Статьи журнала - Saratov Medical Journal
Все статьи: 77
Статья научная
Objective: to identify the proportion of complications after suburethral implantation of polypropylene slings in women with stress urinary incontinence based on a seven-year experience. Material and Methods. We conducted the analysis of а seven-year experience in various implantation techniques of suburethral slings in 1260 women with stress urinary incontinence: inside-out and outside-in obturator sling fixation; suprapubic sling fixation and non-trocar mini-sling installment. Results. The highest incidence of complications was observed over the first two years after suburethral sling implantation was performed. Subsequently, the proportion of complications declined progressively to the lower limit values of 7-8% in the course of three last years. An incidence of early surgical complications among various suburethral sling implantation techniques had no statistically significant differences. However, after the suprapubic sling implantation, intraoperative and mesh-associated complications prevailed. Conclusion. Our study confirmed that suburethral sling implantation using suprapubic fixation method was associated with a higher incidence of complications and should have been performed exclusively for the target group of the patients, for whom safer surgical procedures were contraindicated.
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Статья научная
Objective: development of the technology of immediate sequential bilateral cataract surgery (ISВCS) and assessment of its clinical effectiveness. Materials and Methods. Our study was conducted in two stages. At stage I, we reviewed the published materials on traditional algorithm of conducting ISВCS, as a result of which, a modified algorithm for performing surgical intervention (mоISBCS) was developed. At stage II, 130 patients (mean age of 58.4±1.8 years) with uncomplicated binocular cataract were under observation. Patients were divided into two groups of similar age and eye condition. The main group included 67 people (134 eyes), who underwent mоISBCS. The control group comprised 63 subjects (126 eyes), who underwent surgery on the second eye (delayed sequential bilateral cataract surgery, DSВCS) 21–28 days after the first operation. Results. The analysis of traditional provisions served the basis for improving ISВCS technology by including a long (at least 60 min) pause between operations with a comprehensive examination of the patient in the algorithm of surgical intervention. The obtained data demonstrated similar clinical effectiveness of mоISBCS and DSВCS. Conclusion. The mоISBCS technology can be considered an effective and safe method of cataract surgical treatment, which is especially important for patients with occupation yielding a visual stress.
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Статья научная
Objective: to study the effect of different pancreatic stump closure techniques and diameter of the main pancreatic duct on frequency and severity of acute postoperative pancreatitis after distal pancreatectomy. Material and Methods. Distal pancreatectomy was performed on 126 patients with neoplasms of body and/or tail of the pancreas. Patients were distributed among four groups based upon the pancreatic stump closure technique applied after distal pancreatectomy: group 1 (control) included the patients with isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing by the gastrocolic omentum or hemostatic sponge; group 2 patients underwent isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing with 2-octyl cyanoacrylate biological glue; group 3 patients had their pancreatic stump closure performed with endoscopic linear cutter stapler; group 4 was composed of the patients with external transduodenal transnasal drainage of enlarged (D>3 mm) main pancreatic duct in the pancreatic stump. Results. The occurrence of acute postoperative pancreatitis in the control group amounted to 45.8%, while, in groups 2, 3 and 4, the frequencies were 44.4, 9.7 and 15.0(%), correspondingly. Besides, the control group was characterized by declined occurrence of the moderately severe form of acute postoperative pancreatitis. Use of endoscopic linear cutter stapler and external transduodenal transnasal drainage of the enlarged main pancreatic duct caused lower acute postoperative pancreatitis frequency in the patients with main pancreatic duct in their pancreatic stumps below 5 mm in diameter. Conclusion. Use of proposed pancreatic stump closure techniques after distal pancreatectomy resulted in lower frequencies of occurrence and severity of acute postoperative pancreatitis.
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Статья научная
Objective: to compare the condition of periodontium in three categories of patients: smokers of electronic cigarettes (EC), smokers of heated tobacco products (HTP) and nonsmokers vs, their age and gender. Materials and Methods. We carried out a comprehensive analysis of 1,754 patient records including EC smokers (n=1,122) and HTP smokers (n=632).Data from 566 nonsmokers were used as a comparison group (CG). Patients of all groups were distributed among subgroups depending on their age and gender. The clinical condition of the periodontium was assessed using dental indices and indicators. For statistical data analysis, we employed Microsoft Excel and STATISTICA 64 version 20.0 software. Results. Gingivitis prevailed in all three groups. Itsprevalence in EC smokers decreasedwith age; the opposite trend was observed in HTP smokers. As for CG, gingivitis was recorded in all age groups. The prevalence of acute periodontitis was the highest in EС and HTP smokers aged 35-39 years vs. 30–34-year-old individuals of the CG. In HTP and EC smokers, the prevalence of gingivitis and acute periodontitis was more pronounced in females, while we observed no statistically significant difference of the kind between men and women of the CG. The frequency of occurrence of localized chronic periodontitis was maximum in EC and HTP smokers at the age of 40–44 years vs. 45–50 years in the CG subjects. However, in the HTPGroup, it was more pronounced in females, while in the EC Group it was more characteristic in males. The frequency of occurrence of generalized chronic periodontitis in individuals of all groups was more pronounced in women. Conclusion. The results of our study confirmed that the use of EC and HTP is a harmful factor causing the occurrence of periodontal disease.
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Статья научная
The objective was to study the dose-dependent effects of glucagon-like peptide-1 receptor agonist, liraglutide, on microcirculation in white rats under the alloxan-induced insulin deficiency. Materials and Methods. Our study was carried out on 70 white rats, divided into four groups: 20 intact control animals; 20 animals of the comparison group with alloxan-induced diabetes; 10 animals with insulin deficiency, injected with liraglutide at a dose of 0.2 mg/kg per day (treatment group No. 1); and 20 animals with insulin deficiency treated with liraglutide at a dose of 0.4 mg/kg per day (treatment group No. 2). Diabetic status, skin perfusion of the posterior limb and mechanisms of blood flow modulation were assessed in all groups of animals. Results. It was established that administering liraglutide at a dose of 0.4 mg/kg per day allowed achieving complete normalization of carbohydrate metabolism in rats with alloxan-induced insulin deficiency, thereby more effectively improving the state of microcirculation, compared with a dose of 0.2 mg/kg per day. Conclusion. The efficacy of correcting the microcirculatory disorders with liraglutide correlates with correcting the carbohydrate metabolism in rats with insulin deficiency and depends on liraglutide dose. The dose-dependent effect is achieved by the endothelial mechanism of flow modulation in microcirculation. However, the restoration of the vascular tone neurogenic component is independent of liraglutide dose.
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Objective: To evaluate the effect of metronidazole loaded into alginate microcapsules impregnated with silver on structural and functional periodontium disorders in periodontitis. Materials and Methods. Our research was conducted on 30 white male rats, randomly distributed among two groups. The comparison group consisted of 15 animals with experimental periodontitis, which received applications of a gel containing microcapsules without additional loading of active substances. The experimental group included 15 animals with periodontitis, which received applications of gel with microcapsules containing metronidazole to the inflamed gums. To assess the morphological changes in periodontium, the mandible was collected followed by its histological examination. Results. Application of a gel containing microcapsules with silver nanoparticles loaded with metronidazole on the gums of animals with periodontitis led to a partial reduction of structural disorders. E.g., out of 15 animals, local disorganization of the periodontal ligament fibers in the experimental group was observed only in 5 cases and signs of limited bone loss were observed in 2 cases. In the comparison group, bone resorption was noted in all 15 animals, while diffuse alteration of fibers throughout the periodontal ligament was confirmed in 13 of 15 cases. Conclusion.The inclusion of metronidazole in alginate microcapsules with silver nanoparticles leads to a significant reduction in the destructive processes occurring in the periodontal tissues during periodontitis.
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Статья научная
Objective: to assess the impact of the remote monitoring system on the lipid profile after myocardial infarction (MI) in urban and rural areas of the Perm Krai. Materials and Methods. Our study conducted from 2020 through 2022 included 253 patients diagnosed with MI. The study compared two groups of patients: those who did not participate (n=105) and those who participated in the Remote Health Monitoring of Patients with Cardiovascular Diseases (RM) program (n=148). RM of patients was carried out at least once a month by telephone calls using an approved list of questions. Results. The group of patients participating in the RM system exhibited a significant improvement in the lipid profile vs. groups of patients not participating in the RM program. The total cholesterol levels in the RM groups of Perm Krai and city of Perm were 3.77 and 4.30 mmol/L, respectively, vs. 5.50 and 4.50 mmol/L in the rural and urban groups without RM. Statistically significant differences between the groups were observed only in Perm Krai (p=0.002). The low-density lipoprotein (LDL) level in patients with RM was 1.77 mmol/L in Perm Krai and 2.31 mmol/L in the city of Perm vs. 3.24 and 2.67 mmol/L in the rural and urban groups without RM (p=0.049 and p=0.025), respectively). Patients in the RM group from Perm Krai were 15.6 times more likely to achieve target LDL values than their counterparts without RM. Conclusion. The RM system had a favorable effect on reducing LDL and cholesterol in both urban and rural groups of residents.
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Статья научная
Objective: to analyze the features of clinical course of lower limb varicose vein disease and acute thrombophlebitis of varicose veins for the patients with undifferentiated connective tissue dysplasia (UCTD) after crossectomy. Materials and Methods. The prospective clinical cohort study involved 132 female patients with varicose disease who underwent crossectomy, of which 67 patients with dysplasia were included into the main group, whereas patients without dysplasia were included into the control group. Examination of patients and ultrasound scanning of leg veins were conducted in 3, 6, 12, and 36 months. The Cox regression analysis was used to assess the effect of dysplasia on the risk of developing thrombophlebitis of varicose veins. Results. The progress of varicose disease clinical manifestations of after crossectomy was detected in 57 (85.1%) female patients with dysplasia and in 14 (21.5%) without it (р=0.002), which resulted in phlebectomy. The recurrent thrombophlebitis of varicose veins was found in 22 (32.8%) female patients with dysplasia vs. 5 (7.7%) without it (р=0.002). Cox regression model Exp (B), which characterizes the predicted change of risks for dysplasia, was 4.216 (95% CI 1.595-11.147). Conclusion. The clinical course of varicose disease in patients with UCTD is characterized by the progression of clinical manifestations of chronic venous insufficiency of a lower limb. UCTD results in over 4.2-fold risk of developing the recurrent thrombophlebitis of varicose veins after crossectomy.
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Статья научная
Objective: to reveal the dependence of the efficiency of platelet (PL) aggregation on crosstalk between signaling pathways associated with stimulation of the thromboxane receptor (TxR) and purine P2 receptors at different activity of cyclooxygenase (COX) during the administration of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with nephrolithiasis (NLT). Materials and Methods. Our study was prospective in its nature. It included 60 patients with NLT who were prescribed non-selective NSAIDs as part of medical expulsive therapy (MET) for analgesia. The cohort of patients was distributed among two groups: with effective (Group 1, n=30) and ineffective (Group 2, n=30) COX inhibition. The activity of the TxR and purine P2 receptors (P2X1 and P2Y receptors) of PL was assessed on a Chrono-Log Hematology Analyzer (USA). Agonists (adenosine triphosphate, adenosine diphosphate and arachidonic acid) were used at EC50 and EC10 concentrations. Results. In Group 1, after 72 hours of MET, the activity of the TxR and P2 receptors of PL decreased to the level of hyporeactivity. Regulation of the compensatory response of PL to hematuria was ensured through the synergism of P2X1 and P2Y receptors, TxR, and P2X1 receptors. In Group 2, after 72 hours of MET, the hyperreactivity of the TxR and P2 receptors persisted. The maximum increase in PL aggregation was achieved with synergism between the TxR and P2Y receptors. Conclusion. The effectiveness of PL aggregation in hematuria of patients with NLT during the administration of NSAIDs is determined by intracellular signaling associated with the TxR and P2 receptors.
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Статья научная
Objective: to identify the effect of a 60-day isolated tartrazine administration, as well as in combination with the Mexidol ®, on the structural features of parafollicular cells in the thyroid of rats at the electron microscope level. Materials and Methods. We distributed 30 white male rats weighing 200–210 g among five groups of equal sizes. Group I served as a control. Groups II and III included rats receiving tartrazine at concentrations of 750 and 1,500 mg/kg, respectively, for 60 days. Groups IV and V comprised animals under similar conditions, but with Mexidol ® administered at a dose of 50 mg/kg. Qualitative changes in parafollicular cells were examined using electron microscopy, while quantitative changes were assessed via morphometry. Results. After exposure to tartrazine, fine-grained or fibrous contents were detected in cisternae of the rough endoplasmic reticulum, and in some mitochondria, there were areas of destroyed matrix. The euchromatin to heterochromatin areas ratio decreased in groups II and III by 5.7% and 56.9%, respectively, and the diameter of secretory granules did so by 12.3% and 19%, correspondingly, vs. the control (Group I). However, the above ratio in Group V increased by 79.6%, and the diameter of secretory granules did so by 8.2% and 6.5% in Groups IV and V, respectively, compared with animals of Groups II and III. Conclusion. Administration of tartrazine in different doses for 60 days triggered dose-dependent qualitative and quantitative changes in the ultrastructure of parafollicular cells, while administration of the Mexidol ® against this background caused a reduction in the severity of changes.
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Статья научная
Objective: to investigate etiological role of opportunistic microflora in the pathogenesis of implant-associated inflammation in patients after primary knee replacement and antibiotic resistance of major infectious agent groups. Material and Methods. We conducted the retrospective analysis of microbiological samples from 383 patients with postoperative implant-associated inflammation after the primary total knee arthroplasty. Results. Gram-positive cocci (63.5%) are the leading agents of implant-associated inflammation. We also noted an increase in the etiological role of coagulase-positive staphylococci. Among the Gram-negative group, Enterobacteriaceae and non-fermenting bacteria were major agents. We revealed high resistance of Staphylococcus spp. to antibiotics of various groups, among which oxazolidinones and glycylcyclines were the most active. Gram-negative bacteria exhibited high resistance to cephalosporine and macrolides, whereas carbapenems and fluoroquinolones worked best. Conclusion. Gram-negative Enterobacteriaceae, non-fermenters, and Gram-positive cocci are the most significant etiological factors in the pathogenesis of implant-associated inflammation in patients after primary total knee arthroplasty.
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Статья научная
Objective: to estimate biocompatibility of matrices manufactured from polycaprolactone (PCL) and mineralized by vaterite (CaCO3) via studying local and systemic manifestations of inflammatory reaction in subcutaneous implantation tests on white rats. Material and Methods. The experiment was conducted on 40 rats divided into four groups of equal sizes: control, comparison (rats with imitation of implantation), negative control (rats with implanted non-biocompatible matrices) and experimental group, comprised of animals with implanted PCL/CaCO3-matrices. Local inflammatory manifestations were analyzed by morphological investigation of implantation area tissues. Systemic inflammatory manifestations were estimated via TNF-α and interleukin-1β (IL-1) concentrations in blood serum by ELISA. Results. The changes in cellular population content demonstrated that, on day 21 after the implantation, the PCL/CaCO3-matrice was evenly colonized by fibroblast cells and afterwards vascularized. Such matrices did not cause intense inflammatory reaction observed in negative control animals. It was accompanied by systemic manifestations, such as statistically significant increase in TNF-α and IL-1 concentrations. Conclusion. Our data confirmed the biocompatibility of PLC/CaCO3-scaffolds, thus experimentally substantiating the potential for their use in tissue engineering.
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Evaluating the efficacy of surgical treatment in infants with choanal atresia
Статья научная
Objective: to evaluate the efficacy of stentless endoscopic surgery for congenital choanal atresia (CCA) in infants. Materials and Methods. Our study involved 51 infants under 1 year of age who underwent stentless choanoplasty. Main group: infants operated for the first time (n=27). Comparison group: infants with relapse after traditional choanoplasty with stents (n=24). Endoscopic examination and saturation levels were employed to evaluate treatment results. Quality of life was assessed using la Qualité de Vie du Nourrisson questionnaire for children from 3 months of age to 1-3 years of age. Parents of 45 infants participated in the survey: 25 infants were from the main group and 20 infants represented the comparison group. Results. No signs of restenosis were detected during endoscopic examination of the nasal cavity and nasopharynx in 50 patients during follow-up observation (1-2 years). Saturation after surgery increased from 98.4±2.4% to 99.4±1.2% (p=0.001) in patients of the main group and from 93.5±4.7% to 99.0±1.0% (p<0.001) in the comparison group. Assessment of quality-of-life values after surgical treatment by the stentless method showed an increase from 14.4±0.4 to 15.3±1.8 (p=0.056) in the main group and from 14.0±0.4 pts to 15.6±1.0 pts (p<0.001) in the comparison group. Conclusion. Endoscopic endonasal stentless method of surgical treatment of CCA in infants is characterized by higher efficacy vs. traditional choanoplasty with stenting.
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The objective of our study was to reveal the morphofunctional interactions between allografts and the recipient nervous system from the experimental model of the mimetic musculature reinnervation. Materials and Methods. The experiments were conducted on Chinchilla rabbits (n=36). All animals were subjected to the facial nerve transection. No other manipulations were performed in the Control Group (n=9). In Treatment Group 1 (n=12), an autograft fragment of the masseter muscle with a neurovascular bundle was attached to the denervated buccinator. In Treatment Group 2 (n=15), allogeneic biomaterials – specifically, Regeneration Stimulator and Vasculogenesis Stimulator, were inserted between specified muscles. The animals were removed from the experiment on days 10, 30, 60 and 180. Tissue pieces from the operation zone were analyzed using transmission electron microscopy. Results. It was established that compensatory and restorative processes in the Control Group and Treatment Group 1 end with scarring of the boundary zone and contracture of mimetic muscles. In Treatment Group 2, we observed revascularization of mimetic musculature, as well as axonal ingrowth into the buccinator and restoration of neuromuscular synapses. Conclusion. Allogeneic biomaterial transplantation creates adequate conditions for the restoration of the organ vascular bed and the innervation apparatus of denervated mimetic muscles. The results of our experiments could be regarded as an example of restoring the interlevel relations in the human body following the use of allogeneic biomaterials.
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Objective: to examine the possibility of reducing the severity of organ dysfunction and inflammatory response with the L-17 compound in a model of acute post-manipulation pancreatitis (APMP). Materials and Methods. APMP was modeled on 40 rats. Laboratory rats were distributed among control (n=20, without treatment) and experimental (n=20, with the introduction of the L-17 compound) groups. The daily dose of the compound was 40 mg/kg of rat body weight. Results. APMP developed in all animals. In the control group, persistent organ dysfunction and inflammatory response corresponded to a severe course of acute pancreatitis with a mortality rate of 70%. In the experimental group, there was a decrease in the severity of organ dysfunction and inflammatory response, with a decrease in mortality down to 30%. Conclusion.Administration of the L-17 compound reduced the severity of organ dysfunction and inflammatory response in experimentally modeled APMP.
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Objective: to conduct an experimental study on the properties of three different types of synthetic polyester matrices, to carry out their comparative assessment, and to identify the optimal carrier for the cultivation and transplantation of limbal stem cells while eliminating limbal insufficiency. Materials and methods. Transparency, mechanical properties (strength, relative elongation at break, and elastic modulus), biocompatibility with corneal cell cultures were assessed, and duration of matrix biodegradation in vivo were studied. Results. In the course of our study, the optical and mechanical properties of matrices, made of polylactide-glycolide (PLG), polylactide-caprolactone (PLC) and poly-E-caprolactone (PCL), were studied. It has been experimentally shown that limbal stem cells of humans and rabbits, as well as human corneal epithelial cells, adhered to the surface of all types of the studied matrices. During the cultivation process, they retained the typical structure of the actin cytoskeleton, along with the ability to proliferate and migrate. Differences in the interaction of different cell cultures with different types of carriers were revealed. The biodegradation time of 5 μm thick PLC matrices was about 30 days. Conclusion. Our results obtained implied the possibility of using 5 μm thick PLC matrices as a carrier for cultured limbal stem cells.
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Objective: to study the effect of the targeted delivery system of tannic acid (TA) in silver alginate microcapsules on the state of gum microvasculature in rats with intact periodontium vs. experimental periodontitis. Materials and Methods. The study was conducted on 90 white rats, distributed among six groups: the control group, two groups with intact periodontium and single application of gel with microcapsules loaded/not loaded with TA, experimental periodontitis group, and two groups of animals with periodontitis and repeated application of gel with microcapsules loaded/not loaded with TA. We assessed gingival perfusion and blood flow modulation mechanisms in rats via laser Doppler flowmetry. Results. Applying gel with silver microcapsules to an intact gum in rats caused 7.5% transient increase in perfusion and activation of microcirculation modulation. Loading microcapsules with TA reduced the severity of transient microcirculatory changes. Using gel with TA-loaded capsules in rats with periodontitis allowed achieving a more pronounced normalization of perfusion and mechanisms of microcirculation modulation vs. using gel containing microcapsules without active components. Conclusion. Loading alginate microcapsules with silver ions and TA yielded reduction of the irritating effect on gingival mucosa accompanied by an increase in the effectiveness of correcting microcirculatory disorders in periodontitis.
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Features of erythrocyte electrophoretic mobility in programmed hemodialysis patients
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Objective: to analyze the electrophoretic properties of erythrocytes in patients receiving programmed hemodialysis treatment. Materials and Methods. The study included 100 patients with an established diagnosis of stage 5D chronic kidney disease, receiving programmed hemodialysis treatment. The control group included 17 healthy blood donors. The following indicators of erythrocyte electrophoretic activity were evaluated: oscillation amplitude, percentage of motile cells, ellipticity, and aggregation index. Results. Compared with the control group, we revealed significant changes in the amplitude of oscillations and the percentage of motile cells (p-0.001). No significant gender-dependent differences were observed (p-0.05). Statistically significant differences between young and senile age groups (p=0.048) were observed in the average oscillation amplitude, whereas ellipticity differed significantly in middle-aged vs. senile patients (p=0.040) and elderly vs. senile subjects (p=0.035). As for the effect of hemodialysis treatment duration, a reduction in the oscillation amplitude was observed when comparing maximum with minimum duration: less than 1 year (p=0.029) and 1 year (p=0.035). Aggregation index values were the highest in the groups with the minimum (p=0.044) and maximum (p=0.035) dialysis duration. Conclusion. In hemodialysis patients, the oscillation amplitude of erythrocytes was significantly reduced, with assumed tendency for further decrease associated with duration of hemodialysis treatment.
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Objective: to determine the features of intercellular interaction of platelets with neutrophils expressing adhesion molecules in psoriasis patients. Material and Methods. The study included 82 patients 20-60 years of age with a plaque psoriasis or pustular psoriasis. As a control group, 50 virtually healthy individuals 20-60 years old were examined. The study of the adhesion molecules spectrum on neutrophils was carried out on a Beckman Coulter FC-500 flow cytometer (USA) using monoclonal antibodies. The platelet-neutrophil aggregates were determined sensu the method by Yu.A. Vitkovsky et al. (2006). Results. In patients with psoriasis, compared with the control group, few intercellular contacts of neutrophils with platelets were revealed. Low values of platelet-neutrophil aggregates with 3, 4, and 5 lobes in the nucleus were observed. The formation of aggregates statistically significantly correlated with the expression of LFA-1 and PECAM-1 adhesion molecules by mature neutrophils. Conclusion. Low rates of intercellular interaction of platelets with three-, four-, and five-lobed neutrophils in psoriasis were indicative of their augmented migration from the peripheral blood to the epidermis. The adhesion molecules LFA-1 and PECAM-1 play a key role in the migration of platelet-neutrophil aggregates.
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Features of microcirculatory responses in experimental wound area in white rats
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Objective: to examine changes in the microcirculatory bed parameters via laser Doppler flowmetry in the course of wound healing and the possibility of their use for upgrading the technology of evaluating the effectiveness of wound healing agents. Materials and Methods. The studies were performed on 25 white rats distributed between two groups: 10 control animals (intact rats) and 15 animals with a full-thickness experimental skin defect. The microcirculation parameters in the skin of experimental wound edges in rats were evaluated using laser Doppler flowmetry, and histological preparations of tissues in the wound area were analyzed. Results. Changes in skin microcirculation at the wound edges were characterized by inflammatory hyperemia manifested by an increase in the perfusion index by 27% and augmented normalized amplitudes of myogenic, respiratory and cardiogenic oscillations. Changes in microcirculation were verified by the morphological picture of inflammation, which reflects an increase in the number of vessels fully filled with arterial and venous blood, as well as in leukocyte infiltration of the wound edges and bottom. Conclusion. Monitoring of microcirculatory disorders occurring in the area of skin wounds allows assessing the dynamics of the reparative process, which could be used for developing and evaluating the effectiveness of existing medicamentous and non-medicamentous methods of stimulating regeneration.
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