Vol 3, No 2 (2012)

The review is dedicated to the use of the cardiopulmonary exercise testing (CPET) in clinical practice. Main modes of CPET, most popular protocols and testing methods are discussed in details. Ample space is dedicated to main parameters measuring during CPET, their physiological values and changes in different pathological states. Main indications for CPET are presented and special attention is given to the use of CPET in chronic heart failure, apnea, lung diseases, skeletal muscle fiber and mitochondrial myopathy, rehabilitation. Emerging applications of CPET like congenital heart disease, pulmonary resection and several other are also discussed.

In the last years several studies have shown that mesenchymal stem cells (MSCs) are able to reduce the systemic inflammatory response and mortality in experimental models of sepsis. As recently found, the surface of MSCs have receptors for erythropoietin (EPO). So we hypothesized that the introduction of EPO together with MSCs may enhance their effect and improve the results of sepsis treatment.

Aim: То evaluate morphologic and immunologic effects of combined treatment with EPO and MSC in an experimental LPS sepsis model in rats.

Methods: 50 Wistar rats were randomized into 5 groups: Group 1 - the healthy controls, Groups 2-5 were intraperitoneally introduced bacterial LPS 20 mg/kg. Two hours after LPS injection animals received the following intravenous treatments: Group 3 - 4xl0⁵ allogeneic MSCs, Group 4 - 8.5 pg of recombinant EPO-beta, Group 5 - MSCs and EPO in the same doses. Surviving animals were euthanased on the 4th day. The morphological study of the liver, spleen, thymus, lungs, kidney tissues was performed. We analyzed the tissue changes, white blood cells count and serum level of IL-lß, IL-2, IL-6, TNF-α.

Results: Mortality in LPS groups did not differ. The highest white blood cells count was found in the group of combined treatment EPO+MSCs (8.15x10⁶ cells/ml) compared with controls (2,15x10^s cells/ml) and LPS controls (6,52x10^s cells/ml). There were no differences in levels of TNF-α, IL-2 and IL-6 between the groups, but serum IL-1ß level in groups 2 and 4 was significantly higher than in treated with MSCs and MSCc + EPO animals. Histologically in the group 5 we observed significantly less leukocyte lung interalveolar septal infiltration and kidney tubular dystrophy. The most significant differences in group LPS + EPO were found in the lymphoid tissue - considerable hyperplasia of spleen white pulp and thymus cortex, whereas in the other groups different degrees of atrophy of the corresponding zones were noted.

Conclusions: Combined treatment with EPO and MSCs can reduce acute lung injury and kidney damage, cause hyperplasia of lymphoid tissue and enhance the immune response more than separate treatment in an experimental model of sepsis in rats.

We describe the first clinical experience of laparoscopic surgery for renal cyst by a single access. Advantages, disadvantages and prospects of this method are analized.

The study concerns a new method of treatment of bone fractures of upper and lower limbs based on osteogenesis stimulation by intramedullary implants with bioactive organic hydroxyapatite (HA). The method decreases consolidation period of diaphyseal fractures to 2-4 times. A technology of osteosynthesis and bone formation dynamics at the fracture zone and around the implant is described.

The clinical case of the patient with squamous cell carcinoma of gall bladder in a combination with cholelithic illness is described. Presurgical diagnostics of gall bladder cancer is difficult, demands a complex and careful assessment of disease anamnesis, a clinical sings, results of laboratory and tool analysis. At impossibility to exclude gall bladder cancer in the presence of a cholelithic illness in all cases operative treatment is needed.