Incidence of chronic diseases is increased in the 21st century due to prolonged life expectancy. Cardiovascular disease is the most common disorder worldwide, complicated with high morbidity and mortality. Upon increased prevalence of this disease, cardiac surgery has become an essential strategy for patients that do not respond to medications and other therapeutic procedures. Some potential complications in cardiac surgery affect kidneys, lung, brain over the postoperative period. Acute kidney injury (AKI) is considered a serious complication of cardiac surgery characterized by rapid loss of kidney function leading to acute increase in the serum creatinine concentration. AKI occurs in up to 30% of patients after cardiac surgery and is observed in 2% of the cases with isolated coronary artery bypass grafting (CABG). There are literature data concerning the patients with coronary artery disease after CABG in the presence of evolving atherosclerosis. Development of inflammation and dysadaptation of innate immunity was established in this work. An imbalance in the cytokine system contributes to the progression of endothelial dysfunction and may promote development of renal injury after CABG. Hypercytokinemia in AKI patients suggests involvement of innate immunity factors in the development of acute inflammatory response. The purpose of this article was to assess the innate immune response in the patients subjected to CABG with different duration of extracorporeal circulation. In the present study, 100 patients underwent CABG, all of whom were in the on-pump group. General clinical, functional, biochemical, instrumental, immunological and statistical methods were used in the work. After analyzing the data on the content of pro- and anti-inflammatory cytokines in blood serum of the patients with stage 1 and 2 AKI (KDIGO), depending on the duration of cardiopulmonary bypass surgery, we found that their dynamics corresponded to the standard pattern of changes after CABG groups and hyperproduction of pro- and anti-inflammatory cytokines in the groups with higher duration of cardiopulmonary bypass. The pathogenetic role of pro- and anti-inflammatory mediators remains unclear. We support the view that the clinical prognosis after cardiopulmonary bypass depends on the balance of pro- and anti-inflammatory cytokines.

HIV infection is closely associated with damage to the nervous system, even despite usage of antiretroviral therapy. Thus, the patients are at a high risk for neurological complications. Due to limited permeability of the blood-brain barrier, the opportunity of its damage, both directly by the proteins of HIV-infected cells and indirectly, by immune system, e.g., inducing the production of inflammatory mediators, the involvement of the central nervous system in pathogenesis of HIV infection seems to be only a matter of time. HIV-associated neurocognitive disorders (HAND) comprise a poly-etiological pathological condition associated with direct and indirect damage to neurons in HIV infection. The role of interaction between the innate immune system and nervous system mediators in viral infections suggests that the specific changes in content and ratios of pro- and anti-inflammatory cytokines that are among the most polypotent mediators of immune regulation can be detectable in the persons prone to the development of HAND in HIV infection. The purpose of the present study was to characterize the features of serum content and the relationship between the indexes of innate immunity factors with the results of neurocognitive testing in the persons living with HIV. 123 persons were included in the study, of which 93 subjects live with HIV infection. They were divided into 3 groups according to the stages of HIV infection, according to the Russian Classification of HIV infection. 30 persons represented a group of healthy volunteers, comparable in age and gender with the members of main groups, and served as a control group. Determination of IL-1 and IL-10 contents in blood serum was carried out by solid-phase enzyme immunoassay. The level of CD4+T lymphocytes was determined by flow cytometry. Neurocognitive testing using Schulte tables, the Munsterberg test was conducted by a medical psychologist, according to generally accepted methods. A significant increase in the serum IL-10 content in subjects from the main groups was revealed as compared with the control group, as well as in group III compared with the values groups I and II. The levels of IL- 1, CD4+T lymphocytes were significantly lower in group III, compared with all other groups. The personal performance index determined by testing with Schulte tables was reduced in all groups, relative to the controls, with a significant predominance of the results in groups I and II over the results of the participants from group III. The scores in Munsterberg test were equally diminished in all the main groups compared to the control values. When assessing the Spearman coefficient, the presence of various correlation profiles was established, depending on the stage of the disease.

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With regard of post-surgical cognitive disturbances, an active search for biological markers of these neurological complications is performed. We have studied the contents of NSE, IL-6, TGF-β1, MMP9 and TIMP1 in blood serum of these patients. The study included 110 patients after aortal-coronary bypass surgery using extracorporeal blood circulation. Splitting into separate groups was based on the test scores, according to Montreal Cognitive Assessment Scale prior to surgery and on day +7 after the intervention: (I) patients without complications ( 3 points); (II) patients with post-surgical cognitive impairment ( 3 points). The comparison group (III) included 35 healthy subjects. Evaluation of NSE, IL-6, TGF-β1, ММP9 and TIMP1 in blood serum was performed by means of ELISA technique (RD Systems, USA). The data were expressed as pg/ml, or ng/ml. Blood sampling was made at 4 terms: before surgery, just after intervention, 24 h later, and on day 7 after the surgery.The patients from group II showed higher NSE levels, except of 7 days after surgery when it became similar to other groups. Increased IL-6 levels were found in the patients from group II at all terms after surgery. Decreased concentration of TGF-β1 was found in the II group prior to operation, 24 h and 7 days after the surgery. However, just after surgery, this index was increased, and its values barely differed from results of groups I and III. Studies of MMP9 showed significant differences between groups I and II only on day +7 after. However, lower MMP9 content was detected in the patients from I and II groups before surgery compared to group III. TIMP1 values showed gradual increase over the observation period, but did not differ between groups I and II. In the patients from group II, an increased content of NSE and IL-6 was revealed, along with low TGF-β1 levels and decreased ММP9/TIMP1 ratio over early postsurgical period, thus suggesting possible role of innate immunity dysfunction in pathogenesis of postsurgical cognitive impairment.

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