Journal articles - Saratov Medical Journal
All articles: 107
Using endoscopic hemithyroidectomy in patients with benign thyroid diseases
Scientific article
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 linezolid and bedaquiline in patients operated for multidrug-resistant pulmonary tuberculosis
Scientific article
Objective: to evaluate comprehensive treatment outcomes in patients operated for multidrug-resistant pulmonary tuberculosis (MDR-TB) with the inclusion of linezolid and bedaquiline in the chemotherapy (CTX) regimens. Materials and methods. We performed a non-randomized continuous single-center retrospective study on 114 patients operated on at the National Medical Research Center for Phthisiology of the Russian Federation Ministry of Healthcare from 2018 to 2022. We conducted a comparative analysis of the effectiveness of CTX regimens in patients with localized and extensive forms. Results. We detected a statistically significantly wider spectrum of Mycobacterium tuberculosis (MTB) drug resistance (DR) in 41.6% (n=32/77) of patients with tuberculomas and in 18.9% (n=7/37) of patients with fibrous cavernous tuberculosis based on the study of resection specimens vs. respiratory specimens (p=0.03). Inclusion of linezolid and bedaquiline in the CTX regimen for patients with MDR-TB resulted in a reduction in the duration of postoperative treatment by, on average, 14.0±1.3 weeks and 11.1±4.5 weeks, respectively, for localized TB forms and by 14.8±3.2 weeks and 14.9±3.7 weeks, correspondingly, for extensive TB forms vs. CTX regimens without these drugs. Conclusion. Addition of new antitubercular drugs (linezolid and bedaquiline) to the CTX regimen in patients with MDR-TB can reduce the treatment duration in case of both localized and extensive forms of the disease.
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Using neural network for restoring the lost surface of skull bones
Scientific article
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
Scientific article
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
Scientific article
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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Scientific article
Objective: to carry out a comparative assessment of risk factors, target organ damage, and gestational outcomes in pregnant women with HTN and normal blood pressure (BP). Materials and Methods. The prospective cohort study included 88 pregnant women distributed among two groups: Group 1 (main group) included 44 women with white coat HTN), while Group 2 (comparison group) comprised 44 women with normal BP). We performed an assessment of clinical factors, 24-hour BP monitoring parameters, damage to target organs (heart, kidneys, and blood vessels), and pregnancy course and outcomes. Results. Women with white coat HTN vs. normotensive pregnant females had a higher prevalence of abdominal obesity (90.9% vs. 47.7%; p<0.001) and history of preeclampsia (11.4% vs. 0%; p=0.021); higher systolic (SBP) and diastolic BP (DBP) during daytime (p<0.001) and at night (p=0.006); higher daytime heart rate (p=0.006); thicker left ventricular posterior wall (p<0.001) and interventricular septum (p<0.001); greater relative wall thickness of the left ventricle (LV) (p=0.003); higher LV myocardial mass (p<0.001) and LV end-diastolic volume (p=0.020); thicker intima-media of blood vessels on the right (p=0.022) and left (p=0.006); and higher value of the right cardio-ankle vascular index (p=0.043) and urine albumin/creatinine ratio (p<0.001). The course of pregnancy in women with white coat HTN was more often aggravated by gestational diabetes mellitus (79.5% vs. 25%; p<0.001) and late-onset preeclampsia (11.4% vs. 0%; p=0.021). Conclusion. Pregnancy in women with white coat HTN is characterized by an increased risk of developing structural and functional changes in target organs and a high frequency of complications vs. normotensive pregnant women.
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Scientific article
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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