Статьи журнала - Saratov Medical Journal
Все статьи: 33
Статья научная
Objective: based on the Russian Federation multicenter registry data, to assess the comprehensiveness of medicamentous therapy in patients with stable coronary artery disease (CAD) from the perspective of 2018 European Society of Cardiology (ESC-2018) recommendations for myocardial revascularization and 2017 American Appropriate Use Criteria (AUC-2017) for the expediency of revascularization. Materials and methods. Anamnestic data of 1531 patients with stable CAD (average age: 61.7 ± 9.8 years; 76% men) were studied. The data source was the Russian Federation multicenter registry of patients with arterial hypertension, CAD, and chronic heart failure. We identified the prescription of optimal medical therapy (OMT) sensu ESC-2018, maximal anti-ischemic therapy (MAT) sensu AUC-2017, and compliance of drug therapy with ESC-2018 and AUC-2017 simultaneously. OMT included at least one anti-ischemic medication + antiplatelet agent + statin + short-acting nitrate + blocker of the renin-angiotensin system in the presence of hypertension, diabetes mellitus, or heart failure. MAT included at least two anti-ischemic pharmaceutical drugs. Compliance with these criteria was determined in the groups of patients who underwent, or did not undergo, myocardial revascularization, as well as among those, for whom invasive treatment was indicated as the first priority, as the second priority, or was not indicated at all, according to ESC-2018 and AUC-2017. Results. Among patients who received solely medicamentous therapy (n=924), OMT was prescribed in 18%, while in the revascularization group (n= 07), in 9% of cases (p <0.001). MAT was also prescribed more often in the conservative therapy group (34%) than in the revascularization group (24%): p = 0.001. OMT sensu ESC-2018 and AUC-2017 in the groups with, or without, intervention was prescribed in 3% vs. 7% of cases, respectively (p <0.001). Conclusion. According to the Russian Federation multicenter registry, medicamentous therapy of stable CAD complies with the provisions of European and American clinical guidelines for myocardial revascularization in a small proportion of patients, regardless of the chosen treatment tactics.
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Methodology of designing specialized medical information registries
Статья научная
The objective. Developing information exchange methodology by means of specialized registries among the core healthcare partakers in the course of provisioning medical assistance to traumatology and orthopedic patients. Materials and Methods. We conducted the analysis and systematization of functionality for 31 registers of traumatology- and orthopedics-related medical information from the databases of the Federal Institute of Industrial Property, European Patent Office and developers’ websites. The search depth has been set at 1979 and defined by the date of the earliest discovered information source. Results. The analysis of specialized registries revealed that majority of those (70.9%) were mono-nosologic, hence containing information about the diagnosis and treatment procedures provided at the level of a specific medical institution. We developed the methodology for evaluating the functionality of specialized medical information registries, containing the data on used medical devices, medications, medical technologies, rehabilitation programs, and assessment of medical treatment effectiveness. Such methodology was designed to operate on data from the information systems of major healthcare partakers. Conclusion. The proposed information exchange methodology defined the necessity of integrated, target-oriented registry development. Its implementation would allow increasing the quality of management decisions proposed by healthcare participants.
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Morphological aspects of orbital defect reconstruction in rats with elastin-based biomaterial
Статья научная
The objective of the study was to identify morphological aspects of replacement of xenogeneic decellularized elastin matrix (ХDEM) transplanted into a bone defect of the upper orbital wall in rats. Materials and methods. The experiment was performed on 60 Wistar rats with artificially created 7×4 mm defect in the upper edge of their orbit. In the experimental group (n=30), DХEM was placed in the defect area. Its size matched the size of the defect, and it was attached with a suture material (50 μm silk). Soft tissues were sutured layer by layer in the control group (n=30). Tissue excision was performed after 1, 3 and 12 months. Histological, immunohistochemical and electron microscopic methods were employed. Results. We were gradually replacing DХEM with bone tissue against the background of a pronounced reaction of CD68+/MMP-9+ macrophages, which implied its resorption and lysis. Osteogenesis occurred via intramembranous ossification and endochondral ossification, which was preceded by centripetal migration of endothelial kidneys with subsequent differentiation into capillaries and overgrowth of loose fibrous connective tissue containing progenitor cells. The microenvironment, represented by reticulin fibers, TGF-β1, and sulfated glycosaminoglycans, could contribute to the differentiation of progenitor cells in the osteogenic direction and to osteogenesis per se. In the control group, the defect remained open throughout the experiment. Conclusion. Decellularized biomaterial, based on elastin matrix, has osteoconductive and osteoinductive properties and can serve an adequate biomimetic for reconstruction of the bone defects.
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Open-heart surgery in elderly patients: short-term vs. long-term effects
Статья научная
The objective of the study was to analyze in-hospital mortality and long-term survival of elderly patients who underwent open-heart surgery and met the criterion of frailty. Materials and Methods. The study involved 266 patients over 75 years old complying with the frailty criterion (F-index ≤5). A total of 155 operations of coronary artery bypass grafting (CABG), 47 surgeries of aortic valve replacement (AVR), and 64 procedures of CABG in combination with AVR were performed. Study subjects were distributed among the groups depending on the surgery type. Postoperative complications were evaluated, and short-term and long-term outcomes were compared. Results. In-hospital mortality was 5.3% in general group, 9.4% in CABG+AVR group, 3.9% in CABG group, and 4.2% in AVR group. There was no significant difference among the rates of in-hospital mortality between the groups (р>0.05). Long-term survival rates in general group were as follows: 98.3% for 1-year survival, 94.6% for 3-year survival, and 82.1% for 5-year survival. Type of surgery had no significant impact on the outcome (р>0.05). Conclusion. Short- and long-term effects of CABG, AVR, and combination of CABG with AVR in the group of elderly patients who meet the criterion of frailty were characterized by low mortality and low incidence of non-fatal complications. The type of cardiac surgery and old age did not affect significantly the outcome of a surgical treatment.
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Optimizing the process of developing human blood vessel models
Статья научная
Objective: to optimize the process of blood vessel biomechanical modeling via developing models of cerebral arterial circle. Materials and methods. Biomechanical modeling requires development of a patient-oriented three-dimensional (3D) solid-state geometric model of the object under study. This task can be resolved by computed tomography (CT) or magnetic resonance imaging (MRI). We developed the program that implements the construction of blood vessel contours from separate slices of MRI in a semi-automatic mode. These contours are exported as saved curves in a specific format to SolidWorks, where they are used to create 3D models of blood vessels. The models obtained this way take into account individual characteristics of the vascular system structure of a particular patient, and can be used in the process of biomechanical modeling. Results. The results of the program implementation of the recursive frontal growth method for processing 2D slices of tomograms are presented. Conclusion. The developed software allows semi-automatic loading of DICOM images and obtaining flat cross-sections (MRI slices) of vessels on their basis, as well as transferring them for further processing into computer-aided design systems.
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Статья научная
Objective: development and efficacy assessment of the tactic of actions in reverse shoulder arthroplasty in bone mass defects and deficiency of the scapular glenoid fossa. Materials and Methods. At the Division of Adult Orthopedics, N.N. Priorov National Medical Research Center of Traumatology and Orthopedics, Ministry of Healthcare of the Russian Federation, 6 patients with glenoid bone mass deficiency were subjected to the reverse shoulder arthroplasty: 4 of those received the replacement of marginal bone defects, whereas 2 subjects underwent the replacement of extensive bone defects. Results. During the follow-up period of the operated patients, which lasted 6-24 months, good clinical, radiological and functional results were obtained. There were no intraoperative or postoperative complications. Conclusion. The proposed replacement method of glenoid defects in reverse arthroplasty exhibited high efficacy.
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Perimortem and postmortem caesarean section: a systematic review
Статья научная
Rationale: Perimortem caesarean section (PMCS) is an emergency procedure performed in pregnant women over 20 weeks of gestation with cardiac arrest, in order to save the mother and the foetus, or only one of them. The objective of the review was to present clinical traits and evaluate survival of mothers and newborns as well as the complications following PMCS. Materials and methods: A systematic review between March and May 2021 was performed using the PRISMA method with the terms "perimortem caesarean section" "postmortem caesarean section", "maternal cardiac arrest", "perimortem caesarean section "AND "case report" "postmortem caesarean section" AND "case report". Results: 23 papers from 12 countries with 39 cases were counted. Of the total sample, 17.94% of the mothers survived and of these, 42.85% had neurological complications. Of 39 newborns counted, 69.23% survived, 28.20% died and in 2.56% the information was missing. 30.76% of the cases followed the five-minute rule and 56.41% required 6 or more minutes, 12.82% did not specify time. Conclusion: The results of this analysis demonstrated higher mortality in women who had a cardiac arrest during pregnancy related to the neonates who survived. The possibility of performing PMCS should neither be ruled out even if the established five-minute time frame has passed, nor should time be invested in verifying foetal viability.
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Republican Arthrology Center and its contribution to the development of orthopedic rheumatology
Статья научная
The article provides information on the organization and functioning achievements of the Republican Arthrology Center (RAC), which has become the first specialized clinic in the Russian Soviet Federative Socialist Republic (RSFSR) that provided arthrological assistance to the population. The result of the organizational and methodological efforts of the RAC employees was the development of a network of rheumatology rooms in almost all territories of the country, along with the organization of the orthopedic rheumatology service and its separation from the cardiovascular rheumatology service. In the RAC, scientific developments were successfully carried out on the problems of arthroplasty of large joints, surgical and conservative treatment of patients with rheumatoid arthritis, osteoarthritis of large joints, prevention of contractures of the knee joint. Saratov Research Institute of Traumatology and Orthopedics (SRITO) hip joint endoprosthesis, a collapsible endoprosthesis and other constructions that have received wide recognition were created at the RAC. In the absence of international experience in creating an orthopedic rheumatology service network, the RAC was, on one hand, a pioneering phenomenon in world health care, and on the other hand, a natural consequence of the power vertical centralization in the USSR. At the same time, it should be emphasized that the need to create the RAC in the Russian Federation was caused by the growth in morbidity of rheumatic diseases, along with population aging and the prospects of orthopedic rheumatology associated, first of all, with the active introduction of total joint replacement with artificial structures in developed countries of the world. Over three decades of its existence, the RAC has been an organizational, methodological, medical, scientific and consulting center providing an orthopedic care to patients with diseases and injuries of large joints throughout the Russian Federation.
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Stress-strain properties of aponeurotic suture in anterior abdominal wall after a midline laparotomy
Статья научная
Objective: method development for preventing postoperative ventral hernias based on experimental assessment of the stress-strain properties of aponeurosis in various types of a midline laparotomy. Materials and methods. We evaluated 42 fascia muscular aponeurotic complexes of the anterior abdominal wall. Based on the technique for dissecting the aponeurosis and its suturing, the complexes were divided into two groups (each containing 21 samples): Group 1 with a bypass of the umbilical ring on the left, and Group 2 with umbilical ring dissection. Results. Fascia aponeurotic complexes dissected and sutured through the umbilical ring (Group 2) had, on the average, higher values of mechanical characteristics. E.g., mean values of tensile stress (S), tensile stress at a maximum load (Smax), Young’s modulus (E), aponeurotic tensile strain (D), aponeurotic tensile strain at a maximum load (Dmax), and maximum load level (Load) were higher in Group 2 by 35.4; 39.8; 14.9; 34.6; 30.2 and 40.2 (%), respectively. Conclusion. We conducted the development, experimental application and evaluation of a novel method for preventing postoperative ventral hernias after a midline laparotomy based on the assessment of the stress-strain properties of aponeurosis.
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Статья научная
Background. The formation and development of industrial model for social processes and systems in the early twentieth century brought to life a novel form of organizing scientific activity via establishing research institutions. Objective. This study aimed to investigate the gaps in the history of traumatology institutions in the early years of the Soviet State. Materials and methods. We carried out a comprehensive analysis to retrieve the data from both State and institutional archives, as well as from the literature sources. The narrative analysis was chosen as the method of data interpretation. Most archive documents are made available to the scientific community for the first time. Our study covered the period of time from 1917 to 1930. Over 500 sources were analyzed. Results. We established that the first five traumatology institutions were founded in the following sequence: Saratov Traumatology Institute in 1919, Rostov Traumatology Institute in 1920; Astrakhan, Moscow Oblast, and Voronezh Traumatology Institutes in 1921. The concept of research institution was mainly designed to achieve the systematic augmentation of scientific knowledge and form a new employee type called a professional scientist. Conclusion. Discovering the history of establishing first traumatology institutions that provided healthcare services and conducted independent scientific studies led us to defining a new, previously unexplored institutionalization stage of Russian traumatology and orthopedics. In the early years of the Soviet State, research institutions facilitated the development and implementation of efficient medical technologies into healthcare practice.
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Ultrasonography screening of carotid arteries in asymptomatic patients
Статья научная
Objective: to identify the most important predictors of carotid artery stenosis in ambulatory patients of Saratov and Saratov Oblast, using multivariate analysis, and to specify an ideal patient for ultrasonographic screening. Materials and methods. In 2014-2018, field consultations and ultrasonographic examinations were performed for asymptomatic patients with suspected carotid artery disease at outpatient clinics of Saratov and Saratov Oblast. Such patients were referred for screening by neurologists and general practitioners. The study encompassed 470 medical charts. The multivariate regression analysis was performed to identify independent predictors of carotid artery stenosis of 50 per cent or more. Results. Carotid artery stenosis of ≥30% was detected in 24.5% (i.e., 115 of 470) of study participants; of ≥50% in 10.2% (48 of 470) patients, and of ≥70% stenosis in 2.9% (14/470) of participants. The multivariate analysis revealed that the odds of finding stenosis of ≥50% in patients, selected by neurologists and general practitioners for ultrasonographic screening, were significantly higher in the presence of the following factors: age exceeding 72, male gender, acute cerebrovascular event in anamnesis > 6 months ago, atherosclerosis of leg arteries, and episodes of speech impairment. We developed the point scale for risk assessment. A point scale for risk assessment has been created. In the absence of prognostic factors, the absolute risk of detecting stenosis ≥50% was just 3%, with 1 point it was 16%, and with 4 points it amounted to >50%. Conclusion. Our analysis enabled us to specify the most significant predictors of carotid artery stenosis in patients observed at outpatient clinics of Saratov and Saratov Oblast, and to obtain a patient model helping to optimize optimize selection for ultrasonographic examination.
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Using endoscopic hemithyroidectomy in patients with benign thyroid diseases
Статья научная
Objective: the development and assessment of endoscopic hemithyroidectomy technique improving visualization of anatomical structures and excluding the so-called conflict of instruments in the operative field. Materials and methods. We analyzed the treatment results of 103 patients who underwent hemithyroidectomy with endoscopic or traditional approaches during 2014-2018 at the S.R. Mirotvortsev Hospital of Saratov State Medical University. In terms of approach mode, patients were divided into two groups. The compression syndrome, functional autonomy of a thyroid, and results of a punch biopsy were indications to operation. Results. Unilateral vocal cord paralysis (UVCP) was diagnosed in one patient after traditional intervention, diminishing after 1.5 months; and in three patients after endoscopic hemithyroidectomy, diminishing anywhere between 7 days and 1.5 months. Signs of hypoparathyroidism were not found in any of the patient groups. There were no complications associated with the introduction of carbon dioxide. No conversion was required in any of the cases. Conclusion. Development, application and assessment of a new endoscopic hemithyroidectomy technique, which proved itself feasible, safe and provisioning highly esthetic outcome were conducted.
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Using pharmacopuncture for chronic tension-type headache treatment
Статья научная
Objective: assessing pharmacopuncture effect on pain syndrome and level of anxiety-depressive disorders in patients with chronic tension-type headache (CTTH). Materials and methods. An open-label controlled trial was conducted on 95 CTTH patients split among two groups by means of adaptive randomization. The comparison group subjects were receiving 35-70 mg/day of amitriptyline and 450 mg/day of tolperisone, while patients of the treatment group were assigned 2-4 courses of pharmacopuncture by the original method. The results were evaluated on the basis of the scores obtained via Visual Analogue Scale (VAS), McGill Pain Questionnaire, Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI) sensu Ch. Spielberger and Yu. Khanin. Results. Patients in both clinical groups were inclined to a positive evaluation of received treatment. Based on the results of McGill Pain Questionnaire, we determined both affective and sensory pain descriptors, with a predominance of the latter. Both groups exhibited moderate depressive symptoms according to BDI of the psychological status. Prevalence of trait anxiety over reactive anxiety was determined by STAI. According to VAS, pain intensity after the treatment declined from 5.26±0.87 to 1.7±0.78 points (p<0.05) and from 5.17±0.78 to 1.65±0.79 (p<0.05) in the comparison group versus the treatment group. An improvement of anxiety and depression indicators was detected. Conclusion. Our results have demonstrated that pharmacopuncture is very promising in treating CTTH patients.
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