Journal articles - Saratov Medical Journal
All articles: 107
Scientific article
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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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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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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Directional coupling diagnostics is a promising method for the early noninvasive diagnosis of cardiovascular diseases. However, the complexity of living systems imposes unique requirements, necessitating the development of specialized approaches. This study explored the feasibility of solving the problem of directional coupling diagnostics using deep machine learning methods. Three fundamentally different artificial neural network architectures were considered: fully connected, recurrent, and convolutional. These architectures were compared for the accuracy of estimating the strength of directional coupling and their robustness to noise typically present in actual cardiac signals. The artificial neural networks were trained and tested on synthetic data: time series generated by functional mathematical models simulating the low-frequency oscillatory components of actual heart rate variability and mean blood pressure (Mayer waves). The fully connected artificial neural networks achieved an error of less than 3% when analyzing signals lasting only 70 seconds. The obtained results are promising in terms of the development of noninvasive methods for monitoring the state of autonomic circulatory control and for the advance of personalized medicine.
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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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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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Objective: to evaluate the activity disorder of the blood clotting factor as a potential risk factor for incomplete closure and recurrence of full-thickness macular holes (FTMHs) after surgical intervention with autologous conditioned plasma (ACP). Materials and methods. We conducted a single-center retrospective cohort study involving 62 patients (62 eyes) with primary FTMHs. The patients underwent microinvasive subtotal vitrectomy with removal of epiretinal and internal limiting membranes, application of ACP mass, and air tamponade. We divided the patients into two groups: the main group (31 patients with coagulogram abnormalities) and the control group (31 patients with normal values of coagulogram parameters). Results. Surgical outcomes demonstrated that among patients with abnormal coagulogram, recurrence of FTMH was observed in 85.7% of cases vs. 14.3% in the control group (p=0.005). When assessing the deviations in the coagulogram parameters among patients with recurrent macular hole, we revealed that in 83.3% of cases there was an increase in prothrombin time (p=0.042) and 75.0% of patients exhibited a reduction in fibrinogen concentration (p=0.049). Conclusion. Abnormalities in the coagulogram may be a risk factor for unsuccessful closure of the FTMH when using ACP mass. Relapse was detected six times more often with an increase in prothrombin time, as well as with a reduction in the blood fibrinogen content below 2.0 g/L.
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Evaluating the efficacy of surgical treatment in infants with choanal atresia
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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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Objective: to evaluate the role of soluble fms-like thyroxine kinase-1 (sFlt-1) and anti-endothelial cell antibodies (AECA) in patients with acute coronary syndrome (ACS) in the post-COVID era. Materials and Methods. The study included 118 patients (including 57 women, 61 men) with ACS and a history of novel coronavirus infection (NCI). All patients were measured for the levels of sFlt-1and AECA in the blood. The comparison group consisted of 121 patients with ACS without NCI. Results. Elevated levels of sFlt-1 and AECA were more often detected in the ACS group and group with a history of NCI vs. the comparison group: relative risk (RR)=2.768 [95% confidence interval (CI): 2.0810-3.681], p<0.001; and RR=1.554 [95% CI: 1.216-1.987]; p=0.002), respectively. In the group of patients with ACS and a history of NCI, a more severe course of ACS was also observed: arrhythmia was observed more often (RR=1.372 [95% CI 1.005-1.784]; p=0.032), along with rehospitalization in the first 14 days for cardiovascular diseases (RR=1.475 [95% CI: 1.100-1.977]; p=0.032) and in-hospital mortality (RR=1.610 [95% CI: 1.160-2.233]; p=0.042). Conclusion. Levels of AECA and sFlt-1 are associated with the risk of developing a severe course of ACS in patients who have previously undergone NCI.
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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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Objective: to evaluate echocardiographic changes in patients with acute coronary syndrome (ACS) combined with post COVID-19 syndrome (PCS). Materials and methods. The study included 118 patients (61 men and 57 women) with ACS+PCS. All patients were subjected to the echocardiography (EchoCG) on the first day, in addition to coronary angiography and general clinical examination methods. The comparison group included 121 patients with ACS but without PCS. Results. In the ACS+PCS group, the following parameters were statistically significantly more frequently recorded than in the ACS group: elevated blood pressure (risk ratio, RR 2.327; 95% confidence interval, CI 1.582-2.699), tachycardia (RR 2.067, 95% CI 1.415-3.730), dyspnea (RR 2.022, 95% CI 1.495-2.736), weakness (RR 4.077, 95% CI 2.946-5.643), and insomnia (RR 1.893, 95% CI 1.519-2.358); p<0.001. According to EchoCG results, in the ACS+PCS group of patients, an increase in the mean pulmonary artery pressure, expansion of its diameter, and mitral valve regurgitation were noted (p<0.001). Of the cardiac complications, the most common were left ventricular apical thrombus (RR 1.785, 95% CI 1.304-2.444), left ventricular aneurysms (RR 1.736, 95% CI 1.234-2.443), along with hypokinesis and akinesis (development of myocardial infarction) (RR 1.673, 95% CI 1.275-2.196; p<0.05). Conclusion. Patients who experienced ACS in combination with PCS exhibited more pronounced EchoCG changes vs. patients without PCS.
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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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Functional prognosis of acute ischemic stroke patients from their neuropsychological features
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The objective was to evaluate the relationship between the patient neuropsychological condition and recovery of his/her motor activity disorder due to acute cerebrovascular accident. Materials and Methods. The study involved 103 patients with ischemic stroke in the pools of middle and anterior cerebral arteries. We carried out clinical and neurological assessments of the patient condition, and conducted neuropsychological testing via Beck Hopelessness Scale (BHS), Montreal Cognitive Assessment (MоCA), SF-36, and Visual Analog Scale (VAS). The examination was performed on three occasions: during the acute phase of cerebral circulatory disorders, after two weeks and within the range of 24-36 months. After the long-term follow-up, all patients were distributed among two groups: with a favorable outcome and with unfavorable outcome. We attempted to identify the most typical values of above-mentioned scales for each group. Results. The general physical health (GPhH) indicators based on the results of SF-36 (p=0.007), BHS (p=0.003 and 0.002), and VAS (p=0.025), collected after acute ischemic stroke, were prognostically significant. In both groups, the most important indicators for the stroke prognosis were MоCA (p=0.038), BHS (p=0.009) and SF-36 (GPH) (p=0.002), regardless of the stroke phase. Conclusion. The connection between the patient neuropsychological condition and restoring the motor functions after the stroke was revealed. The investigated questionnaires can be included in the multivariate forecast model of the stroke prognosis among other criteria for the outcome of this disease.
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Objective: assessing the association of sequence variants rs8192678, rs1801282, rs9939609, rs7799039 and rs1137101in PPARGC1A, PPARG2, FTO, LEP and LEPR genes, respectively,with non-alcoholic fatty liver disease (NAFLD) inyounger adults (18-44 years old) of the Russian Federation. Materials and Methods. Our case-control study encompassed 100 patients distributed between two groups: Group 1 (cases) with patients suffering from NAFLD (n=50) andGroup 2 (controls) with individuals without it (n=50). All subjects underwent a conventional sonography of their liver and shear wave elastography (Aixplorer®, France): both ultrasound examinations assessed the severity of liver steatosis and fibrosis. Results. We discovered two sequence variants associated with an increased risk of NAFLD in women: rs9939609 and rs7799039: A/A rs9939609 genotype (OR 5.33, 95% CI 1.14-24.90,p=0.041) and G/G rs7799039genotype (OR 7.5, 95% CI 1.04-54.12,p=0.026). Conclusion.The A/A genotype of the rs9939609 gene in younger women of the Russian population yielded the fivefold increase in the likelihood of NAFLD, whereas the G/G genotype of the rs7799039 gene resulted in a 7.5-fold likelihood ofNAFLD occurrence.
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Impact of bone marrow allotransplantation on functional state of mast cells in lymph nodes
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Objective: to analyze the functional state of mast cells (MC) after bone marrow allotransplantation at the early stages of the experiment. Materials and Methods. The experiments were carried out on 40 outbred male mice, which were divided into 3 groups: Group 1 with intact animals (n=10); Group 2 with control animals injected with 0.85% sodium chloride solution (n=10); Group 3 with experimental animals (n=30) injected into their tail vein with a cell suspension from another mouse under ether anesthesia. The state of mast cells was evaluated by the method of staining with polychrome toluidine blue sensu P.G. Unna. Results. Forty minutes after the introduction of foreign bone marrow in the medulla, metachromatic MC were found near the vessels, and their proportion (60%) prevailed over orthochromatic MC (40%). MC were most often located in groups, especially near the vessels, in contact with each other. The morphometric parameters of MC were changing (diameter, 8.00-17.00 μm 6.00-12.00 μm vs in intact MC). Two hours after the experiment, in accordance with the degree of heparin sulfation, metachromatic mast cells were predominantly detected (92%), and extensively degranulated MC predominated (61%), p<0.05. The size of MC was changing (diameter: 3.00-9.00 μm; distance between cells: 29.00-53.00 μm). One-way analysis of variance established that there was a significant effect of the experiment duration on the change in the proportion of MC with metachromatic staining. Conclusion. An introduction of bone marrow transplant significantly changes the functional profile of mast cells.
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