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Volume 1 No.1   February 2008        ISSN 1882-763


                   Japan, Nagasaki
EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008
                     EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

Editor-in-Chief: MEIRMANOV Serik

Associate Editors:
AKANOV Aikan                                   KHURTSILAVA Otari
ISHIBASHI Hiromi                               SEKINE Ichiro
KHAMZINA Nurgul                                TOMONAGA Masao

Editorial Board:
ITO Masahiro                                   AKANOV Zhanay
NAKASHIMA Masahiro                             AKILZHANOVA Ainur

ABYLAIULY Zhangentkhan                         TAPBERGENOV Timur
RAKHYPBEKOV Tolebay                            URAZALIN Marat
SANDYBAEV Marat                                ZHUNUSSOVA Tamara

BULGIN Dmitri                                  SHAPIRO Naum
DOROSEVICH Alexander                           SMOLYANINOV Alexander



Ministry of Public Health, Kazakhstan
State Institution of Professional Education, Russia
Belarusian State Medical Academy, Belorussia
Association of Doctors and Pharmacologists, Kazakhstan
Association of Surgeons, Kazakhstan
Association of Internal Medicine, Kazakhstan
Association of Endocrinologists, Kazakhstan
Association of Clinical Cytology, Kazakhstan
Greetings   from the EurAsian Journal of Biomedicine

                       EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

                          Dear Colleague,
                          I would like to introduce a newly launched EurAsian Journal of Bio-

                          The mission of EurAsian Journal of BioMedicine (EAJBM) is to faci-
                          litate the equitable dissemination of high-quality medical and bio-
                          technology researches mainly in CIS countries; to promote interna-
                          tional dialogue and collaboration on medical and molecular biology
issues; to improve clinical practice; and to expand and deepen the understanding of health and
health care.

Join EAJBM as Author
It is prevailing practice in CIS countries that scientists don’t have enough experience to publish
their manuscripts in International Journals written in English language, and on the other
hand the requirements for publications of many International Journals are somewhat compli-
cated for applying. EAJBM aim is to fill this gap. As author you only need to be a physician or
researcher and a desire to write your experience. We will provide you our services to improvise
you manuscript including English language help and peer review of it. EAJBM gives priority to
original research reports that are likely to have important implications for human health,
biotechnology field and clinical practice.
Join EAJBM as Peer Reviewer
Unbiased, independent, critical assessment is an intrinsic part of all scholarly work, including
scientific investigation. Peer reviewers are experts in their field who are not part of the edi-
torial staff and thus are an important extension of the scientific process. Peer reviewers are
asked to submit their review within three (3) weeks.
Join EAJBM as Editor
If you are interested to serve as Editorial board member, send a brief email to the editor, stat-
ing the subject area you are most interested/experienced in. Enclose a full list of publications, a
list of funded research as principal investigator, and activities as editorial board member or
referee for other journals or research programs.

I invite you to publish your original articles, observations and case reports and make a signif-
icant contribution to the medical and biotechnology fields. We help you in your endeavor and
reward you suitably.

                             Serik MEIRMANOV M.D, PhD
                             Editor in Chief
                      EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

                        Dear Colleagues!
                        This is first edition of new international journal – Eurasian Journal of
                        Biomedicine, which created by support of Asian and Europe countries.
                        International collaboration and friendly relationship today is necessary
                        part of modern Science.
                        This journal was created as science-researching information portal for
                        researchers, medical doctors and scientists in biomedicines area.
                        Creating new collaboration in any different research or projects , In-
                        ternational Educational Programs, exchanging of new scientific data
and hypothesis, this is aims of our editorial team.
As you well know, unfortunately, International scientific community have not full information
of scientific work in CIS-countries and appositive, this forum is a new way to future join work.
                            Aikan Akanov, MD, PhD, Professor
                            Rector of Kazakh National Medical University,
                            Republic of Kazakhstan.

                       Development of up to date medicine is not possible without implemen-
                       tation of new technologies. Today more than ever it is very important to
                       integrate efforts of fundamental science and clinical experience. Such
                       interaction will make it possible to motivate application of new treat-
                       ment and prognostics methods and their further promotion into practice.
                       Scientists all over the world have been working on the problems of cell
                       technologies which could contribute the most severe categories of pa-
                       tients treatment improvement.
This Journal is assigned for exchange of information and ideas on contemporary progress of
medical science in this field. I am pleased to point out than the editorial board consists of
medical and research centers representatives from different countries.
In particular representatives from the St-Petersburg Medical Academy of Postgraduate Stu-
dies, the oldest education institution of postgraduate medical training in Russian Federation,
were actively engaged in the process of initiation of the Journal. Our constructive union with
the leading scientists from the Nagasaki University is a fine example of effective cooperation in
the field of medical science.
We hope that our Journal will be of interest of not only as a resource of up to date information
on different topics of medical science, connected with cell technologies, but at the same time
will become a certain motivation for their development in Russian Federation.

                            Otari KHURSILAVA, MD, PhD, Professor,
                            Rector of St-Petersburg Medical Academy of Postgraduate Studies
                            Russian Federation
                     EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

                       Dear colleagues!
                       New technologies in science very widely involved in medicine. Faced
                       with patients in the clinic everyday, research could mean the use of
                       science to improve diagnostics, treatment or prevention of diseases and
                       the quality of life of patients with different pathological conditions.
                       Today the main objectives of biomedical research are basic fundamental
                       studies integrated with clinical medicine. EurAsian Journal of BioMe-
dicine has been designated as a tool for exchanging opinions, results of research for scientists
from different countries.
On behalf of the editors, I want to express our appreciation to those who reviewed the papers
submitted for this journal. Furthermore, I hope EurAsian Journal of BioMedicine has suc-
cessfully provided scientists a good opportunity to publish results of their research work and to
inspire them to greater efforts on their future studies and will get appropriate place among
other international journals.
I would like to invite everybody to contribute interesting and valuable papers in our journal.
                                Ichiro SEKINE, MD, PhD, Professor
                                Division of Tumor and Diagnostic Pathology,
                                Atomic Bomb Disease Institute
                                Nagasaki University Graduate School of Biomedical Sciences

                       Dear colleagues!
                       Congratulations for the issue of a new international journal, “EurAsian
                       Journal of Biomedicine”. The journal looks beautiful and contents are
                       great. I am really surprised at the early issue of the first volume of the
                       journal after I heard about this project from the editor-in-chief, Dr, Se-
                       rik Meirmanov.
                       Before, Japanese scientists published many valuable scientific papers in
journals which were written in Japanese. Consequently, the valuable scientific findings were
not understood by scientists outside Japan. It is now the age of globalization and information
instantly circulates all over the world. Scientists are also required to respond to these social
changes. Therefore, they should send their new findings obtained from their study to the world
in articles written in language that passes internationally.
        I hope that many valuable messages or new scientific findings will be sent to the world
by this new journal, “EurAsian Journal of Biomedicine”.
                                Hiromi ISHIBASHI, M.D, FACP, FACG
                                Director General, Clinical Research Center,
                                National Hospital Organization(NHO) Nagasaki Medical Center,
                                Professor, Department of Hepatology Nagasaki University
                                Graduate School of Biomedical Sciences,
                  EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

Table of Contents                     Vol.1 No.1 February 2008

Influence of coronary artery bypass grafting on the level of circulating CD34
positive cells and cytokine production that modulate biological activity of he-
matopoietic stem cells.
    Mukhtar Aliev, Nikolai Belyaev, Mustafa Rysuly, Arystan Seidalin, Kuat
    Abzaliev, Almat Kodasbaev, Kuralai Battalova, Tamara Supniyazova, Yu-
   liya Perfilieva, Raikhan Tleulieva, Ermek Akhmetov, Bayan Zhumabaeva,
   Zhannat Satybaldieva, Manas Ramazanov                                          1

Morphological changes of a mucous membrane of stomach workers of petro-
leum industry with gastro-duodenal pathology in a combination of pulmonary
   Gaukhar Abildaeva                                                              6

Morphological changes of a mucous membrane of a stomach at patients with
gastro-duodenal pathology
   Gaukhar Abildaeva, Enin E., Zhanar Yelubaeva                                   9

Prognostic criteria based on morphological specialties of breast cancer.
   Tasbolat Adylchanov                                                            14

Morphology and clinical data dynamics in the patients with chronic hepatitis B
treated different way.
    Sarieva S.A                                                                   19

Disease prevention significance in facing the challenge of high sickness rate
with chronic non-communicable diseases among the Republic of Kazakhstan
   Turdaliyeva B.S.                                                               23
                        EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                           1

Influence of coronary artery bypass grafting on the
level of circulating CD34 positive cells and cytokine pro-
duction that modulate biological activity of hematopoietic
stem cells.
Mukhtar Aliev,1 Nikolai Belyaev, 2 Mustafa Rysuly, 3 Arystan Seidalin,1 Kuat Abzaliev,1
Almat Kodasbaev,1 Kuralai Battalova,1 Tamara Supniyazova,2 Yuliya Perfilieva,2
Raikhan Tleulieva,2 Ermek Akhmetov,1 Bayan Zhumabaeva,4 Zhannat Satybaldieva,4
Manas Ramazanov1

1 A.N.Syzganov   National Scientific Centre of Surgery MH RK, Almaty, Kazakhstan
2   M.A.Aitkhozhin Institute of Molecular Biology and Biochemistry MES RK, Almaty, Kazakhstan
3   Stemcord Ltd., Almaty, Kazakhstan
4   National Centre for Drug Expertise MH RK, Almaty, Kazakhstan.


    investigation                  hematopoietic                                             pa-
The investigation studied of CD34+ hematopoietic stem cell (HSC) circulation in the blood of pa-
tients suffering from ischemic cardiomyopathy, undergoing cardiosurgery of different severity,
coupled with cytokines specifically influencing the functional activity of HSC. A total of 27 patients
having                                                  35-                             (experi-
having myocardial infarction in anamnesis at the age of 35-55 were observed. Two groups (experi-
mental and control) were separated in principle by extend of surgical operation. 10 patients from
the experimental group with multiple lesions of coronary arteries underwent coronary artery by-
pass grafting. Endoprosthesis replacement was carried out in 17 patients of the control group.
                                                G-     GM-         SDF-
Presence of CD34+ cells and levels of LIF, SCF, G-CSF, GM-CSF, and SDF-1 in peripheral blood
before operation and also after 1 and 10 days were estimated. Initial content of HSC in both groups
was equal (0.69±0.17 and 0.65±0.12%, respectively). Surgical operation did not modify this level in
control group in any period. The experimental group showed no changes in CD34+ cell content on
the day after operation but increased by 2.9 times after 10 days. No changes on all estimated cyto-
kines were observed in the control group at any periods. An increase of G-CSF (2.6-times) and
SDF- (3.5-                   ob                                 at
SDF-1 (3.5-times) levels was observed in the experimental group at 1 and 10 days respectively after
operation. Thus, considerable tissue injuries induced by surgery operation stress results in G-CSF
production that, in turn, stimulates HSC mobilization from born marrow. The obtained data sug-
                        G-                             SDF-
gest the existence of a G-CSF – HSC – injured tissue – SDF-1 axis as a natural process of tissue
Key words: Coronary arteries bypass grafting, hematopoietic stem cells (HSC), cytokines
2                         EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

    INTRODUCTION                                       connection with surgical operation, is one of
                                                       the most important stages in the described
    Discovery of the hematopoietic stem cell           process.
    (HSC) plasticity phenomenon has initiated            The purpose of the present research is di-
    eruption of the research interest to possibili-    rected on study of the CD34+ HSC level in
    ties of regeneration of tissues injured with       peripheral blood of patients, undergone sur-
    pathologic processes or trauma of vital or-        gical operation of various severities in com-
    gans, such as heart, liver, lungs, and spinal      bination with estimation of cytokine level,
    cord. A number of experimental investiga-          especially influencing functional activity of
    tions carried out on animals has proved re-        HSC.
    generative potential of HSC obtained from
    bone   marrow    or    mobilized   with   colo-                  METHODS
                                                       MATERIALS AND METHODS
    ny-stimulating factors and originated new
    concept of rehabilitation therapy of injured       Realization of the present research provided
    tissues, based on the natural mechanisms of        examination of 27 patients with coronary
    cell reparation. Prospective mechanism sup-        heart disease, at the age of 35-55. More than
    poses that any cell destruction induced with       a half of patients (68%) suffered from coro-
    trauma (including surgical) or any patholog-       nary heart disease within 1-5 years and ma-
    ical process, including infectious and nonin-      jority of patients (93 %) have had an acute
    fectious inflammation, infarction (for exam-       myocardial infarction in anamnesis. Ex-
    ple, caused by ischemia), stroke, etc., results    amined patients were separated into two
    in release of factors having mobilizing prop-      groups depending on volumes of surgical
    erties with respect to bone narrow HSC, from       treatment. 10 patients included into experi-
    hearth of tissue injury into the bloodstream.      mental group have undergone coronary ar-
    HSC leave their natural niche and move             tery bypass grafting. In addition 3 patients
    through the bloodstream to the injured tis-        have undergone aneurysm ectomy and re-
    sues by homing stipulated by the number of         modeling of left ventricular.   17 patients in-
    factors appearing in such injured tissue.          cluded into control group have undergone
    Chemokine SDF-1 (Stroma Derived Factor),           endoprosthesis replacement of coronary ar-
    being one of the most studied factor of hom-       teries (from 1 up to 4) with Johnson and
    ing, is specifically distinguished by receptor     Johnson Company’s “CYPHER” stents.
    CXCR4 [1] on HSC. This results in accumu-            We have analyzed peripheral blood of pa-
    lation of HSC in the injured tissue and re-        tients taken one day prior to operation, the
    paration of damaged cells. However, experi-        next day after operation and at the discharge
    mental data require confirmation, as well as       from the hospital (8-10 day). Percentage
    existence of the natural cell reparation phe-      content of CD34+ cells were determined by
    nomenon in human. Studying HSC mobiliza-           flow cytometry on FACS Calibur using sta-
    tion phenomenon and homing mechanisms              dard protocol according to recommendations
    initiated with tissue injury, in particular in     of BD Biosciences Ltd. (Germany). Concen-
                     EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                        3

trations of LIF (Leukemia Inhibitory Factor),       Figure 1 shows results of CD34+ cell de-
SCF (Stem Cell Factor), G-CSF (Granulocyte        termination in dynamics of observation. As it
Colony Stimulating Factor), GM-CSF (Gra-          turned out, initial level of HSC both in con-
nulocyte-Monocyte Colony Stimulating Fac-         trol and experimental groups was identical
tor) were determined in the blood serum by        and made 0.69±0.17 and 0.65±0.12 % cor-
ELISA Kits (IBL, Germany). SDF-1 was de-          respondingly. Stenting procedure has re-
termined according standard methodical ap-        sulted in increase of circulating HSC level in
proaches [2] using polyclonal antibodies to       60% of patients. However, average value
SDF-1 (PeproTech, USA), immobilized on a         have not showed significant distinctions
polystyrene plate (Nunc, Denmark), biotini-       (P=0.380). At the discharge from hospital,
lated polyclonal antibodies to SDF-1 (Pepro-      HSC concentration in all patients came back
Tech, USA), and         polymeric streptavi-      to initial level. Concentration of CD34+ cells
din-peroxidase conjugate (Sigma, USA).            in patients of experimental group was not
  Obtained data were processed by mathe-          deviated from initial level (Р=0.183) on the
matical statistic methods in applied Micro-       next day after surgical operation. However,
soft Excel program. Average arithmetic and        at the discharge from hospital the patients
standard deviation were calculated. Signifi-      have shown significant increase of circulat-
cant distinctions (Р) of average parameters       ing HSC by 2.9 times (Р=0.048).
were estimated via ТТЕСТ function.                  Estimation of factors, capable to regulate
                                                  HSC behavior, has shown that their role in
RESULTS                                           mobilization of HSC from bone marrow is not

   Figure 1. Content of CD34+ cells in the peripheral blood of patients suffering
   ischemic cardiomyopathy, undergoing coronary endoprosthesis replacement (control
   group) or coronary artery bypass grafting (experimental group)
4                         EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

    identical. According to table 1, the level of      level was observed on the next day after sur-
    GM-CSF practically has not been changed in         gical operation, and level of circulating HSC
    patients of both groups during the whole pe-       increased at the discharge from hospital,
    riod of examination. Moreover, particular          while G-CSF level has reduced to initial in-
    values of this parameter varied insignifi-         dicators. Analysis of SDF-1 level has shown
    cantly, thus testifying complete absence op-       no distinctions between control and experi-
    erational stress influence on its level in pe-     mental group prior to and on the first day
    ripheral blood.                                    after surgical operation. Patients from the
    Analysis of LIF cytokine concentrations has        control group have shown no changes at the
    shown single change of its level in patients of    discharge from hospital. However, patients
    the control group at the discharge from hos-       from the experimental group have shown 3.5
    pital, expressed as triple reduction of its        time increase of SDF-1 blood concentrations
    concentration in comparison with initial           that coincided with the increase of CD34+
    value (Р=0.005). As level of CD34+ cells in        cell blood level in the same group.
    patients of the control group in the very same       Thus, our investigations have shown that
    terms remained constant, it is possible to         surgical operations result in mobilization of
    conclude, that LIF level in the peripheral         CD34+ HSC/precursors from bone marrow
    blood just can not modulate mobilization of        into peripheral bloodstream. Moreover, scope
    HSC from the bone narrow. Patients of the          of surgical intervention plays major role in
    experimental group have not shown any              this process. As it is shown earlier, surgical
    changes of LIF level in dynamics of observa-       stress and hard physical loadings induce
    tion. As patients of the experimental group        mobilization of dendrite cells and HSC from
    have shown increase of HSC level in the end        bone marrow [4, 5]. Significant increase of
    of the observation period, this fact also con-     circulating HSC level has been observed at
    firms the conclusion that autologous LIF           orthotopic transplantations of liver, and at its
    does not influence mobilization of HSC at          partial resection at hepatocellular carcinoma
    surgical stress.                                   [6]. Recently group of Polish scientists has
    Contrary to the aforementioned facts, the          confirmed that stroke and acute myocardial
    G-CSF level in patients of the experimental        infarction result in sufficient mobilization of
    group has been transitory increased by 2.6         HSC from bone marrow [7]. Our studies also
    times (Р=0.044) after the surgical operation,      show that increase of G-CSF level on the next
    whereas, in the control group it remained          day after surgical operation, testifies that
    stable and did not show any changes in dy-         surgical stress induces increase of its pro-
    namics of observation.                             duction. Despite the fact that GM-CSF and
                       Discussion                      SCF may be also referred to immobilization
      G-CSF is known to represent itself strong-       factors, as they can either independently or
    est HSC mobilization factor. So it is used for     in cooperation with other factors induce mo-
    these purposes in clinical practice [3]. It is     bilization of HSC from bone marrow [3, 8],
    worth mentioning that increase of G-CSF            absence of changes in their production during
                     EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                         5

post operation period clearly testify on their    dently of monocyte counts. Blood 98: 140-145,
non-participation in CD34+ cell mobilization      2001
process at surgical stress.                       5. Bonsignore MR., Morici G, Santoro A et al.
  Taking into account our obtained data we        Circulating hematopoietic progenitor cells in
can assume that surgical stress results in        runners. J Appl Physiol 93: 1691-1697, 2002
transitory increase of G-CSF production,          6. Lemoli R, Catani L, Talarico S et al. Mobi-
which, in turn, initiates mobilization of         lization of bone marrow-derived hematopoie-
CD34+ cell from bone narrow. Moreover, pe-        tic and endothelial stem cells after ortotopic
ripheral blood HSC concentration essentially      liver transplantation and liver resection.
grows only on the 8-10 day. Simultaneous          Stem Cells 24: 2817-2825, 2006
increase of SDF-1 level, playing the role of      7. Paczkowska E, Larysz B, Rzeuski R et al.
HSC homing factor, obviously, testifies in fa-    Human     hematopoietic     stem/progenitor   -
vor of the hypothesis, confirming participa-      enriched CD34+ cells are mobilized into pe-
tion of HSC in damaged tissue regeneration        ripheral blood during stress related to
processes.                                        ischemic stroke or acute myocardial infarc-
                                                  tion. Eur J Haematol 75: 461-467, 2005
ACKNOWLEDGMENT                                    8. Glaspy JA, Shpall EJ, LeMaistre CF et al.
                                                  Peripheral blood progenitor cell mobilization
  The present research was supported by           using stem cell factor in combination with
Ministry of Health of Kazakhstan Republic         filgrastim in breast cancer patients. Blood
in the framework of Scientific and Technical      -90: 2939-2951, 1997
Program O.0364.


1. Kucia M, Reca R, Miekus K, et al. Traf-
ficking of normal stem cells and metastasis of
cancer stem cells involve similar mechan-
isms: Pivotal role of the SDF-1 – CXCR4 axis.
Stem cells 23: 879-894, 2005
2. Antibodies. A Practical Approach (Catty D
ed. IRL Press, Oxford, New York, Tokyo) V. 2,
3. Cottler-Fox MH, Lapidot T, Petit I et al.
Stem cell mobilization. Hematology :419-436,
4. Ho ChSK, Lo´pez JA, Vuckovic S et al.
Surgical and physical stress increases circu-
lating blood dendritic cell counts indepen-
6                          EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

    Morphological changes of a mucous membrane of stomach
                                       gastro-         pa-
    workers of petroleum industry with gastro-duodenal pa-
    thology in a combination of pulmonary tuberculosis
    Gaukhar Abildaeva

    Кazakh National Medical University named for S.D.Asfendiyarov, Almaty, Kazakhstan


    Examination of the state of gastrointestinal tract in patients with tuberculosis is very important
    because of the extended duration of chemotherapy administered in this category of patients. Con-
    current diseases of gastrointestinal tract are more frequent in patients with active study of pul-
    monary tuberculosis.

    Key words: Helicobacter pylori, gastritis, pulmonary tuberculosis, workers

                                                         denal ulcer were in the limelight of the ma-
    INTRODUCTION                                         jority of authors. Data on other diseases of
                                                         this zone are only slightly presented in the
    Pathology of gastrointestinal tract concomi-         literature [1,2,3,4].
    tant a pulmonary tuberculosis substantially
    burdens its current, complicates treatment           MATERIALS AND METHODS
    and worsens outcomes. Changes of upper
    gastrointestinal tract at consumptive are to         As a material for research were 30 gastro-
    be found in 8,7-31,7% cases. Contradictory           bioptats, received at fibergastroscopy from 70
    data are given in literature on studying of          workers of petroleum industry with ga-
    functional-morphological     condition    of    a    stro-duodenal pathology in a combination of
    mucous membrane at consumptives; there is            pulmonary tuberculosis.
    an aspiration to connect depression of secre-        At taking of bioptats for morphological re-
    tory process with side effect of tuberculos-         search were received in two pieces from the
    tatic therapy in some cases. The lesion of a         middle of antral part of stomach on lesser
    stomach    with   tuberculosis    happens      ex-   and greater curvature and in two pieces from
    tremely seldom, however nonspecific changes          the middle of a body of stomach on anterior
    of a mucous membrane become apparent                 and posterior wall. Received at biopsy frag-
    much more often. Stomach ulcer and duo-              ments of a mucous membrane fixed in 10%
                      EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                           7

neutral buffered formalin pH 7,2-7,4 and             stomach at oilmen with pulmonary tubercu-
filled in paraffin by the standard technique         losis were founding in 8 % cases, were cha-
during 24 hours. Paraffin sections with a 4-5        racterized ulceration of a mucous membrane
microns thick were painted with hematoxilin          at the bottom of which were defined necrotic
and eosin, picrofuxin on Van-Hizon. For an           masses impregnated with cells of an in-
estimation of morphological changes of a             flammation. Focal inflammatory prolifera-
mucous membrane of a stomach was used a              tion of epithelium is evident at edges of ul-
visually-analog scale for semiquantative de-         cerous defect. Mucous membrane of stomach
termination of intensity of an inflammation,         is presented by obvious atrophic changes in
activity of process, presence of an atrophy of       60% cases, characterized by disappearance of
intestinal metaplasia and degree of HP con-          rugosity of a mucous membrane (venticular
tent (Dixon M/F., 1996) developed on the ba-         poles and fields were absent), epithelium is
sis of Sydney system of classification of a          thickened, nucleous of epithelial cells are
chronic gastritis (Price A.B., 1991).                displaced to apical surface, cytoplasm is with
                                                     granular    granules.   Fine   vacuoles   were
RESULTS                                              founding in some cells. Basic membrane is
                                                     thickened here and there, edematic, its fibers
The given group was characterized by change          are separated. Lumens of glands have round
in a mucous membrane of a stomach of                 form, cells covering them are thickened, and
preatrophic and atrophic character. A mucous         mucous membrane was absent. Н.pylori was
membrane is covered with flattened cylin-            funding in 8 % of subatrophic and atrophic
drical epithelium. Infiltration is presented by      gastritis. The degree of semination in suba-
lymphohistiocytic     epithelium.       Intestinal   trophic gastritis was reaching up to 20 %
metaplasia was found in a mucous mem-                (Н.pylori quantity from above 30), up to
brane in some areas. There were observed             10-15 % in atrophic gastritis (Н.pylori quan-
epithelium was cast-off here and there and           tity up to 30).
erosions. Infiltration is presented lympho-                  Thus, atrophic gastritis, solitary ero-
histiocytic by the elements located in mucous        sions and chronic ulcers are determined at
and submucous layers, they were infiltrated          patients of a petroleum industry with ga-
by a muscular layer here and there. Sub-             stro-duodenal pathology, against the back-
mucous basis was edematic on the big extent;         ground of various forms of pulmonary tu-
the vessels of capillary type filled with eryt-      berculosis, in morphological researches of a
hrocytes are visible in it. Walls of vessels are     mucous membrane of a stomach. Н.pylori
thickened due to superfluous enlargement of          content sharply decreased because of absence
a coarse-fibred connective tissue in some            of making mucins by mucous membrane of
areas. Areas with lymphoid follicles without         glands, it is necessary to note and toxic ac-
malpighian zones were founding in a wall of          tion of antitubercular preparations.
a stomach.
 Ulcerous defects of a mucous membrane of a
8                         EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

    REFERENCES                                         3. Tarasova A.S., Potashova V.A., Shubnikov
                                                       I.V. Results of treatment of consumptives
    1. Kireeva L.M. Function of a stomach at           with a combined pathology of a gastrointes-
    consumptives./Vrachebnoe            delo.-1979.    tinal tract and a liver. // Problems of tubercu-
    1.-p.81-84.                                        losis-1986.12. p. 31-34.
    2. Mikienko L.I. Functional and morphologi-        4. Panisjak A.I., Zhukova E.M., Seleduova
    cal changes of a mucous membrane of sto-           G.V. Prevalence, structure and features of
    mach at patients with first revealed active        revealing gastro-duodenal pathologies at con-
    pulmonary tuberculosis. // Trudi Smolensko-        sumptives. // Trudi Moskovskogo NII tuber-
    go instituta.-1975. p. 89-93.                      kuleza.-1989.-115.-p. 110-116.
                       EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                              9

Morphological changes of a mucous membrane of a sto-
                         tro-         pathology.
mach at patients with gastro-duodenal pathology.
        Abildaeva,       E.,
Gaukhar Abildaeva,1 Enin E.,2 Zhanar Yelubaeva2

1Кazakh   National Medical University named for S.D.Asfendiyarov, Almaty, Kazakhstan
2A.N.Syzganov   National scientific center of surgery, Almaty, Kazakhstan


Morphological picture in workers engaged in oil industry and having gastroduodenal pathology
was characterized by subatrophic and atrophic gastritis; erosions and ulsers; formation of lym-
phoid follicles with centers of growing; changes in microcapillary beds in the walls, development of
rough fibrous connective tissue that would result in vasoconstriction with following lack of oxygen
and nutrients intake, and to development of ischemic process.

                                                       MATERIAL AND METHODS
There is a big number of clinical and mor-
phological researches devoted heli obacteriosis:       As a material for research were 750 gastr -
pathogenesis, endoscopic picture and morpho-           bioptats, received at fibergastroscopy from 343
logical aspects, clinic and treatment of heli -        patients    with     gastro-duodenal   pathology,
obacterassociated gastritis and stomach and du-        workers of a petroleum industry. The first
odenal ulcer.                                          group   constituted     124   workers    of   the
  The complications developing at long-lasting         oil-extracting manufacture, the second group
heli obacteritic infection have been revealed:         - 158 workers of petrochemical manufacture,
the phenomenon of metaplasia and atrophy of            the third group - 61 drivers from the same
gastric and intestinal epithelium, bond with           branches. All examined were subjected to
blastmotoz processes - development malignant           gastrobiopsy in 2 pieces from antral section and
lymphoma and stomach cancer [1,2,3,4].                 upper 1/3 bodies of a stomach on the greater
  The purpose of research - studying of dys-           curvature and bulb of duodenum.
plastic changes of a mucous membrane of a               In order to determinate a structure of mucins
stomach at workers of a petroleum industry             and typing of the focuses of intestinal metapla-
with gastro-duodenal pathology.                        sia in cells of mucous membrane of stomach
10                         EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

     was used the reaction with 1 % alcian blue,         toplasm was vacuolated, contained periodic
         -2,5 (sour sialomucins), aldehyde-fuchsine      acid Schiff - positive inclusions in apical
     stain on Homori (GHF-a method sulfomucins,          parts of a cell. Glands looked as not changed.
     Shan K.A., 1997), periodic acid Schiff reac-        Own layer of a mucous membrane is ex-
     tion on the basis of a standard technique           panded, was infiltrated by histolymphocytic
     with the basic fuchsine. Also it was applied        elements with an impurity of plasmatic cells,
     the combination of methods alcian blue              sometimes solitary polymorphous-nuclear leu-
     (   -2,5) + a GHF-method, alcian blue (     -2,5)   kocytes. Infiltrate was situated only in super-
     + periodic acid Schiff reaction because ac-         ficial layers of a mucous membrane, usually,
     cording to some authors, exactly such com-          at a level of fossas. Quite often hyperemia is
     bination of methods gives the optimal histo-        apparent in vessels of a mucous membrane.
     chemical verification of sites of intestinal me-    Reduction of quantity of secretory granules
     taplasia in mucous membrane of stomach      and     located in apical supranucleus part of cells was
     provides differentiation of its variants (1,2).     observed electron microscopically in superficial
     In verification of types of metaplasia by this      epithelial cells. There was decreasing the
     principle was rested on the most detailed           number of microfibers. Individual long mi-
     classification suggested by Jass S.R, Filipe        crofibers have been appearing against the
     M.I in modification Ming S.-C. According to it      background of deformed and shortcut. There
     in order to verify histochemical type of intes-     were indistinct cellular granules and mem-
     tinal metaplasia the leading part is allocated to   brane structures. Intercellular spaces were
     determination of a dominating profile of mu-        sharply expanded. There were destroyed
     cins in column epithelial cells, located between    dense contacts between cytoplasmic processes.
     goblet cells, determination of attributes of        Lymphocytes often were situated in inter-
     specialization (to onset of brush borders). Sour    cellular. Dystrophic processes in cells of
     mucins were determined at staining with al-         glands were observed in chronic gastritis with
     cian dark blue at    -2,5 (a marker enteral me-     adenosis    without     atrophy,    along    with
     taplasia), sulphated at staining with alde-         changes of superficial epithelium; solitary pe-
     hyde-fuchsine on Homori (a marker enteral           riodic acid Schiff positive inclusions were
     metaplasia) (Shan K.A., 1997; Mozgovoj S.I.,        appearing in main cells was increasing the
     2004), (incomplete metaplasia of gastric type).     quantity of additional cells which were
                                                         staining with alcial blue. Histolymphocytic
     RESULTS                                             infiltration of stroma was reaching a gland level.
                                                           At electron microscopical research mucoidi-
     In a chronic superficial gastritis were found       zation of main cells was shown in hypertro-
     dystrophic and atrophic changes of superficial      phies of complex of Goldgy and onset of se-
     epithelium, cells with indistinct granules had      cretory granules, typical for granules of ad-
     the extended form or were thickened, nucleuses      ditional cells. Secretory granules were getting
     have been losing a basal position in some epi-      electron-dense nucleus, located on periphery.
     thelial cells, didn’t have an identical size, cy-   Numerous      neutrophilous   leukocytes     with
                      EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                             11

attributes of a devastation of granules were         tients. In superficial epithelium of mucous
observed between epithelial secretory cells.         membrane are revealed changes of nucleuses
  In the second group (workers of petro-             (up to 16 gastric cushions were located on
chemical manufacture) prevailing 65 % was            sites) which was accompanied by change of
observed chronic atrophic a gastritis which          nucleuses of cells not only at the top, but also
was characterized by sharp reduction of              on a lateral surface of cushions: there was a
quantity of glands around of which were ob-          dispersion and disappearance of chromatin
served a sclerosis with plentiful histolympho-       which grains were situated mainly on peri-
cytic infiltration. At an exacerbation of disease    phery of a nucleus owing to what they be-
were amplifying hyperemia of vessels and             came light, and contours became more dis-
leukodiapedez. Pyloric glands were revealed          tinct. Disappearance of cromatin was quite
at chronic atrophic gastritis with change in a       often combined with increase in the sizes of
body of stomach which cells were diffusely           nucleuses and their displacement in apical
stained at the periodic acid Schiff reaction.        part of cytoplasm. Against the background of
Intestinal crypts were forming in forestomach.       the marked dystrophic changes of superficial
Superficial mucous cells alternated with             epithelium was revealed a depression of mucin
goblet cells filled with large, of flaky structure   production, mainly at the top of gastric cu-
and secretory granules. Formation of the ex-         shions. In one cells neutral mucopolysaccha-
tensive fields filled in mucous masses was           rides in the form of a narrow strip occupied
observed in the main cells along with trans-         apical part of cytoplasm, in others, located
formation of granules in mucous membrane.            near, secretion did not defined at all. On a
Sliming of cells was accompanied by streng-          lateral surface of gastric cushions the secre-
thening of destructive changes of a nucleus          tion gave intensive periodic acid Schiff reac-
and organelles, up to a condition of fractional      tion and filled almost all cytoplasm.
necrosis. There were appearing fields of sharply       The active chronic gastritis was characte-
changed cells with fine hyperchromatic nucleus,      rized with infiltration of polymorphous - nuclear
vacuolization of granular cytoplasmic reticulum      leukocytes of epithelium and own plate against
and swelling mitochondrion. The lumen of             the background peculiar to a chronic gastritis
blood capillaries has been sharply narrowed          infiltration of plasmatic cells and lymphocytes,
both with the phenomena of compensatory              diagnosed at patients of group 1 (80,0%),
hypertrophy of      endotheliocytes and desola-      group 2 (85%), group 3 (83%). In group of
tion of some vessels. Macrophages, located in        persons with atrophic gastritis there prevailed
own layer of a mucous membrane, were pre-            II stage (moderately expressed) of activity of
sented by young and involutory forms.                inflammatory process - leukocytic infiltration of
  In group 3in the bulk of bioptats was observed     own plate, superficial and fossa epithelium.
atrophic-hypertrophic gastritis, an atrophy of         Frequencies of detection of an inactive ga-
glands was combined with a deepening of              stritis have made 14,6% with the tendency to
poles and prolifiretation of fossa epithelium.       decrease as atrophy of mucous membrane of
There are revealed erosions at 50 % of pa-           stomach has been progressing. Revealing of an
12                           EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

     inactive gastritis even in a zone of coloniza-        which are in dependence on age of patients,
     tion   .pylori indicates that persistence   .pylori   duration of disease and level of gastric secre-
     precedes the development of a chronic ga-             tion. Besides strengthening of regeneration
     stritis and marks severity of inflammatory            processes in a stomach takes place in increase
     process, at about 40 % of patients of group 2         of    limphoplasmacytic infiltration of own plate of
     with an inactive chronic gastritis was ob-            a mucous membrane that testifies to an op-
     served II stage of activity of inflammatory           portunity potentiative influences of elements of
     process, in 41 % there was the most evident           mesenchyma on proliferative activity of epithe-
     activity of a gastritis, III stage was characte-      lium. Morphological distinctions of thickness
     rized with evident infiltration of own plate and      of a mucous membrane of a stomach and
     epithelium, there were observed «intra fossa          duodenum in homotypic condition of its histo-
     abscesses», testifying about active damage of         structure in different groups of patients specify
     epithelium. I the stage is revealed in 15,7% of       features of morphogenesis of diseases of
     cases. According to the received results, ac-         stomach and duodenum.
     tivity of an inflammation corresponds to a                 Thus, being based in the studied morpho-
     degree of colonization mucous membrane of             logical picture at workers of a petroleum in-
     stomach      .pylori. Frequency of intestinal me-     dustry with gastro-duodenal pathology there
     taplasia at patients of group 1 reached 62 %, at      were observed: preatrophic and atrophic gastri-
     that was observed the distinct tendency to            tises; erosion and ulcers; formation of lym-
     increase of its detection as progressing of           phoid follicles with malpighian centers; change
     atrophy. At patients of group 2 with non              of microcapillary channels in walls of it, the
     atrophic an active gastritis intestinal metapla-      development of a fibrous connective tissue
     sia is revealed in 33 % of cases, and in group 3      leading to narrowing of a lumen.
     - in 38 %.
       Conducted researches have allowed re-               REFERENCES
     vealing distinctions in frequency and cha-
     racter of morphological changes of a mucous           1. Aruin A.I., etc. Morphological diagnostics
     membrane of a stomach and duodenum at                 of illnesses of a stomach and intestines. M
     chronic gastritis patients and consumptives,          1998. 13-268 p.
     who are workers of the petrochemical indus-           2.     ruin L.I. // Diagnostics and treatment of
     try. Morphological changes in a stomach are           diseases, associated with Helicobacter pylori:
     found more often and are marked more                  2-nd International symposium « Modern
     strongly then in duodenum that can be con-            problems of physiology and pathology of di-
     nected with high secretory activity of sto-           gestion » .- ., P. 33-37.
     mach. With increase of severity of morpho-            3. Kanaretseva T, D., Migutova E. Y. Function-
     logical changes in stomach and duodenum in            al morphology of a mucous membrane of a
     various forms of a chronic gastritis and a            stomach at duodenal ulcer and in separate
     stomach ulcer is observed strengthening in a          terms after isolated selective proximal vagot-
     mucous membrane of proliferative processes            omy // Archive of patalogy.1990. 10. P. 16-20
                    EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                     13

4. Stepanjanom N.A., Shapiro N.A. Histologic     damental and applied bases of medicine. Vo-
and cytologic diagnostics of diseases of hu-     ronezh, 2006-382 p.
man internals, // Selected lectures on fun
14                        EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

     Prognostic criteria based on morphological specialties of
     breast cancer.

     Tasbolat Adylchanov

     Semipalatinsk Regional Oncology Center, Semipalatinsk,Kazakhstan


     Choice of treatment of the breast cancer patients bases on the level of prognostic factors including
                                                                             nodes.                     di-
     morphological characteristics of initial tumor, state of axillary lymph nodes. Search for reliable di-
     agnostic and prognostic criteria remain to be actual. Different morphological types in 407 females
     operated in Semey Oncology Center since 2002 to 2006 years were studied.

     Key words: breast cancer, prognosis

                                                        state of patients and age /2/.
     INTRODUCTION                                          Taking into consideration that search for
                                                        reliable diagnostic and prognostic criteria
     Annually 3000 new cases of breast cancer           based on morphological specialties of BC
     (BC) are diagnosed in Kazakhstan. Morbidity        being actual, the main goal of the research –
     age reach peak in 30-50 years interval. BC         study of several morphological forms of BC
     incidence rate tends to grow very rapidly in       for the period of 2002-2006 years.
     Republic of Kazakhstan and mortality rate’s
     accretion tends to be higher than the ana-         MATERIAL AND METHODS
     logous dynamic of morbidity /1/.
       The choice of local or systemic treatment,       The materials for research were 407 speci-
     its tactic bases on several prognostic factors     mens from BC patients undergone surgery in
     including clinical and morphological charac-       Semey Oncology Center from 2002 to 2006
     teristics of initial tumor, state of axillary      years. Age of the patients varied from 25 to
     lymph nodes, level of hormone receptors in         89 years. Specimens were fixed in 10% for-
     tumor, expression of HER-2/neu, presence of        malin solution and prepared in paraffin.
     metastasis, concomitant diseases, general          Processing of specimens was conducted by
                                   EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                                  15



Number of cases




                         20-29         30-39     40-49         50-59        60-69        70-79     80-89


                                   Figure 1. Correlation of BC cases with age

Table 1.
                morphological types
Distribution of morphological types of BC
              Types of Breast Cancer                                            No.                          %
              Invasive duct carcinoma                                           334                         82.1
              Mucinous carcinoma                                                    13                       3.2
              Medullar carcinoma                                                    6                        1.5
              Duct carcinoma in situ                                                4                        1.0
              Pedzhet disease                                                       4                        1.0
              Polymorph carcinoma                                                   4                        1.0
              Invasive papillary carcinoma                                          3                        0.7
              Invasive lobular carcinoma                                            30                       7.4
              Large cell cancer                                                     2                        0.5
              Tubular carcinoma                                                     2                        0.5
              Anaplastic cancer                                                     1                        0.2
              Fibrosarcoma                                                          1                        0.2
              Liposarcoma                                                           1                        0.2
              Neuroblastoma                                                         1                        0.2
              Crico-cellular carcinoma                                              1                        0.2
              Total                                                             407                         100

“Tissue-Tek” (Japan, 2000).                                            eosin. Diagnosing procedures were carried
Slices of 3 µm in thickness were prepared                              out according to the
with microtome ESM-100 L (Japan, 2000).                                  International      Histology   Classification’s
Staying was performed with hematoxilin and                             rules. The image capture was made by digital
16                          EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

     camera “Nikon Model Eclipse E 600 (Japan,              Pedzhet cancer affected equally 4 periods.
     2001) and digital camera Pixera pvo 600 ES                Invasive duct carcinoma (Fig 2). Macros-
     (Japan, 2004).                                         copic pictures of tumors vary, but star or oval
                                                            form nodes dominate. They are of firm con-
     RESULTS                                                sistency, white color.
                                                               Microscopically there is definite stromal
     In the materials 14 morphological forms of             fibrosis expressed. Trabecular, alveolar, al-
     BC are available which are as shown in Table           veolar-papillary, solid, scirrous structures
     2. The most frequent morphological form is             which look like carcinoid. Mucinous form
     invasive duct carcinoma. It affected females           (Fig.3): macroscopically – gray node with well
     of 40-69 years old (79,2%) with the peak at            expressed boundaries and with humid gela-
     50-59 years; mucinous carcinoma was more               tinous surface at cutting. Microscopically:
     often at 40-49 years; medullar at 40-49 years,         there are solid and alveolar complexes with

                                                  Fig.1                                           Fig. 2

                                                  Fig.3                                           Fig.4

       Fig.1.Invasive                (scirrous     al       parts)
       Fig.1.Invasive duct carcinoma (scirrous and alveolar parts)
       Fig.2. Mucinous carcinoma (cancer complexes in mucous lake)
                                (lymphoid                 stroma)
       Fig.3 Medullar carcinoma (lymphoid infiltration of stroma)
                               (bunches                   epidermis)
       Fig.4. Pedzhet disease. (bunches of light cells at epidermis)
                       EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                       17

many monomorphous cells containing muc-              trated by lymphoid and plasma cells. Pedzhet
ous in cytoplasm encountered among massive           cancer (Fig.5): microscopically in nipple’s
mucous accumulations.                                epidermis predominately at its deep parts

Table 2.
Localization of tumor in BC patients and regional lymph node metastasis
                                                                                No. of metastases
  Localization of Breast Cancer                        No.                %
  Central                                               68           16,7 %         27(39.7%)
  Upper inner                                           52           12,8 %         19(36.5%)
  Lower inner                                           11            2,7 %         6(54.5%)
  Upper outer                                          246           60,4 %         123(50%)
  Lower outer                                           17            4,2 %         9 (52.9%)
  Axillar posterior part of breast                      2             0,5 %             0
  Breast with more than 1 part affected                 11            2,7 %         6( 54.5%)
  Total                                                407            100%

                                                     encounter large cells with pale cytoplasm
  Medullar carcinoma (Fig. 4): macroscopi-           which sometimes form bunches but they do
cally – gray node with well expressed boun-          not penetrate derma. Pedzhet cancer always
daries and friable consistency. Sometimes            was combined with duct infiltrating cancer.
there may be decomposition and a cavity              The main localization of BC is upper outer
formed in the center. Microscopically one can        part of breast – 60,4% (Table 2). In 218
discover fields consisted of cells with bubble       (53,5%) patients regional lymph node me-
like nucleus which contain some smaller              tastasizing was present. In 208 of them me
nuclei in. It is harsh polymorph but weak
hyper chrome. There may be often mitosis
expressed. Stroma is gentle, diffusely infil-

Table 3
Distribution of BC cases by size.
                               Size of tumor                         No.                 %
  Tumor up to 2 cm in diameter T1                                     30               7,4 %
  Tumor from 2-5 cm T2                                               303              74,4 %
  Tumor larger than 5 cm T3                                           39               9,6 %
  Tumor of any size spreading to thorax or skin T3                    39               9,6 %
  Tumor of any size spreading to thorax T4                            35               8,6 %
  All                                                                407               100%
18                          EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

     tastasizing was on the same side and in             With 2 cm tumor regional metastasizing was
     111(50,9%) there were more than 1 lymph             in 20% cases, and with 5 cm tumor especially
     node involved that corresponded to N2 TNM.          when spread to thorax or skin metastasizing
     In our investigation highest metastasizing to       incidence increased to 52,5% and 71,4% re-
     regional nodes with lower inner part of             spectively. (Table 4)
     breast was observed. Invasive duct carcino-
     ma 169(77,5%) was responsible for majority          CONCLUSION
     metastasizing to regional lymph nodes; with
     medullar carcinoma 3(50%); mucinous -               Results of investigation demonstrate that in
     4(30,8%). There were only 3 cases with tu-          the Semipalatinsk region the most affected
     bular and anaplastic forms and they all gave        by BC females are in age group 50-59 (27,5%),
     metastasizing to regional lymph nodes.              40-49 (26,3%), 60-69 (25,5%) respectively.
     Pedzhet disease produced 1 case (25%). Dis-         The main cancer morphological type is inva-
     tant metastasis took place in 5 cases.              sive duct carcinoma – 361 (88,7%) that cha-
       The patients had the sizes of tumor indi-         racterizes by aggressive development, prone
     cated in Table 3.                                   to metastasize – 169 (77,5%) cases. Metasta-
       Direct correlation between size of tumor          sizing was prominent in the patients with
     and regional metastasizing was observed.            more than 1 part of breast affected – 54,5%
                                                         cases. Direct correlation between size of tu-
                                                         mor and metastasizing was observed. All
     Table 4
                                                         mentioned may be of benefit in disease
     Distribution of metastasizing to regional lymph
                                                         prognosis and for choosing an option of
     nodes depending on size of tumor
                    Size                No.      %
     Tumor up to 2 cm in diameter
                                        6       2.9      REFERENCES
     Tumor from 2-5 cm     T2           159     76.8
                                                         1.Adrachmanov B.E. 1996, Abdrachmanov
     Tumor larger than 5 cm T3          17      8.2
                                                         Z.N. 1999, Abdrachmanova A.Z. 2000, Esen-
     Tumor of any size spreading
                                        0       0.0      culova S.A. 2000.
     to thorax or skin
                                                         2. Komissarov A.B. “Criteria of eligibility for
     Tumor of any size spreading
                                        25      12.1     organ sparing surgery in patients with 1 and
     to thorax T4
                                                         2 stage breast cancer” // Dissertation of can-
     All                                211              didate of medical science – M., 1982
                      EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                           19

Morphology and clinical data dynamics in the patients
with chronic hepatitis B treated different way.
Sarieva S.A.

Scientific Research Institute of Cardiology and Internal Diseases
Almaty, Kazakhstan

INTRODUCTION                                                        METHODS
                                                      MATERIALS AND METHODS

According to World healthcare organization            There were 36 patients in the group. The di-
(WHO), one million patients with viral hepa-          agnosis chronic hepatitis B was detected
titis dies, as well it takes 9 places among           analyzing presents of HBV-marker in the
other causes of lethality. It relates to global       blood samples and morphologic changes in
morbidity and results in cirrhosis and hepa-          tissue samples. The level of activity has been
tocellular carcinoma.                                 detected in accordance to system Knodell
  The outcome of the disease depends on               from 1 to 18 grades. The index of fibrosis has
development of the hepatic fibrosis. Even             been detected by grade system, suggested by
though significant successes in fibrogenesis          V.J. Desmet. Morphologic samples were in-
understanding, exact timing when it becomes           cluded in standardized in classific scheme of
unreturnable stays unknown. Medical ther-             Metavir.
apy for the hepar cirrhosis is limited (1).             All the patients were divided into 2 groups.
  To find the way to stop fibrosis is one of the      First group was consisted of patients admi-
significant mutters of hepatology.                    nistered interferon alfa 5000000 ME daily
  At the present time, along with interfe-            under skin during 16 weeks. Second group
ron-a which being used in clinic 20 years             (20 patients) was administered lamivudin
more, lamivudin is getting popular, especial-         100mg daily per os.
ly in the patient with hepatic failure. Al-             Analyzing blood serum, most of the pa-
though, there are no clear administrating             tients in both groups had no HBeAg-negativ:
time, side effects are unknown. In addition,          63 %(10) – in first group, and 70% (14) – in
fast developing resistance and recidives, de-         second group. The HBeAg-positiv patient
crease chances (2,3,4,5).                             were 37 %( 6) and 30 %( 6) accordingly.
  The purpose of the study is t follow up               All the patients underwent hepar puncture
clinical and morphologic changes in the pa-           biopsy. Tissue structure was safe. Portal
tients with chronic hepatitis B in different          tracts were enlarged and infiltrated with
stages of antiviral therapy.                          lymphoid epithelium. There were no clear
20                        EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

     border between tracts and parenchyma. In-          moderate activity – 13 (65%) in 1 group, and
     flammatory brunches, infiltration and fibro-       12 (75%) in 2 group.
     sis fibers destroy borderline, intervene into        Estimating the patients by fibrosis severity,
     parenchyma, surrounding small groups of            reveled that 16 (93, 7%) patients received
     hepatocytes (Fig.1). Some of them are necro-       interferon alfa, had moderate and mod-
     tized. Well seen central veins sclerosis, ex-      erately expressed hepatic fibrosis. The same
     pressed sinusoid capillarization, anizocytosis,    changes had group with lamivudin. 3 (15%)
     and anisocoriosis. Also, one may see dig           patients administrated lamivudin, and 1
     groups of hepatocytes with grained cytop-          with interferon showed severe hepatic fibro-
     lasm and vacuolated nuclears. In some fields       sis.
     of vision are hepatocytes with acidophil cy-         Comparative analysis of biochemical and
     toplasm and picnotic nuclears. In the lumen        histological changes CVG in HBeAg-positiv
     of some sinusoids there are acidophil forma-       and HBeAg-negativ patients showed that
     tions (Kaunsilmen particularities). There are      those positive HBeAg, activity ALT and index
     seen single small groups of lymphocyte infil-      of histological activity were significantly
     trating between hepatocytes. Histological          higher comparing to HBeAg-positiv patients.
     response was estimated with tissue analysis
     taken after treatment course was over.                         DISCUSSION
                                                        RESULTS AND DISCUSSION

                                                        During treatment both groups showed sta-
                                                        tistically significant decrease of fever ex-
                                                        pression and astenic syndrome. Hepatic sizes
                                                        decreased in the patients with lomivudin. All
                                                        the     patients   with   jaundice   got   serum
                                                        bilirubin normal.
                                                              Mainly (72%) of the patients administered
                                                        interferon lowered daily activity. The pa-
                                                        tients with lamivudil had no such side effects.
                                                        Comparing biochemical response, it was de-
                                                        tected that at the end of therapy, 15 (75%)
                                                        patients received lamivudin and 9 (56, 3%)
                                                        those with interferon had normal ALT activ-
       Fig.1 Morphologic changes in the patients with   ity. Normal level of ALT during 6 months af-
                  chronic hepatitis B.                  ter treatment kept in 10 (50%) and in 10 (62,
                                                        5%) patients accordingly.
                                                          Analysis of the virusologic response at the
       According to the results, absolute majority
                                                        end showed that clearance HBV DNA was
     in both groups made patients with histologi-
                                                        observed in 18(90%) patients with lamivudin,
     cal index 8-11, fibrosis grade 1-2, Metavir
                                                        and in 13 (81, 3%) patients with interferon.
     A1-A2, F1-F2. Generally there were low and
                      EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                          21

                                   Fig 2                                                  Fig 3

  Fig.2. Morphologic changes in the patients with chronic hepatitis B administered lamivudin.
  Fig.3                                                                           inter
  Fig.3 Morphologic changes in the patients with chronic hepatitis B administered interferon.

  Stable clearance iHBV DNA during 6                 noticed significant reduction of inflammatory
months after the end was observed in 13              infiltration of hepar tracts, no necrotized
(65%) and 10 (62, 5%) patients, accordingly.         hepatocytes, dystrophy reduction in hepatic
To detect histological changes on the back-          cells in all three zones of hepatic acinus.
ground of the therapy, rebiopsy were carried            The speciality of histology on the back-
out in 23(88%) patients with lamivudin, and          ground of lamivudil therapy was reduction of
in 18 (90%) patients with interferon.                collagen fibres at the places it was saturated
  The morphology in group 1 was as follows:          with fibroblasts and fibrocytes. There were
hepar structure had arch form, portal tracts         no changes at the places rich with collagen.
slowly enlarged, moderately scleroses and            Hepar biopsy in those treated with interferon
infiltrated with single lymphoid cells (Fig 2).      showed no development as well as reduction
In some fields of vision fibber of connecting        pf collagen.
fabric grows in hepar tissue. Small groups of           Improvement of hepar histology revealed
hepatocytes is coloured with orsein in lightly       in 15 (75%) patients with lamivudil and in 13
brown, single hepatocytes with vacuolated            (81, 3%) patients with interferon. Compara-
nuclear are seen. There is no necrosis.              tive analysis showed no significant differ-
  The morphology in group 2 was as follows:          ences nor lamivudil or interferon on activity
hepar structure is safe, portal tracts infil-        of inflammatory and necrotic processes in
trated with single round cell elements (Fig.3).      hepar. But, 8 (40%) patients treated with
In some fields of vision coloured with picro-        lamivudil was detected reduction of hepatic
fuxin (by Van-Gizon), growth of collagen fib-        fibrosis. 40 % of the patients had no devel-
bers are seen. There are single hepatocytes          opment of hepatic fibrosis. In the patients
with light cytoplasm. There are no necroses.         treated with interferon was no reduction of
  Comparing histological changes of hepar in         hepatic fibrosis degree, although process was
the patients with viral hepatitis B, it can be       stop in 68, 8% (11) patients.
22                           EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

     CONCLUSIONS                                           1. Karayiannis P. Hepatitis B virus: old, new
                                                           and future approaches to antiviral treatment.
       1.    In     the    patients    with    chronic     J Antimicrob Chemother, 2003.
     HBeAg-positiv hepatitis B biochemical and             2. Schalm S.W., Heathcote J., Cianciara J. et
     histological   activity    is   higher   than    in   al. Lamivudine and alpha interferon combi-
     HBeAg-negativ patients.                               nation treatment of patients with chronic
       2.    Lamivudin and interferon decrease             hepatitis B infection: a randomized trial //
     inflammatory necrotic changes in hepar in             Gut. – 2000. – Vol. 46. – P. 562-568.
     majority       with       HBeAg-positiv         and   3. Lenghel A. Effect of the alpha interferon
     HBeAg-negativ patients.                               2b therapy on the liver fibrosis // Gut. – 2000.
       3.    Lamivudil therapy leads to statisti-          – Vol. 47 (suppl.111). – A19.
     cally significant decrease of hepatic fibrosis        4. Brenner D.A., Waterboer T. New aspects of
     (p 0, 05) while interferon therapy stops hepar        hepatic fibrosis // J. Hepatol. – 2000. – Vol. 32
     fibrosis progression.                                 (suppl.), № 1. – P. 32-38.
                                                           5. Leung N. Liver disease – significant im-
     REFERENCES                                            provement with lamivudine // J. Med. Virol. –
                                                           2000. – Vol. 61, № 3. – P. 380-385.
                     EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                               23

Disease prevention significance in facing the challenge
of high sickness rate with chronic non-communicable
diseases among the Republic of Kazakhstan population
Turdaliyeva B.S.

National Center for Problems of Healthy Life Style Development, Almaty


In the course of the given research chronic non-communicable diseases prevalence and their risk
factors                               popu
factors development among adult urban population of some Kazakhstan’s cities and preventive
measures influence on risk factors occurrence dynamics have been studied. It has been revealed
that before starting preventive interference chronic non-communicable diseases prevalence
amounted to 19.69% including 17.92% amongst males and 21.25% amongst females. Digestive ap-
paratus       sicknesses   have   been    claimed       the   most   commonly    encountered   chronic
non-                            (35.35%),                             taken    cardiovas
non-communicable diseases group (35.35%), prevalence second place was taken by cardiovascular
diseases (20.28%), then come chronic nonspecific lungs diseases (11.63%), urinary chronic dis-
eases (11.77%), diabetes mellitus (6.94%). Risk factors occurrence indexes such as smoking, exces-
sive alcohol abuse, low physical activity, overweight used to be high till launching the preventive
measurers and then were reduced after various models of preventive interference introduction that
                                                                            non-             dis-
proved prevention effectiveness in facing the challenge of fighting chronic non-communicable dis-
eases high rates.

  Key words prevention, risk factors, chronic non-communicable diseases

                                                        death rates issue due to chronic pathology is
INTRODUCTION                                            actual for Kazakhstan as official statistics
                                                        documents data show which were obtained
Preventive health care in particular Chronic            during recent years [1, 2, 3]. A whole bunch of
Non-communicable Diseases (CND) is one of               authors in their scientific researches has
important medical care tools rendered to                proved the fact that the current situation is
population. Meanwhile nowadays preventive               stipulated by some changes in the public life
measures are considered as some auxiliary               style: highly popularized smoking, low phys-
sphere of medical activity.       Disease and           ical activity, fat high-caloric products with
24                         EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

     high cholesterol content dominating in basic        ered 5709 people between the ages of 15-64
     diet, widely spread alcohol consumption often       living in the stated above cities, males con-
     in large quantities, stresses, and as their         tributed 2 659 (46.58 %), and females 3050
     consequences increasing number of over-             (53.42 %). To evaluate preventive measures
     weight people, high occurrence of arterial          influence on CND prevalence risk factors and
     hypertension – these and other factors which        to check their efficiency the epidemiological
     are   important    development      aspects    of   situation comparison of risk factors in Astana,
     Chronic Non-communicable Diseases          have     Almaty, Semipalatinsk and Shymkent has
     become prevailing among population of Ka-           been carried out after introducing some pre-
     zakhstan led to high incidence and death            ventive measures. The study covered 4807
     rates due to chronic pathology [4, 5, 6 and         people between the ages of 15-64 in the 4 ci-
     others.]. This fact calls for tackling the actual   ties of Kazakhstan. Males numbered 2271or
     problem of promoting public health state.           47.24% of the whole population and females
     One of the most effective ways of reducing          numbered 2536 or 52.76%. The first study
     high incidence and death rates due to               was carried out in 2000 and the second one
     Chronic Non-communicable Diseases              is   was held in 2003. For proper evaluation of
     developing a comprehensive approach for             risk factors prevalence a special question-
     cutting down CND incidence rate and creat-          naire was applied as recommended by the
     ing a national integrated strategy on Chronic       World Health Organization for nations –
     Non-communicable        Diseases     Prevention     members     of   Countrywide     International
     based on scientifically proven results of re-       Non-Communicable Diseases Implementa-
     vealing common risk factors of primary dis-         tion Program.
     eases development, preventive interference            Contemporary statistical analysis methods
     effectiveness assessment, application of new        were used to process all obtained data. All
     preventive technologies, health management          data received during the study were mathe-
     scientific foundations promotion [7, 8, 9, 10].     matically and statistically processed by
       This research objective is to determine the       means of the SPSS software. For measuring
     effectiveness of preventive measures taken          frequency level on different variables the
     for mitigating risk factors prevalence among        frequency study method was introduced (in
     adult urban population.                             percentage) with calculating average and
                                                         standard mean square errors. Exactness
     MATERIALS AND METHODS                               authenticity was checked by the Student
                                                         coefficient (t). To figure out the relationship
     A social and hygienic study has been done to        between independent and dependent va-
     evaluate public health state in terms of            riables correlation coefficients were calcu-
     Chronic      Non-communicable          Diseases     lated. To compare samples average values
     spreading and life pattern factors amongst          and to compute the discrepancies significance
     adult urban citizens of Astana, Almaty, Se-         level the variance analysis has been intro-
     mipalatinsk and Shymkent. The study cov-            duced. During the study the statistical mod-
                     EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                        25

eling combined with the regression analysis       of developing CVD by 1.11 times, Diabetes
were conducted which let to envisage the          Mellitus Diseases – by 1.18 times, Urinary
relative risk of possible chronic pathology       Organs Diseases – by 1.10 times. EBW in-
development in the population part being          creases risks of developing CVD       by 2.01
considered. The population attributive risk       times, CDDO – by 2.70 times, DM – by 1.92
prognosis was made through the regression         times. Also the biological risk factors were
analysis and formulating trend lines.             evaluated which resulted from the behavioral
                                                  ones in particular hypercholesterolemia and
RESULTS                                           arterial hypertension. The results showed
                                                  that hypercholesterolemia increases ratio of
The study results showed that population          CVD likelihood to CVD unlikelihood by 1.52
has a high occurrence of such diseases as the     times, CNLD – by 1.43 times,      UOD – by
Cardiovascular ones (CVD) the incidence           1.77 times, DM – by 1.72 times; and Arterial
number of which numbered           20.28%, the    Hypertension increases risks of CVD occur-
Chronic    Nonspecific     Lungs      Diseases    rence by 2.85 times, CNLD – by 1.22 times,
(CNLD) (11.63%), Chronic Diseases of Diges-       DM – by 1.90 times.
tive Organs (CDDO) - (35.35%), Urinary Or-          As it was mentioned above the most effec-
gans Diseases (UOD) - (11.77%), Diabetes          tive ways to solve the problem of high inci-
Mellitus (DM) - (6.94%).                          dence and death rates due to CND are the
  Population life style analysis has shown        comprehensive integrated approach and de-
that at average 31.91% of the respondents         velopment and introduction of various mod-
smoke, 62.82% - drink alcohol immoderately,       els of preventive interference. Various models
over 2/3 (71.98%) lead inactive life (that is     of preventive interference intended for sep-
they feature behavioral risk factors), over 1/3   arate population groups were elaborated and
of population or 36.39% have Overweight,          introduced in the experimental areas in par-
and 12.77% of the respondents have arterial       ticular an Educational Model for compre-
hypertension (biological risk factors).    The    hension school teenagers, a Medical Model
highest number of behavioral risk occurrence      intended for treating population through
is encountered in the age group under 45,         rendering first medical and sanitary aid
especially in the ages between      25-34 and     system (district medical service and family
35-44, whereas biological risks are typical for   medical ambulance stations) and a Preven-
people over 45.                                   tive Interference Model at Work Place. All
  A Mathematical Modeling has been held as        the Models had common approaches and
well as CND Spreading Prognosis according         used integration principle. At the same time
to the study risk factors data has been made.     the Models had their own features which
The analysis showed that smoking increases        constituted according to various population
exposure to CVD cases by 1.17 times, CNLD         groups differences being exposed to preven-
– by 1.13 times, DOI – by 1.24 times, DMI –       tive influence introduction, chronic pathology
by 1.15 times. Alcohol abuse increases risks
26                           EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

     prevalence regional peculiarity as well as life      approaches and constructing preventive in-
     style risk factors.                                  terference models enabled to make distinct
       Our results showed that various models of          discrimination of responsibilities and opera-
     preventive interference had their own fea-           tion areas for all concerned parties, max-
     tures. Thus the Educational Model includes:          imized target groups coverage and effectively
     close inter-department cooperation between           organized preventive activity.   Building up
     Health Care and Education systems; active            preventive interference models based on sit-
     participation of teenagers themselves in             uation assessment scientific data with using
     creating healthy life style, development of          the integrated approach which included ad-
     skills and habits for building up their own          ditionally participation of non-medical or-
     proper healthy way of living; promoting pos-         ganizations in prevention activity intended
     itive    attitude     towards   themselves,   the    for prophylaxis the first priority risks of
     healthy man image; acquiring healthy life            population life style and chronic diseases
     style knowledge and skills as a part of edu-         major categories, combining different strate-
     cational and mentoring process; creating fa-         gies in treating population and prevention
     vorable      environment        for   personality    kinds (population, group, individual, high
     self-development within school and family            risk strategy, primary and secondary pre-
     through active involvement and training              vention) – all these let to develop adequate
     teachers and parents.                                prevention approaches aimed at separate
       The Medical Prevention Model according to          population categories.
     the research results has such peculiarities            To evaluate the introduced models effi-
     as: increasing medical staff role significance       ciency the second epidemiological research
     in preventive medical care for population;           has been held to study risk factors occurrence
     enhancing medical staff knowledge and pro-           amongst adult urban population.           The
     fessional skills in the field of CND prevention      second study showed that the 2-year preven-
     at population, group and individual levels;          tion interference has resulted in reducing
     preventive measures coverage opportunity             CND cases occurrence major risk factors
     over the whole population (employed and              among the target cities population. At aver-
     unemployed people) subjected to a particular         age smoking occurrence has been decreased
     medical-prophylactic facility.                       by 5.09% (р<0.05), Alcohol Consumption – by
       Preventive Interference Model at Work              5.01% (р<0.05), Excessive Body Weight – by
     Place was specified by rendering preventive          2.68%, Low Physical Activity –by 8.66%
     aid to able-to-work people; work conditions          (р<0.05).
     supervising opportunity and evaluating pre-
     ventive interference in one singled out target       DISCUSSION
     group; obtaining by an enterprise medical
     efficiency as a result of preventive interfe-          Hereby according to the given data the
     rence.                                               most common risk factor among adult urban
       On the whole applying different prevention         population is Low Physical Activity to blam
                         EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                         27

(71.98%) which is an independent risk factor          teracy regarding healthy life style, risk fac-
of some chronic diseases cases and also fa-           tors roles in developing CND, correcting risk
vors gaining excessive body weight thereby            factors among population through first med-
deteriorating      the       picture   of   chronic   ical and sanitary service system, elaborating
non-infectious diseases high incidence.               professional literature and training aids for
  The second place in terms of frequency is           population, holding additional and control
taken by Alcohol Consumption in dangerous             scientific researches to determine dynamics
quantities that is its consumption over 280           of risk factors prevalence as a consequence of
grams a week. This stipulates both direct             preventive activities having held.
and indirectly high incidence of Digestive              On the whole the performed activities
Organs Diseases (35.35%) and CVD (20.28%)             promoted reducing risk factors prevalence
among population.                                     which in turn showed that Situation of be-
  The results analysis showed that almost             havioral risk factors occurrence under moni-
1/3   of      people   are    averagely     smokers   toring among adult urban population of Ka-
(31.91%). This factor is mainly distributed           zakhstan turned up to be capable of being
among rather males (50.66%±1.36) than fe-             modified and controlled. The introduced
males (15.57%±1.66) (р<0.05). The biggest             prevention models enabled to decrease beha-
occurrence was noticed in the age group be-           vioral risk factors occurrence, define positive
tween 25-34 (41.27%±2.28), among males –              tendencies of reducing the incidence of sep-
62.86%±2.86 and among females accordingly             arate biological risks and which showed
– 22.84%±3.46 (р<0.05).                               medical efficiency achieved during the expe-
  Studying the relationship and forecast of           riment. Considering mutual interconnection
CND incidence and risk factors let me have            between risk factors with appearance and
all the necessary info for planning preventive        development of chronic pathology among the
measures in particular to define population           target contingent one can suppose that
categories and approaches to preventive in-           chronic non-infectious diseases spreading
terferences considering attributes of risk            would reduce on condition if dynamics of
factors and CND occurrences within the tar-           risks occurrence related to life style is kept.
get cities.                                           Theoretical projects were embodied in prac-
  On the basis of received data preventive            tical Health Care in Kazakhstan at both na-
interference models were developed with one           tional and regional levels. Pursuing the goal
common goal of reducing risk factors of de-           to introduce them into practical Health Care
veloping CND by means of promoting the                several documents were elaborated and ap-
Package through existing Health Care or-              plied which enabled to advance prevention
ganizations and non-medical organizations             normative-legislative basis, medical profes-
intended for preventing and controlling ma-           sionals training system for both under- and
jor risk factors conducive to CND develop-            postgraduate levels was arranged, guidelines
ment. Major guidelines of preventive work             and recommendations for practitioners and
were: training professionals, population li-          middle class medical personnel were drawn
28                        EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008

       up, particularly standard protocols for         5. Germanyuk T.A. Theoretical and metho-
     preventing major non-infectious diseases risk     dological basis of promoting KZ public health
     factors and prevention action plans for first     state under conditions of social and econom-
     medical-sanitary aid personnel, some re-          ical       transformations.      [dissertation],
     gional prevention programs of several first       St-Petersburg; 2001.
     priority diseases were carried out.               6. Kairbekov A.K. Cardiovascular and some
                                                       chronic non-infectious diseases prevention
     REFERENCES                                        and its efficiency among rural population
                                                       exposed to agrochemical factors. [disserta-
     1. Public Health state of the Republic of Ka-     tion]; 1998.
     zakhstan and Health Care organizations ac-        7. Lissitsyn Y.P. Public Health and Health
     tivity in 2003, (Statistics annual) Asta-         Care. Moscow 341 p. 2002.
     na-Almaty, 2004                                   8. Oganov R.G. Preventive Cardiology: suc-
     2. Public Health state of the Republic of Ka-     cesses, failures, perspectives. (Cardiology).pp.
     zakhstan and Health Care organizations ac-        4-8, 1996:3.
     tivity in 2004, (Statistics annual) Asta-         9. Dobrossy L. editors. Prevention in primary
     na-Almaty, 2005                                   care. Recommendation for promoting good
     3. Public Health state of the Republic of Ka-     practice. Copenhagen: WHO, Regional Office
     zakhstan and Health Care organizations ac-        for Europe. 216 p. 1994.
     tivity in 2005, (Statistics annual) Asta-           10. Oganov R.G., Glazunov I.S., Ivanov
     na-Almaty, 2006                                   A.V.,     Grabausskas   V.I.   Developing    an
     4. Akanov A.A. Major chronic non-infectious       Integral Program of Non-Infectious Diseases
     diseases epidemiology and prevention among        Prevention. (Regional Archive). pp.6-8. 1989.
     rural population of the Republic of Ka-           V.61:1.
     zakhstan. [dissertation], Bishkek; 1992.
                        EurAsian Journal of BioMedicine, Vol.1, No.1, Feb.2008                                     29

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