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Acta Biomedica Scientifica

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Vol 6, No 3 (2021)
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COMMENTS OF CHIEF EDITOR

OBSTETRICS AND GYNAECOLOGY

9-16 1183
Abstract

 Diabetes mellitus in pregnant women is one of the topical problems of modern medicine. Recently, there has been an increase in cases of type 2 diabetes, especially an increase in the frequency of early onset in children and adolescents, respectively, in the fertile age, in a few years; they will enter with the burden of pathology. This is particularly problematic and important during pregnancy, since type 1 and type 2 diabetes are accompanied by a high risk of adverse obstetric and perinatal complications, which are detected in most women with type 1 and type 2 diabetes. The purpose of this review was to assess the role of vascular endothelial dysfunction and subclinical inflammation in the genesis of placental insufficiency causing the development of a number of pregnancy complications in diabetes mellitus, to search for biological markers of these processes, which may reveal some pathogenetic mechanisms for the formation and diagnosis of these disorders.
The review shows changes in the content of a number of biological markers, primarily such as pro-inflammatory cytokines (IL-1, TNFα, IL-6); CRP, for certain pregnancy complications in diabetes mellitus women. It is the imbalance of cytokines that very often determines the development of gestational complications and disrupts immunological tolerance in the mother-placenta-fetus system. The degree of severity of angiogenesis processes depends on the level of hyperglycemia, manifestations of subclinical inflammation and is reflected in the increase in the VEGF expression level and its receptors in terminal and stem villi of the placenta.
Thus, the review shows the role of endothelial dysfunction and subclinical inflammation in the development of obstetric and perinatal complications in diabetes mellitus patients, which is indicated by the changes in a range of proinflammatory cytokines and other biologically active markers. 

17-30 1361
Abstract

 Bacterial vaginosis (BV) is the most common infectious non-inflammatory disease in women of reproductive age. The key feature of BV is that in the  absence of a specific pathogen, the disease develops against the background of vaginal biotope dysbiosis. According to the opinion of some authors, initially, the main role of BV in the pathogenesis was assigned to the species G. vaginalis. However, using of molecular methods made it possible to significantly expand the range of microorganisms found in women with BV, and to identify Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp., Prevotella spp. as the primary causative agents of BV. A number of studies have confirmed the sexual transmission of BV pathogens, with a new sexual partner being significant risk factors for episodic BV, and sexual contact with the same partner without using barrier methods of contraception for recurrent BV. At the same time, BV-associated bacterias  rarely exist as planktonic forms of one species, more often, they thrive in complex polymicrobial communities surrounded by an extracellular matrix, the so-called biofilms. In patients with BV, biofilms are detected in 90% of cases. G. vaginalis and Prevotella bivia are widespread in women with BV and, being the primary colonizers, create a bacterial biofilm, to which secondary colonizers can subsequently join, including A. vaginae, Sneathia spp. and potentially other BVABs. The resistance of bacterias in the biofilm to antimicrobial drugs is 1000 times higher than of planktonic forms, which can lead to chronicity of the infectious process and torpid course of the disease.
The aim of this review was analyzing of modern studies on the prevalence, characteristics of opportunistic microorganisms associated with BV, to present their clinical and diagnostic significance and role in the pathogenesis of  diseases. 

31-42 1013
Abstract

 This review includes an analysis of clinical studies evaluating the effect of adenomyosis on reproductive function, as well as a review of studies on the relationship between surgical treat-ment options for adenomyosis and reproductive outcomes. 
Different studies of women populations after in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) and after surgical treatment of  deep adenomyosis have shown that adenomyosis in both cases has a negative effect on the reproductive outcome, although there are significant differences in these populations. In the literature, there are relatively few data on the degree of influence of the depth of the lesion on the realization of the reproductive function, however, a significant correlation was revealed between them. The positive effect of treatment with gonadotropin-releasing hormone agonists, followed by surgical treatment of adenomyosis, has also been described in several literary sources, but there have been no controlled studies on this topic. Many studies do not meet the validity criteria due to the lack of clear criteria for inclusion and exclusion from the study.
The choice of the optimal treatment options for adenomyosis based on the actual data is difficult due to the lack of reliable evidence of the relationship between fertility and the degree of adenomyosis. However, it is known that adenomyosis can reduce the likelihood of successful implantation so  ramatically that surgical or other treatment options are reasonably recom-mended. At the same time, it is necessary to assess the possible positive effect of the treatment options available in the doctor’s arsenal. Thus, timely referral to specialized treatment of ade-nomyosis may be crucial for the successful implementation of reproductive function in patients with suspicion or with an established diagnosis of adenomyosis in combination with recurrent miscarriage, who refuse to use assisted reproductive technologies, medical institutions. This review will analyze the relationship between infertility and adenomyosis, as well as review studies of reproductive outcomes in different options for surgical treatment of adenomyosis in infertile patients. 

43-52 1078
Abstract

 Background. At present, the role of cytomegalovirus infection in the disruption of acental formation and associated pathological conditions of the fetus is bvious, which are based on oxidative and inflammatory reactions that cause disruption of igration and invasion of trophoblasts, angiogenic modulation of placental and uterine vessels.

Objective: To analyze the quantitative indicators of hypoxia-inducible factor 1α, α-tocopherol and docosahexaenoic acid in the peripheral blood in comparison with morphological changes in the placenta and uterine mucosa in seropositive women with spontaneous abortion associated with reactivation of ytomegaloviral infection.

Methods: Studies were carried out at 7-9 weeks of gestation. 67 observations were analyzed, including 35 seropositive women in the first trimester with spontaneous abortion associated with reactivation of cytomegaloviral infection and 32 healthy seronerative women with voluntary termination of pregnancy. Stabilized blood from vein, epithelium of the inner surface of the cheek, cervical canal, urine, villous chorion, and uterine mucosa were used as the test material. Enzyme immunoassay was used to detect serological markers of cytomegaloviral infection (CMV-IgG/IgM antibodies, CMV-IgG avidity), hypoxia-induced factor 1α, α-tocopherol – by fluorometric method, PCR (polymerase chain reaction) in real time – DNA CMV, the method of gas-liquid chromatography – docosahexaenoic acid, histological methods – the general plan of the structure of the chorionic villus and the mucous membrane of the uterus.

Results: In seropositive women with spontaneous abortion associated with reactivation of cytomegaloviral infection, the average of hypoxia-induced  factor 1α was 1.54 times higher, α-tocopherol and docosahexaenoic acid were 1.71 times lower and 1.40 times lower (p < 0.001, respectively) than in the group of eronegative women. Strong inverse correlations were revealed. Morphologically, there were signs of delayed formation of villi, decidualization of the endometrial stroma and the formation of uteroplacental vessels. 

Conclusion. In seropositive women with spontaneous abortion associated with reactivation of cytomegaloviral infection, a strong association of high HIF-1α values with decrease in α-tocopherol and docosahexaenoic acid in the peripheral blood was revealed, which can be considered as an unfavorable factor in the disruption of placenta formation. 

INTERNAL DISEASES

53-59 1085
Abstract

 Background. A critical condition of any genesis may be accompanied by the development of multiple organ failure, one of the manifestations of which is acute renal injury. Often, the process is subclinical in nature and the «classical» approaches to diagnose renal damage by creatinine concentration, urea level and assessment of glomerular filtration rate may not fully reflect the degree of impaired renal function, while acute kidney injury is a well-known predictor of high hospital mortality among critically ill patients.

Aims. The purpose of this study was to assess functional state of the kidneys
by determining the serum concentration of the markers of kidney injury  NGAL and Cystatin C in patients with pneumonia associated with influenza A/H1N1.

Materials and methods. 85 patients with pneumonia associated with influenza A/H1N1 were examined, 30 patients with severe pneumonia, 55 with non-severe pneumonia. The control group was formed by 15 healthy donors. The serum concentration of NGAL and Cystatin C molecules was determined by flow cytometry on a Beckman Coulter analyzer (USA), using a Human Immune Checkpoint Panel 1 multiplex assay kit (Biolegend, USA). The glomerular filtration rate was calculated using the CKD-EPI formula.

Results. It was found that in patients with severe pneumonia with the influenza A/H1N1, the concentration of NGAL increased 3.8 times compared with the control group, the concentration of Cystatin C increased 1.4 times, the glomerular filtration rate did not change.

Conclusion. Timely diagnosis of subclinical kidney injury makes it possible to  objectify the severity of the condition, make adjustments to therapy, which can help to an increase in the survival rate of critically ill patients. 

INFECTIOUS DISEASES

60-69 1063
Abstract

 This review article analyzes the data on the role of selenium in the regulation of the metabolic and immune status of a macroorganism. The data on endogenous
functional selenium-containing molecules, which include selenocysteine, selenomethionine, and selenoproteins, are considered. The data on the pathologies associated with the deficiency of this microelement, its  immunotropic properties and adjuvant effects are presented. The role of selenoproteins in the regulation of redox processes has been shown. The data on the immunotropic activity of compounds containing selenium and the prospects for their use as adjuvants are analyzed. The last section is devoted to the analysis of literature data on the biological properties of synthetic selenium compounds with an activity that mimics the catalytic activity of selenoproteins. The analysis of the data on the functional activity of selenoproteins carried out in this work indicates their key role in the regulation of metabolic and immune processes, as well as in maintaining homeostasis. The information presented in this review on the biological activity and mechanisms of action of new synthetic low-toxic organic compounds of selenium can serve as a basis for the development of nonspecific means of metabolic and immune correction of vaccinal processes caused by both live attenuated vaccines and artificially created ones. 

70-76 1126
Abstract

 Background. Today, the critical care medicine is actively developing, and rapid progress is closely related to the achievements of molecular biology, immunology, and pathological physiology. The study of the role of individual molecular structures in the realization of the reactions of innate and adaptive immunity, which underlie the pathogenesis of critical conditions, is an urgent scientific direction and is of interest.

Aims. To assess the contribution of the protein complex MRP-8/14 to the
development of systemic inflammation by determining its plasma  concentration in patients with pneumonia with influenza A/H1N1.

Materials and methods. 85 patients with pneumonia associated with influenza A/H1N1 were examined. Of these, 30 patients with severe pneumonia, 55 with non-severe pneumonia. The plasma concentration of the S100A8/A9 protein complex (MRP-8/14) was determined by flow cytometry on an analyzer (Beckman Coulter, USA).

Results. It was found that in patients with severe pneumonia with influenza A/H1N1, the concentration of MRP-8/14 increased in 1.9 times compared  with healthy. At the same time, in patients with severe pneumonia with influenza A/H1N1 with a fatal outcome, the concentration of MRP-8/14 increased in 2.1 times.

Conclusion. An increase in the level of MRP-8/14 in patients with severe pneumonia associated with influenza A/H1N1, on the one hand, reflects the severity of the course of systemic inflammation, on the other hand, the molecules MRP-8 and MRP-14, acting as damage-associated molecular patterns (DAMPs) stimulate a pro-inflammatory response and contribute to the development of critical state. Thereby, the protein complex MRP-8/14 can be considered as a potential point of application of pharmacological action in the intensive care of critical conditions. 

MORPHOLOGY, PHYSIOLOGY AND PATHOPHYSIOLOGY

77-85 1147
Abstract

 Background. Diabetes mellitus has been the most common endocrine disease in the world for decades. The growth rate of this disease has become a global pandemic. With diabetes, the risk of developing macrovascular complications increases dramatically, this often leads to serious complications such as diabetic foot.

The aim of the study was to determine the levels of «old age proteins» and markers of endothelial dysfunction characteristic to the diabetic foot syndrome.

Materials and methods. The study was carried out in the Laboratory
of experimental and clinical biochemistry and immunology of the research Institute of Molecular medicine of the Chita State Medical Academy and  included determining of endothelial dysfunction markers (homocysteine, endothelin, NOx, NO2, NO3), MMP-9, GDF-15/MIC-1, CCL11 by solid-phase enzyme immunoassay. 

Result. Diabetic foot syndrome is characterized by the level of GDF-15/MIC-1 equal to 1440 PG/ml or more, and by NOx that equal to 20 mmol/l or more. When these thresholds are reached, the probability of developing diabetic foot syndrome in diabetic patients increases in 10 and 4 times, respectively, which is confirmed by the results of statistical analysis in the IBM SPSS Statistics Version 25.0 program.

Conclusions. Increased levels of GDF-15/MIC-1 protein and nitric oxide metabolites in patients with type II diabetes can be considered as predictors of diabetic foot syndrome. The inclusion of these indicators in the structure of the regression model allows us to diagnose the preclinical stage of diabetic foot syndrome, which in the future will allow us to optimize the management and treatment of these patients. 

MICROBIOLOGY AND VIRUSOLOGY

86-94 1099
Abstract

 Background. Pseudotuberculosis remains a serious public health problem, which dictates the need to develop simple and rapid diagnostic methods for this disease. The effectiveness of the latter largely depends on the activity and specificity of the diagnostic sera. Currently, in our country, a diagnostic serum for Yersinia pseudotuberculosis O-monovalent (serotype I, III) is produced with a regulated area of application: for an approximate agglutination reaction on glass (Pasteur NIIEM, St. Petersburg). Preparation of pseudotuberculosis sera for a wider scope of their use, in particular, as a  source of specific antibodies in the design of diagnostic immunobiological preparations and test systems for pseudotuberculosis, is relevant and in demand in healthcare practice.

Aims. To obtain hyperimmune pseudotuberculosis sera, promising for use in the practice of laboratory studies for pseudotuberculosis.

Materials and methods. Chinchilla rabbits aged 3–6 months, weighing 2.5–3.0 kg served as animal producers of pseudotuberculosis sera. As immunogens, we used a corpuscular antigen (CAg) - a suspension of cells of the epidemically significant Yersinia pseudotuberculosis 3704 O: 1b strain isolated by an outbreak of pseudotuberculosis in the town of Zima, Irkutsk region, inactivated by boiling, and a preparation obtained from the outer membranes, containing the main surface immunogen of the strain. For the adsorption of experimental sera, in order to minimize the nonspecific response, we used heterologous microorganisms Escherichiacoli, Salmonella typhimurium, Shigella flexneri and Y. enterocolitica O:3, which have a similarity of surface antigenic structures with the causative agent of  pseudotuberculosis. The presence of specific antibodies in experimental pseudotuberculosis sera was determined in a volumetric agglutination
reaction.

Results. Optimal schemes of rabbit immunization were selected, which made it possible to obtain hyperimmune sera against Y. pseudotuberculosis 3704 O:1b antigens with an agglutination activity of 1:3200-1:6400. In low dilutions of experimental sera (1:100–1:400), obtained against corpuscular antigen and outer membrane antigens (Escherichia coli, Salmonella typhimurium, Shigella flexneri , Y. enterocolitica О:3, S . enteritidis Gartnery) was observed in the agglutination reaction (AR). After the adsorption of experimental pseudotuberculosis sera by cells of heterologous strains, there was no cross-reaction with the indicated microorganisms in the  agglutination reaction.

Conclusions. The obtained hyperimmune adsorbed sera against the boiling-inactivated Y. pseudotuberculosi s 3704 O: 1b corpuscular antigen and outer membrane antigens can be used as a source of specific antibodies in the design of diagnostic immunobiological preparations for the detection of pseudotuberculosis microbe, as well as in the monitoring of the epidemic situation. 

NEUROLOGY AND NEUROSURGERY

95-102 1082
Abstract

 A clinical example shows a rare case of surgical treatment of facet syndrome, which is formed against the background of instability of the spinal motion segment of the spine at the LIV-LV level using the method of laser vaporization  and denervation of the facet joints.
The aim of the work is to consider the clinical and diagnostic indicators of facet syndrome and to assess the role of imaging research methods in the diagnosis of this syndrome. At the outpatient stage, with long-term persistent pain syndrome in the lumbar spine, non-stop conservative methods of treatment, the patient underwent survey radiography and MRI examination of this area in order to exclude a specific process (oncopathology, pathological fracture against the background of osteoporosis, spondylitis, etc.) Chronic pain syndrome with its ineffective conservative treatment leads to maladjustment of the psychoemotional and professional-labor state of the patient. Determining the source of pain impulses in the lumbar spine can be difficult, since pain can cause degenerative and pathological changes in various anatomical structures of the spine (intervertebral disc, facet joints, ligaments, muscles, etc.), which can form a clinical picture of pain syndrome with its various manifestations and symptoms, which do not always clearly determine the level and structure of the affected spine. In this connection, for the timely and correct determination of the diagnosis of all patients with chronic pain syndrome in the lumbar spine, it is necessary to be sent to specialized neurosurgical institutions, in which patients undergo a set of necessary medical and diagnostic procedures to determine the further management tactics and treatment algorithm for this category of patients. 

103-112 1696
Abstract

 This review contents the information on the theory of the structure and mechanisms of damage to the body fascial system, proposed by American osteopath S. Tipaldos and named by him the Fascial Distortion Model (FDM), as well as on the original method of diagnosis and treatment of muscle pain syndromes associated with fascial damage (distortion). The author describes classifications of connective tissue and fascial structures, created by S.  Tipaldos, which are based on anatomical and functional features that determine the role of each type of fascia in compensating for various types of external influences. The conditions, mechanisms of formation and characteristics of six types of fascial lesions identified by S. Tipaldos are considered in detail: triggerband, herniated triggerpoint, continuum distortion, folding distortion, cylinder distortion, tectonic fixation. All elements of the fascial distortions diagnosis are discussed in detail, including the specification of complaints (characteristics of pain syndrome), anamnesis (history of the pain onset and its development) and an objective examination (the actual diagnostic techniques). At the same time, the special role of the patient’s description of his own painful sensations with the help of specific gestures and movements, called «body language», is emphasized. The principles and some methods of therapeutic effects used in FDM-therapy, indications and contraindications for the use of the considered manual techniques, possible side reactions that may occur during manipulation or after a session of FDMtherapy are presented. Particular attention is paid to  the evidence base of FDM therapy effectiveness in comparison with traditional methods of myofascial pain syndromes manual treatment: the results of controlled studies by foreign authors, confirming the new technique effectiveness in the treatment of certain muscle algic phenomena types, are considered. 

ONCOLOGY

113-125 1129
Abstract

 The review includes 70 articles, most of which have been published for the last 5 years.
The aim of the review: explore the modern possibilities and prospects of early diagnosis of stomach cancer. In 2018 in Russia, the mortality rate within one year after the diagnosis was 47.4%. Leading experts in luminal endoscopy from Japan, where more than 60% cases of stomach cancer are detected at an early stage, recommend using advanced endoscopic equipment for routine diagnostics, which allows enlarging the image, examining the capillaries of the mucosa and taking series of pictures. Artificial intelligence improves accuracy. Gastroscopic study with artificial intelligence compensates errors and limited capabilities of people, and provides greater accuracy. However, this technology is expensive, and esophagogastroduodenoscopy itself is an invasive method and can be used only in a clinical setting. In patients with a detectable lesion, a biopsy should be performed. It is important to obtain a sufficient amount of tissue when collecting material, however, many patients take anticoagulants, and thus sampling of numerous fragments can lead to bleeding. Given the limitations of esophagogastroduodenoscopy with biopsy and the fact that only 12.4% cases of stomach cancer in 2018 in Russia identified on the stage I, the searching of effective diagnostic tools is still relevant. MicroRNAs have been in the «cancer research arena» for over 10 years and are considered biomarkers that can help to differentiate between the patients with normal range, dysplasia and those with cancer. MicroRNA regulates all vital processes of a cell, moreover, they are stable and easily extracted from various biological materials, including tissues, blood, feces, saliva, ascitic fluid and even paraffin blocks. And although microRNAs are only entering clinical practice, the results obtained are encouraging.

126-133 1043
Abstract

 Background: The high social significance of cervical cancer, the shortcomings of the performed cervical screening is prerequisites for research in the field of mproving the diagnosis of this disease. We hypothesized that the systemic level of some inflammatory proteins could be used as a diagnostic criterion for cervical cancer.

The aim of the study was to study the level of some vascular-inflammatory markers in the blood serum in patients with precancerous diseases and cervical cancer in order to improve their diagnosis and also to identify markers for predicting an unfavorable outcome in patients with cervical cancer.

Materials and methods. A non-randomized prospective controlled study was carried out, the participants of which were patients with the diagnosis of cervical cancer (n = 49) and cervical intraepithelial neoplasia of the III degree (n = 13). The control group included 15 relatively healthy women. The following spectrum of inflammatory proteins was determined in blood serum by flow cytometry using the Human Vascular Inflammation Panel 1: myoglobin, calprotectin, lipocalin A, matrix metal peroxidase 2, osteopontin, myeloperoxidase, serum amyloid A, protein 4, which binds insulin-like growth factor cell-cell adhesion 1, vascular cell adhesion molecule, matrix metalloperoxidase 9, cystatin C. Statistical analysis was carried out by calculating the Mann-Whitney test with Bonferroni’s correction. The model was created using binary logistic regression to diagnose cervical cancer.

Results. In the intergroup comparison of the protein`s spectrum in the blood serum, no significant differences were obtained. However, using the binary logistic regression method, an equation was drawn up to calculate the diagnostic coefficient of cervical cancer, which allows diagnosing cervical cancer with an accuracy of 82%, and in terms of information content is not inferior to cytological diagnostics. The developed coefficient can be used to predict an unfavorable outcome of cervical cancer after 1 year from the moment of diagnosis. 

Conclusion. The developed diagnostic coefficient makes it possible to  diagnose cervical cancer with high accuracy and can be used to predict cervical cancer.

OPHTHALMOLOGY

133-141 1339
Abstract

Background. The current trend towards an increase in age-related macular degeneration (AMD) incidence rate in the population, including the working-age population, with a possible loss of professional activity, indicates the need for early preclinical identification of risk groups, timely prevention and treatment. In the prevention and treatment of AMD, the prospect of using melatonin is being actively discussed.

Aim: to analyze serum and tear fluid levels of melatonin in patients with AMD and study their correlation with risk factors.

Materials and methods. In the course of the study, two groups were formed: the main group - patients with non-exudative AMD and senile cataract (n = 40) and the reference group - conditionally healthy patients without AMD and cataract (n = 20). Patients of both groups were surveyed to identify risk factors for AMD. The content of melatonin in blood serum and lacrimal fluid was determined by enzyme-linked immunosorbent assay using the Melatonin ELISA Kit (USA).

Results. In the course of the study, it was found that the concentration of melatonin in blood serum and tear fluid in patients with AMD was significantly lower than in patients of the reference group (p <0.05). Serum and tear fluid melatonin levels depend on the following factors: age, body mass index (BMI), arterial hypertension, eye color, insomnia, and night work. It is possible that the local determination of melatonin in the lacrimal fluid can be a biomarker in the determination of ophthalmic pathological conditions.

Conclusion. The obtained results can be used as recommendations for clarifying individual regimens for the use of melatonin, especially in the treatment of patients with AMD.

PEDIATRICS

142-153 1330
Abstract

 The pandemic of the new coronavirus infection COVID-19 in 2020 has become the main health problem across the globe. A special characteristic of the SARSCoV-2 virus is tropism to the vascular endothelium with the  development of endotheliitis, which entails a number of typical disorders of the blood coagulation system: coagulopathy with increased thrombin generation, D-dimer, decreased fibrinolysis and prolonged prothrombin time. The coagulation disorder in COVID-19 is called thromboinflammation. Hyperinflammation, increased blood levels of von Willebrand factor, coagulation factor VIII, neutrophil extracellular traps, platelet activation, microvesicles play a significant role in the pathogenesis of hypercoagulation in COVID-19. To date, it is known that cases of COVID-19 in children and adolescents constitute a small part of the total number of patients with diagnosed COVID-19, and disorders of the blood coagulation system are similar to those in adults. The degree of hypercoagulable syndrome and the risk of thrombosis depend on the severity of COVID-19. And for children they are most expressed with the development of a hyperinflammatory immune response, called multisystem inflammatory syndrome. At the same time, clinical studies of the pathogenesis of COVID-19 in adults and children and the search for optimal methods of therapy for thrombus inflammation, which underlies the pathogenesis of COVID-19, continue. 

OCCUPATIONAL DISEASES

154-162 1162
Abstract

Background. The severity of the course of silicosis is aggravated by the addition of complications; one of the serious and rare complication of silicosis is silicoarthritis or Kaplan’s syndrome (KS), which accounts for 0.1-0.6% of all cases of silicosis. Silicoarthritis significantly reduces the quality of the life of patients and leads to early and persistent disability.

Aim. To establish the most significant methods of diagnosing silicoarthritis for early detection of the disease and prevention of complications.

Materials and methods. The article presents clinical cases of silicosis and its rare complication - SC. The basis for the diagnosis of this pathology is X-ray, immunological and functional methods.

Results. In patients with more than 5 years of experience exposed to aerosols of fibrogenic action, crystalline silicon dioxide, with an excess of the MPC level from 2.3 to 4 times on the basis of MSCT of the lungs, during which multiple polymorphic foci with a diameter of 2 up to 10 mm, partly merging with each other into peribronchovascular couplings, as well as perifocal areas of reduced airiness like ground glass and thickening of the axial interstitium, a diagnosis of late silicosis, stage 2 nodular form was established, the diagnosis was confirmed by biopsy data. In dynamics, after 5 years, arthralgic complaints joined. On the basis of immunological (increased TNF-alpha, IL-1b), X-ray examination (osteoarthritis of the distal and proximal interphalangeal, wrist, metatarsophalangeal joints), the diagnosis was clarified as Silicoarthritis: Kaplan’s syndrome.

Conclusion. Diagnosis of silicosis and its complications at the preclinical stage in workers who have been in contact with silica dust for 5 years or more should include: MSCT of the lungs, determination of TNF-alpha, IL-1b, rheumatoid factor, and a study of respiratory function.

PSYCHOLOGY AND PSYCHIATRY

163-173 1249
Abstract

Background. In modern society, the growth of the overweight and obese population increase every year. This confirms the status assigned to the problem under consideration as a non-infectious epidemic of the 21st century. At the same time, the amount of scientific information about the influence of excess weight on various aspects of human life is actively increasing. This undoubtedly requires a systematic generalization of the available data.

Aims. The presented literature review is devoted to the analysis of modern scientific research on the specificity of cognitive impairment in overweight and obese people.

Materials and methods. Information search was carried out using Internet resources (PubMed, Web of Science, eLibrary.ru, frontiersin.org, sciencedirect. com, ncbi.nlm.nih.gov), literature sources were analyzed for the period from 2001 to 2020 for the following keywords: obesity, overweight, cognitive functions, cognitions, cognitive impairments.

Results. As a result of the literature review, the main directions of research on the relationship between cognitive impairment and overweight, as well as the relationship between cognitive dysfunction and obesity, were identified. The specificity of diametrically opposed opinions within the framework of each consecrated trend is presented. According to the results of the analysis of the identified areas, in the scientific community the most common point of view is the presence of a connection between obesity and cognitive impairment. In this connection, the authors identified the main cognitive impairments associated with excess weight and their mediating mechanisms. And also the age specificity of the problem under study is indicated.

Conclusions. Despite the fact that the problem of the relationship between obesity, overweight and cognitive functions is comprehensively studied, there is a shortage of data on the state of thinking, attention, praxis, gnosis, and speech in overweight people.

TRAUMATOLOGY

174-184 1105
Abstract

Introduction. Epidural fibrosis is an urgent problem in modern spinal surgery and orthopedics. The formation of connective tissue in the epidural space after performing surgical interventions on the spinal column inevitably leads to adhesion of the latter to the dura mater and compression of neural structures, followed by the formation of clinical and neurological symptoms. The  search for literary sources in domestic and foreign scientific databases has demonstrated the presence of several works studying the effectiveness of barrier methods for preventing the development of epidural fibrosis. It should be noted that the results of these studies are ambiguous and largely contradictory.

The purpose was to study the effectiveness of using a spatially cross-linked polymer in the postoperative lumbar epidural fibrosis prevention in an experiment.

Materials and methods. The study included 26 male Wistar rats (average body weight 338.5±9.07 g), which were divided into two groups: Group I (control, n = 12): animals underwent laminectomy at the level of vertebral bodies LVII – SI  without application of spatially crosslinked polymer; Group II (experimental, n = 14): animals underwent laminectomy at the level of vertebral bodies LVII – SI  followed by application of a spatially cross-linked polymer to the dura mater. The morphological and instrumental parameters were studied.

Results. Significant differences were noted in the severity of epidural fibrosis (χ2 = 14.846, p = 0.003), the number of newly formed vessels (F = 14.371, p<0.001), the number of fibroblasts (F = 11.158, p<0.001), as well as in the severity of vertebral stenosis channe l according to multislice computed tomography (χ2 = 17.207, p=0.002) between the control and experimental groups of animals.

Conclusion. Application of a spatially cross-linked polymer to the dura mater is an effective way to prevent the development of postoperative epidural fibrosis.

185-192 1087
Abstract

The destabilization of bone fixators has led to repeated surgical interventions that increased the risk of migrations of metal fixators, infectious and inflammatory complications as well. The modern trends in hip bone injury surgery are related to developing and using of metal fixators, which are effective in acute injury; however, sometimes the condition of the patient and the technical support of hospitals don’t allow performing surgery in the acute period, and these metal fixators are ineffective for chronic damage. Consequently, until now, the problem of finding the optimal design of structures for fixing chronic damage of anterior pelvic semi-ring which will be able to exclude its destabilization, is still of current interest.

The purpose of the study: developing and experimental researching of durable features of original plate for reconstruction of the anterior pelvic semi-ring.

Materials and methods: In order to ensure stable fixation of chronic pelvic injuries, the original metal plates have been worked out. They are made individually in accordance with the anatomical and functional structures of the anterior pelvic semi-ring of the patient with using additive technologies. The study of the reliability of the different variants of ostiosynthesis of the anterior pelvic semi-ring with using well-known pelvic plates and a new original design was carried out. Stability tests for different plate fixing methods and mechanical strength of metallophyxators were carried out on a universal test machine of LFM-50kN series.

Results: one plate fixation in tensile test showed the lowest result – 0.341 kN, a low result of shear loads was received with the same object. The best result was shown by the polyaxial monolithic plate fixation in case of stretching – 0.51 kN at the shear loads – 0.591 kN. Necessary force applied to destabilizing of the metal structure while using a polyaxial monolithic plate was a half-higher than stretched, and a third higher than at shear loads, it demonstrates the benefits of using these metal fixators.

Conclusion: It is experimentally confirmed that the polyaxial monolithic plate provides the highest stability of fixing anterior pelvic semi-ring indicator in contrast with fixing of one or two plates.

193-208 1543
Abstract

Idiopathic scoliosis is a severe pathology of the musculoskeletal system that affects children and adolescents all over the world. The disease occurs in approximately 0.2-0.6% of the general population, and is the largest subgroup of spinal curvature in humans (70-90% of all known scoliosis cases). In idiopathic scoliosis, a threedimensional deformation of the vertebral column is formed, leading to the formation of a rib hump, curvature of the ribs and chest, asymmetry of the pelvis and impaired development of internal organs. The main feature of the disease is the spontaneous development of deformity during the growth of the child and the tendency to progress. Scoliosis is not only an orthopedic disease, but also a ignificant cosmetic, and, consequently, a psychological and social problem.
The standard of treatment for scoliotic disease remains unchanged for a long time: observation, corset treatment and surgical correction. The prognosis for the development of pathology varies depending on the degree of deformation. The corset-therapy, hospitalization, surgery and treatment of chronic back pain have a negative impact on the psychoemotional state of children and adolescents. Despite significant advances in the methods of diagnosis of deformity, improvement of surgical treatment methods and in the study of pathogenesis, the etiological factor of pathology is still unknown. The search for the causes of idiopathic scoliosis covers almost all aspects of its possible origin: genetic, environmental, hormonal, metabolic, biochemical, neurological, and others. In recent decades, relevant theories of the development of scoliosis have been formulated, but none of the theories reveals the essence of the pathological process and has no clear justification. The greatest number of supporters is the genetic theory: genetic factors play a key role in the occurrence and development of idiopathic scoliosis. Understanding the underlying factors of the disease will enable prevention, early diagnosis, and identification of the risk groups of the patients in question.

SURGERY

209-215 1550
Abstract

 Pylephlebitis is a rare and potentially lethal complication of acute appendicitis. It leads to the development of liver abscesses and sepsis. Usually, this  complication is the result of late diagnosis. Only rare cases of successful treatment of pylephlebitis in the context of acute appendicitis are published in special literature.
The aim of the demonstration is to analyze of the diagnosis and medical tactic mistakes as a case of pylephlebitis in a patient with acute appendicitis; show the possibilities of modern methods of diagnosis and treatment, which made it possible to achieve a success.
The case of successful treatment patient with pylephlebitis was shown in the article. Late diagnosis of acute appendicitis was associated with the patient’s refusal and with some diagnostic and tactic mistakes that were analyzed. The case presented by jaundice, liver failure and fever. Thrombosis of portal vein diagnosed by U/S, CT scan with intravenous contrast on day 11 of the illness. Appendectomy was performed. Intensive care with extracorporeal therapy, antibacterial and anticoagulant therapy were also provided. Septic thrombosis  of portal vein was complicated by an abscess of the right lobe of the liver and sepsis. 
The case of successful treatment of patient with septic thrombosis of portal vein and superior mesenteric vein complicated by liver abscess and sepsis is considered in the article. Intensive therapy, extracorporeal detoxification and abdominal abscess drainage under the U/S control have resulted in a fully  repatency of portal vein that was confirmed by CT scan data. 

ECONOMICS AND HEALTHCARE MANAGEMENT

216-226 1200
Abstract

The pandemic of COVID-19, the threat of technogenic and anthropogenic character, brought to the foreground non-market aspects of the general, corporate branch culture and strategy in medicine and health care. Therefore, in many countries, despite differences in state and private property ratios in health infrastructure, the state priority is ensuring cooperation within the national health care system which capable quickly and well-coordinated work in the extremely dangerous epidemics conditions and other emergency situations. The purpose of this article is discussing a problem of public and private models of medical care organization in Russian health care system.
Materials and methods. Content analysis methods, economical and statistical analysis, information and analytical materials of the Russian and foreign news agencies, a summary across Russia of Rosstat form No. 62 of the state statistical observation «Data on resource providing and on delivery of health care to the population» (legal entities - the medical organizations which are carrying out activity in the sphere of compulsory health insurance), analytical materials and statistical data of World Health Organization (The European portal of information of health care of WHO: https://gateway.euro.who.int/en/hfa-explorer/), statistical data and metadata on the countries of the Organization for Economic Cooperation and Development (OECD, https://stats.oecd.org/), the materials of monographic researches and periodicals including placed on the Internet were used in this article.
Results: the system of compulsory health insurance is an ancestor of the program of the state guarantees of free medical care of in Russian citizens. The length of the text of this Program so far was increased in 130 times in comparison with initial edition of 1998. At the same time, there is still no clear delineation for the bases, volumes and conditions differentiation of free and paid medical care rendering. As a result, the major human right to free medical care remains not completely realized. The numbers of the non-state medical organizations to provide free of charge medical care to the population according to the policy of obligatory medical insurance (i.e. financed from the state sources) in the period of 2011 to 2019 – from 648 to 2423 organizations respectively were increased in Russia four times. This demonstrates the creation of the new, «integrated» model of health care in Russia in the mode of public and private partnership for deciding of social tasks. Although, free medical care for citizens in the private medical organizations is not mentioned in the Constitution of Russian Federation (Main Law). In emergency situations such integration allows private medical structures to involve capacities and also be coordinated with one of the tasks of the Ministry of health target program «Development of the Fundamental, Transmitting and Personalized Medicine».
Conclusions. There is a formation of the integrated, public and private (hybrid) model of health care in modern Russia that needs developing of a new partnership and principles of management in the sphere of medical care organization. State policy in the health care financing sphere should be directed not only to the state guarantees of medical care specification, but also to a gap in social and economic inequality reduction. The social protection systems should be focused, first of all, on people who are most in great need of medical care. For the protecting population from catastrophic payments for medical care, it is necessary to bring the concept of the social standards - a number of the general rules, norms and standards which must guarantee the state ensuring constitutional rights of citizens to free medical care in the health care legislation.

EPIDEMIOLOGY

227-238 1409
Abstract

Purpose. Determination of the SARS-CoV-2 population humoral immunity among the population of the Krasnoyarsk Territory during the COVID-19 epidemic.

Materials and methods. The study was carried out as a part of project for assessing population immunity to SARS-CoV-2 among the population of Russian Federation using unified methodology developed by Rospotrebnadzor, with the participation of the Research Institute for Epidemiology and Microbiology named by Pasteur, and taking into account the recommendations of the WHO. The work involved 2907 volunteers, selected by the online survey and randomization by age and territory. All volunteers were divided into 7 age groups: 1–17, 18–29, 30–39, 40–49, 50–59, 60–69, 70 and older (70+), including a total 246–449 people. Population immunity testing was carried out during the formation of groups (1st stage), and then twice more, with the interval of 6–8 weeks. Serum was obtained from venous blood samples obtained from volunteers, in which antibodies to the SARS-CoV-2 nucleocapsid were determined by the enzyme immunoassay. The results were analyzed by methods of nonparametric statistics: median, interquartile range, rank correlation coefficient were calculated in the Excel statistical package. The confidence interval to seroprevalence indicators (95% CI) was calculated using the WinPepi statistical package (version 11.65). The statistical significance of the differences was assessed with a probability level of p ≤ 0.05.

Results. The seroprevalence of the population of the Krasnoyarsk Territory during the 5-month period of seromonitoring had increased 3.3 times from 12.8% (95% CI 11.3–14.4) to 41.7% (95% CI 39.4–4.0) , while the grouping by age had not revealed any peculiarities throughout the study. The trend towards a decrease in the incidence was formed on the 6th week of 2021. The seroprevalence of convalescents after COVID-19 during the initial testing was 61.5% (95% CI 40,6–79.8), among those who were in contact with patients with COVID-19 or convalescents –23.8% (95% CI 13.9–36.2) . Among the volunteers, 347 seropositive persons were identified, 324 of which were observed asymptomatic course.

Conclusion. The structure of the population humoral immunity to SARS-CoV-2 of he population of the Krasnoyarsk Territory has been investigated. It was found that an increase in seroprevalence to 41.7% (95% CI 39.4–4.0) was accompanied by a decrease in morbidity.



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ISSN 2541-9420 (Print)
ISSN 2587-9596 (Online)