Journal of Clinical Practice

Dear Colleagues!

The main idea of our journal is to provide description and analysis of clinical cases with severe, rare and difficult for diagnoses diseases, occurred in the clinics of Federal Medical-Biological Agency of Russia. Such clinical analysis is aimed to develop “clinical” type of thinking, always have been the characteristic feature of Russian/USSR medical school. The journal purpose is also to improve scientific discussions and cooperation between physicians of different specialties.

Revival of historical traditions in our journal is the one of the components of continuing education, which is especially important in “closed” territories, where doctors can`t regularly participate in clinical conferences. An important aspect is to provide a printed tribune for any doctor who has an interesting clinical observation and wish to share his experience with colleagues. That is why we named our journal "Clinical Practice" and address it, first of all, those skilled in applied medicine. Of course, we also publish the results of original researches, clinical guidelines, current reviews and medical news. The journal is multidisciplinary and we hope that it will be interesting to doctors of different specialties. The journal is published by means of the Federal Research and Clinical Center of FMBA of Russia. Placement of all materials, except for advertising, are free of charge to authors.

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Current Issue

Vol 12, No 3 (2021)

Original Research

The choice of an optimal graft for the superior capsule reconstruction of the shoulder with a massive rotator cuff tear
Naida D.A., Dokolin S.Y., Kochish A.Y., Akhpashev A.A., Tyulkevich B.V.
Abstract

Background: The study hypothesis is that the knowledge about the mechanical properties of biological tissues will help surgeons to choose a transplant.

Aim: To determine the optimal type of a graft, based on the assessment of the mechanical properties of three types of grafts used for the superior capsule reconstruction of the shoulder joint with a massive rotator cuff tear.

Methods: In the experimental work, 3 types of biological tissues were studied: allografts of the fascia lata and of the dura mater, and the DX Reinforcement Matrix (a dermal ECM xenograft). The experiment was divided into two parts. In the first part, the mechanical strength at rupture of the samples was evaluated and compared, in the second part the resistance of a vertical suture was studied. The tests included uniaxial stretching with the force and strain at rupture recorded.

Results: The fascia lata allograft showed the highest ultimate tensile strength, while the dura mater allograft had the lowest ultimate tensile strength. All the three materials showed rather high values of the rupture strain. The lowest value of the rupture strain was detected for the dura mater allograft — 15.2±2.6%, the highest value was obtained for the dermal ECM xenograft — 63.3±20.8%. The largest value of the fracture stress was recorded for the DX Reinforcement Matrix — 33.5 N. The minimum value was recorded for the fascia lata allograft — 9.9 N.

Conclusion: The fascia lata allograft and DX Reinforcement Matrix have the optimal mechanical characteristics and can be recommended as grafts for the superior capsule reconstruction of the shoulder joint with a massive rotator cuff tear.

Journal of Clinical Practice. 2021;12(3):5-12
pages 5-12 views
The tandem gait test: kinematics and temporal parameters for normal children and for posterior fossa tumor survivors
Skvortsov D.V., Kasatkin V.N., Aizenshtein A.D., Anisimov V.N.
Abstract

Background: Tandem Gait (TG) testing is known as a clinical method for studying the walking function with complicated coordination. The precise biomechanical walking parameters in this test remain poorly investigated. Moreover, TG is a modified locomotion of walking. In general, walking is a highly automated movement. TG introduces a component of voluntary control into it.

Aims: A study of functional and biomechanical symptoms in children after the treatment for the posterior fossa tumor in the long term.

Methods: The study involved 15 healthy subjects aged 12 to 35 years (20.4±7.2), among them 4 men and 11 women — control group. The group of patients comprised 33 children who had a tumor of the posterior cranial fossa (HF) at the age of 7 to 17 years (12.3±3.1), of these 15 boys and 18 girls, who were admitted for rehabilitation treatment to the "Russkoe pole" Rehabilitation Center. A study on the TG kinematics was performed with the Optitrack system.

Results: The results showed asymmetry in the duration of the step cycle and an increase in its duration proportional to the severity of the functional state. The pelvic movements showed different abnormalities. The flexion-extension movements in the hip joints were characterized by an extension lag at the end of the transfer period and a slight decrease in the amplitude, which probably became more pronounced with an increase in the degree of the motor impairment. The movements in the knee joints demonstrated two main phenomena: an increase in the flexion setting of the joint and a decrease in the amplitude of the main swing flexion. In addition, there was a delay in the maximum of the swing flexion. The kinematic parameters of the TG of the examined patients, in contrast to the control group, are not stable. This is, presumably, due to the fact, that normally such a modification of walking is easily automated and does not require voluntary control. In patients with SCF, each step in the TG mode requires additional voluntary control, and under these conditions, the stability and repeatability of a movement are dramatically reduced.

Conclusions: In contrast to the routine clinical version of the test, the analysis of the movement biomechanics allows one to present an accurate qualitative and quantitative characterization of functional disorders. According to our research, motor function disorders develop at various levels of the musculoskeletal system. The degree of their severity is in a good agreement with the expert assessment of the patient's functional state.

Journal of Clinical Practice. 2021;12(3):13-20
pages 13-20 views
Pathological syndromes of the biliary tract decompression
Mejidov R.T., Magomedova S., Mamedova E.P., Abdullaeva A.Z., Nasibova U.A.
Abstract

Background: The increased incidence of cholelithiasis and tumoral lesions of the hepatopancreatoduodenal zone leads to an increase in the number of patients with obstructive cholestasis.

Aims: To identify the spectrum of pathological conditions developing after decompression of the biliary tract in obstructive cholestasis and to develop an effective pathogenetically determined algorithm for treating patients.

Methods: The results of the examination and treatment of 216 patients with obstructive cholestasis, who underwent various options for decompression of the biliary tract, were analyzed. Obstructive cholestasis of a tumor genesis was present in 112 (51.8%) patients, benign cholestasis in 104 (48.2%). The main group included 112 patients, the comparison group included 104 patients. A two-stage tactics was applied in 133 (61.6%) cases, 83 patients (38.4%) were operated in one stage. The treatment results were compared for the experimental group (n=112) in which a pathogenetically based algorithm was applied and for the control group (n=104) receiving a standard therapy.

Results: Accelerated decompression syndrome developed in 31 (14.3%) cases, of those 26 in the comparison group, 5 in the main group. Disorders of the water and electrolyte balance occurred in 32 (46.4%) patients with complete external bile diversion. Digestion remodeling syndrome was present in 44 patients from 117 patients with external bile diversion.

Conclusions: It has been shown that the pathogenetically based therapy after biliary decompression significantly reduces the number of complications in the postoperative period.

Journal of Clinical Practice. 2021;12(3):21-29
pages 21-29 views
Development and evaluation of a loop-mediated isothermal amplification assay (lamp) for the diagnosis of campylobacteriosis
Shuryaeva A.K., Malova T.V., Tolokonceva A.A., Karseka S.A., Davydova E.E., Shipulin G.A.
Abstract

Background: Different species of Campylobacter are the most common cause of bacterial gastroenteritis. There are many methods to detect the presence of Campylobacter, including PCR, but it takes no less than 5 -6 hours. Development of fast molecular diagnostic tests based on a loop-mediated amplification assay will allow simplifying the procedure and reducing the time of detection for a bedside application.

Aims: To develop a loop-mediated isothermal amplification assay (LAMP) with a fluorescent probe for the diagnosis of campylobacteriosis.

Methods: Stool suspensions were prepared and bacterial fractions were separated as described in the methodological recommendations of the Central Research Institute of Epidemiology. DNA was extracted using AmpliTest RIBO-prep (FSBI SPC FMBA, Russian Federation) according to the manufacturer's instruction and detected with AmpliSens® OKI-screen-FL (FBIS CRIE, Russian Federation). Primers and probes were selected in a 16S rDNA gene region. Analytical specificity was confirmed on bacterial cultures, analytical sensitivity was assessed using a recombinant plasmid containing the target Campylobacter DNA sequence fragment. LAMP amplification was performed at 65°C for 30 min.

Results: An assay for the detection of Campylobacter spp. based on loop-mediated isothermal amplification has been developed, the reaction time does not exceed 30 minutes. The analytical sensitivity of the developed technique is comparable to the real-time PCR and is equal to 103 copies/ml, the analytical specificity is 100%. The evaluation of 127 clinical samples, previously characterized by a commercial kit, AmpliSens® OKI-screen-FL (FBIS CRIE, Russian Federation), showed high diagnostic specificity and sensitivity of the developed LAMP-method. No false positive results were found, 108 samples were negative by LAMP and PCR. Campylobacter spp. DNA was detected by the LAMP method in 18 out of 19 PCR-positive samples. One discordant LAMP negative sample can be attributed to the low bacterial load of Campylobacter spp. for a given sample. Conclusions: A method for the rapid detection of Campylobacter spp. loop-mediated isothermal amplification has been developed, and its high analytical and diagnostic characteristics have been shown experimentally.

Journal of Clinical Practice. 2021;12(3):30-35
pages 30-35 views
Diagnostics of hereditary cancer syndromes by ngs. A database creation experience
Abramov I.S., Lisitsa T.S., Stroganova A.M., Ryabaya O.O., Danishevich A.M., Khakhina A.O., Zakamornaya A.I., Matsvay A.D., Shipulin G.A.
Abstract

Background: More than 500 thousand new cases of malignant neoplasms are registered annually in the Russian Federation, of which more than 50 thousand new cases are due to hereditary forms. Improving the diagnosis of these diseases will make it possible to detect tumors at the early stages and take timely preventive and therapeutic measures.

Aims: Creation of a database and development of a software for the NGS data analysis for the prevention and early diagnosis of hereditary forms of oncological diseases.

Methods: The present study used 636 DNA samples obtained from cancer patients with a high hereditary risk or a burdened family history. DNA was isolated from blood lymphocytes. DNA libraries were prepared with a KAPA Target Enrichment Panel (Roche). The panel included probes for targeted enrichment of the coding region of 44 genes. NGS was performed on the MiSeq platform (Illumina).

Results: We identified 65 pathogenic/ probably pathogenic nucleotide sequence variants in 96 patients in the ATM, BLM, BRCA1, BRCA2, CHEK2, EPCAM, MEN1, MLH1, MSH2, MSH3, MSH6, MUTYH, PALB2, TP53 genes. We also identified 2858 nucleotide sequence variants of unknown clinical significance. Conclusions: We have created a local database that contains both genetic variants and clinical and anamnestic data. The database contains 4763 nucleotide sequence variants at the moment, among which 2522 are unique variants identified in a single patient.

Journal of Clinical Practice. 2021;12(3):36-42
pages 36-42 views

Reviews

Modern aspects of computer visual syndrome
Trubilin V.N., Yudin V.E., Ovechkin I.G., Trubilinа M.A., Orlova O.M., Kovrigina E.I., Budko A.A., Matvienko V.V.
Abstract

The review presents the pathogenetic, diagnostic, therapeutic and rehabilitation aspects of computer visual syndrome. The importance of an integrated approach to the implementation of treatment and rehabilitation measures is emphasized. The promising directions of scientific and practical activity on the problem of treating patients with computer visual syndrome symptoms from the standpoint of modern requirements for medical rehabilitation have been determined.

Journal of Clinical Practice. 2021;12(3):43-50
pages 43-50 views
Computer simulation in the development of vaccines against covid-19 based on the hla-system antigens
Vologzhanin D.A., Golota A.S., Kamilova T.A., Shneider O.V., Sсherbak S.G.
Abstract

The genetic variability of population may explain different individual immune responses to the SARS-CoV-2 virus. The use of genome- and peptidome-based technologies makes it possible to develop vaccines by optimizing the target antigens. The computer modeling methodology provides the scientific community with a more complete list of immunogenic peptides, including a number of new and cross-reactive candidates. Studies conducted independently of each other with different approaches provide a high degree of confidence in the reproducibility of results. Most of the effort in developing vaccines and drugs against SARS-CoV-2 is directed towards the thorn glycoprotein (protein S), a major inducer of neutralizing antibodies. Several vaccines have been shown to be effective in the preclinical studies and have been tested in the clinical trials to combat the COVID-19 infection. This review presents the profile of in silico predicted immunogenic peptides of the SARS-CoV-2 virus for the subsequent functional validation and vaccine development, and highlights the current advances in the development of subunit vaccines to combat COVID-19, taking into account the experience that has been previously achieved with SARS-CoV and MERS-CoV. The immunoinformatics techniques reduce the time and cost of developing vaccines that together can stop this new viral infection.

Journal of Clinical Practice. 2021;12(3):51-70
pages 51-70 views
Clinical and radiological variants of lung damage in the infection caused by staphylococcus aureus
Vinokurov A.S., Smirnova A.D., Belenkaya O.I., Yudin A.L., Yumatova E.A.
Abstract

Despite the high level of modern technologies in the field of laboratory methods and imaging of the respiratory system, the problem of early and accurate differential diagnosis of inflammatory lung diseases remains important in practical medicine. It leads to improved treatment results and a reduction in the number of complications (pleural empyema, fistulas, mediastinitis, sepsis, etc.), and in some cases allows suspecting the presence of a primary purulent source in the body, such as that in the case of septic pulmonary embolism. The review covers the Staphylococcus aureus specifics as a pathogen of lung diseases, relevant epidemiology, pathogenesis, clinical features and imaging diagnostics of various types of inflammatory changes in the lungs with a focus on destruction.

Journal of Clinical Practice. 2021;12(3):71-89
pages 71-89 views
Degenerative scoliosis of the spine: diagnosis, classification and surgical approach in older patients
Yarikov A.V., Denisov A.A., Smirnov I.I., Kalinkin A.A., Dolotin D.N., Masevnin S.V., Dokish M.Y., Perlmutter O.A., Sosnin A.G., Fraerman A.P., Simonov A.E., Sannikova E.V.
Abstract

Adult scoliosis is a deformity of the spine with an angle of more than 10° (according to Cobb) in people with a fully formed bone system. Due to the aging of the population, improvement of surgical techniques, creation of new implants and progress in anesthetic aids, the problem of degenerative scoliosis has been more and more frequently considered from the viewpoint of a surgical approach. There are many theories about the factors that contribute to the formation of degenerative scoliosis. The conservative therapy of degenerative scoliosis includes non-steroidal anti-inflammatory drugs, bracing, epidural and paravertebral injections with glucocorticosteroids and physical therapy. In case the conservative therapy is ineffective and there is a significant decrease in the quality of life, the issue of the surgical intervention is raised individually for each patient. Currently, the role and the volume of the surgical intervention in individuals with this pathology remains debatable. The choice of a surgical technique depends on a thorough assessment of clinical symptoms, neurological status, data of instrumental methods and a mandatory estimation of the parameters of the global vertebral-pelvic balance. Therefore, in this article, we pay special attention to the surgical algorithms based on the choice of the decompression type and the fusion length. We describe the generally accepted criteria for selecting the level of spondylosynthesis. Special attention is paid to the risk factors of the surgical treatment, as well as associated complications.

Journal of Clinical Practice. 2021;12(3):90-103
pages 90-103 views
Tomosynthesis in pediatrics: a retrospective of its application in the world practice and own data
Simonovskaya H.Y., Sholokhova N.A., Zaytseva O.V.
Abstract

Tomosynthesis is a modern effective and informative method of low-dose X-ray diagnostics, which allows obtaining a significant number of layered images with the subsequent volumetric image reconstruction. The use of tomosynthesis provides a one-time examination of a large anatomical area without loss of the image quality and diagnostics of difficult-to-visualize pathological changes that are not detected by digital radiography. The article presents an overview of the problem of improving low-dose imaging options in the radiation diagnostics, as well as the authors’ own data on the use of tomosynthesis for the diagnosis of community-acquired pneumonia in children.

Journal of Clinical Practice. 2021;12(3):104-111
pages 104-111 views

Case report

A successful placement of the left ventricular lead for the cardiac resynchronization device using the orthodromic snare technique: clinical case
Dubrovin O.L., Shugaev P.L.
Abstract

Background: The main aim of Cardiac Resynchronization Therapy (CRT) is a positive response of the patient, particularly, reduction of the symptoms and improvement of the heart contractility, that can be reached in 50–70% of patients. The possibility of appropriate positioning the left ventricular (LV) lead is of great importance for the response to CRT. Certain instruments and technical approaches are used for the placement of the LV lead. Here, we describe the use of the orthodromic snare technique, which is quite rare in practice, but allows one to overcome some anatomical obstacles.

Clinical case description: Patient A., suffering from the heart failure with a low ejection fraction and left bundle branch block, was admitted to the hospital for CRT implantation. Before the operation, all the necessary routine instrumental and laboratory diagnostics was performed. During the operation, venography of the cardiac veins revealed unsuitability of the lateral cardiac vein for the placement of the LV lead due to its very small diameter. The posterolateral vein was suitable for the LV lead implantation but still had some anatomical difficulties: an acute angle of inflow and local stenosis in the proximal segment. During the procedure, the following techniques were used without success: positioning the LV lead by a simple translational movement forward, a subselective catheter, introduction of several coronary guides in order to smooth out the acute angle of inflow. These circumstances warranted the use of the orthodromic snare technique for a successful LV lead placement.

Conclusion: This clinical case illustrates the possibility of a safe and effective use of the orthodromic snare technique for LV lead implantation. Such anatomical difficulties as a small diameter, acute angle of inflow, local stenosis have also been illustrated and discussed.

Journal of Clinical Practice. 2021;12(3):112-119
pages 112-119 views

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