Pathogenetic Mechanisms of Mental Disorders: Endogenous Intoxication

The review describes the syndrome of endogenous intoxication in patients with mental disorders. Oxidative stress, middle-mass endotoxic molecules, impaired functional properties of serum albumin and albumin thiol groups, neurotrophic factors, and enzymes, including monoamine oxidase and semicarbazide-sensitive amine oxidase contribute to the development of endogenous intoxication. Possible pathogenetic mechanisms of the endogenous intoxication development in mental disorders and approaches to its treatment are discussed.

Endogenous intoxication in development of experimental periodontitis of bacterial-immune genesis

INTRODUCTION

Excessive lipoperoxidation is accompanied by accumulation of peroxidation products and depletion of antioxidant re-serves, which cause hyperenzymemia and the accumulation of toxic substances. The level of endotoxicosis is determined by the content of hydrophilic and hydrophobic products in the blood.

AIM

To define the pathogenetic role of endogenous intoxication in the dynamics of development of experimental periodontitis of bacterial-immune genesis.

MATERIALS AND METHODS

The experiment was conducted on rats. The animals were divided into three groups: group 1 - control group/intact; group 2 - model periodontitis at 7 days; group 3 - model periodontitis at 30 days. The experimental bacterial-immune periodon-titis was induced by injection into the tissue of the periodontal complex of the microorganisms' mixture diluted with egg's albumin. For the study, we selected the blood serum in which the content of middle molecular weight molecules and erythrocyte intoxication index were determined. The results were statistically analyzed by means of non-parametric indices methods.

RESULTS

The development of generalized periodontitis is characterized by the occurrence of oxidative stress, which leads to violation of the metabolism in the mucous membrane of the oral cavity resulting in the accumulation of toxic products and the development of endogenous intoxication. The results show that the content of middle molecular weight molecules (aromatic amino and chain amino acids) determined on day 7 of the experiment was 1.11 times higher than that of the control group (p<0.01) and by 1.16 times (p<0.01), respectively. Comparing the levels of the above hydrophilic components of endogenous intoxication at 30 days of experimental peri-odontitis, we found a probable increase in these indicators compared with those at 7 days of the experiment. Studying the level of eryth-rocyte intoxication index, we found that at 7 days of experimental periodontitis this index was 1.28 times higher (p<0.01) than that of the intact group and continued to increase at 30 days.

CONCLUSIONS

The dynamics of experimental periodontitis of bacterial-immune genesis show that the highest rates of endogenous intoxication are found in the late stages of the dynamics of the inflammatory process in the periodontium, namely at 30 days of the experiment, which may indicate chronic inflammation.

[Cell therapy for destructive pancreatitis]

OBJECTIVE

To evaluate therapeutic efficacy of mesenchymal stem cells in patients with severe acute pancreatitis.

MATERIAL AND METHODS

There were 60 patients with severe acute pancreatitis randomized into 2 groups: the first group (n=30) - endoscopic surgical treatment, mean age 44.7±2.93 years (18 (60.0%) males and 12 (40.0%) females); the second group (n=30) - complex therapy (standard treatment + cell therapy), mean age 50.8±3.8 years (16 (53.3%) men and 14 (46.7%) women). Taxation of endogenous intoxication, immunity state and regional microcirculation were assessed. Genetic analysis of eNOS (C774T) gene polymorphism was also carried out.

RESULTS

Early period of acute severe pancreatitis is accompanied by significant disorders of homeostasis (endogenous intoxication, immune imbalance, severe disorders of regional microcirculation). Genetic analysis showed that polymorphic genotype (T774T) of the endothelial NO synthase gene in a larger percentage (66.7-71.6%, p=0.001) occur in patients with severe acute pancreatitis and more severe homeostatic disorders (p<0.05). Inclusion of mesenchymal stem cells into standard therapy in early phase of acute severe pancreatitis makes it possible to purposefully and relatively quickly exert its effect on abnormal processes of homeostasis, inhibiting toxemic phenomenon, restoring immune response, and improving microcirculation. A particularly positive therapeutic effect of the drug is observed in patients with the eNOS gene mutation (T774T).

CONCLUSION

Mesenchymal stem cell drugs are advisable in early period of acute pancreatitis, mainly in patients with severe forms of disease.

Hemofiltration in Patients with Severe Acute Pancreatitis (Review)

Questions regarding the application of extracorporeal detoxification to patients with severe acute pancreatitis have been considered. Hemodialysis, the historically first method of extracorporeal detoxification for such patients, has been also described in the review. Appropriateness of using renal replacement therapy methods and among them continued renal replacement therapy has been shown. Hemofiltration and hemodiafiltration technologies are described in detail including different modes of their application and the possibility of using various types of filters. Available data on hemofiltration for patients with severe acute pancreatitis have been analyzed. Great attention is paid to the unsolved aspects of hemofiltration in severe acute pancreatitis such as determining renal and extrarenal indices; time of starting hemofiltration; selection of volume replacement modes and a buffer system; procedure duration; anticoagulation measures, defining criteria to assess the adequacy of hemofiltration, state severity, and organ dysfunction degree. Further multicenter investigations are necessary to be able to assess the efficacy of the hemofiltration procedures on the basis of the thoroughly worked out and pathogenically grounded protocol using adequate control methods taking into consideration endogenic intoxication phases and intensity of the multiple organ failure syndrome.

[Preventive therapy with mexidol in toxic damage to the heart]

The purpose of this study was to efficacy of mexidol in the prevention of toxic damage to the heart in acute pancreatitis.

MATERIAL AND METHODS

The paper presents the results of experimental studies conducted on 30 adult mongrel adult dogs, which simulated acute focal pancreatic necrosis. We studied the influence of mexidol in the complex therapy for changes in the qualitative and quantitative composition of the lipid tissue structures of the heart, the intensity of processes of lipid peroxidation, antioxidant capacity, phospholipase A₂ activity and morphofunctional state of the heart muscle in experimental acute focal pancreatic necrosis. Th.

RESULTS AND DISCUSSION

The preventive use of antioxidant drug mexidol in complex treatment of acute focal pancreatic necrosis, which limits the development of endogenous intoxication, increased intensity of lipid peroxidation and restores antioxidant capacity, reduces leading to phospholipase activity in tissue structures of the heart, corrigiruet lipid metabolism and morphofunctional state of the heart, and, consequently, toxic damage to the heart during endotoxic.

[The evaluation of endogenous intoxication and level of proteins of acute phase in onco-urological patients depending on course of disease.]

The purpose of the study is to carry out a comparative analysis of endogenous intoxication and content of proteins of cute phase in patients with urinary bladder cancer with successful treatment and complicated course of disease. To evaluate level of endogenous intoxication in patients the analysis was applied concerning content of molecules of average mass and functional characteristics of albumin assessed by ratio of efficient and total concentration of albumin. The coefficient of intoxication was calculated reflecting balance between cumulation of toxic ligands in blood plasma and their binding. The analysis was implemented concerning indices of endogenous intoxication in patients with urinary bladder cancer prior to treatment, after complex treatment and in patients with main disease complicated by renal insufficiency and in patients with onco-urology of both localizations when post-operational period was complicated by development of gram-negative sepsis. The results of study of endotoxicosis in case of onco-urological pathology were compared against the level of acute-phase proteins: C-reactive protein and haptoglobin. In case of patients with muscular non-invasive urinary bladder cancer and patients with kidney cancer typically occurred decreasing of efficient concentration of albumin and its binding capacity against the background of increased level of endotoxins. In patients with urinary bladder cancer with chronic renal insufficiency alterations of all indices were expressed in a higher degree. The maximal derangement of capacity of albumin to bind products of endotoxicosis, increasing of level of molecules of average mass and multiple increasing of C-reactive protein were specific in patients with developed sepsis. The obtained data testifies the informativeness of analyzed indices for evaluation of condition of oncourological patients.

[The level of endogenous intoxication iт oncologic gynecologic patients.]

The leading role of syndrome of endogenous intoxication in structure of clinical manifestations of tumor disease conditions actuality of studying components determining its development, in dynamics of malignant process and under anti-tumor therapy. Among all studied groups of oncogynecological patients, the most expressed decreasing of functional activity of albumin binding toxic compounds is observed under ascitic form of ovary cancer. In the group of patients with ovary cancer of stage I-II and also in condition of remission of process in patients with ovary cancer of stage III, the values of total and effective concentration of albumin and its binding capacity, on the contrary, are approaching to donor values. Under cervical carcinoma and vulva cancer the statistically significant decreasing of effective concentration of albumin and its binding capacity was established. However, thisdecreasing is manifested in minor degree than in patients with ascitic form of ovary cancer.

Application of spatially distributed field of electric impulses for correction of angiogenesis in ischemic muscular tissue

Influence of spatially distributed field of electric impulses in a projection to cervical ganglions of the sympathetic nervous system on angiogenesis in ischemic muscular tissue of a rat's shin has been studied. It is revealed that blood supply of animals, influenced by the field, is restored through increase in quantity of capillaries in ischemic tissues, and number of products of endogenous intoxication is reduced.