Статьи журнала - Saratov Medical Journal
Все статьи: 77
Functional prognosis of acute ischemic stroke patients from their neuropsychological features
Статья научная
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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Статья научная
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
Статья научная
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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Impact of excess weight on surgical treatment of the ankle joint
Статья научная
Objective: to assess the possible effect of excess body weight on the results of surgical treatment outcomes of ankle osteoarthritis.
Materials and Methods.Our study sample included 134 patients with moderate to advanced ankle osteoarthritis who underwent supramalleolar osteotomy or ankle arthrodesis.Patients were distributed among four groups according to their body mass index values: A) underweight (BMI≤18.5kg/m2), B) normal weight (18.5
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Статья научная
Objective: to evaluate the effects of alginate microcapsules on morphological changes in periodontitis depending on silver nanoparticle concentration in them. Materials and Methods. The study was conducted on 30 rats distributed among three groups of 10 animals: the comparison group comprising animals with an experimental model of periodontitis and two experimental groups including animals with 5-week periodontitis, which were subjected to applications of the gel containing microcapsules with high (0.25 M, Group 1) and low (0.1 M, Group 2) concentrations of silver on the surface of their gums. To assess morphological changes, the mandible was sampled for subsequent examination. Results. In animals with periodontitis, changes in the supporting structure of the tooth took place, including defibration and perivascular edema in periodontal ligament of the tooth, and bone resorption via its replacement with connective tissue. The application of a gel containing microcapsules with silver nanoparticles led to a partial reduction of such disorders: particularly, it reduced bone resorption and its replacement with connective tissue. Destructive changes in periodontal tissues caused by gel with a high content of silver nanoparticles (0.25 M) were less pronounced than those caused by capsules with a low content of silver (0.1 M). Conclusion. Gels containing microcapsules with silver nanoparticles contributed to the reduction of destructive changes in the supporting structure of the tooth in periodontitis. The severity of the effects of the gel increased with an increase in the content of silver nanoparticles in alginate microcapsules.
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Indicators of antioxidant activity in unexplained infertility: A cohort study
Статья научная
Objective: to evaluate the levels of antioxidant protection markers in women with unexplained infertility vs. women who had at least one term birth of a live full-term fetus. Materials and Methods. We conducted a comparative retrospective cohort study, which included 52 women with unexplained infertility and 85 women without infertility. During the study, we examined standard biochemical parameters, along with antioxidant and peroxidase activity. Results. In women with unexplained infertility, the overall antioxidant activity was more pronounced than in women without infertility (2.21±0.312 and 1.970.312 ng/mL, respectively; p<0.001), while they exhibited a lower peroxidase activity (11.6±3.96% and 13.46.67%, correspondingly; p<0.001). Conclusion. Our study established that in women with unexplained infertility, the level of overall antioxidant capacity of serum was higher than in women who have executed their reproductive function, while peroxidase activity in the former was less pronounced.
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Instances of folliculogenesis in rat thyroid: The norm vs. the experiment
Статья научная
Objective: identification and characterization of the stages of new follicle formation, along with measuring the frequency of folliculogenesis in various parts of the thyroid in normal and experimental conditions. Materials and Methods. The experiment was performed on 36 mature white rats distributed among three groups: the control (Group I), 60-day exposure to sodium benzoate at a dose of 1,000 mg/kg (Group II), and administration of Mexidol at a dose of 50 mg/kg against the background of a 60-day exposure to sodium benzoate (Group III). The stages of folliculogenesis were studied using light microscopy followed by statistical analysis of its frequency. Results. The formation of a new follicle begins with the proliferation of thyrocytes on the cell wall of the mature follicle, after which a cavity is formed between the cells into which they secrete colloid. As the follicle grows, the height of the thyrocytes declines, and the size of their cavity and the amount of colloid increase. In Group II vs. Group I, on days 3 and 24 of the experiment, signs of folliculogenesis were detected 1.7 and 1.4 timesless frequently in the thyroid center, and 2 and 1.2 times less often in the thyroid periphery; while in Group III vs. Group II, these were observed1.3 and 1.6 timesmore often in the center of the organ, and 1.3 and 1.3 times more frequently in the thyroid periphery. Conclusion. During folliculogenesis in the thyroid, focal proliferation of thyrocytes develops in the cell wall of one of the follicles with further formation of the cavity of the newly formed follicle and its growth. Normally, the formationfrequency of new follicles is higher in the organcenter vs. the periphery and lower in both thyroid zones in the group of rats exposed to sodium benzoate. However, in the group of rats where sodium benzoate administration waspharmaceuticallycorrected by Mexidol, the frequency of the young follicleformation increased, albeitit did not reach the control values.
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Статья научная
Objective: to conduct a comparative analysis of the features of intracellular metabolism in polymorphonuclear leukocytes (PMN) in the peripheral blood of rats with inherited stress-induced arterial hypertension (ISIAH) vs. normotensive animals (NTA). Materials and Methods. In the leukocytes of rat blood (15ISIAH rats and 20 NTA), the indicators of carbohydrate and lipid metabolisms, the activity of a number of key enzymes reflecting the state of redox processes, and PMN functional activity level were determined using histochemical methods. Results. The study established that a stable increase in blood pressure was accompanied by hypertrophy of the left ventricle, degenerative changes in cardiomyocytes and a decrease in the density of the microvasculature. At the same time, the amount of intracellular glycogen in leukocytes decreased by 23% while the amount of intracellular lipids remained unchanged. The levels of activity of intracellular ATPase and myeloperoxidase decreased by 22% with a slight increase in the activity of succinate dehydrogenase (by 13%). The number of PMN with a positive hematocrit (НСТ) test was higher by 35% in ISIAH rats.Conclusion. Analysis of the studied PMN metabolism indicators revealeddisorders in the energysupplying and enzymatic processes of leukocytes in arterial hypertension.
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Malnutrition in hospitalized children
Статья научная
Objective: Our study aimed to determine the prevalence and grade of malnutrition in patients hospitalized for various indications and to examine its relationship with comorbidities and socio-demographic factors. Materials and Methods: This study enrolled children aged 1 month to 15 years old with a median age (Q25; Q75) of 1.8 (1.27–3.47) years, admitted to our hospital with various diagnoses between 1 January 2019 and 31 December 2019. Our study included 498 patients, 286 (57.4%) of which were male and 212 (42.6%) were female. Results: Of all patients, 40 (19.7%) with a median age of 2.25 (1.27–3.48) years had a weight z-score of less than –2SD. Of our patients, 47.2% (n=235) had malnutrition sensu the Waterlow classification. There were significant differences between the groups in socioeconomic level and C-reactive protein (CRP) content. Conclusion: Malnutrition is associated with a low socioeconomic status. It plays an important role in hospitalizations with various diagnoses.
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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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Microbiological aspects of acute odontogenic osteomyelitis in children
Статья научная
Objective: to identify the species composition of pathogens causing acute odontogenic inflammatory process in the children’s jaws; to examine the sensitivity and resistance of the isolated microflora to antibiotics of various groups; and to determine the dependence of the disease clinical course on the type of dominant pathogen. Materials and Methods.The results of a microbiological study of exudate from purulent odontogenic foci of 900 children regarding periostitis and osteomyelitis of the jaws were analyzed. Results. In 65.6% of cases, the causative agent was Streptococcus pyogenes known as group A beta-hemolytic streptococcus (GABHS) possessing a high sensitivity to vancomycin (99%), fluoroquinolones (98%), beta-lactam antibiotics (91%), and the highest resistance to macrolides (41%). We have also isolated Streptococcus viridans (6.1%), Streptococcus pneumoniae (4.3%) andmixed microflora (14.3%). The syndrome of endogenous intoxication of the body was manifested by high fever in 56% of cases, by leukocytosis in 38% of patents, and by acceleration of the erythrocyte sedimentation rate in 57.4% of study subjects. There was no statistically significant difference in the degree of endogenous intoxication between groups with different types of streptococci. Conclusion. The cause of the inflammatory process in the jaws was GABHS (65.6% of cases) with a high sensitivity to vancomycin (99%), fluoroquinolones (98%), and beta-lactam antibiotics (91%).
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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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Статья научная
Objective: analysis of opinion dynamics in young people on prevention and treatment of sexually transmitted infections (STIs) against the background of COVID-19 pandemic vs. the pre-pandemic period. Materials and Methods. Our research was based on a comparison of data from a sociological survey of 400 respondents 16-21 years of age in 2021 and an analysis of 838 questionnaires from participants of the same age in a similar study in 2017. The research employed the methodology of sociological questionnaire. The original questionnaire was used, consisting of 46 questions, combined into five thematic blocks: assessment of the STI problem relevance, likelihood of infection risk, readiness to undergo preventive screening examinations, preferred directions for seeking medical help in the event of STI, and consent to examination and treatment in conjunction with a sexual partner. By gender, the distribution of study subjects was as follows: 51% of women (n=427) in 2017 vs. 52% (n=208) in 2021; 49% of men (n=411) in 2017 vs. 48% (n=192) in 2021. In processing and presenting the data, extensive indicators were used, compared with the assessment of the significance of differences sensu Student’s t-test. Results. In 2021, we observed an increase in the interest of young people in undergoing screening examinations (79.5% vs. 63% in 2017, p=0.006) and seeking medical help (93.5% vs. 89.5%, p=0.007); on the other hand, in 2021, young people were more likely to conceal their health status from a partner (32.2% vs. 8.3%, p=0.003). Conclusion. The study revealed a change in the opinions of respondents regarding STIs during the pandemic, specifically, an increase in understanding the need for regular examinations and seeking medical help in the event of STI symptoms, but at the same time, there was a reduced responsibility for the sexual health of their partner.
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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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Pathomorphological characteristics of the wound bed prior to skin autografting
Статья научная
Objective: to conduct a comparative pathomorphological analysis of wounds of various origins requiring full-thickness skin autografting. Materials and Methods. Histomorphological comparison of the wound bed prior to plastic surgery with full-thickness skin autografts was performed in three groups of patients: (1) during excision of scar tissue in elective surgery; (2) in case of traumatic skin detachments with autografting sensu Krasovitov; (3) when excising the granulation tissue to the fibrous layer. The object of the study included biopsy specimens from patients of three study groups. Results. The histological picture of wounds after removal of scars was characterized by well-developed dense fibrocellular connective tissue and had signs of chronic inflammation. In contrast to the cicatricial wound, acute lesions were characterized by granulation and mature dense fibrous connective tissues with pronounced inflammatory changes, each of which had its own characteristics. Conclusion. The results of the comparative analysis revealed the features of the morphological picture of wounds depending on the type of damage. In the group of acute injuries, traumatic and burn wounds, the most pronounced tissue damage was revealed. Given the obtained data, it should be assumed that full-thickness skin autografting will yield the best result in the group of patients after the planned excision of scar tissue.
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Pentraxin 3: possibilities and prospects for using a biomarker in patients with COVID-19
Статья научная
Objective: to determine the potential predictive value of serum biomarkers for adverse cardiovascular events in post-COVID-19 patients. Materials and Methods. The prospective study included 114 patients hospitalized with confirmed COVID-19. In addition to standard examinations, blood samples were collected on the day of admission to determine levels of serum cardiovascular biomarkers, including pentraxin 3 (PTX3). Patients were monitored for 366 [365; 380] days after discharge from the COVID-19 hospital with registration of all major adverse cardiovascular events (MACE) that developed. Results. During follow-up, we observed MACE in 19 patients (16.7%), including 2 deaths (1.8%) from cardiovascular causes. The incidence of MACE was higher in patients with higher concentrations of PTX3 (OR 1.28, 95% CI 1.13-1.45; p<0.001), interleukin 6 (OR 1.01, 95 % CI 1.0-1.02; p=0.048), D-dimer (OR 2.05, 95% CI 1.16-3.6; p=0.019), lactate dehydrogenase (OR 1.08, 95% CI 1.03-1.13; p<0.001), and MB fraction of creatine kinase (OR 1.19, 95% CI 1.02-1.39; p=0.001). PTX3˃3.1 ng/mL predicted the development of MACE with a sensitivity of 94.0% and specificity of 82.1% (AUC 0.885; p<0.001). Conclusion. Serum biomarkers, in particular PTX3, can be used to predict the development of MACE in the long-term follow-up of post-COVID-19 patients.
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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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