Статьи журнала - Saratov Medical Journal
Все статьи: 77
Статья научная
Objective: assessment of the anatomical and topographical parameters of the wound channel formed in the course of the posterolateral musculofascial approach with the purpose of identifying the possibility of its clinical use in decompressive and stabilizing surgical interventions. Materials and Methods: a posterolateral musculofascial approach to the lumbar spine was modeled using material from 20 male and female cadavers 54 – 76 years of age (median 67.5 years) who died from diseases not associated with the pathology of the spine. The study examined wound length, depth, wound depth index, and wound access zone, as well as the angle of intersection of the wound edges with the surface of surgical instruments. Results: the mean length of the surgical wound when performing the lateral musculofascial approach was 149.75±6.35 mm. The mean depth of the wound was 116.75±8.85 mm. The mean value of the surgical wound depth index with interfascial approach was 77.96±5.04. The mean area of the intervertebral disc available for removal was 71.2±2.8%. The length of the aperture in the annulus fibrosus was on average 15.8±0.78 mm. The mean angle of the intersection of the wound edge by the trajectory of transpedicular screw implantation was 3.15±1.25°. Conclusion:the assessment of the anatomical and topographical parameters of the wound channel formed during the posterolateral musculofascial approach allowed concluding that such surgical approach could be used to improve the functional outcomes of decompressive and stabilizing interventions on the lumbar spine.
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Статья научная
Objective: to assess the readiness of patients for online communication with a healthcare worker and the demand for medical care in a remote format. Materials and Methods. We interviewed 507 patients using the original questionnaire, which allowed obtaining data on the respondents’ experience in using online communication with a doctor, their readiness for digital health care instead of office visits, and the impact of Internet resources on the patient’s trust in the recommendations given by the attending physician. Results. We established that 30.6±2.1% of patients used online communication with their doctor, while 40.5±2.2% would like to have this opportunity. We observed a difference in readiness for digital communication between groups of respondents interested in pediatricians (parents of children attending city children’s polyclinics) and groups of central district hospital patients and multidisciplinary city hospital patients (p<0.001). The effect of age on the patient’s readiness for online communication has been confirmed. The most in demand in the remote format were referral services (for laboratory tests and hospitalization), especially in the group of parents of children attending city children’s polyclinics. The study of the patient’s behavior in relation to the search for a second opinion on the Internet showed that the majority of the respondents did not intend to double-check their doctor’s prescriptions, and the absolute majority of respondents (82.8±1.7%) trusted more their attending physician than Internet sources. Conclusion. The results of the study indicate the readiness of the population to implement digital communication and transfer part of medical care to the digital sphere. The most in-demand services were those for issuing referrals for hospitalization and to specialists, as well as for tests and pharmaceutical prescriptions that the patient receives on an ongoing basis.
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Статья научная
Objective: to identify the relationship between the results of in silico and in vivo studies of hypoglycemic, hypolipidemic, and hepatoprotective properties expressed by a new 1,4-dihydropyridine derivative with the laboratory code AZ-383. Material and Methods. Virtual biological screening of the AZ-383 compound was conducted using SwissTargetPrediction online tool. The identified biotargets were promising for pharmacological correction of multiple metabolic disorders, which was confirmed in an in vivo experiment conducted on male Wistar rats: the levels of glucose, total cholesterol, triglycerides, alanine aminotransferase, aspartate aminotransferase, and total bilirubin in the blood were examined; the microarchitecture of the rat liver was assessed after pharmacological correction (using the AZ-383 compound) of the modeled metabolic disorders. Results. The presence of hypoglycemic, hypolipidemic and hepatoprotective properties in the compound AZ-383, along with its favorable effect on body weight, was revealed. The glucose level reached values of 7.9±0.4 mmol/L. The body weight of rats after the use of AZ-383 was 378±12 g. Under the influence of AZ-383, we observed an increase in the number of hepatocytes by 17.8%, a reduction in the size of hepatocytes by 7%, and a decrease in the area of the cytoplasm and nuclei of hepatocytes by 5.2% and 18.7%, respectively, vs. the control group of animals. Conclusion. Our in vivo experimental study confirmed the presence of hypoglycemic, hypolipidemic and hepatoprotective properties in the AZ-383 compound, which corresponds to the biotargets determined in silico for this 1,4-dihydropyridine derivative.
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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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Статья научная
Objective: to conduct a comparative analysis of the accuracy of intraocular lens (IOL) selection in patients with an eye length of less than 22.0 mm using the Barrett Universal II, Kane, and Hoffer Q formulas, as well as via artificial intelligence (AI). Materials and Methods. We analyzed the outcomes of 88 phacoemulsification cataract surgeries with monofocal IOL implantation. Preoperative biometry and IOL calculations were performed on an IOL Master 700 (Zeiss, Germany). The accuracy of IOL selection was also determined via the LensCalc software based on AI (DecisionTreeClassifier). Results. The axial length of the eyes in patients ranged from 19.8 to 22.0 mm. The prediction of achieving the target refraction was most accurate when using the Barrett Universal II formula rather than Hoffer Q (Z=2.12; p=0.034). The mean error in achieving the target refraction when using the Barrett Universal II formula did not differ from the Kane formula (p>0.05). Using AI, we established that higher accuracy in the IOL power calculation was achieved when using the Barrett Universal II formula. Conclusion. Based on a comparative analysis of the study results and an assessment of the accuracy of IOL selection using AI, we established that the Barrett Universal II formula (4th generation) was more accurate in determining the optical power of the IOL in short eyes than the Hoffer Q formula (3rd generation). Our calculation results based on using the Barrett Universal II formula, unlike the Hoffer Q formula, were similar (p>0.05) to those calculated using the Kane formula (5th generation), which, according to the results of the majority of published studies, is currently the most accurate formula for IOL selection.
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Skin autofluorescence as a factor of adverse prognosis in patients with peripheral atherosclerosis
Статья научная
Objective: to determine the prognostic value of skin autofluorescence (SAF) as a factor of cardiovascular complications and mortality. Materials and Methods. Our prospective study included 122 patients with peripheral arterial disease (PAD): atherosclerotic stenosis of the brachiocephalic trunk was detected in 95 patient (77.9%), while chronic arterial insufficiency (CAI) of the lower limbs was found in 47 study participants (38.5%). SAF was measured by an original device developed by the authors. Clinical, anthropometric and biochemicalparameters, along with instrumental parameters of the heart and blood vessels, were studied via ultrasound examination. The prospective part of the study (follow-up) was carried out for up to 1,043 (on average, 736) days. Results.The SAF parameter correlated directly and significantly with scores on the scale of clinical prognostic signs, CAIof the lower limbs, and history of surgeries on the leg arteries. In the course of the follow-up period, there were seven deaths and at least one hospitalization for cardiovascular reasons in 42 patients. The most common were hospitalizations due to conservative treatment of CAI, the need for coronary artery bypass grafting, and coronary stenting. Using the logistic regression method, we determined that the incidence of hospitalization or mortality was associated with SAF values, plasma glucosecontent, and the presence of chronic heart failure above functional class 1. The sensitivity and specificity of the model were 71% and 68%, respectively. Conclusion.The SAF parameter can be used as an integral independent predictor in patients with multifocal atherosclerosis.
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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
Objective: to evaluate total testosterone level in men with type 2 diabetes mellitus (DM) and varying degrees of carbohydrate metabolic compensation. Materials and Methods. The continuous cross-sectional non-interventional screening study included 100 men 45 [43; 48] years of age with newly diagnosed type 2 DM. The study continued from February through May of 2021. The level of glycated hemoglobin (HbA1c) and total blood testosterone were determined. Group comparisons were performed via Mann–Whitney U test, Kruskal–Wallis test and Fisher’s exact test. The differences were assumed statistically significant at p<0.05. Results. When comparing patients with different HbA1c content, we discovered that in patients with HbA1c from less than 6.5 to 9.9%, total testosterone levels as well as testosterone deficiency prevalence did not differ statistically significantly. At HbA1c -12%, the prevalence of testosterone deficiency increased statistically significantly (p<0.001), and testosterone levels decreased (p<0.001). Comparison of patient groups with HbA1c levels from less than 6.5 to 9.9% and from 10 to 11.9% did not yield statistically significant differences in the testosterone deficiency prevalence and testosterone content. However, there was a trend towards worse parameter values in the latter group, especially because patients with HbA1c levels from less than 6.5 to 9.9% were older. Conclusion. Total testosterone levels in type 2 DM patients are associated with carbohydrate metabolic compensation. Negative impact on testosterone production was detected in patients with HbA1c content of ≥10%.
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Статья научная
Objective: to identify the nature of proliferation and apoptosis process disorders in the gingival epithelium in postmenopausal women with varying degrees of bone mineralization for early diagnosis and optimization of combination therapy. Materials and Methods. We examined 80 women aged 55–60 years with chronic generalized periodontitis (CGP) and reduced bone mineral density (BMD). All patients underwent a standard dental examination, including an index assessment of periodontal tissues. BMD was quantified via a densitometric analysis of the bone tissue condition. The investigation of periodontal epithelial cell renewal was performed using immunohistochemical studies. Results. We discovered that in postmenopausal patients with CGP and BMD disorders, there was a reduction in the proliferation of gingival epithelial cells with activation of their apoptosis (Iapt=0.73±0.03%, Iki-67=11.77±0.27%) vs. the patients with intact periodontium (Iapt 0.29±0.04%, Iki-67=9.88±0.09%), p=0.04. Conclusion. We discovered that CGP in postmenopausal women occurs with enlarged activity of apoptosis of gingival epithelial cells against the background of their reduced proliferation. The activity of inflammatory destructive processes in periodontal tissues is higher in patients with osteopenia vs. those without BMD impairment.
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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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Статья научная
Objective: to assess the informativity of using the cytological rapid method for examining sentinel lymph nodes in patients breast cancer. Materials and Methods. Our included 46 patients 30-85 years of age with verified breast cancer. On the day before the surgery, approximately 150-200 MBq of the 99mTc-NanoTop radiopharmaceutical were injected peritumorally into the parenchyma of the affected mammary gland. After 1.5-2 hours, lymphoscintigraphy was performed, followed by SPECT/CT. The latter helped visualizing sentinel lymph nodes. The next day after the administration of the radiopharmaceutical, during surgery, sentinel lymph nodes were identified using a gamma detector. Further on, the surgeon removed the lymph node(s) and sent it/them for the examination by the cytological rapid method. To assess the informativity of this method, we compared its results the gold standard of morphological diagnostics: histological examination of postoperative material. Results. The cytological rapid method revealed the presence of metastases in sentinel lymph nodes in 12 patients, which substantially influenced their further treatment tactics. We therefore conformed that this method is not inferior to the histological examination of the tumor. The sensitivity and specificity of the cytological rapid method are 100%. When comparing the results of cytological rapid method and planned histological examination, we revealed no discrepancies in diagnoses based on the state of the lymph nodes. Conclusion. Cytological rapid method is an informative method for sentinel lymph node detection in breast cancer patients.
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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 neural network for restoring the lost surface of skull bones
Статья научная
Objective: To assess the sensitivity, specificity and accuracy of a digital algorithm based on convolutional neural networks used for restoring the lost surface of the skull bones. Materials and methods. The neural network was trained over 6,000 epochs on 78,000 variants of skull models with artificially generated skull injuries. The key parameters of the algorithm were assessed on 222 series of multislice computed tomography (MSCT) of patients with defects of the skull bones, presented in DICOM format. Results. For the group as a whole, the sensitivity, specificity, and accuracy rates were 95.3%, 85.5%, and 79.4%, respectively. Multiple experiments were conducted with a step-by-step elimination of 3D models in order to find the underlying cause of unsatisfactory outcomes of the skull lost surface restoration. Incorrect identification of the defect zone most often occurred in the area of the facial skeleton. After excluding series with the presence of artifacts, the mean increase in metrics was 2.6%. Conclusion. The accuracy of identifying the reference points (specificity) on a 3D model of the skull by the algorithm had the greatest impact on the ultimate accuracy of repairing the lost surface. The maximum accuracy of the algorithm allowing the use of the resulting surfaces without additional processing in a 3D modeling environment was achieved in series without the presence of artifacts in computed tomography (83.5%), as well as with defects that did not extend to the base of the skull (79.5%).
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Using orthobiologics products in knee osteoarthritis
Статья научная
Objective: comparison of the treatment effectiveness in patients with grades II or III knee osteoarthritis using autologous bone marrow aspirate concentrate (BMAC) and autologous platelet-rich plasma (PRP) infused intraosseously into the area of overload bone marrow edema. Materials and Methods. The prospective study was conducted on the basis of two medical clinics from 2016 to 2019. It involved 40 patients with grades II–III knee osteoarthritis. The patients of the treatment group underwent a single intraosseous infusion of BMAC, whereas patients in the comparison group were subjected to a single intraosseous PRP infusion. The results were assessed after 1, 3, 6, and 12 months using visual analog scale (VAS), Lequesne index for knee osteoarthritis, WOMAC osteoarthritis index, and verbal rating scale (VRS). Results. After 12 months, there was a reduction in the VAS index to 3.9±0.3 points in the treatment group and 4.2±0.1 points in the control group. Similar decrease was observed for Lequesne index for knee osteoarthritis (to 5.8±0.7 points in the treatment group and to 6.1±0.8 points in the control group) and WOMAC osteoarthritis index (to 40.6±0.3 points in the treatment group and to 42.5±0.6 points in the control group). The VRS scores after 3 and 6 months were better in the treatment group (subjected to autologous BMAC), while after 12 months, the differences between the groups were not significant. Conclusion. Use of orthobiologics products for osteoarthritis treatment was effective, with higher efficacy of intraosseous BMAC infusion vs. PRP infusion in terms of pain, knee functionality, physical activity, and patient satisfaction over the entire monitoring period. Both treatment methods were safe.
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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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Статья научная
Objective: to assess the concentration of the sST2 biomarker and its relationship with the morphological and functional parameters of the LV myocardium in patients with coronary artery disease (CAD) and functional class (FC) I-III chronic heart failure (CHF), who survived COVID-19 or did not experience it. Materials and Methods. We examined 100 patients (66 males) of median (Me) age of 65 [63; 67] years with stable CAD and FC I-III CHF (sensu New York Heart Association), distributed among two groups depending on the presence of COVID-19 in their anamneses. Along with the conventional clinical examination, the concentration of serum sST2 was determined via ELISA. Results. We revealed that in patients surviving COVID-19 (Group 1), the sST2 level was 38.4 [35.5; 44.8] ng/mL, while in the comparison group (Group 2), it amounted to 29.63 [27.9; 32.7] ng/mL (p<0.001). In Group 1, the end-diastolic volume and the end-systolic volume of the left ventricle (LV) significantly exceeded values of these parameters in Group 2 (p=0.004 and p=0.02, respectively) and amounted to 118.2 [107.5; 166.5] mL and 44.1 [35.0; 58.1] mL, correspondingly, in Group 1 and 107.5 [92.4; 129.5] mL and 37.9 [29.5; 47.4] mL in Group 2. The number of patients with grade 2 diastolic dysfunction (DD) in Group 1 (18–33.9%) significantly exceeded that in the comparison group (7%–14.9%). Changes in global longitudinal strain (GLS) of the LV in Group 1 (-15.6 [-20.8; -13.8] %) were more pronounced than in the comparison group (-19.9 [-21.5; -16.3] %), p=0.018. Conclusion. CAD patients with FC I-III CHF, who survived COVID-19, had statistically significantly higher serum sST2 concentration, more pronounced LV DD, and greater LV GLS.
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