bluuebunny/crossref_metadata_2025 huggingface dataset:
Cytomorphological characteristics and cytokine profile of induced sputum and nasal secretions of children with community-acquired pneumonia and acute bronchitis
Authors: Galimova L F , Pikuza O I , Agafonova E V
Published: November 2019

Aim. To characterize the mechanisms of nonspecific airway inflammation using the parameters of induced sputum and nasal secretions in children with community-acquired pneumonia and acute bronchitis. Methods. A total of 100 children aged 7 to 16 years with acute respiratory system diseases including 49 patients with community-acquired pneumonia and 51 patients with acute bronchitis were examined. The control group consisted of 25 healthy children and was age- and gender-comparable. The cellular composition, degree of neutrophils and epithelial cells destruction, and cytokines levels both in nasal secretions and in induced sputum were measured. Results. The increase of neutrophils number was accompanied by a high degradation degree in induced sputum оf children with community-acquired pneumonia in contrast to children with acute bronchitis. A simultaneous decrease of alveolar macrophages number was observed. An increase of pro-inflammatory cytokines levels (interleukine-8, -17 and tumor necrosis factor α) with a marked decrease of anti-inflammatory cytokine level (interleukine-10), characteristic for community-acquired pneumonia, correlated with the degree of cell components degradation and depend on the morphological forms of inflammatory lung disease. Conclusion. With increasing severity of inflammation in the respiratory tract number of destructive changes of neutrophils also increases and disbalance of pro- and anti-inflammatory cytokines deepens.
Influence of triphenyltetradecylphosphonium bromide on the Na+-Li+- countertransport rate in the erythrocyte membrane in patients with genetically different permeability of cell membranes to sodium
Authors: Orlova O V , Oslopov V N , Sidullina S A
Published: November 2019

Aim. To study the influence of triphenyltetradecylphosphonium bromide [(PPh)3P+C14H29] Br- on the cell membranes permeability to Na+ by determining the rate of Na+-Li+-counter transport in erythrocyte membrane depending on it’s variable initial condition. Methods. Blood samples of 10 healthy volunteers with different Na+-Li+-counter transport rate distribution in erythrocyte membrane were analyzed: I quartile (5 subjects) - low permeability, III quartile (5 subjects) - moderately high permeability. Results. Na+-Li+-counter transport rate change in erythrocyte membrane under the influence of triphenyltetradecylphosphonium bromide depends on genetically determined initial membrane permeability. In subjects belonging to III quartile of Na+-Li+-counter transport the initial membrane permeability is high, and after administration of 0.001 and 0.005 μM concentrations of [(PPh)3P+C14H29] Br- membrane permeability to Na+ increased. In subjects belonging to I quartile of Na+-Li+-counter transport (low initial permeability) [(PPh)3P+C14H29] Br- did not alter membrane permeability to Na+. Conclusion. Triphenyltetradecylphosphonium bromide increases erythrocyte membrane permeability to Na+ in subjects belonging to III quartile of Na+-Li+-counter transport and dose not influence subjects belonging to I quartile of Na+-Li+-counter transport.
Rational use of medicines: contribution to development of healthcare systems
Authors: Shaydullina L Y , Ziganshina L E
Published: November 2019

Development of World Health Organization (WHO) Rational Use of Medicines concept internationally and its implementation in the Russian Federation is reviewed. The need to consolidate efforts for the introduction of the WHO-developed strategy for the use of medicines improvement is explained. The WHO strategy to improve the use of medicines is described. Abundance of medicines, medicinal products and various formulations of the same active substances, as well as of promotional materials, which often mislead healthcare community and consumers, requires establishment of a system promoting effective and safe use of medicines and ensuring access to essential medicines of all members of the society. The factors which contribute to irrational use of medicines, avoidable causes, and consequences of irrational use of medicines are presented. Current situation in the Russian Federation regarding the use of medicines: legal and regulatory framework, the results of the registration process, documents valid on a national level and in particular regions that determine pharmaceutical policy is described in detail. Methodology of assessing prescribing practices and medicine consumption recommended by the World Health Organization for implementation and use globally is revealed. The implementation of the WHO concept of the rational use of medicines in the Republic of Tatarstan is described as an example. An illustration of the authors’ findings on effects of clinical pharmacology services on containment of medicines’ costs at the level of internal diseases department of municipal hospital is presented. The leading thesis of WHO Rational Use of Medicines concept - the establishment of independent multidisciplinary regional structures responsible for the quality use of medicines - is substantiated.
Alteration of medical radiation exposure annual collective effective dose of the population of Tatarstan from 1998 to 2010
Authors: Ryzhkin S A , Ivanov S I , Patyashina M A , Ismagilov R K
Published: November 2019

Aim. To find out the contemporary principles of collective effective dose of medical radiation formation gained due to medical X-ray and radiological examinations. Methods. Data analysis of radiation and hygiene passports of Republic of Tatarstan territory for the period from 1998 to 2010 was fulfilled. Change of healthcare radiation sources number over time was defined. Number of performed medical X-ray and radiological examinations, average patient’s individual and total effective radiation doses were compared. Results. The number of medical X-ray and radiological examinations increased annually. The rate of different X-ray and radiological examinations as well as gained total effective radiation doses has changed significantly during the analyzed period of time. Use of digital technologies in radiology allowed to decrease average patient’s individual doses to 0.16 mSv for chest photofluorography and to 0.15 mSv for standard X-ray. In recent years, X-ray computed tomography is the largest contribution (40.6%) to the collective effective medical exposure dose of the population. Conclusion. Ionizing radiation use in medical practice remains one of the leading sources of the combined population radiation, primarily due to modern X-ray and radiological examinations; it requires attention and development of special arrangement, technical, prevention measures to decrease unfavorable influence of radiation to population.
Modern death risk factors in patients with community-acquired pneumonia
Authors: Povalyaeva L V , Borodulin B E , Borodulina E A , Chernogaeva G Y , Chumanova E S
Published: November 2019

Aim. To study death risk factors in patients with community-acquired pneumonia in municipal hospitals in Samara. Methods. 75 cases of deaths of patients hospitalized because of community-acquired pneumonia were studied (study group), 300 convalescent patients with community-acquired pneumonia discharged from the hospital were included in the control group. The retrospective comparative «case control» study was performed. Results. Mean age of the patients who died was 47.4±2.2 years; men were more prevalent (70.6%), time since admission date till death was 6.5±2.5 days, more than a third (36.0%) died before 24 hours after admission. The study group contained significantly higher number of unemployed (72.0%) and intravenous drugs users (16.0%). HIV infection was found in 37.3% of the patients who died, compared to 19.6% prevalence in control group. Multifactorial logistic regression of clinical signs revealed the following death risk factors in patients with community-acquired pneumonia: infiltrates on X-ray involving more than one lung lobe, arterial hypotension (systolic blood pressure ≤100 mm Hg, diastolic blood pressure ≤60 mm Hg), tachypnea (breath rate over 25 per minute). Conclusion. Factors having the highest positive prognostic value for a lethal outcome at patients with community-acquired pneumonia are: late admission, multilobar pneumonia; arterial hypotension; tachypnea; HIV infection, social unemployment and male gender.
Features of static, paralytic and iatrogenic foot joints deformities diagnosis and treatment
Authors: Ezhov M Y , Batalov O A , Ezhov Y I
Published: November 2019

Aim. To evaluate the efficiency of treating patients with orthopedic foot diseases for previous 30 years, including treatment using high technology methods. Methods. 700 patients aged from 16 to 85 years underwent surgical treatment. All foot state parameters were scored using a 10-point grading system. To specify the transversal arch parameters, computed tomography and magnetic resonance tomography were performed. To assess the general condition of the foot, vascular ultrasound, electroneuromyography, biomechanical examination using ink print mats and podometry. In treating patients with hallux valgus in most of the cases (55%) straightening surgery of first metatarsus partial removal at proximal epiphysis was preferred. First metatarsophalangeal endoprosthesis, orhtopedic casts and various types of osteotomy for hallux valgus straightening were also used. Results. Patients had the mean total foot condition score at 31.3 points (normal range is upper than 50) indicating grade II-IV, after the surgical treatment the mean total foot condition score was 46.7 points in 91.6% of treated patients. Inappropriate staging of surgical treatment has leaded to inadequate treatment outcomes, in particular, surplus caput osteotomy of first metatarsus leaded to first metatarsophalangeal joint osteoarthritis progression and to hallux varus development. Conclusion. Appropriate pre-surgical planning and use of high technology methods of surgical treatment allows to compensate even advanced foot deformities.
Pathogenetic treatment of the patient with splenic marginal zone lymphoma complicated by Evans syndrome
Authors: Romanenko N A , Bessmeltsev S S , Abdulkadyrov K M
Published: November 2019

A case report of a patients with splenic marginal zone lymphoma, in whom clinical remission was initially achieved by 5 continuous courses of combined treatment with fludarabine 25 mg/m2 and cyclophosphamide 350 mg/m2 at days 1-3. Nevertheless, 6 months after patient developed a clinical picture of Evans syndrome, characterized by severe hemolytic anemia, thrombocytopenia and neutropenia. Corticosteroid treatment accompanied by blood transfusion was initiated, the effect was marginal and short-lasting. Switch to rituximab monotherapy allowed to archieve complete clinical and hematological remission with full blood count parameters reversal.
Puncture drain interventions in treatment of acute pancreatic necrosis
Authors: Korymasov E A , Krichmar A M , Dzharar R M
Published: November 2019

Aim. To define the prognostic factors for puncture drain interventions efficiency and of an optimal time point for the open surgeries. Methods. Surgical treatment results in 56 patients with acute pancreatic necrosis are described. The first group (28 patients) included the patients treated only by. The second group (28 patients) included the patients who underwent puncture drain interventions with further open surgery. Puncture drain surgery efficiency was evaluated using laboratory data and results of instrumental examinations. Results. Body temperature, leukocytosis and a «left shift» on a white blood cell count performed not later than 7 days after the surgery were the key factors for assessing the puncture drain surgery efficiency. During the first 7 days after surgery the body temperature has come to normal in 100% of patients from the first group and in 30% of patients from the second group (c2=15,83, р 0,0005), in other 70% of patients from the second group the body temperature has come to normal later than 7 days after surgery. White blood cell count has come to normal during the first 7 days after surgery in 75% of patients from the first group and in 0% of patients from the second group (c2=11,14, р 0,0016), in 25% of patients from the first group and in all patients from the second group it has only came to normal range at least 7 days after surgery. A marked «left shift» during the first 7 days after surgery was registered in 50% of patients from the first group and in 0% of patients from the second group (c2=6,12, р 0,05), in 50% of patients from the first group and in all patients from the second group it has only came to normal range at least 7 days after surgery. A conservative approach should be preferred if these parameters improve over time and no significant changes in pancreas are seen on computed tomography, otherwise, especially when there are the signs of incomplete debridement on the computed tomography, an open-access surgery should be performed. Conclusions. Puncture drain intervention may be an independent and final method of surgical treatment or may become the first stage of combined surgical treatment in patients with acute pancreatic necrosis. Indications for an open-access surgery should be assessed 7-8 days after the puncture drain surgery was performed if no positive change of laboratory data is seen.
Markers of ischemic neuronal damage, neurological complications of carotid endarterectomy and their management depending on anesthesia type
Authors: Shmelev V V , Neymark M I
Published: November 2019

Aim. to identify the anesthesia method for carotid endarterectomy providing minimal ischemic neuronal damage and decreasing the number of post-surgical complications; to adjust the optimal treatment for associated neurological disorders. Methods. An assessment of anesthesia methods was performed in 190 patients who underwent the carotid endarterectomy. The intravenous anesthesia with propofol (first group, 60 patients), regional anesthesia using deep cervical plexus block (second group, 60 patients), and inhalational anesthesia with sevoflurane (third group, 70 patients) were compared. Brain perfusion parameters, neurological status, ischemic neuronal damage markers were examined. Results. In patients undergoing carotid endarterectomy an ischemic neuronal damage is provoked due to brain perfusion decrease as a result of common carotid artery clipping regardless of anesthesia method. Inhalational anesthesia was associated with relatively lower ischemic neuronal damage markers levels. Some patients form every group have developed serious post-surgical neurological complications (stroke, transient cerebral ischemic attack, neurological status deterioration). Post-surgical complications were registered in 10 (16.7%) patients from the first group, in 9 (15%) patients form the second group, in 3 (4.3%) patients from the third group. Citicoline was the most effective drug for associated neurological disorders treatment. Conclusion. Inhalational anesthesia with sevoflurane compared to intravenous anesthesia with propofol and regional anesthesia using deep cervical plexus block limits the neuronal damage and is associated with lower number of post-surgical neurological complications, which can be treated with citicoline.
Blood and vitreous humor cytokine profile in patients with proliferative diabetic retinopathy and post-vitrectomy hemophthalmia
Authors: Putienko A A , Pogorely D N
Published: November 2019

Aim. To study vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β) and interleukin-1 receptor antagonist (IL-1RA) blood and vitreous humor levels in patients with proliferative diabetic retinopathy (PDRP) and post-vitrectomy hemophthalmia. Methods. 82 patients (82 eyes) with PDRP and post-vitrectomy hemophthalmia present 2 months (from 55 to 78 days) after performed vitrectomy were examined. Results. In patients with proliferative diabetic retinopathy (PDRP) and post-vitrectomy hemophthalmia VEGF blood level remained normal in 92.7% of cases, TNF-α blood level was normal at all times, blood level of IL-1β was within normal ranges in 93.8% of cases, and IL-1RA blood level was decreased in 74.4% of cases. Vitreous humor level was above normal ranges for VEGF - in 84% of cases, for TNF-α - in 9,9% of cases, IL-1β vitreous humor level was within reference ranges at all times, and IL-1RA vitreous humor level was decreased in 84.1% of cases. Conclusion. The gained data indicates further vascular proliferation in the eye cavity as a leading factor for hemorrhage relapses, despite the vitrectomy performed.
To the issue of normalizing the heart rhythm in patients with mitral valve disease complicated by atrial fibrillation
Authors: Yambatrov A G , Medvedev A P , Chiginev V A , Zhurko S A , Pichugin V V
Published: November 2019

Aim. To examine an opportunity of sinus rhythm recovery in patients with mitral valve disease and atrial fibrillation (AF) by the means of surgery and concomitant procedures. Methods. 180 patients with AF who underwent mitral valve surgery using cardiopulmonary bypass in 2007-2011 were examined. Patients’ mean age was 52.5±0.5 years, 71 (39.4%) were male, 109 (60.6%) - female. Patients were divided into 3 groups: 22 patients with paroxysmal AF were included in Group I. 109 patients with persistent AF who underwent mitral valve surgery only were allocated to the Group II. 49 patients with persistent AF who underwent additional pulmonary vein isolation (radiofrequency ablation) were included in the Group III. Results. 83 (46.1%) of patients had single mitral valve disease, 62 (34.4%) of patients had multiple valve disease with involvement of tricuspid valve, 21 (11.7%) of patients had multiple valve disease with involvement of aortic valve, 21 (11.7%) of patients had all abovementioned valves involved. Mean arrhythmia duration was 36.3±3.8 months. Sinus rhythm was restored during the surgery in 16 (72.7%) patients of the Group I, in 60 (55.0%) patients of the Group II, in 41 (83.7%) patients of the Group III. Sinus rhythm was still registered at the discharge in 14 (63.6%), 19 (17.4%) and 13 (26.5%) respectively. Conclusion. It is possible to recover and hold regular rhythm in early postoperative period in more than 60% of cases in patients who underwent surgery for mitral valve disease and concomitant paroxysmal AF. Simultaneous radiofrequency ablation performed in patients with persistent AF increases sinus rhythm recovery rate in first day after surgery.
Cardiomyocyte apoptosis in vasorenal hypertension as a consequence of catabolism error
Authors: Azova M M , Blagonravov M L , Frolov V A
Published: November 2019

Aim. To investigate the effects of phosphocreatine and ethylmethylhydroxypyridine succinate on cardiomyocyte apoptosis intensity and degree of ventricular cardiomyocytes hypertrophy in rabbits with vasorenal hypertension (VH) model. Methods. VH was modeled on rabbits by artificial abdominal aortic stenosis by one-third of the diameter just above the renal arteries arising. Rabbits were divided to 4 groups: rabbits with 4-week VH without treatment, rabbits with 4-week VH treated with phosphocreatine, rabbits with 4-week VH treated with ethylmethylhydroxypyridine succinate, and healthy rabbits (control group). Cardiomyocyte apoptosis intensity and degree of ventricular cardiomyocytes hypertrophy was assessed in all of the rabbits by evaluation of nuclear-cytoplasmic ratio. Results. Use of phosphocreatine or ethylmethylhydroxypyridine succinate led to a significant reduction of the apoptotic index in the left ventricular myocardium, whereas the similar effect on the right ventricle was only typical for phosphocreatine. None of these drugs had an effect on myocardial hypertrophy degree, which remained on the same level as in the untreated hypertensive animals. Conclusions. Energy deficiency is one of the factors inducing cardiomyocyte apoptosis, so administration of phosphocreatine or ethylmethylhydroxypyridine succinate might be an important component of heart failure prevention and treatment in hypertension. Myocardial hypertrophy has no effect on the cardiomyocyte apoptosis intensity in case of proper energy supply.
The who concept of essential medicines and the who ethical criteria for medicinal drug promotion: history and lessons for domestic pharmaceutical sector
Authors: Ziganshina L E , Niyazov R R , Ziganshin A U
Published: November 2019

The review covers the history and evolution of the WHO initiatives in pharmaceutical policy - for better and safer use of medicines, their scientifically based selection and ethical promotion. The WHO Concept of Essential Medicines, the WHO vision of the Rational Use of medicines and the WHO Ethical Criteria for Medicinal Drug Promotion are reviewed. Contribution of these WHO designed initiatives, definitions and documents to Global Health, particularly relating to modern Russian health system problems is discussed. The principles and methodology of drug selection are presented. The review describes health system benefits of the WHO Essential Medicines Concept implementation at a national level. Advantages of the WHO Model List of Essential Medicines use not only as a model product, but as a model process and an healthcare instrument are emphasized. The WHO principles of the Rational Use of Medicines, the history of its International development, the WHO key strategies towards the Rational Use of Medicines and the major barriers on the way are described. The history of the WHO Ethical Criteria for medicinal drug promotion development is presented in line with the basic principles and objectives of this unique international document. The core goal of the WHO Ethical Criteria is to improve health and healthcare through the rational use of medicines. The global implementation of the WHO Essential Medicines Concept and the ever growing barriers to the rational use of medicines and advances in public health, as well the advances and problems of the Russian national health system, are discussed in the historical perspective.
Clinical features and prognosis in patients examined in medical and social expertise bureaus due to peptic ulcer disease
Authors: Soshina A A , Sergeeva V V , Zinyaeva T V
Published: November 2019

Aim. To study the clinical features, disability degree and expert examination results in patients with peptic ulcer disease. Methods. Acts of expertise of patients with peptic ulcer disease (gastric ulcer - 44 patients, duodenal ulcer - 47 patients) performed in medical and social expertise bureau on internal diseases of Saint-Petersburg, Russia from 2009 to 2011 were examined. Results. The most frequent peptic ulcer disease risk factors found in both of the groups were: predisposing diet and dietary habits (65.9% of patients with gastric ulcer, 78.7% of patients with duodenal ulcer), smoking (53.2 and 63.6% respectively), stress (70.5 и 87.2% respectively). In 10 (22.7%) patients with gastric ulcer and in 38 (80.9%) patients with duodenal ulcer peptic ulcer disease was associated with presence of Helicobacter pylori. There was a combination of predisposing factors in a majority of patients. In most of the cases a moderate activity and a long term of the disease was registered. Complications were diagnosed in 30 (68.2%) patients with gastric ulcer and in 27 (57.4%) patients with duodenal ulcer, most frequently: gastrointestinal bleeding - 19 (43.2%) and 12 (25.5%) patients respectively, gastric outlet obstruction - 10 (22.7%) and 9 (19.2%) patients respectively. According to the medical and social expertise algorithm 19 (43.2%) patients with gastric ulcer and 17 (36.2%) patients with duodenal ulcer were primarily rated as disability degree III, 3 (6.8%) and 2 (4.3%) patients respectively - as disability degree II. Contraindicated jobs and labor conditions, low labor, functional and social status were the reasons of setting up the status of disabled. Conclusion. The preliminary data show that peptic ulcer disease is not only a medical, but a major social problem, requiring novel treatment and prevention methods, as well as personal rehabilitation programs development and improvement.
Metabolism of quantity elements and essential trace elements in patients with essential arterial hypertension in different ecological settings
Authors: Khabibrakhmanova Z R , Makarova T P , Sadykova D I
Published: November 2019

Aim. To study the specifics of lead, zinc, copper, magnesium and calcium metabolism in children and adolescents with essential arterial hypertension living in different ecological settings. Methods. 100 children and adolescents aged 13-17 years with arterial hypertension, living in «industrial» (52 patients) and «residential» (48 patients) areas were examined in cardiology ward. 33 healthy children and adolescents comparable by age and gender were included as healthy controls. According to 24-hour blood pressure monitoring, groups with stable, labile arterial hypertension and «white coat hypertension» were formed. The levels of elements in 24-hour urine and in serum were measured by atomic absorption spectrophotometry. Results. In children and adolescents with stable arterial hypertension living in industrial areas, parameters of 24-hour blood pressure monitoring (mean 24-hour and mean daytime systolic blood pressure values, time of systolic hypertension, mean 24-hour and mean daytime blood pressure values) were higher compared to the same parameters in children from residential areas, the difference was statistically significant. The study of elements metabolism revealed increased lead exposure in children with essential arterial hypertension living in industrial areas, and misbalance of essential elements in those patients compared to the same parameters in children from residential areas. Conclusion. Results suggest increased exposure to arterial hypertension and marked misbalance of essential elements in children and adolescents with essential arterial hypertension living in industrial areas.
Arterial stiffness of peripheral vasculature in patients with chronic obstructive pulmonary disease and its association with arterial hypertension
Authors: Gajnitdinova V V , Bakirov A B , Akhmetzyanova E Kh , Berdikaeva N F , Zakirova V B
Published: November 2019

Aim. To study the structural and functional state of vascular wall, arterial stiffness of large peripheral arteries (common carotid arteries, renal arteries) in patients with severe chronic obstructive pulmonary disease and its association with arterial hypertension. Methods. The study included 67 patients of working age, mainly males, having chronic obstructive pulmonary disease. Among them, 52 patients had severe chronic obstructive pulmonary disease (defined by GOLD III, 2011), 15 had concomitant arterial hypertension of I and II stage. Structural and functional status of common carotid arteries, renal arteries was assessed by measurement of intima-media thickness, arterial stiffness indexes were calculated. Arterial elasticity indices: arterial compliance, elastic index, Young’s elastic modulus were calculated based on the results of ultrasonography of main arterial wall parameters (diameter, arterial wall thickness) and blood pressure measurement. Results. A decrease in common carotid arteries and renal arteries wall elasticity was revealed in patients with chronic obstructive pulmonary disease. Increase of stiffness index in patients with severe chronic obstructive pulmonary disease associated with arterial hypertension, marking the decreased arterial wall elasticity, was registered both in common carotid arteries and renal arteries. Conclusion. In common carotid arteries vascular wall thickness contribute the most in vascular wall stiffness increase, compared to altered hemodynamics in renal arteries. Development of arterial hypertension in these patients is a predicting factor for further large vessel remodeling associated with hypoxia.
Cytokine profile in adolescent girls with candidal vulvovaginitis
Authors: Ziyadullaev U Kh
Published: November 2019

Aim. To establish the pathogenic value of serum cytokine (interleukin-6 and interleukin-8) production in patients with candidal vulvovaginitis to optimize diagnostic and therapeutic approaches. Methods. 74 adolescent girls suffering from candidal vulvovaginitis aged from 12 to 19 years were examined. The diagnosis of candidal vulvovaginitis was verified according to the international classification of World Health Organization (ICD-X codes B37.3 and N77.1). At the stage of clinical examination, medical and general history was analyzed, general and gynecological examination was performed. The diagnosis of candidiasis was confirmed by the presence of vegetative forms of Candida spp. (budding yeast cells, pseudomycelium and/or mycelium) in Gram-stained smears from the mucous membranes of the vulva, urethra. The control group consisted of 20 healthy patients of appropriate age and sex. Serum levels of interleukin-6 and interleukin-8 were measured by enzyme-linked immunosorbent assay using «ELISA interleukin-6» and «ELISA interleukin-8» test systems (ZAO «Vector-Best», Russia). Results. The study has shown increased serum levels of interleukin-6 in adolescent patients with candidal vulvovaginitis. Interleukin-6 level in peripheral blood was significantly higher in patients with candidal vulvovaginitis (21.7±2.4 pg/ml) compared to controls (9.4±1.5 pg/ml, p 0.02). Serum interleukin-8 level was also significantly higher (51.2±2.1 pg/ml) in patients with candidal vulvovaginitis compared to controls (23.9±1.04 pg/ml, p 0.01). Conclusion. The revealed features of interleukin-6 and interleukin-8 production may be used as additional objective criteria of the orientation of the inflammatory response in patients with various forms of vaginal candidiasis. The changes of the studied parameters might reflect the state of the immune system and the severity of the inflammatory response.
Differentiated approach to the use of the modern surgical technologies in patients with tubal infertility
Authors: Yakovleva N V
Published: November 2019

Aim. To elaborate the differentiated approach to the surgical treatment of the patients with tubal and peritoneal infertility using the endoscopic and microsurgical methods and to evaluate its efficiency. Methods. 1840 female patients with infertility underwent complex clinical and laboratory examination, including endoscopy. 1257 patients underwent surgical treatment. Endo-video-surgical interventions were carried out in 1070 women, microsurgical techniques were applied in 187 patients. Results. The laparoscopic reconstructive plastic surgery was the most effective manipulation in patients with the disease of the distal part of the fallopian tubes and peritoneal adhesions. Treatment results were defined by the severity of distal part of the uterine tubes damage and severity of peritoneal adhesions in the pelvic cavity. The most favorable results of the treatment were noted after salpingo-ovariolysis (success rate 61.4%), by 2.3 times exceeding the pregnancy frequency after salpingoneostomy (26.9%; p 0.001) and by 1.6 times compared to fimbrioplasty (39.2%; p 0.001). In patients with proximal occlusion, results depended on the type of the tubular occlusion. In 69.7% patients with proximal occlusion due to synechiae, small polyps, foreign bodies, hysteroscopic interventions were an effective method of recanalization, allowing to restore the reproductive function in 40.2% patients. The microsurgical method demonstrated the 5.9 fold higher efficiency in patients with fibroid proximal occlusion of the uterine tubes compared to the laparoscopic methods (41.7% vs 7.1%). The microsurgical method was the most effective in patients with true fibrous proximal occlusion after the surgery on uterine tubes for tubular pregnancy and surgical sterilization. Conclusion. The differentiated approach to the surgical treatment of the patients with tubal infertility allowed to use the endo-video-surgical method in 85.1% of cases, improving the treatment’s results due to the decrease the surgical trauma and surgery duration, due to economic and cosmetic effect.
Objective monitoring of neuromuscular transmission in laparoscopic surgery
Authors: Kurenkov D A , Chizhevskaya S Yu , Nikolaenko E M
Published: November 2019

Aim. To assess the importance of quantitative neuromuscular transmission monitoring in laparoscopic surgery. Methods. 30 patients [11 (37.7%) males, 19 (63.3%) females, mean age 52.3±7.18 years] who underwent laparoscopic surgery and general anesthesia associated with skeletal muscles relaxation, were examined. The degree of neuromuscular transmission recovery and time to trachea extubation performed by an anesthetist after the end of surgery (like laparoscopic cholecystectomy, appendectomy) and general anesthesia associated with skeletal muscles relaxation were assessed using quantitative monitoring of neuromuscular transmission and «blind» control. Results. In 21 patients no drugs were used to reverse the skeletal muscles relaxation. Trachea extubation in this group was performed 10.5 minutes after the end of surgery in average at the neuromuscular transmission Train of Four (TOF) level of 43-81% for 15 patients and at the TOF level over 90% in 6 patients. In 9 patients, sugammadex (2 mg/kg) was used for neuromuscular transmission reversal, the average level of neuromuscular blockade (TOF) in those patients was 41±6.5%. TOF average recovery time up to 90% was 1 minute 48 seconds. Trachea extubation was performed no later than 4 minutes after the sugammadex administration. Conclusion. The subjective assessment of neuromuscular transmission recovery, based on the assessment of clinical signs, is not able to completely exclude the residual muscle relaxation. Objective monitoring of neuromuscular transmission is required to determine the time of intubation, administration of maintenance doses of muscle relaxants, and for assessment of efficacy of reversal and possibility for trachea extubation.
Assessment of glaucoma morbidity in Irkutsk region
Authors: Grishchuk A S , Yuryeva T N , Shchuko A G , Savilov E D , Mikhalevich I M , Mikova O I
Published: November 2019

Aim. To study the changes of glaucoma prevalence from 1992 to 2012 and to define the main epidemiologic trends by statistical analysis. Methods. Considering the fact that 80% of patients with glaucoma who live in Irkutsk Region, undergo primary deep examination in the Interbranch Scientific and Research Complex «Eye Microsurgery» named after S.N. Fedorov, the gained data were extrapolated on the epidemiological situation in the region at whole. The analysis of 300 000 medical charts of patients who were diagnosed with glaucoma and attended the Irkutsk branch of Interbranch Scientific and Research Complex «Eye Microsurgery» named after S.N. Fedorov from 1992 to 2012 were analyzed, with the morbidity level assessment according to the following criteria: form and stage of glaucoma, gender, age, patients’ place of residence. The data were processed using regression analysis and analysis of variance. Results. The increase in glaucoma morbidity from 45.2 to 140.6 on 1000 examined patients, mainly affecting women, was revealed. A better detection of glaucoma on preclinical stages was noted. At the same time, the detection rate of glaucoma at advanced stages remains stable. Four periods, in which the prevalence growth significantly exceeds the predicted results, were determined. These periods corresponded to the introduction of new diagnostic technologies, conducting management measures, and change in staff of ophthalmologists. Conclusion. The obtained statistical results allow analyzing and estimating the epidemiologic situation on glaucoma, identifying the main trends of its development, getting prognostic models for key epidemiological indicators and can be used in prediction of the basic epidemiological trends.
Solar maculopathy. Results of five years of follow-up
Authors: Akhmetshin R F , Abdulaeva E A , Bulgar S N
Published: November 2019

Aim. To investigate the clinical features of solar maculopathy in a long run by optical coherence tomography. Methods. 31 patients (40 eyes) complaining on scotoma appeared after sun gazing without protection were referred to an advisory clinic of Republican Clinical Hospital of Ophtalmology, Kazan. The mean age of patients was 25.2 years, mean visual acuity - 0.72. In addition to the standard examinations, all patients underwent optical coherence tomography. The patients were followed up for up to 5 years. The examinations were performed before the treatment initiation and repeated on the 15th, 30th and 90th day after the treatment completion. 7 patients (8 eyes) were followed up for 5 years. Results. According to the results of optical coherence tomography, focal retinal edema was found in 9 patients (18 eyes) at the first week. Patients received antioedematic drugs and antioxidants. According to the results of optical coherence tomography a lamellar defect has been formed in fovea centralis on 15th day of treatment. Mean visual acuity improved to 0.78. On 30th and 90th days of treatment, lamellar defect persisted, visual acuity remained unchanged. After 5 years, 7 patients (8 eyes) were re-examined. The mean visual acuity was 0.78, the lamellar defect was still observed by optical coherence tomography. No macular degenerative and dystrophic changes were observed in followed up patients. Conclusion. Sunlight causes permanent damage of the retina. In the first week after the sunburn, marked focal retinal edema in the foveolar area was observed on the tomography, with further formation of a lamellar defect that was not accompanied by degenerative changes in the long-term period. Optical coherence tomography is an informative method of diagnosing solar maculopathy.
The change of splenic morphometric parameters in aged laboratory animals exposed to ionizing radiation after undergoing stem cells transplantation
Authors: Grebnev D Yu , Yastrebov A P , Maklakova I Yu
Published: November 2019

Aim. To study the changes of splenic morphometric parameters in aged laboratory animals exposed to ionizing radiation in the dose of 4Gr after multipotent mesenchymal and hematopoietic stem cells transplantation. Methods. The experiments were conducted on 72 white male laboratory mice at the third year of life with the body weight of 50 g. Multipotent mesenchymal stem cells and hematopoietic stem cells were obtained from 8 laboratory female mice with the body weight of 30 g aged 3-4 months, the gestation term was 14 days. The first group (36 animals exposed to radiation) was subdivided to 2 subgroups of 18 animals each. The suspension of multipotent mesenchymal stem cells (6 000 000 cells/kg) and hematopoietic stem cells (330 000 cells/kg) was introduced as single intravenous injection to the experimental subgroup (18 animals) 1 hour after the animals were exposed to radiation. The animals of control subgroup (18 animals) were injected 0.2 ml of normal saline. The second group included two subgroups 18 mice each that underwent the same procedure without being exposed to radiation. 9 animals from each group were withdrawn from the study at 1st and 7th day each. The lymphoid follicle gross area, area of the T-cell and B-cell zones, general numbers of cells in the red pulp of spleen, including erythrocyte and lymphocyte count, were measured in splenic histologic specimens using the morphometric «BioVision 2008» software. Results. It was shown that on the 7th day after exposure to ionizing radiation followed by stem cells transplantation, the area of thymus-independent zone of lymphoid follicle restored back to normal ranges. The effect of multipotent mesenchymal stem cells and hematopoietic stem cells transplantation also resulted in the increase of the number of cells in the red pulp of spleen. There were no significant changes observed in numbers of erythroid cells and white blood cells in the spleen red pulp compared to control subgroup. At the same time, the leukocyte number in the red pulp of spleen restored to normal values. Conclusion. The restoration of the basic morphometric parameters in spleen of aged laboratory animals exposed to ionizing radiation may be explained be increased homing of splenic colony-forming units with subsequent activation of extramedullary hematopoiesis in spleen, and apoptosis-reducing effect of multipotent mesenchymal stem cells.
Glucocorticoid pulse therapy аnd carbohydrate metabolism in rheumatic diseases
Authors: Nurullina G I
Published: November 2019

Glucocorticoids are used in clinical practice for more than 50 years and are a great advance in the treatment of systemic inflammatory diseases. High doses of intravenous glucocorticoids (pulse therapy) are effective in conditions requiring rapid immunosuppression and antiinflammatory effect, such as systemic lupus erythematosus, rheumatoid arthritis, glomerulonephritis and systemic vasculitides. The advantage of this method are increased efficacy and lower rate of complications associated with prolonged administration of glucocorticoids. At the same time, glucocorticoid pulse therapy is associated with increased risk of hyperglycemia or even can be a cause of steroid-induced diabetes in patients without known hyperglycemia, as well as worsen glycemia control in patients with diabetes. Increased hepatic gluconeogenesis, inhibition of glucose uptake and metabolism in peripheral tissues and altered both receptor and post-receptor insulin action can lead to an increased serum glucose levels. In patients with inadequate compensatory reserves of pancreas, a clinical picture of diabetus mellitus can develop while treated with glucocorticoids. Blood glucose levels begin to rise 6-12 hours after the infusion of high doses of glucocorticoids. Risk factors for developing glucose intolerance and diabetes include advanced age, obesity, family history of diabetes and high cumulative doses of glucocorticoids. Glucocorticoid-induced diabetes is a common complication of pulse therapy, but exact causes are still not elucidated yet, current literature data on glucocorticoid-induced hyperglycemia are scarce.
The modern approach to the diagnosis of chronic constipation
Authors: Shakurov A F
Published: November 2019

A review of literature devoted to the problems of chronic constipation diagnosis is presented. Chronic constipation occurs in all population groups and manifests with persistent or intermittent failure to pass stools. According to the Russian and foreign authors, a significant increase in constipation syndrome prevalence has been seen recently. The variety of etiological factors determines the challenge in diagnostics, and the variety of treating methods - the importance of exact and timely identification of the underlying cause. The definition of constipation syndrome and its classification is presented from the modern point of view, the most widespread risk factors of constipation are reviewed. The different views on the diagnostic algorithms in patients with constipation syndrome are discussed, the need for special questionnaires use to objectively assess patient’s complaints is emphasized. Various methods of instrumental examination of colonic anatomical and functional characteristics and tests assessing the anorectal function are described. Different authors’ opinions on informative value of different diagnostic tests to assess the colonic follow-through are presented. It is concluded that approach to constipated patients is the difficult task, requiring a complex of different clinical and instrumental methods of examination. Thereby an organic etiology of constipation needs to be excluded on a first priority basis. To answer the question if the constipation syndrome is secondary to other disease or is a primary functional disorder is possible only after patient’s careful examination and exclusion of all possible colonic and extracolonic causes. The paper should be interesting for general practitioners, gastroenterologists, coloproctologists and surgeons.
Integrated ultrasound for early diagnosis of visceral ischemic syndrome
Authors: Barkhatov I V
Published: November 2019

Aim. To study the incidence of unpaired visceral arteries occlusive disease and clinical types of visceral ischemic syndrome in patients with persistent abdominal pain. Methods. The study included 326 patients with chronic atrophic gastritis and duration of abdominal pain over 3 months. The first group included 184 patients with inflammatory conditions. The second group consisted of 142 patients with visceral ischemic syndrome associated with visceral arteries stenosis. The mean age of patients with inflammatory conditions did not exceeded 60 years, and duration of abdominal pain syndrome was less than 6 months. In patients with visceral ischemic syndrome, patients’ age was over 60 years, and abdominal pain persisted for more than 12 months (p 0.01). All patients underwent an integrated ultrasonography and two-staged functional Doppler ultrasonography of visceral arteries. Results. At endoscopy, atrophic gastritis was associated with atrophic colitis and bowel motility disorders in 14.7-15.3% of patients with visceral ischemic syndrome and in 2.1% of patients with inflammatory conditions (p 0.001). On Doppler, 53.5% of patients with visceral ischemic syndrome had clinical picture of subcompensated celiac trunk arterial insufficiency (36.8%) or a combination of two visceral artery diseases (13.2-18.4%). 46.5% of patients with visceral ischemic syndrome had clinical signs of decompensated visceral arteries chronic arterial insufficiency caused by external compression (69.7%) or atherosclerosis (30.3%). The classification of ultrasonic stages of visceral ischemic syndrome was developed, which allows optimizing patients’ follow-up, treatment tactics and better assessing their effectiveness. Conclusion. Integrated ultrasound of visceral arteries revealed visceral arteries disease in 43.6% of patients with persistent abdominal pain, as well as the stage and degree of the disease. In 46.5% of visceral ischemic syndrome cases, arterial stenosis was diagnosed, and in 53.5% of cases - functionally reduced visceral blood flow.