords: periodontitis, gingivitis, inflammation, endothelial cells, microcirculatory system, coagulation, hypertension, chronic ischemia of the brain, blood platelets.
Epidemiological researches of the population ofvarious regions of our country testify about high prevalence of inflammatory diseases of parodontitis (from 80 to 100 %) in various age groups [3; 4].
In structure of parodontal diseases gingivitis and periodontitis prevail. Diseases of parodontitis adversely act to functions of organs of system of digestion, leading to a sensibilization and infectioning of an organism, and also reduce its resistance. As damaging agents at an inflammation act not only microorganisms themselves, but also their endo- and exotoxins, various enzymes of pathogenicity of bacteria, components of a bacterial cellular wall (lypopolisaharidis, peptidoglicans, teychoid acids). The first visible stages of inflammatory process are haemodynamic changes — vessels in a place of an inflammation of risk are extended, it arises with gas of blood cells with the subsequent exit of leukocytes from a blood channel in a place of tissue damage of parodontitis. In process ofvicodiliatation there participate such endothelial factors, as thrombinis, hystaminis and leycotrinenum C4. In the present situation thrombinis appear at the expense of activation of vascular-thrombositis (microcirculatory) and coagulation links of system of a hemostasis [1].
The answer mechanism of endothelial cells on action of thrombinis is distinguished and it develops quickly. In the present situation endothelial cells produce endothelies — 1, thrombocytosis growth factor (GsFR) and the activation factor of thrombocytes (VEILS) which strengthen aggregation activity of thrombocytes.
In measure of generalization of pathological process of disturbances of microcirculation grow, and changes in vessels get generelized character both at patients with chronic parodontitis, and at patients with a chronic ischemia of a brain caused by an atherosclerosis. Damage of endotheliocytes at disturbances in microcirculation system is accompanied by development of sladge — a syndrome that in confirmed by the presence of significant amount of thrombocytes, settling down not only in a gleam of vessels, but also actually in a gum mucous membrane. However, now there are only unique works devoted to functional activity of thrombocytes at patients of ChGP in a combination with a syndrome of an atherosclerosis. However, it is necessary to notice that biomark-ers of coagulation activity and endothelial cellular activity, and also the subclinical atherosclerosis is improved from parodontal therapy [5]. Taking into account high prevalence of diseases of parodontitis, the given risk factor is considered important from the point ofview of public health.
The work purpose: to study the significance of functional activity of thrombocytes in pathogenesis of microcirculatory disturbances at patients with ChGP in combination with atherosclerosis syndrome.
Materials and methods
For object achievement under our supervision there were 52 patients with ChGP. From them 24 patients were without accompanying diseases; 28 patients — with ChGP in combination
Section 6. Medical science
with an atherosclerosis syndrome. Patients were on out-patient treatment of stomatological department of clinics of TSDI. Patients with a syndrome of an atherosclerosis at the age from 40 till 65 years composed basically contingents suffering from disturbance of the brain blood circulation, caused by an atherosclerosis of brain vessels and were under out-patient supervision. At 78.8 % of patients the accompanying arterial hypertensia has been noted. Criteria of an exception were age above 70 years, a myocardium heart attack in the anamnesis of longitude not less than 6 months, insulin dependent diabetes, presence of malignant new growth. At the given contingent of patients the atherosclerosis syndrome had been established a chronic ischemia of a brain on the basis of carrying out ofultrasonic doplerogrophy of cerebral vessels, estimating a thickness of CIM.
For all 52 examined patients with atherosclerosis syndrome and without an accompanying pathology there was available chronic generalized parodontitis of moderate severity level. At statement of the diagnosis of chronic generalized parodontitis it was used "classification of diseases of parodontitis, accepted on XVI Plenum of the All-Union society of stomatologists" (1983). The comparison group was made by 12 patients at the age of25-35 years with intact parodontitis without a somatic pathology.
In the work with the examined patients there were followed the ethical principles reflected in the Helsinki declaration of the World medical association (1964).
For an objective estimation of a condition of tissues ofparodonti-tis the examination ofpatients ChGP was carried on the following indicators: definition of a hygienic index (Green-Vermellion, 1969); definition of capillary — marginal alveolar index (Parma C., 1960); definition of parodontal index (Ruzel A., 1956); test of functional firmness of capillaries on V. I. Kulazhenko (1967); the index of peripheral blood circulation, considered on the basis of indications of firmness of capillaries and time of resolving of hematomas at definition of functional firmness of capillaries (Dedova L. N., 1981). Bleeding-ness of gums at sounding (Baver G. M., Lemetsky G. I., 1996); depth measurement ofparodontal holes were carried on by a direct method; degree of mobility of teeth (Gavrilov E. I., 1954).
Clinic-laboratory observation of all patients was conducted on the standard method including the general analysis ofblood and urine.
In blood serum it is defined the maintenance of C-reactive protein, concentration of neutral enolases, protein S-100 and lypo-protein associated with phosphorus-lypasis A2 by a method of im-muneferment analysis using the equipment and reactants of firm "HUMAN" and also reactants of firm BCM Diagnostic delivered by firm Bio Chem. Mach (Russia). The maintenance of desquamated endotheliacytes in blood plasma was investigated by method of Hladovec J. (1978). Calculatio n of the quantity of thrombocytes was carried on by haematological analyzer of firm "Rosh", aggregation degree of thrombocytes, induced, ADF 1 x 10-3 M was carried on by means of agrometer "Payton" (Canada) where it was found degree of aggregation on maximum level of light passing of plasmas after introducing inductor of aggregation. An adhesiveness estimation of thrombocytes to glass balls was carried on by method A. of Hellen (1987).
Static processing was conducted by the use of a package of static programs «Statistica». Reliability of distinctions between groups was estimated by criterion of Student (t). Distinctions were considered statistically authentic at P < 0.05.
Results and their discussion
Apparently from the presented results of research (table 1), unlike a banal inflammation of parodontitis, parodontitis combined by an atherosclerosis syndrome was characterised by heavier disturbance of a capillary bloodflow in parodontitis that in our opinion, is caused by systemic atherogenic process and endothelial dysfunction. Character of an immune inflammation at patients of ChGP of average degree combined by an atherosclerosis syndrome accompanied by authentic increase of level C-reactive protein in 9 times whereas at patients with ChGP it exceeded indicators of group of comparison in 4.9 times (P < 0.05) that specifies in development of inflammatory process and strengthening of athero-genesis. At patients with ChGP combined by a syndrome of an atherosclerosis disturbance of a capillary bloodflow is caused by a system of atherogenic process and dysfunction of endothelial cells of vessels it is shown by a level growth of desquamated en-dothelyocytes on the average in 2.3 times in group of combined disease and on 20 % in group ChGP at comparison with indicators of healthy people.
Tablel. - Biochemical indicators of blood and functional activity of thrombocytes at patients ChGP in a combination by an atherosclerosis syndrome
Indicator Comparison group n = 12 Patients ChGP of average degree (are healthy)
Without an atherosclerosis syndrome n = 24 An atherosclerosis syndrome n = 28
C-reactive protein, mg/l 5.81 ± 0.34 28.6 ± 1.13* 54.6 ± 4.12*
Lypoprotein combined by phospholypasis A2, mkg/l 164.0 ± 9.61 261.2 ± 9.91* 428.4 ± 11.43*
Desquamated endothelial cells, 1 x 10 4/l 2.74 ± 0.19 3.03 ± 0.18 6.41 ± 0.42*
Protein S-100, ng/ml 0.15 ± 0.02 0.16 ± 0.63 0.36 ± 0.03*
Heyronal enolasis, ng/ml 2.98 ± 0.15 3.01 ± 0.24 8.51 ± 0.72*
Quantities of thrombocytes. 1x109/l 288.6 ± 9.61 278.0 ± 8.63 255.0 ± 11.0*
The sum of active forms of thrombocytes, % 12.4 ± 0.79 18.4 ± 0.91* 26.4 ± 0.81*
Index of adhesiveness of thrombocytes, % 44.6 ± 2.12 45.8 ± 1.09 49.6 ± 1.68*
Aggregation of thrombocyte to stimulation of ADF, 1 x 103 M of Tma % 38.1 ± 16.9 40.4 ± 2.04 49.8 ± 2.46*
Note: * — reliability of distinctions P < 0.05.
One of the most studied markers of atherogenesis in last years is lipoprotein — combined phospholipasis A2 (LpPhLA2). The atherosclerosis is a specific syndrome of an inflammation, the starting moment ofpathogenesis ofwhich is blockade of absorption by cells
by LPNP and inside of cellular deficiency of essential saturated fat acids. At an atherosclerosis there is a blockade of receptive absorption by cells of LPNP, and as consequence of it, activation of LPNP absorption by functional phagocytes (monocytes, macrophags),
Surgical treatment of non-epithelial tumors mandible
in a consequence of that arises deficiency of essential saturated fat acids that activates an inflammation syndrome. Feature of enzyme of LpFLA2 is specificity concerning a vascular inflammation and is about the inflammatory enzyme, showing physiological activity in the relation of intims of arteries.
Apparently from the received results of research, indicators of studied enzyme (LpFLA2) at patients of ChGP combined by an atherosclerosis syndrome authentically raise and have exceeded values of an indicator of group of comparison in 2.6 times (P < 0.05) whereas concerning group of patients with ChGP it have exceeded reference values on 59 %. Hence, the elicited fact specifies in direct correction between indicators of studied enzyme with weight of disturbance of capillary of blood circulation not only in tissues of parodontitis, but also expressiveness of endothelial dysfunctions and display of an atherosclerotic syndrome.
The revealed changes in character of endothelies of vessels, their morphological and functional damage is one of the development reasons of atherogenesis at combined form of ChGP with an atherosclerosis syndrome. In the present condition research of markers of a chronic ischemia of a brain can reflect dysfunction degree of endothelial cells and neyrodegenerative processes in a brain.
Carried on by us immunepherment analysis of the maintenance of protein S-100 at patients of ChGP combined by a syndrome of atherosclerosis has shown to the high values of level of studied protein in blood serum on the average in 2.4 times concerning indicators of group of comparison that is in our opinion caused by disturbance of trophics of nervous cells in the conditions of a cerebral ischemia as astrocytes and microglies are the basic sources of synthesis of protein S-100. Along with disturbance of trophics of a nervous tissue at patients with ChGP an atherosclerosis syndrome disturbance of a carbohydrate exchange in nervous cells is noticed at an ischemia that results in to an exit of neyronalic enzyme of gly-colisis — enalases in blood where its concentration has exceeded reference values in 2.9 times (P < 0.05).
The considerable role in development of a chronic ischemia of a brain and microcirculatory frustration plays functional condition of thrombocytes which is a link of vascular-thrombocytaric, coagulation and fibronilitic rings of haemocoagulation systems. Adhesion and aggregation of thrombocytes against an exit in a blood channel ofbiologically active substances can promote occurrence of haemor-ragical syndrome.
Recently it is proved that one of factors stimulating synthetic activity of endothelium is activation of thrombocytes with discharging of serotaninum, ADF, thrombinum [2]. The endothelial dysfunction observed at combined form of disease promotes increase of aggregation activity of thrombocytes for the account of thrombomodulator of ADF. Apparently from results of research, at given groups.
At patients we observe the increase of the sum of active forms of thrombocytes in 2 times, an adhesiveness index of thrombocytes to % and the maximum aggregation at stimulation of ADF to 31 % (P < 0.05).
Activated thrombocytes substantially promote generirising of thrombinum, catalizing and providing factors for reactions of humoral coagulation cascade.
Conclusions
The generality of an inflammatory syndrome in tissues of parodontitis and an atherosclerosis syndrome (a chronic cerebral ischemia) is more full natural, as both syndromes form the same cells: endothelial, monocytes, thrombocytes, etc. in both situations at participation of sytacinum synthesis and secretion in blood of the protein acute phases and lypoproteins, proteases increase. Clinically both the inflammation syndrome, and process of atherogenesis can prolong long time, both syndromes are nonspecific and consist of the same functional reaction. In the present situation functional and structural damages of endothelia ofvessels are accompanied by disturbances in vascular — thrombocytic hemostasis link at ChGP combined by an atherosclerosis syndrome.
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Khasanov Akbar Ibragimovich, D. m. s, Scientific leader Head and Neck tumors department National Research Center of Oncology, MH RUz E-mail: [email protected]
Bekmirzayev Rahimjon Melikuziyevich, Senior Researcher, Department of tumors of the head and neck, E-mail: [email protected]
Surgical treatment of non-epithelial tumors mandible
Abstract: In this article were studied surgical treatment of non-epithelial tumors mandible. In the period of2013-2015 the department head and neck tumors NRCO MH of R. Uzbekistan were treated 26 patients with non-epithelial tumors of the
