AIDSimpact special issue: stigma, serostatus disclosure, coping strategies, and the role of social capital resources among HIV care-nonadherent MSM in Russia: a qualitative analysis

The HIV epidemic continues to expand in Russia, with suboptimal levels of care uptake. This qualitative study aimed to characterize social capital resources and lived stigma experiences, coping, and disclosure among care-nonadherent men who have sex with men (MSM) living with HIV in Russia. Twenty-five HIV-positive MSM - recruited online - completed in-depth interviews over Zoom, with data analyzed using MAXQDA software. Stigma was more likely to be encountered in interactions with persons with whom social ties were weaker such as medical providers and relatives, particularly males. Close friends - often other HIV-positive MSM and female relatives - were the most supportive and least stigmatizing. Similar persons were most often considered for HIV serostatus disclosure. Coping strategies to reduce the impact of stigma included ignoring stigmatizing experiences, seeking support from members of one's social circle, minimizing contact with stigmatizing persons, seeking new relationships with persons who are also HIV-positive, proactively reducing stigma through involvement in advocacy roles, and correcting myths and educating others about HIV infection. These findings underscore the need for interventions to assist HIV-positive MSM in building accepting social capital resources to reduce the impact of stigma and to build support within their social networks, often with other HIV-positive MSM.

Endogenous Regeneration of Alveolar Bone by Decellularized Tooth Matrix

The efficiency of bone tissue regeneration by decellularized tooth matrix, demineralized tooth matrix, and commercial xenograft Bio-Oss Spongiosa was compared on the model of a critical-size circular defect in the alveolar bone of the upper jaw of adult Wistar rats. The defect healing dynamics was assessed using histological, histomorphometrical, and immunohistochemical methods on days 30 and 60. In contrast to demineralized matrix and commercial xenograft, decellularized matrix induces the formation of the new bone tissue by day 60. Decellularized matrix can be considered as a biomaterial for cell-free tissue engineering for alveolar bone restoration in dentistry and maxillofacial surgery.

[Nutrition and adipose tissue distribution in low cardiovascular risk individuals, depending on the central obesity]

The low cardiovascular risk group according to SCORE in relation to the clinical and laboratory characteristics of patients is very heterogeneous, which leads to the presence of a residual risk of cardiovascular events. This category may include individuals with a family history of cardiovascular disease at a young age, with abdominal obesity (AO), endothelial dysfunction, and high levels of triglyceride-rich lipoproteins. In this regard, an active search is underway for new metabolic markers within the low cardiovascular risk group. The purpose of the study was to compare the nutrition, the adipose tissue distribution in low cardiovascular risk individuals, depending on the AO. Material and methods. The study included 86 healthy low risk (SCORE<1%) patients (mean age 42.6±2 years), who were divided into 2 groups: with AO [waist circumference (WC) >=94 cm in men and >=80 cm in women] - 44 patients (32% of men) and without AO - 42 patients (38% of men). The body composition was carried out using the bioimpedance analyzer. The distribution of ectopic fat deposits in the liver, pancreas and epicardial region was studied using ultrasound methods. A frequency questionnaire (Diet Risk Score) was used to assess nutrition. Results. In low risk patients with AO, signs of unhealthy diet are statistically significantly more common (in 52 in the main group vs 2% in the control group, p<0.01), ectopic deposition of adipose tissue in the liver (53 vs 9%, p<0.001), pancreas (56% in the main group, absent in the control group, p<0.001), epicardia l region (the epicardial fat thickness median is 4.24 mm in the main group vs 2.15 mm in the control group) compared with a control group. Conclusion. The low cardiovascular risk group is very heterogeneous. One of the markers of heterogeneity is central obesity - a marker of unhealthy diet, subclinical ectopic fat deposition and hypertriglyceridemia. Patients with AO of the low cardiovascular risk group require a more thorough examination with the obligatory determination of waist circumference, ultrasound assessment of the liver and pancreas parenchyma, and determination of the epicardial fat thickness. Using a short nutrition questionnaire allows you to quickly identify signs of unhealthy diet and discuss them with the patient.

[Piecewise linear regression model of hemostasis dynamics in donors and patients with schizophrenia]

OBJECTIVE

This work is to develop and use a new approach to the analysis of differences between the velocity profiles of registered light signals in groups of patients with schizophrenia and healthy donors.

MATERIAL AND METHODS

The present study involved 62 patients (all female) with schizophrenia or schizoaffective disorders in the acute period (observational study - 2016-2017). 44 patients were diagnosed with paranoid schizophrenia with an attack-progredient type of course (F20.01 according to ICD-10) or with a continuous type of course (F20.02). The fibrinodynamics test (FD) was performed on the T-2 thrombodynamics device (Hemacore LLC, Moscow), which makes it possible to monitor the processes of coagulation and fibrinolysis in the cuvette channels filled with fresh blood plasma. The result of the test are the brightness profiles of the clot.

RESULTS

In the proposed approach, each profile is characterized by a vector of distances between it and other analyzed profiles. At that the distances between the profiles are calculated as the sum of the modules of differences at different points of the observation interval. This method makes it possible to overcome a certain loss of information that occurs when using a standard method based on the calculation of several parameters that characterize the analyzed velocity profiles. The method includes the construction of all kinds of statistically significant piecewise linear regression models that link the distances to two profiles. The velocity profiles corresponding to the points lying on opposite sides of the break point of such models have significantly different shapes. In practice, it turns out that for many piecewise linear regression models, the break points also significantly separate the velocity profiles for the compared groups of donors and patients with schizophrenia. Statistically significant deviations at the level p≤0.01 exist for 16.1% of 3143 statistically significant piecewise linear models.

CONCLUSION

The developed method makes it possible to visually establish the relationship between the shape of the velocity profile and the presence of the disease.

People Living With HIV in St. Petersburg, Russia: Gender and Exposure Group Differences in HIV Care Engagement, Psychosocial Health, Substance Use, and Transmission Risk Behavior

This study examined psychosocial and health needs of persons living with HIV (PLWH) in Russia. The study combined baseline datasets from two social network samples of PLWH in St. Petersburg (N = 872). Samples were recruited between 2014 and 2018 by enrolling a PLWH seed who was either out-of-care or treatment nonadherent as well as network members surrounding each seed, assessing each participant's HIV care, transmission risk, substance use, and mental health characteristics. Almost one-quarter of participants said they were never offered antiretroviral therapy (ART), and-among those offered ART-one-quarter refused or discontinued therapy and 45% were <95% ART-adherent. Almost half of participants had detectable viral load, and many reported continued condomless intercourse with potentially nonconcordant serostatus partners or needle sharing. Over 46% of participants had elevated scores on measures of depression, hopelessness, state anxiety, or poor social support. Study findings illustrate unmet needs of PLWH in Russia.

[Is there a claudin-low phenotype of breast cancer?]

The novel molecular subtype of breast cancer (BC), named "claudin-low", was described in 2007. It was characterized by the consistently low expression of genes involved in the formation of epithelial tight junctions in combination with the high activation of genes associated with the epithelial-to-mesenchymal transition, as well as tumor stem cell markers. The similar claudin- low subtype was later identified at the transcriptional level in bladder cancer, gastric cancer, and serous ovarian cancer. However, only in relation to BC, attempts were made to create a surrogate panel for immunohistochemical identification of this subtype in a manner like the intrinsic molecular BC subtypes identified using three main markers, such as ER, PR, and HER-2. At the same time, the ambiguity in the expression of claudins among the subtypes of BC, which is defined by various authors at the immunohistochemical level, as well as the absence of both the confirmed set of immunohistochemical criteria and a unified approach to their assessment, complicate these efforts. The purpose of the review is to show that the immunohistochemical identification of claudin-low subtype of BC is a separate problem that has significant limitations, needs standardization and has not yet reached diagnostic value.

[Epithelial-stromal interactions in pancreatic adenocarcinoma: the role of stroma in disease progression]

Pancreatic ductal adenocarcinoma (PDAC) is the most common and difficult to treat form of pancreas cancer. PDAC and other solid cancers contain both tumor cells and normal connective tissue cells called stromal cells, which are responsible for the excess production of extracellular matrix. It is known that in more than 90% of PDAC tumors and in many other types of cancer, mutations of the KRAS gene are observed, the reciprocal signaling of which has been shown between tumor and stromal cells in vitro. Pancreatic stromal stellate cells are considered precursors of activated or tumor-associated fibroblasts (CAFs), which are an increasing population of cells that proliferate in situ or are recruited into the tumor. CAFs are a heterogeneous population of stromal fibroblasts with different molecular profiles that change during tumorigenesis. Both immunosuppressive and immunosuppressive subsets of CAFs can coexist in the stroma of a single tumor. Based on the heterogeneity of the intertumor stroma, attempts are being made to classify PDAC and predict the course of the disease.

[Application of machine learning for predicting the outcome of treatment of patients with schizophrenia according to the indicators of «Thrombodynamics» test]

OBJECTIVE

To identify relationships between thrombodynamic values and the severity of the condition in patients with schizophrenia spectrum disorders (SSD) before and after treatment.

MATERIAL AND METHODS

The study included 92 patients in an acute state of schizophrenia or schizotypal disorder, aged 16 to 57 years (median age [Q1; Q3] - 25 years). All patients received complex psychopharmacotherapy adequate to their psychopathological state. The PANSS was used to assess the severity of symptoms in patients. The coagulation parameters were determined by the thrombodynamics test, in which the growth of fibrin clots in platelet free plasma are observed from special activator. The patient population was divided into two groups with weak and strong response to treatment. Data analysis included machine learning (ML) techniques: logistic regression, random forests, decision trees, support vector machines with radial basis functions, statistically weighted syndromes, permutation method.

RESULTS

An analysis using permutation method revealed statistically significant different thrombodynamics values between groups of patients with weak and strong responses. There are significant differences between thrombodynamics values: T1D, T2D, T2Tlag and DTlag, and values characterizing the severity of positive symptoms before and after treatment (T1PposTot, T2PposTot), severity of psychopathological symptoms before treatment (T1Ppsy1, T1Ppsy6, T1Ppsy13). All ML techniques showed the relationship between thrombodynamics values and response to treatment. The best statistical significance was for statistically weighted syndromes method.

CONCLUSION

The combination of the results of different ML techniques at a high level of statistical significance identifies the thrombodynamic predictors of weak effect of treatment of SSD.

Mobilizing individual social capital resources for HIV care support: results of a pilot intervention in St. Petersburg, Russia

Half of HIV-positive persons in Russia are on antiretroviral therapy (ART), and only 27% are virally suppressed. A feasibility pilot intervention to mobilize social capital resources for HIV care support was conducted in St. Petersburg. Out-of-care or ART-nonadherent HIV-positive persons (n = 24) attended a five-session intervention to increase access social capital resources (i.e., family, friends, or providers) to mobilize supports for entering care, initiating care, and adhering to ART. HIV care indicators were assessed at baseline, an immediate followup (FU-1), and 6-month followup (FU-2) points. At FU-1, participants more frequently discussed their care experiences with others, verifying the intervention's mechanism of action. Participants increased in scales of medication taking adherence (p = 0.002, FU-1; p = 0.011, FU-2), self-efficacy (p = 0.042; FU-1), and outcome expectancies (p = 0.016, FU-2). Among persons not on ART, HIV Medication Readiness scale scores increased at FU-1 (p = 0.032) but became attenuated at FU-2. Participants tended to more frequently keep care appointments (79%, baseline to 90%, FU-1, p = 0.077); to have undetectable viral load (54%, baseline to 74%, FU-2; p = 0.063); and to have fewer past-month days with delayed or incomplete medication doses (7.8, baseline to 4.2, FU-1; p = 0.084). This novel social capital intervention is promising for improving HIV care-related outcomes and warrants a full-scale evaluation.

Prevalence of Alcohol Use and Factors Associated With Problem Drinking in Social Networks of People Living With HIV Infection in St. Petersburg, Russia

Russia has over 1.2 million HIV infections and Europe's highest HIV incidence. Although its HIV epidemic is intertwined with high alcohol consumption rates, the interaction between alcohol use and HIV care in Russia is understudied. Five hundred eighty-six HIV-positive persons were recruited using social network methods in St. Petersburg. Fifty-nine percent of males, and 45% of females, drank regularly. Thirty percent of alcohol users reported binge drinking (males: ≥ 5 drinks; females ≥ 4 drinks) in the past week. Alcohol use was associated with lower HIV care engagement and having a detectable viral load. Multivariate analyses showed that any alcohol consumption, number of alcohol drinks consumed, and having a binge drinking day in the past week were associated with male gender, use of illicit drugs, drug injection, smaller social network size, lower social supports, being unmarried, and reporting condomless intercourse with non-main partners. Interventions to improve HIV care in Russia must comprehensively address the use of alcohol and substances that interfere with care engagement.

Predictors of HIV Care Engagement, Antiretroviral Medication Adherence, and Viral Suppression Among People Living with HIV Infection in St. Petersburg, Russia

Over 1 million HIV infections have been diagnosed in Russia, and HIV care uptake and viral suppression are very low. 241 HIV-positive individuals in St. Petersburg were enrolled through social networks, provided blood for viral load testing, and completed measures of medication-taking adherence, readiness, and self-efficacy; psychosocial well-being; and substance use. Outcomes included attending an HIV care appointment in the past 6 months, >90% ART adherence, and undetectable viral load. 26% of participants had no recent care appointment, 18% had suboptimal adherence, and 56% had detectable viral load. Alcohol use consistently predicted all adverse health outcomes. Having no recent care visit was additionally associated with being single and greater past-month drug injection frequency. Poor adherence was additionally predicted by lower medication-taking self-efficacy and lower anxiety. Detectable viral load was additionally related to younger age. Comprehensive interventions to improve HIV care in Russia must address substance abuse, anxiety, and medication-taking self-efficacy.

Reprogramming of Human Retinal Pigment Epithelial Cells under the Effect of bFGF In Vitro

We studied the effect of bFGF on human retinal pigment epithelial cells in vitro In ARPE-19 cells, enhanced expression of KLF4 mRNA and reduced expression of PAX6, MITF, and OTX2 mRNA specific for retinal pigment epithelium were observed after bFGF application. The expression of KLF4 mRNA peaked in 72 h after bFGF application and then sharply decreased, which was accompanied by a 3-fold increase in TUBB3 mRNA expression (neuronal marker). Immunocytochemical analysis showed that in the presence of bFGF, some cells retained epithelial properties and showed positive staining for connexin-43, while others had long axon-like processes and demonstrated positive staining for βIII-tubulin, which attests to their neuronal transdifferentiation. Despite the prevalence of the epithelial properties, ARPE-19 cells under the influence of bFGF can show proneuronal properties.

Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia

Russia has a large HIV epidemic, but medical care engagement is low. Eighty HIV-positive persons in St. Petersburg completed in-depth interviews to identify barriers and facilitators of medical HIV care engagement. The most commonly-reported barriers involved difficulties accessing care providers, dissatisfaction with the quality of services, and negative attitudes of provider staff. Other barriers included not having illness symptoms, life stresses, low value placed on health, internalized stigma and wanting to hide one's HIV status, fears of learning about one's true health status, and substance abuse. Care facilitators were feeling responsible for one's health and one's family, care-related support from other HIV-positive persons, and the onset of health decline and fear of death. Substance use remission facilitated care engagement, as did good communication from providers and trust in one's doctor. Interventions are needed in Russia to address HIV care infrastructural barriers and integrate HIV, substance abuse, care, and psychosocial services.

[Tumor stem cells in breast cancer]

High mortality from breast cancer is associated with the high heterogeneity of tumor and the frequent recurrences of the pathological process, which are due to the presence of tumor stem cells. The review considers the biological properties of tumor stem cells, the molecular mechanisms of their regulation, interaction with the microenvironment, and their role in the heterogeneity of the morphological and clinical forms of breast cancer.

Effect of hrWnt7a on Human Retinal Pigment Epithelial Cells In Vitro

Human recombinant protein Wnt7a (hrWnt7a) inhibits cell proliferative activity and triggers cell polarization. Although cell polarization process was maintained only over a short time, probably via microenvironmental stimuli, hrWnt7a is involved in the transformation of the retinal pigment epithelium. Analysis of Wnt signaling pathway and its regulation will help to understand the processes in retinal pigment epithelial cells under pathological conditions, which can be useful in developing new generation drugs.

[Molecular epidemiological analysis of the HIV infection in the Blagoveshchensk and Khabarovsk Area (Russian Far East)]

The results of the molecular-epidemiological analysis of the HIV-1 variants circulating in Blagoveshchensk and Khabarovsk (Russian Far East) were presented. In Blagoveshchensk HIV-1 IDU-A variants were dominated (92.5%), similar to the regions of the European part of Russia. In Khabarovsk the heterogeneity of circulating HIV-1 variants was noted. In addition to IDU-A variants (66.0%), the strains of subtype B (12.6%), C (4.4%) and recombinant strain form CRF02_AG (17.0%) were identified. Using the phylogenetic analysis method the version of the penetration of HIV-1 variants from China and Japan was not supported.

Effect of transplants of retinal pigment epithelial cells from adult human eye on degenerative processes in the brain of rats with experimental acute hypoxia

Stimulation of cell regeneration in the brain and eye retina in various degenerative processes is a pressing problem in neurobiology. A promising approach is transplantation of somatic cells reprogrammed towards neural lineage. We studied the effect of transplantation of retinal pigment epithelial cells from adult human eye transdifferentiated in culture on degenerative processes in the brain of rats subjected to acute hypoxia. Immunohistochemical and molecular genetic analysis suggests that retinal pigment epithelial cells transdifferentiate in vitro and express markers of low-differentiated neural cells. The cells transplanted into rat brain survive for at least 20 days. During this period, they stimulate compensatory and reparative processes that protected cortical neurons in the recipients from hypoxia-induced degeneration.

[Experimental models of human retinal degenerations: induced models]

Existing approaches in experimental animal modeling of human retinal degenerations are reviewed, in particular models, in which pathological processes in animals were induced by chemical, biological and physical exposure.

[Experimental models of human retinal degenerations: genetic models]

Existing approaches in experimental animal modeling of human retinal degenerations, genetic models in particular, that allow to study the pathogenesis are reviewed.

Male labor migrants in Russia: HIV risk behavior levels, contextual factors, and prevention needs

Although the dire life circumstances of labor migrants working in Russia are well-known, their HIV risk vulnerability and prevention needs are understudied. Low socioeconomic status, lack of access to services, separation from family, and limited risk awareness all contribute to migrants' HIV vulnerability. Male labor migrants in St. Petersburg (n = 499) were administered assessments of their sexual behavior practices, substance use, and psychosocial characteristics related to risk and well-being. Thirty percent of migrants reported multiple female partners in the past 3 months. Condom use was low, ranging from 35% with permanent to 52% with casual partners. Central Asian migrants had very low AIDS knowledge, low levels of substance use, moderate sexual risk, high depression, and poor social supports. Eastern European migrants had higher AIDS knowledge, alcohol and drug use, and sexual risk. Improved HIV prevention efforts are needed to reduce the risk vulnerability of migrants who relocate to high disease prevalence areas.

[Adult human retinal pigment epithelial cells - a potential source of cells for regeneration retina]

Retinal pigment epithelium (RPE) arises from neuroectoderm and plays a key role in support of photoreceptor functions. Several degenerative eye diseases, such as macular degeneration or retinitis pigmentosa, are associated with impaired RPE function that may lead to photoreceptor loss and blindness. RPE cell culture derived from adult human eyes autopsy could be an important source for transplantation to cure such retinal degenerative diseases. RPE cells subsequent isolation and maintenance in culture are described. Besides the results of immunocytochemical analysis that characterizes dedifferentiated state of cultured adult human RPE cells are given. Our findings demonstrate that mature human RPE cells have the capacity to express neural markers in response to conditions that promote dedifferentiation.

[Prospects for using non-invasive diagnostic techniques for assessment of cardiac rhythm variability in coronary restenosis]

The aim of the study was to evaluate dynamics of heart rhythm variability (HRV during a1, b1, and b2-adrenoblockade by carvedilol in patients with coronary heart disease (CHD) and recurrent angina pectoris treated by endovascular revascularization. The study included 39 men (mean age 57.5 +/- 0.8 years) who underwent stenting of coronary arteries (CA) 6 month or more before the study. For the purpose of analysis, patients with CA restenosis were allocated to group 1 (n = 17), those without restenosis or complaining of chest discomfort in the absence of restenosis during repeated coronaroventriculography comprised group 2 (n = 22). Patients having no complaints were followed up by coronarography 1 year after stenting. HRV was estimated from the analysis of short (15 min) fragments of the standard ECG obtained in the basal state and during a1, b1, b2-blockade by carvedilol (mean dose 22.88 +/- 2.1 mg/day) for 2 weeks. Carvedilol blockade of a1, b1, b2-adrenoreceptors following coronary stenting significantly improved both temporal and spectral components of HRV. This improvement may serve as an independent marker of revascularization efficiency and an earlier predictor of coronary restenosis or reflect progress of the atherosclerotic process in native arteries.

[Clinical significance of markers of endothelial dysfunction and angiogenesis in progressing of the lung interstitial diseases]

The data obtained suggest an important role of the FRES and ET-1 in progressing of the lung interstitial diseases; they can be used as diagnostic criteria of the disease activity, risk of pulmonary hypertension, and extra-pulmonary manifestations.

[Cerebral sodium-uretic peptide: pathogenetic and clinical significance in pulmonary arterial hypertension associated with interstitial diseases of the lungs]

Sodium-uretic peptides (SUP) are the main humoral system opposing pathological remodeling of vascular bed in diseases of cardiovascular system and kidneys. In the paper, pathogenetic and clinical significance of the cerebral SUP in pulmonary arterial hypertension, including the one associated with interstitial diseases of the lungs.

[Proteolytic activity of placenta with EPH-gestosis]

Essential edema-proteinuria-hypertension (EPH) gestosis still represents an important obstetrical problem. We have investigated the activity of carboxypeptidase H (CPH), phenylmethylsulfonyl fluoride inhibited carboxypeptidase (PMSF-CP), carboxypeptidase M (CPM) and angiotensin-converting enzyme (ACE), the main carboxypeptidases in human placenta under normal conditions and mild EPH-gestosis. Gestosis was accompanied by the decrease in activity of the enzymes involved into metabolism of regulatory peptides (ACE, CPH, PMSF-CP, CPM) compared with their activity in placenta under physiological pregnancy. Correlation analysis revealed positive correlation between placental CPH and CPM (r = 0.2735*) in EPH-gestosis. These findings suggest involvement of placental proteases into formation of compensatory-adaptive reactions in the fetoplacental complex at EPH-gestosis; the data obtained may be also employed for the development of methods of prophylaxis and corrections of metabolic impairments in pathology of pregnancy.

HIV/STD prevalence, risk behavior, and substance use patterns and predictors in Russian and Hungarian sociocentric social networks of men who have sex with men

This study recruited four sociocentric networks (n = 156) of men who have sex with men in Budapest, Hungary, and St. Petersburg, Russia. The sampling approach was based on identifying an initial "seed" in the community for each network, and then recruiting three successive friendship group waves out from the seed. HIV prevalence in the networks was 9%, and the composite rate of other sexually transmitted diseases was 6%. 57% of participants reported both main and casual male partners, and two thirds reported unprotected anal intercourse in the past 3 months. Fifty-five percent of men's most recent anal intercourse acts were with nonexclusive partners, and 56% of most recent anal intercourse acts were unprotected. Sexual risk predictors were generally consistent with behavioral science theory. In addition, risk was associated with more often talking with friends about AIDS, higher ecstasy use, and less often drinking. Sociocentric social network sampling approaches are feasible and constitute a modality for reaching hidden high-risk populations inaccessible through conventional methods.

[Endothelin-1 and brain natriuretic peptide in the development of pulmonary hypertension in interstitial lung diseases]

AIM

To study the plasma concentration of brain natriuretic peptide (BNP) and endothelin-1 (ET-1) as markers of pulmonary hypertension (PH) developed in interstitial lung diseases (ILD).

SUBJECTS AND METHODS

Along with physical examination, 97 patients with ILD underwent measurements of the plasma concentrations of BNP and ET-1, 6-minute walk test, external respiration function test, echocardiography, by measuring pulmonary artery systolic pressure (P(syst)), and chest multispiral computed tomography, by estimating the mean diameter of the pulmonary artery trunk.

RESULTS

The plasma concentration of ET-1 proved to be significantly higher in the presence of active lung lesion (5.2 +/- 3.9 and 2.8 +/- 1.8 pg/ml; p = 0.0001). In patients with ILD, persistent PH was associated with the significantly elevated plasma concentrations of BNP (69.3 +/- 341.35 and 23.7 +/- 26.69 pg/ml; p = 0.018). The increase of plasma BNP concentrations correlated with the shorter distance covered during a 6-minute walk test and diminished functional vital capacity.

CONCLUSION

The increased plasma levels of ET-1 in ILD reflects the transient pulmonary artery pressure elevation associated with the activity of the pulmonary process while those of BNP are indicative of developed persistent PH.

[Estimation of plasmic concentration of the brain natriuretic peptide in interstitial pulmonary diseases with pulmonary hypertension: clinical role]

AIM

To study a plasmic concentration of the brain natriuretic peptide (BNUP) in patients with interstitial pulmonary disease (IPD) as a possible diagnostic parameter in pulmonary hypertension (PH).

MATERIAL AND METHODS

Plasmic BNUP concentration, external respiration function were studied in 24 patients with IPD. The following tests were also made: 6-min walk, echocardiography (echo-CG) with estimation of systolic pressure in the pulmonary artery, multislice computed tomography of the chest with measurement of the mean diameter of the pulmonary artery trunk.

RESULTS

As shown by echo-CG and chest MSCT half of the IPD patients had PH. IPD patients with PH had a significant elevation of plasmic BNUP concentration which, in intact left ventricular contractile function indicates development of secondary PH characterized by reduction of volume parameters of the respiratory pulmonary function. The rise of BNUP concentration correlated with reduction of 6-min walk distance and functional lung capacity.

CONCLUSION

Plasmic BNUP can be used for diagnosis of PH in IPD patients.

[Natriuretic peptides in diagnosis of pulmonary hypertension]

Pathogenetic and diagnostic role of natriuretic peptides in different variants of pulmonary hypertension is discussed. Structure, mechanism of action and physiological effects of some natriuretic peptides and their role in diagnosis and monitoring of the course of pulmonary hypertension are described.

[Molecular factors of angiogenesis in renal tissue of patients with chronic glomerulonephritis: association with nephrosclerosis and anemia]

AIM

To study correlations between accumulation of angiogenesis molecular factors (hypoxia-inducible factor-1alpha - HIF-1alpha, vascular endothelial growth factor - VEGF, thrombospondin - TSP-1) in kidney biopsy tissue from chronic glomerulonephritis (CGN) patients and severity of nephrosclerosis, obliteration of renal capillary bed, filtration dysfunction and anemia.

MATERIAL AND METHODS

We examined 22 patients with marked proteinuria (2.77; 5.7, mean 4.2 g/ day). Half of the patients had nephrotic syndrome. Glomerular filtration rate (GFR) by Cochroft-Golt formula was 68 (53;84) ml/min/1.73 m2. According to renal biopsy findings, CGN was detected in 19 patients, 2 patients had lupus nephritis (LN), 1 patient had renal amyloidosis. Nineteen CGN patients were divided into two groups by nephrosclerosis severity: group 1-7 patients with moderate nephrosclerosis, group 2-12 patients with severe nephrosclerosis. Cryostate sections of renal biopsy tissue samples were studied immunohistochemically using monoclonal antibodies to HIF-1alpha, VEGF, TSP-1, CD34. The reaction intensity was assessed by 6-point scale semiquantitative method.

RESULTS

Response to HIF-1alpha was stronger in the tubular epithelium than in glomeruli. No correlation was observed between accumulation of HIF-1alpha in the glomeruli and tubular epithelium. Intensity of glomerular staining correlated with severity of proteinuria (Rs = 0.63, p < 0.05), intensity of HIF-1alpha accumulation in tubular epithelium correlated with duration of the kidney disease (Rs = 0.74, p < 0.001), duration of persistent arterial hypertension (Rs = 0.68, p < 0.05) and severity of nephrosclerosis. VEGF and TSP-1 were found in equal quantity both in the glomeruli and renal interstitium. CGN patients with marked nephrosclerosis had lower accumulation of VEGF and higher TSP-1 in the interstitium. No correlation was found between intensity of tubular epithelium response to HIF-1alpha and accumulation of VEGF in the interstitium. Patients with severe nephrosclerosis demonstrated weaker staining of tubulointerstitium to CD34, reflecting the degree of its vascularisation. Significant correlation between CD34 and expression of HIF-1alpha, VEGF, TSP-1 was not registered. In patients with low intensity of tubular epithelial staining to HIF-1alpha (less than 2 points) anemia was detected in 63% versus 18% in patients with more intensive accumulation.

CONCLUSION

CGN progression is associated with development of renal tubulointerstitial ischemia. High tubular production of HIF-1alpha was not accompanied with activation of VEGF accumulation in renal interstitium but was associated with reduced risk of anemia in CGN patients with manifest nephrosclerosis.

[Long-term results of coronary endovascular revascularisation with sirolimus-eluting stents in patients with ischemic heart disease comorbid with type-2 diabetes mellitus: data from 18-month prospective study]

AIM

To study long-term results of 3-42-month (mean 18.1 +/- 1.2 month) of a prospective clinically and angiologically controlled follow-up after coronary endovascular revascularisation with sirolimus-eluting stents (SES) in patients with coronary heart disease (CHD) comorbid with type 2 diabetes mellitus (DM).

MATERIAL AND METHODS

A total of 108 CHD patients with angina pectoris resistant to antianginal therapy were divided into 2 groups: 51 CHD patients with mild and moderate type-2 DM (group 1); 57 CHD patients free of diabetes (group 2). All the patients have undergone successful coronary endovascular revascularisation with SES. Anti-ischemic efficacy and safety of stenting were studied in the course of 18-month prospective follow-up.

RESULTS

An anti-ischemic effect of stenting in hospital setting was achieved in all the patients. 18 months after stenting frequency and severity of anginal attacks reduced in group 1 by 70.6%, daily need in nitroglycerine--by 71.9%, in group 2--by 87.1 and 93.1%, respectively. As a result, exercise tolerance improved in group 1 by 38.3%, in group 2--by 40.8%. Quality of life improved by 22.7 and 25.1%, respectively. Most of the patients showed no deterioration of carbohydrate and lipid metabolism compensation. Recurrent angina and symptoms of painless myocardial ischemia occurred in 39.3 and 14% patients of group 1 and 2, respectively. More frequent causes of the recurrence were progression of coronary artery atherosclerosis de novo and Cypher stent restenosis (11.8 and 3.5% in group 1 and 2, respectively).

CONCLUSION

SES implantation provided good anti-ischemic efficacy in 60.7 and 86% CHD patients with and without DM, respectively. It significantly improved exercise tolerance and quality of life.

[Immunomodulating, metabolic and cardioprotective effects of AT1-angiotensin receptors blocker losartan in patients with coronary heart disease and type 2 diabetes mellitus]

AIM

To evaluate effects of 6-month therapy with losartan in combination with indapamide on a clinical course, immunological, metabolic parameters, left ventricular function, exercise tolerance and quality of life in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS).

MATERIAL AND METHODS

Forty six CHD patients with postinfarction cardiac dysfunction in MS were randomized into two groups. Group 1 consisted of 22 patients with impaired glucose tolerance, group 2--of 24 type 2 diabetics. Treatment included combination of losartan (50 mg/day) with indapamide (1.5 mg/day), on demand nitrates, nebivolol. Basic therapy in diabetes included sugar-reducing drugs. Clinical condition, findings of echocardiography, parameters of lipid and carbohydrate metabolisms, immunoglobulins, circulating immune complexes, autoantibodies to cardiolipin (AB to CL), spectrum of proinflammatory cytokines were studied before and 3 months after course treatment.

RESULTS

Overactivation of cytokines (primarily IL-2, IL-1, TNF alpha) with high expression of IgA, IgG, CIC, AB to CL was found in CHD patients with type 2 diabetes mellitus and less evident in impaired glucose tolerance. Losartan in both groups had an antihypertensive effect, stabilized LV hypertrophy, improved clinical symptoms leading to cytokines expression decline: TNF alpha by 9.8%, IL-1--by 6.1%, IL-6--by 6.7%. Losartan was well tolerated, caused no negative metabolic effects.

CONCLUSION

New original facts of cytokine overactivation and humoral immunity disturbances were discovered which play an essential role in pathogenesis of postinfarction dysfunction and LV remodeling developing in type 2 diabetes mellitus. Losartan 6-month treatment in the fixed combination has a positive effect on clinicohemodynamic and immunometabolic indices. This gives grounds for wider use of losartan in CHD combined with type 2 diabetes mellitus.

[Late results of endovascular coronary revascularization in patients with type 2 diabetes mellitus]

The aim of this work was to evaluate anti-ischemic and angiographic efficiency of endovascular revascularization of ischemic myocardium by implantation of Sirolimus-eluting stents from the results of a 18 moth-long prospective study of patients with coronary heart disease and/or type 2 diabetes mellitus (DM). The study included 108 patients with angina of effort randomized into two groups: CHD with DM (n = 51) and CHD without DM (n = 57). All of them received anti-ischemic and antihypertensive therapy and two desaggregants; DM patients also used oral hypoglycemic preparations. The patients underwent implantation of Sirolimus-eluting stents. The frequency of restenosis of the target arteries, development of serious cardio-vascular events (death, MI, cerebral stroke, and the need in repeat revascularization) were compared within 18 months after primary endovascular revascularization. Although Sirolimus-eluting stents markedly improved long-term prognosis in DM patients, results of their implantation were worse than in patients with CHD without DM.

[Clinicoimmunological disorders in patients with postinfarction left ventricular remodeling and chronic cardiac failure]

AIM

To characterize clinical and immune disorders in patients with ischemic heart disease (IHD), postinfarction left ventricular remodeling (PLVR), clinical manifestations of chronic cardiac failure (CCF).

MATERIAL AND METHODS

A comparative clinical controlled trial of immune system was made. The immune system was assessed by diagnostic and prognostic significance of changes in population composition of T- and B-lymphocytes, by activation of proinflammatory cytokines (IL-1alpha, IL-2, IL-6, IL-8, Inf-alpha, TNF-alpha); high expression of circulating immune complexes (CIC), autoimmune complexes to cardiolipin (CL) in 94 CCF patients with PLVR. The patients were divided into 3 groups according to severity of CCF. Group 1 consisted of 32 patients with CCF (FCII by NYHA) and normal ejection fraction (EF) of the left ventricle (52.0 +/- 2.8%). Group 2--31 CCF (FCIII) patients with decreased EF (by 43.8%) (36 +/- 4.3%). Group 3--31 CCF (FCIV) patients with low (25 +/- 3.8%) EF of the left ventricle. The protocol required conduction of echocardiographic parameters, paired bicycle exercise tests, 6-min walk tests, 24-h ECG monitoring, population cell composition of T- and B-lymphocytes, concentrations of cytokines, IgG and IgG autoantibodies to CL.

RESULTS

A dominating hyperactivation of cytokines TNFalpha, IL-1alpha, IL-2, IL-6 with high expression of CIC and autoAB to CL was associated with moderate or severe CCF (FCII-IV by NYHA), declined inotropic function of the left ventricle (EF 38-23%), low exercise tolerance and remodeling of the left ventricle.

CONCLUSION

Immune disorders in the form of hyperactivation of proinflammatory cytokines (most of all TNFalpha, IL-1alpha, IL-2, IL-6), enhanced expression of CIC and autoAB to CL growing with severity of CCF and abnormal heart pump function play an important role in CCF pathogenesis in IHD patients with LCPR and can be markers of the disease progression.

[Clinico-immunological disorders in patients with ischemic heart disease combined with metabolic syndrome and modulating effect of nebivolol for their correction]

AIM

To evaluate clinico-immunological disorders in patients with ischemic heart disease (IHD) and metabolic syndrome (MS), to study an immunocorrective action of nebivolol during 6-month treatment.

MATERIAL AND METHODS

A total of 54 patients with postinfarction left ventricular dysfunction and chronic cardiac failure of NYHA functional class II-III were divided into two groups: group 1 (n=24) comprised patients with effort angina FC II-III and impaired glucose tolerance, group 2 (n=30) consisted of anginal patients associated with type 2 diabetes mellitus (DM). Clinical, laboratory and functional indices were registered before therapy with nebivolol and 6 months after it. Immunological control included determination of the subpopulation composition of lymphocytes, immunoglobulins, circulating immune complexes (CIC), antibodies to cardiolipin (CL), proinflammatory cytokines: IL-1alpha, IL-2, IL-6, IL-8, alpha-interferon, tumor necrosis factor alpha (TNFalpha).

RESULTS

Nebivolol demonstrated good antihypertensive and anti-ischemic cardioprotective efficacy in IHD patients with MS, it did not deteriorate atherogenic dyslipidemia and impaired carbohydrate metabolism. As a good immunocorrector, nebivolol significantly inhibited cytokine overactivation, had a weak effect on dysimmunoglobulinemia, CIC level and expression to CL antibodies. Side effects were not recorded.

CONCLUSION

IHD patients with MS (especially patients with type 2 DM) have manifest immune disorders presenting with overactivation of proinflammatory cytokines with high levels of IgA, IgG, CIC and antibodies to CL in the presence of low immunoregulatory index. Nebivolol provided good control of arterial hypertension, myocardial ischemia, positive changes in immunological indices, improved intracardiac hemodynamics.

Proliferative activity of retinal vascular cells in newborn rat at different oxygenation modes

We evaluated the relationship between the percentage of oxygen in inhaled air and alternation of this parameter and proliferative activity of cells in retinal vessels of normal newborn rats. The relationships between these parameters and the mean diameter of retinal vessels were evaluated. The study was carried out on total retinal preparations and tangential sections of the retina by the immunoperoxidase and immunofluorescent methods. Hypoxia and hyperoxia significantly suppressed proliferative activity, while alternation of hyperoxia and normoxia significantly increased both proliferative activity of vascular cells and the mean diameter of retinal vessels.

[Effects of a superselective beta1-adrenoblocker nebivolol on the course of coronary heart disease and insulin resistance in patients with diabetes mellitus type 2 after coronary artery bypass grafting]

AIM

To study safety and effects of nebivolol on the course of coronary heart disease (CHD) and insulin resistance (IR) in patients with diabetes mellitus type 2 (DM-2) after coronary artery bypass grafting.

MATERIAL AND METHODS

The study included 53 CHD patients with DM-2 (mean age 56.7 +/- 1.3 years). All the patients were divided into two groups: 22 patients with IR (group 1) and 31 patients free of IR (group 2). All the patients received an 8 week course of nebivolol the efficacy of which was assessed by changes in coronary failure, exercise tolerance, quality of life, lipid and carbohydrate metabolism.

RESULTS

In group 1 an antianginal effect of nebivolol manifested with less frequent (by 54.7%) development of angina pectoris (p = 0.0003), a 59.8% (p = 0.0004) decrease in 24-h need in nitroglycerine. In group 2 these reductions were 63.4 and 61.6% (p < 0.01), respectively. Exercise tolerance increased by 36.2 and 25.2%, left ventricular ejection fraction significantly increased by 5.9 and 5%, respectively, quality of life improved by 25 and 23%, respectively. As a result, a functional class of chronic cardiac failure lowered. Nebivolol had no negative effect on compensation of blood lipid and carbohydrate metabolism. A trend to blood insulin fall by 18.4% was found. IR index diminished by 11.9%.

CONCLUSION

Administration of nebivolol in a dose 1.25-5 mg/day raised exercise tolerance, improved quality of life, reduced IR index by 11.9%, triglycerides level by 5.3%. This lowered the risk of effects of diabetic atherogenic dyslipidemia.

[Hippocratic fingers: clinical importance and differential diagnosis]

Changing of the distant finger phalanges into the form of a drumstick or fingernails into the form of a watch-glass (hippocratic fingers--HF) presents a well-known clinical phenomenon that suggests the presence of various diseases, especially those associated with hypoxia, i.e. manifested by respiratory and/or heart failure, as well as malignant tumors and subacute infective endocarditis. At the same time, the fact that this clinical phenomenon can accompany other diseases (Crohn's disease, HIV-infection) should be taken into consideration as well. HF often appear ahead of more specific symptoms. In this connection, correct interpretation of this clinical sign, augmented with laboratory tests, allows for early and valid diagnosis.

[The long-term results of coronary artery bypass grafting in patients with type II diabetes]

A three-year follow-up of patients with coronary heart disease (CHD) and type II diabetes after coronary artery bypass grafting, shows that the following pathologic conditions are significantly more frequent: arterial hypertension, visceral obesity, marked disturbances of blood lipid spectrum, an increases CHD duration, and an increased rate of myocardial reinfarction and revascularizations. The study shows that the presence of diabetes mellitus in CHD patients undergoing coronary artery bypass grafting, is associated with pronounced disturbances in blood lipid spectrum, and is an important risk factor of coronary event progression.

[Prognosis of remote consequences of combat mental trauma using logical statistical methods]

Prognosis of remote consequences of acute stress disorders and adaptation disorders as posttraumatic stress disorders (PTSD) is possible using relevant mathematical methods. The authors have used the following logical statistical methods: algorithms for search and statistical verification of optimal fragmentation of variables in multi-dimensional space ("Q-nearest neighbors", "statistically weighed syndromes") as well as a program of searching for multiple conjunctions of variables that allowed to single out statistically significant combinations of variables (p<0,001) and to divide the sample into two groups: with favorable and with unfavorable outcome both at the acute and remote stages of mental trauma. Predictors of unfavorable outcome found in the acute period of mental trauma were as follows: affective tension, impulsivity, high personal anxiety and depressive tendencies with reduced activity. Comparing to clinical evaluation, subjective criteria of mental state (self-rating) retained its informativeness for prognosis of protracted PTSD types. Using this set of variables, it became possible to predictt remote consequences (2-4 years) of psychogenias of combat situation with reliability of recognition of 85% for the favorable outcome and 79% for cases of protracted types.

[The role of clinical and imaging criteria in risk assessment during preoperative chemotherapy for osteosarcoma]

Prognosis for stage IIB osteosarcoma was evaluated versus the role of preoperative management of clinico-radiologic status in 293 patients. Three--five preoperative intra-arterial cycles of doxorubicin 90mg/m2 or cisplatin 120mg/m2 were given in 1986-1999, and later were followed by 3-4 cycles of doxorubicin and cisplatin in similar doses. Clinico-radiologic status was assessed in the course of preoperative chemotherapy. One hundred fifty patients were alive at the last examination, 139 had died of tumor progression, and 4 - chemotherapy complication. The two courses of preoperative chemotherapy were followed by more favorable outcome. Complete clinical response, tumors downsized to 300 mm, intra-osseous healing, periosteal assimilation and margination of extra-osseous masses had a significant positive impact on disease-free survival in the chemotherapy group. The data were used for the developing of models for individual risk evaluation and prognosis. Clinico-radiologic status monitoring in the course of preoperative chemotherapy is instrumental in predicting risks as well as designing alternative strategies of treatment at earlier stages.

[Antiischemic and metabolic effects of nebivolol and metaprolol CR/XL (betalok ZOK) in patients with postinfarction heart dysfunction]

The purpose of the study was to evaluate anti-ischemic and metabolic effects of the cardioselective beta-adrenoblockers nebivolol and retarded metoprolol-metaprolol CR/XL (betalok ZOK) in patients with postinfarction heart dysfunction, associated with type II diabetes mellitus (DM). 40 patients with coronary heart disease (CHD), functional class (FC) II-III exertional angina, postinfarction left ventricular (LV) dysfunction, and NYHA FC II heart failure, associated with type II DM, were randomized into 2 groups. The 20 patients of the 1st group were administered nebivolol in a dose of 1.25 to 5 mg per day, the 20 patients of the 2nd group - betalok ZOK in a dose of 12.5 to 100 mg per day. The course therapy lasted 8 weeks. The effects of the treatment were evaluated using paired veloergometry, echoCG, and lipid spectrum analysis. The study found that nebivolol in a mean dose of 4.2 +/- 0.3 mg per day and betalok ZOK in a dose of 46.5 +/- 6.2 mg per day reduced the frequency and severety of angina attacks (by 73.8% and 67.8%, respectively) and daily nitroglycerine uptake (by 78.6% and 69.1%, respectively), and increased activity tolerance (by 7.9% and 25.3%, respectively). None of the preparations displayed any adverse effects on carbohydrate exchange and blood lipid spectrum. Nebivolol, unlike betalok ZOK, significantly (p = 0.02) reduced triglyceride blood level by 29%. Thus, the new generation cardioselective beta1-adrenoblockers nebivolol and metoprolol CR/XL (betalok ZOK) provide anti-ischemic and metabolic effects in patients with CHD and postinfarction LV dysfunction, associated with type 2 diabetes mellitus. Nebivolol is preferable as far as blood lipid spectrum is concerned.

von Hippel-Lindau protein binds hyperphosphorylated large subunit of RNA polymerase II through a proline hydroxylation motif and targets it for ubiquitination

The transition from transcription initiation to elongation involves phosphorylation of the large subunit (Rpb1) of RNA polymerase II on the repetitive carboxyl-terminal domain. The elongating hyperphosphorylated Rpb1 is subject to ubiquitination, particularly in response to UV radiation and DNA-damaging agents. By using computer modeling, we identified regions of Rpb1 and the adjacent subunit 6 of RNA polymerase II (Rpb6) that share sequence and structural similarity with the domain of hypoxia-inducible transcription factor 1 alpha (HIF-1 alpha) that binds von Hippel-Lindau tumor suppressor protein (pVHL). pVHL confers substrate specificity to the E3 ligase complex, which ubiquitinates HIF-alpha and targets it for proteasomal degradation. In agreement with the computational model, we show biochemical evidence that pVHL specifically binds the hyperphosphorylated Rpb1 in a proline-hydroxylation-dependent manner, targeting it for ubiquitination. This interaction is regulated by UV radiation.

[Primary culture of prostatic adenocarcinoma: a model for studies of stromal-epithelial interactions]

Primary culture of prostatic adenocarcinoma is obtained from surgical material after radical prostatectomy. Typing of the obtained culture with antibodies to vimentin and cytokeratins has shown that the proportion of basic cell components--stromal and epithelial--in vitro correlates with such in the initial tumor tissue. In cultivation in different media active migration and proliferation of all cell types in the presence of embryonal serum and suppression of the stromal component in the medium where the serum was replaced for bovine hypophysis extract were observed. A comparative immunohistochemical analysis registered a release into culture of alpha SMA-positive myofibroblasts and active expression of TGF beta-1 in the medium containing serum. Design of dynamic mixed cell systems may serve a convenient model for investigation of stromal-epithelial interactions and their changes in cancer progression.

Regulation of gene expression for neurotransmitters during adaptation to hypoxia in oxygen-sensitive neuroendocrine cells

Reduced oxygen tension (hypoxia) in the environment stimulates oxygen-sensitive cells in the carotid body (CB). Upon exposure to hypoxia, the CB immediately triggers a reflexive physiological response, thereby increasing respiration. Adaptation to hypoxia involves changes in the expression of various CB genes, whose products are involved in the transduction and modulation of the hypoxic signal to the central nervous system (CNS). Genes encoding neurotransmitter-synthesizing enzymes and receptors are particularly important in this regard. The cellular response to hypoxia correlates closely with the release and biosynthesis of catecholamines. The gene expression of tyrosine hydroxylase (TH), the rate-limiting enzyme for catecholamine biosynthesis, is regulated by hypoxia in the CB and in the oxygen-sensitive cultured PC12 cell line. Recently, genomic microarray studies have identified additional genes regulated by hypoxia. Patterns of gene expression vary, depending on the type of applied hypoxia, e.g., intermittent vs. chronic. Construction of a hypoxia-regulated, CB-specific, subtractive cDNA library will enable us to further characterize regulation of gene expression in the CB.

[Optimization of conditions for isolating chromosomes in flow sorting]

Factors for purity and efficiency of flow chromosome sorting were analysed on the base of quantitative analysis. The sorting rate and relative purity of individual chromosome fractions are determined both by the quality of initial chromosome suspension, instrument parameters and gate position on experimental histograms. The described procedure of analysing sorting efficiency and fraction purity allowed to formulate general tips for optimization of sorting conditions depending on a given strategy: maximization of quantity of obtained material, or achieving maximum purity for sorted fraction. The analysis is carried out on the bases of chromosome distribution parameters: their relative halfwidths and distances. These parameters can be obtained by the quantitative analysis programs for flow cytometry data. It is shown that the critical parameter for sorting purity is the level of contaminated objects in a zone of sorted chromosome signal registration. In addition, the fraction purity depends on the cover extent between different chromosome distributions. Created procedure allows to build up nomograms linking the sorting efficiency with fraction purity, depending on the position of sorting gates. These monograms permit to determine the position of sorting gates in relation to one or another strategy: 1) maximum rate for chromosome material obtaining, 2) maximum fraction purity, or 3) compromise between the two. The presented analysis allows to optimize the chromosome sorting process for subsequent genome investigations providing chromosome material with controlled characteristics.

[Changes in the components of the extracellular matrix and its regulators in the endometrium of women with habitual abortion]

Biopsies of the endometrium from 93 patients with habitual abortions (HA) were studied immunohistochemically. Chronic endometritis (CE) was diagnosed in 26 patients. Decreased tenascin expression in the endometrial stroma with merozin accumulation in the glandular basal membranes, covering epithelium and vessels were found in HA combined with CE. Abnormal distribution of collagen type I and III with predominance of type I collagen and appearance of merozin. This is indicative of alteration in the endometrium maturation which may result in inadequate ovum implantation and pregnancy interruption. Stromal alterations in HA with or without chronic endometritis are under multifactorial control of various mediators. High level of MMP-9 combined with low level of TFP-beta 1 may serve a prognostic criterion of successful completion of pregnancy regardless of CE. Low level of MMP-9 may increase the risk of pregnancy interruption.

[Morphological characteristics of chronic endometritis]

The immunohistochemical examination of 46 endometrial biopsies from women with chronic endometritis (CE) suffering from habitual abortions has found disturbance of correlations between various types of immunocompetent cells with domination of T-suppressors, increased accumulation of IgG on the surface of glandular epithelium. In CE, thickening of spiral arteries occurs not because of sclerosis but due to muscular hypertrophy, endometrial stromal-epithelial relations are impaired. Alterations in the distribution of the extracellular matrix components indicate defective endometrium maturation which may lead to inadequate oocyte implantation.