Vol 81, No 6 (2009)

Articles
Statistics on rheumatic conditions in the Russian Federation in early 2000es
Nasonova V.A., Folomeeva O.M., Erdes S.F., Nasonova V.A., Folomeeva O.M., Erdes S.F.
Abstract
The analysis of rheumatic disease morbidity in the Russian Federation in early XXI century is presented.
Terapevticheskii arkhiv. 2009;81(6):5-9
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Prevalence of mental disorders in SLE patients: correlations with the disease activity and comorbid chronic conditions
Lisitsyna T.A., Vel'tishchev D.Y., Seravina O.F., Kovalevskaya O.B., Marchenko A.S., Novikova D.S., Novikov A.A., Aleksandrova E.N., Nasonov E.L., Lisitsyna T.A., Veltischev D.Y., Seravina O.F., Kovalevskaya O.B., Marchenko A.S., Novikova D.S., Novikov A.A., Alexandrova E.N., Nasonov E.L.
Abstract
Aim. To study effects of the disease activity and comorbid chronic conditions on the incidence of mental disorders in patients with systemic lupus erythematosus (SLE) treated in the State Institute of Rheumatology, RAMS. Material and methods. A total of 115 patients with documented SLE (age 24-45 years, median 34 years, SLE duration 4-17, median 8 years) participated in the study. SLE activity was evaluated by SLEDAI scale, atherosclerosis - by ultrasonic arterial dopplerography, mental disorders - by psychological and psychic scales according to IDC-10. Results. Mental disorders were detected in 76 of 115 (66%) patients: anxiety and depression (83%), depression episodes (40%), maladaptation (24%), generalized anxiety (10%), dysthymia (9%). Manifest cognitive disorders were seen in 7% of examinees. SLE patients with and without mental disorders did not differ by age, gender, SLE duration and activity, cumulative doses of glucocorticoids and cytotoxic drugs, but differed by diagnosed atherosclerosis (23 and 8%, respectively). All SLE patients with the history of myocardial infarction had mental disorders. SLE patients with antiphospholipid syndrome had mental disorders in 85%, while controls - in 49%. Conclusion. Mental disorders are found frequently in SLE patients (66%). 83% of these disorders are anxiodepressive. Incidence of mental disorders in SLE patients do not correlate with age, gender, SLE duration and activity, doses of glucocorticoids and cytotoxic drugs, but correlate with comorbid diseases (atherosclerosis, myocardial infarction, acute cerebral attacks, antiphospholipid syndrome and Sjogren's syndrome.
Terapevticheskii arkhiv. 2009;81(6):10-15
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Poor prognosis factors in SLE: results of 5-year follow-up
Sushchuk E.A., Zborovskiy A.B., Suschuk E.A., Zborovsky A.B.
Abstract
Aim. To determine factors of poor prognosis of systemic lupus erythematosus (SLE). Material and methods. Clinical and device examinations were made in 64 patients hospitalized with verified SLE. Its activity was assessed by SLAM and SLEDAI indices, severity - with SLICC/ACR. Five years after the primary examination the patients were re-examined. Prognostic factors were investigated using multiple linear regression and binary logistic regression. Results. A 5-year survival of SLE patients was 87.5%. For 5 years SLICC/ACR has risen from 1.24 ± 1.29 to 2.58 ± 1.89 points (p < 0.001). Reproductive, nervous, cardiovascular and osseomuscular disorders made the greatest contribution to this rise. The age of SLE onset, SLICC/ACR at the start of the study, the absence of a rapid response to treatment were significant predictors of SLICC/ACR rise in the model of linear regression. This model explains 62.7% of the dependent index variance. The model of binary logistic regression, in which a dependent variable was survival, identified the same three indices as statistically significant. The model explained 74.4% of 5-year survival variance and predicted an outcome correctly in 86.2% cases. Conclusion. Key factors of a poor SLE prognosis are a late SLE onset, a severe initial lesion and no rapid response to therapy.
Terapevticheskii arkhiv. 2009;81(6):16-19
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The role of parotid gland biopsy in early detection of lymphoma in primary Sjogren's syndrome
Vasil'ev V.I., Logvinenko O.A., Probatova N.A., Kokosadze N.V., Gorodetskiy V.R., Kovrigina A.M., Kondrat'eva T.T., Mitrikov B.V., Gayduk I.V., Safonova T.N., Simonova M.V., Radenska-Lopovok S.G., Varlamova E.Y., Vasiliev V.I., Logvinenko O.A., Probatova N.A., Kokosadze N.V., Gorodetsky V.R., Kovrigina A.M., Kondratieva T.T., Mitrikov B.V., Gaiduk I.N., Simonova M.V., Radenska-Lopovok S.G., Varlamova E.Y.
Abstract
Aim. To investigate the incidence of MALT-lymphoma in Sjogren's disease by means of biopsy of the enlarged parotid glands. Material and methods. The incisional parotid biopsy was performed in 57 primary Sjogren's syndrome (pSS) patients with existing parotid enlargement. The median age was 54 years (range 19-75 years). The median pSS duration was 7 years (range 1-30 years). The palpable parotid enlargement was defined as grade 1 and massive (visional) enlargement of the parotid glands was defined as grade 2. Histologic and immunohistochemical examinations for diagnosis of lymphoma were made. High resolution electrophoresis and immunofixation were performed for detection of monoclonal immunoglobulins in the serum and their free light chains in the urine. Results. Biopsy of he enlarged parotid glands identified MALT-lymphoma in 37 of 57 (64.9%) pSS patients. Of 37 pSS patients with parotid enlargement of grade 2, diagnosis of MALT-lymphoma was made in 89.2%. Of 20 pSS patients who had parotid enlargement of grade 1, MALT-lymphoma was diagnosed in 20%. In patients with grade 1 enlarged parotid glands MALT-lymphoma was identified only in cases with the presence of monoclonal immunoglobulins in the serum and their free light chains in the urine (3 of 4 patients) or in case of disseminated disease (lymphoma involved regional lymph nodes and soft tissues of the face) - 1 of 4 patients. In patients with grade 2 enlargement of parotid glands MALT-lymphoma located most frequently in affected parotid glands (69.6%). Conclusion. The incisional biopsy of enlarged parotid glands is necessary for detection of MALT lymphoma in pSS patients.
Terapevticheskii arkhiv. 2009;81(6):20-26
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Effects of recurrent herpetic infection on functional activity of T-cells in patients with rheumatoid arthritis
Sviridova V.S., Kologrivova E.N., Pronina N.A., Eliseeva L.V., Naslednikova I.O., Sviridova V.S., Kologrivova E.N., Pronina N.A., Eliseeva L.V., Naslednikova I.O.
Abstract
Aim. To evaluate effects of recurrent herpetic infection on functional activity of regulatory cell subpopulations in patients with rheumatoid arthritis. Material and methods. We studied in vitro production of marker cytokines of type 1 T-helpers (IL-2), type 2 T-helpers (IL-4), type 3 T-helpers TGFb and type 1 T-regulators (IL-10) and counted CD4+CD25+ T-cells in the blood of patients with recurrent herpetic infection and having no clinical manifestations of Herpes virus reactivation. Results. Patients with recurrent herpes had more active production of IL-10, but reduced count of CD4+CD25+ lymphocytes. Conclusion. IL-10 hyperproduction observed in recurrent herpetic infection may contribute to progression of rheumatoid arthritis.
Terapevticheskii arkhiv. 2009;81(6):27-28
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Cardiovascular risk in patients with rheumatoid arthritis
Nikitina N.M., Rebrov A.P., Nikitina N.M., Rebrov A.P.
Abstract
Aim. Cardiovascular risk determination in patients with rheumatoid arthritis (RA) on the basis of standard and new risk factors (RF). Material and methods. Incidence of standard cardiovascular RF was studied in 312 RA patients and 57 healthy controls. Overall coronary risk (OCR) and cardiovascular death risk (SCORE scale), coronary heart disease risk (Framingem scale) were analysed. In addition, such RF as severity of systemic inflammation, some hemostatic indices, arterial wall stiffness were assessed. Results. Arterial hypertension (AH) occurred in 63.5% and hypercholesterinemia in 57.7% patients. AH in RA males is detected significantly more often than in population while blood lipid composition is satisfactory because of high HDLP cholesterol. The Framingem index in RA patients is lower than in the controls (7.7 ± 5.4 and 9.4 ± 9.3%), mean SCORE was 2.16 ± 2.9% (17.3% patients had high SCORE), a high OCR was registered in 25.7%. High level of C-reactive protein, platelets (320 Ѕ 109/l), hyperfibrinogenemia were found in 70.2, 31.1% and 55.9% patients, respectively. RA is accompanied with high activity of Willebrand factor, a low level of antithrombin III, suppression of fibrinolysis in blood plasm (p < 0.05). This reflects high thrombogenic blood potential, high risk of thrombosis and related complications of coronary heart disease. Aortic pulse wave velocity over 12 m/s was recorded significantly more frequently in RA than in control patients (p < 0.001), RA females had high arterial rigidity both in the periphery and aorta. Conclusion. Cardiovascular risk indices based on standard RF cannot assess the risk in RA patients. Additional factors should be taken into consideration: severity of inflammation, hemostasis, arterial stiffness.
Terapevticheskii arkhiv. 2009;81(6):29-33
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Combined basic therapy of rheumatoid arthritis with methotrexate and plaquenil
Sergiets N.A., Erov N.K., Sergiets N.A., Erov N.K.
Abstract
Aim. To compare efficacy of basic RA treatment with methotrexate+plaquenil and basic monotherapy with methotrexate. Material and methods. Two groups of rheumatoid arthritis (RA) patients were studied: group 1 (n = 82) received combined basic treatment with methotrexate (7.5 mg/week) in combination with plaquenil (0.2 ?mg/day); group 2 (n = 60) received methotrexate monotherapy according to the same scheme; all the patients received also diclofenak in a dose 100 mg/day; low-dose glucocorticosteroids were given to 36 and 24 patients, respectively. To improve methotrexate tolerance, all the patients took folic acid (1-2 mg/day 5 days a week). Efficacy of the treatment was evaluated by regression and final value of inflammation activity. Results. 6-month treatment produced in groups 1 and 2 good effect in 27.6 and 21.4%, satisfactory effect - in 65.5 and 66.6% patients, respectively. No effect was seen in 6.8 and 11.9% patients, respectively. A good effect was achieved in group 1 in 73.3 ± 5.4 days; in group 2 - in 93.7 ± 5.9 days (p < 0.05). In 12 months good and satisfactory effects persisted. Side effects occurred with the same frequency in both groups primarily in those who did not take folic acid. Conclusion. Combined basic therapy of RA with methotrexate and plaquenil was more effective than monotherapy with methotrexate because it produced good effects more frequently and earlier while no response was seen less often.
Terapevticheskii arkhiv. 2009;81(6):34-36
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Neurohumoral regulation of blood pressure in rheumatic patients
Shilkina N.P., Stolyarova S.A., Yunonin I.E., Dryazhenkova I.V., Shilkina N.P., Stolyarova S.E., Dryazhenkova I.V.
Abstract
Aim. To study characteristics of neurohumoral regulation of blood pressure (BP) in patients with systemic diseases of the connective tissue and hemorrhagic vasculitis (HV). Material and methods. The trial included 45 patients with systemic lupus erythematosus (SLE), 25 patients with scleroderma systematica (SS), 30 HV patients and 30 healthy controls. The following parameters were estimated: activity of plasmic renin, aldosteron concentration in plasma, catecholamines (noradrenaline and adrenalin), serum level of endotheline-1, number of desquamated endotheliocytes by J. Hladovec (1978) with use of Goryaev's camera. A BP 24-h profile was obtained by the standard method with the device Kardiotekhnika 4000 AD. Renal function was assessed by blood creatinine (Reberg's test). Results. Contribution of different factors to pathogenesis of arterial hypertension (AH) in rheumatic conditions was different. SLE activity enhancement was associated with renal dysfunction and growth of plasmic renin leading to AH resultant from activation of the renin-angiotensin-aldosteron system (RAAS), sympathico-adrenal system (SAS) and suspended by endothelial dysfunction. AH in SS patients presented with SAS activation, endothelial dysfunction and moderate pathology of the kidneys. HV activation provoked renal and endothelial dysfunction, SAS activation leading to development of AH. Conclusion. In rheumatic diseases AH develops with activation of SAS, RAAS, endothelial and renal dysfunction.
Terapevticheskii arkhiv. 2009;81(6):37-40
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Cardiovascular risk in psoriatic arthritis
Badokin V.V., Yanysheva A.V., Aleksandrova E.N., Mach E.S., Popkova T.V., Badokin V.V., Yanysheva A.V., Alexandrova E.N., Mach E.S., Popkova T.V.
Abstract
Aim. To evaluate cardiovascular risk in psoriatic arthritis (PA). Material and methods. The examination covered 61 PA patients (52.9% females) aged 30-55 years and 45 controls without inflammatory and degeneratory diseases matched by gender, age and body mass. Standard cardiovascular risk factors were analysed. C-reactive protein was measured with a highly sensitive method. Carotid arteries were subjected to duplex scanning. Results. PA patients had a high cardiovascular risk. Dyslipidemia manifested with a high total cholesterol, LDLP cholesterol which correlated with inflammation activity. PA was more frequently associated with subclinical atherosclerosis and atherosclerotic plaques. Conclusion. Chronic immune inflammation underlying pathogenesis of PA contributes to development of early atherosclerosis and its complications. A high cardiovascular risk is a constituent of PA which had an impact on long-term prognosis of this disease.
Terapevticheskii arkhiv. 2009;81(6):41-46
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Clinical implication of assessment of heart rate variability in patients with psoriatic arthritis
Novikova D.S., Korotaeva T.V., Loginova E.Y., Popkova T.V., Markelova E.I., Novikov A.A., Aleksandrova E.N., Mach E.S., Nasonov E.L., Novikova D.S., Korotaeva T.V., Loginova E.Y., Popkova T.V., Markelova E.I., Novikov A.A., Alexandrova E.N., Mach E.S., Nasonov E.L.
Abstract
Aim. To evaluate clinical significance of heart rate variability (HRV) in patients with psoriatic arthritis (PsA). Material and methods. HRV was investigated by means of time-domain analysis of 24 h ECG ambulatory recording in 113 PsA (70 female) patients < 55 years old and 65 age-matched healthy subjects. We assessed the presence of standard cardiovascular risk factors, performed carotid and femoral ultrasound with measurement of intima-medial thickness (IMT) in PsA patients. Inflammatory markers (CRP, fibrinogen) were detected in all the patients. Results. Significantly lower values of HRV parameters adjusted by Mean NN (SDNNn%, SDNNIN%) were detected in PsA men and women when compared to the control group. There was a significant negative correlation between HRV and disease duration, PsA activity (DAS4, Ritchi index), swollen and tender joint counts, femoral IMT, CRP in PsA males (p < 0.05). SDNNin% was lower in PsA male smokers than in non-smokers (p = 0.03). There was a significant negative correlation between HRV and age, systolic blood pressure, dyslipidemia, body mass index, carotid IMT, CRP, fibrinogen in PsA women. Conclusion. Reduced HRV reflects sympatho-vagal imbalance in PsA patients associated with the disease duration and activity, smoking, femoral IMT, markers of inflammation (CRP) in males; with standard cardiovascular risk factors, fibrinogen, CRP, carotid IMT in women, and may be identified as a risk factor for cardiovascular morbidity and mortality in further studies.
Terapevticheskii arkhiv. 2009;81(6):47-51
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Content of C-reactive protein, interleukin-1, interleukin-6 and interleukin-1 receptor antagonist in the blood of patients with early osteoarthrosis of the knee joints
Svetlova M.S., Vezikova N.N., Romashina V.V., Sobanina T.S., Pavlov Y.L., Cheplyukova I.A., Svetlova M.S., Vezikova N.N., Romashina V.V., Sobanina T.S., Pavlov Y.L., Cheplyukova I.A.
Abstract
Aim. To analyse the levels of C-reactive protein (CRP), IL-1, IL-6 and IL-1 receptor antagonist (IRA) in the blood of patients with early gonarthrosis (GA). Material and methods. Clinical, x-ray and arthrosonographic examinations to stage GA, to identify knee joint synovitis, degree of pain and joint dysfunction were made in 62 males and females with early GA and 20 healthy donors. The levels of CRP, IL-1, IL-6 and IRA were measured with reference to GA stage and activity of the inflammatory process. Results. CRP levels did not differ significantly in synovitis and no synovitis, in different GA stages, in patients and normal controls. Cytokines, except IL-6, were significantly higher in patients with knee joint osteoarthrosis (KJO). The highest levels of IL-1 and the lowest of IRA occurred in the group of roentgen-negative patients versus patients with the pathological process of stage I and II. The cytokines content did not reflect severity of inflammation in the knee joints. Conclusion. In early GA inflammation may be not systemic. CRP level does not correlate with activity of local joint inflammation. Most active cartilage tissue degradation takes place at the earliest (preroentgenological) stage of KJO. This stage is most appropriate for initiation of active pathogenetic therapy of the disease.
Terapevticheskii arkhiv. 2009;81(6):52-55
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Heart rate variability in patients with ankylosing spondilitis (Bekhterev's disease)
Poddubnyy D.A., Gaydukova I.Z., Rebrov A.P., Poddubny D.A., Gaidukova I.Z., Rebrov A.P.
Abstract
Aim. To study autonomous regulation of cardiac activity in patients with alkylosing spondylitis(AS) according to heart rate variability. Material and methods. A total of 51 male patients aged 35.4 ± 7.3 years with verified AS participated in the trial. Patients with manifest cardiovascular pathology, disturbances of cardiac rhythm or conduction were not included. All the patients were screened for basic cardiovascular risk factors. AS activity was studied with a clinical index BASDAI and acute phase indices. HRV was analysed by 5-min at rest ECG fragments. The control group consisted of 23 healthy males at the age 35.7 ± 11.5 years matched by basic cardiovascular risk factors with AS patients. Results. Basic time and frequency HRV parameters were much lower in AS patients than in healthy controls. A significant negative correlation was found between HRV parameters and acute phase parameters (ESR, C-reactive protein, fibrinogen) evidencing for a significant impact of persistent systemic inflammation on autonomic regulation of cardiac activity consisting in regress of parasympathic and/or enhancement of sympathetic activity and leading to reduction of HRV in AS patients. Conclusion. AS patients have abnormal autonomic regulation of cardiac activity manifesting with subnormal HRV. This is closely related with the activity of systemic inflammation. Reduced HRV may be one of the factors of a high cardiovascular risk in AS patients.
Terapevticheskii arkhiv. 2009;81(6):56-61
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Combined treatment of gastric ulcers induced by nonsteroid anti-inflammatory drugs. Results of 4-week population-based controlled trial of efficacy of proton pump inhibitor combination with tripotassium bismuth dicitrate
Karateev A.E., Uspenskiy Y.P., Pakhomova I.G., Nasonov E.L., Karateev A.E., Uspensky Y.P., Pakhomova I.G., Nasonov E.L.
Abstract
Aim. To study efficacy of a combination of proton pump inhibitor (PPI) and bismuth tripotassium dicitrate (BTD) in gastric ulcers (GU) induced by non-steroid anti-inflammatory drugs (NSAD) in rheumatic patients with factors affecting PPI efficacy. Material and methods. Fifty rheumatic patients entered the study (5 males and 45 females, mean age 63.5 ± 6.2 years) with NSAD-induced GU. Criteria of participation in the study: ulcer size > 1.0 cm, 2 and more ulcers, administration of glucocorticoids (GC) and/or cytotoxic drugs. The patients were divided into two groups. Group 1 patients received omeprasol 20 mg twice a day + BTD 240 mg twice a day; group 2 patients received omeprasol alone 20 mg twice a day. The groups were matched by demographic and clinical parameters, consisted mainly of women with rheumatoid arthritis, most of the patients took GC, methotrexate or leflunamid. The result of the treatment was evaluated by the findings of endoscopic examination 4 and 8 weeks after treatment. Results. Three patients from group 1 and 2 patients from group 2 were withdrawn from the study. For 4 weeks ulcer heeling was achieved in 15 patients of group 1 (68.2%) and 8 patients of group 2 (34.8%), p = 0.038. On week 8 ulcers healed in 86.3 and 78.3% patients, respectively. Severe side effects were absent. Conclusion. Combination of omeprasol with BTD stimulated heeling of NSAD-induced gastric ulcer.
Terapevticheskii arkhiv. 2009;81(6):62-66
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Affection of target organs in hypertensive patients with and without metabolic syndrome
Sharipova G.K., Saidova M.A., Balakhonova T.V., Mychka V.B., Chazova I.E., Sharipova G.K., Saidova M.A., Balakhonova T.V., Mychka V.B., Chazova I.E.
Abstract
Aim. To study damage to the heart, kidneys and vessels in patients with arterial hypertension (AH) of different severity with and without metabolic syndrome. Material and methods. The trial enrolled 303 patients with AH of the first-third degree aged 25-70 years (mean age 52 ± 18 years), 110 males and 193 females. The patients were matched by sex and age. All the patients were divided into two groups: group 1 (n = 151) without metabolic syndrome (MS) and group 2 (n = 152) with MS. The following parameters were studied: lipid spectrum, blood glucose, glomerular filtration rate, MAU, data of 24-h blood pressure monitoring, echocardiography, Doppler ultrasonography of the brachiocephalic arteries. Results. Early AH was accompanied with diastolic LV myocardial dysfunction, subnormal glomerular filtration rate and the presence of MAU. In AH of the second degree there was LV remodeling. In AH of the third degree left ventricular myocardial mass (LVMM) and thickness of intima-medial complex (TIM) were increased. Close correlations were found between the disturbance of diastolic function and MAU, thickness of interventricular septum and thickness of the inferior wall and LVMM index with MAU. Less manifest correlation existed between diastolic dysfunction and TIM, thickness of the interventricular septum and thickness of the inferior wall and TIM. Conclusion. The presence of metabolic syndrome contributes to earlier and more serious damage of the target organs in patients with arterial hypertension.
Terapevticheskii arkhiv. 2009;81(6):67-72
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Current aspects of glucocorticoid therapy of rheumatic diseases. Pulse-therapy
Solov'ev S.K., Ivanova M.M., Solovyev S.K., Ivanova M.M.
Abstract
Mechanisms of action, clinical efficacy and safety of superhigh doses of methylprednisolone (pulse-therapy) in patients with SLE, RA, systemic vasculitis, Sjogren's disease are outlined.
Terapevticheskii arkhiv. 2009;81(6):73-77
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Back pain: clinical and therapeutic aspects
Damulin I.V., Semenov P.A., Damulin I.V., Semenov P.A.
Abstract
Causes of vertebrogenic back pain are described. Differential diagnosis in this condition is important as visceral pathology may underlie the pain syndrome. Algorithm of the patient examination is given. Paraclinic examination is important but in diagnosis clinical examination is of key value. Pharmacological and non-pharmacological treatment approaches are considered
Terapevticheskii arkhiv. 2009;81(6):78-81
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Rituximab treatment of rheumatoid arthritis: new evidence
Nasonov E.L., Nasonov E.L.
Abstract
New evidence is reviewed on efficacy and safety of chimeric monoclonal antibodies to B-cell CD20 molecule (rituximab) in the treatment of rheumatoid arthritis.
Terapevticheskii arkhiv. 2009;81(6):82-91
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The role of mediator mechanisms in inflammation immunopathogenesis in cardiovascular diseases and osteoporosis
Tsurko V.V., Leonenko I.V., Egorov I.V., Krasnosel'skiy M.Y., Tsurko V.V., Leonenko I.V., Egorov I.V., Krasnoselsky M.Y.
Abstract
General pathophysiological mechanisms of inflammation are reviewed on the models of atherosclerosis, calcinating aortic stenosis, cardiac failure and osteoporosis widely encountered at old age.
Terapevticheskii arkhiv. 2009;81(6):92-92
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