I.P. Pavlov Russian Medical Biological Herald

Editor-in-Chief: Roman E. Kalinin, MD, PhD.

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Access & Publication frequency: subscription; quarterly publishing.

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The main objective of the journal is contributing to the improvement of the quality of specialist education in accordance with strategic directions in providing a unified state policy in the field of state attestation of scientific and pedagogical staff, development of science in the Russian Federation and implementation of the scientific results into practice.

Peer-reviewed journal is a part of the Russian and university scientific and information system. The journal sets the following objectives:

  • to represent the results of scientific, research, practical, and experimental work of staff members, PhD students and postgraduates of higher educational institutions and scientific research institutions in the Russian Federation;
  • advocacy for the main achievements in science and their implementation into practice and education;
  • establishment of the open scientific dispute contributing to the improvement in quality of scientific research and efficacy of scientific expertise;
  • securing the publicity and transparence of publication of the main scientific issues in modern science.

The journal is committed to publishing the results of fundamental scientific researches, applied scientific researches, experimental works, description of the new research techniques, scientific reviews dedicated to the relevant issues in modern science, scientific discussions, description of rare medical observations.

The journal is targeted at physicians, scientists, academicians in medical universities, and specialists in all adjacent medical fields.


The journal is included in the list of the Higher Attestation Commission for the following specialties:

14.01.01 – Obstetrics and Gynecology (medical science),
14.01.02 – Endocrinology (medical science),
14.01.04 – Internal Medicine (medical science),
14.01.05 – Cardiology (medical science),
14.01.06 – Psychiatry (medical science),
14.01.08 – Pediatrics (medical science),
14.01.09 – Infectious Diseases (medical science),
14.01.11 – neurological Diseases (medical science),
14.01.12 – Oncology (medical science),
14.01.13 – Radiation Diagnostics and Radiation Therapy (medical science),
14.01.14 – Dentistry (medical science),
14.01.15 – Traumatology and Orthopedics (medical science),
14.01.17 – Surgery (medical science),
14.01.19 – Pediatric Surgery (medical science),
14.01.24 – Transplantology and Artificial Organs (medical science),
14.01.25 – Oncology (medical science),
14.01.26 – Cardiovascular Surgery (medical science),
14.01.30 – Gerontology and Geriatrics (medical science),
14.02.01 – Hygiene (medical science),
14.02.02 – Epidemiology (medical science),
14.02.03 – Public health and health care (medical science),
14.03.01 – Human anatomy (medical sciences),
14.03.02 – Pathological Anatomy (medical sciences),
14.03.03 – Pathological Physiology (medical sciences),
14.03.06 – Pharmacology, Clinical Pharmacology (medical sciences),
14.03.11 – Restorative Medicine, Sports Medicine, Physical Therapy, Balneology and Physiotherapy (medical sciences)

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Vol 28, No 4 (2020)

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Original researches
Parameters of macrophage reaction and humoral immunity in patients with implant-associated in-flammation after primary endoprosthetics of knee joint
Galashina E.A., Gladkova E.V., Blinnikova V., Shpinyak S.P., Ulyanov V.
Abstract

Aim. To study peculiarities of macrophage reaction and humoral immunity in patients with signs of implant-associated inflammation after the primary endoprosthetics of the knee joint.

Materials and Methods. Examination of 48 patients with signs of implant-associated inflammation after the primary endoprosthetics of the knee joints (the main group) and of 44 patients without signs of inflammatory reactions (comparison group) was carried out. Control group involved 30 healthy donors without diseases of the musculoskeletal system.

Results. In 1 and 12 months after the surgery, patients of the main group showed elevated levels of the factor inhibiting migration of macrophages (MIF), of macrophage stimulating protein (MSP), class A immunoglobulins (IgA), С3 and С4 complement components as compared to control, and also to each previous period. In 1 month after the surgery, the content of class M and G immunoglobulins (IgM and IgG) decreased relative to control; in 12 months after the surgery a more pronounced reduction was noted. Increase in serum concentrations of MIF, MSP, IgA, С3 and С4-complement components was noted in the comparison group in 1 and 12 months and also in comparison with the previous period. Reduction of the levels of IgM, IgG in 1 and 12 months after the operation was noted in comparison with control and with the previous period.

Conclusion. A study of parameters of macrophage reaction, proteins of complement system and the main classes of immunoglobulins permits to identify signs of implant-associated inflammation in 1 and 12 months after surgery, and, consequently, to determine patients of risk groups that require additional diagnostics measures.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):421-428
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Modeling of fibrocystic mastopathy in experiment on animals
Anisimova S.A., Svirina J.A., Maksaev D.A.
Abstract

Nowadays, hormonal imbalance is proven to be a factor that influences initiation of malignant and benign breast tumors. To study the aspects of participation of sex hormones in damage to organs and tissues, it may be necessary to model a common women’s pathology – fibrocystic disease of mammary glands characterized by the most pronounced effects of this pathogenetic factor, on experimental animals.

Aim. To create a model of fibrocystic disease of mammary gland with the subsequent possibility of studying morphological manifestations of the disease in natural and drug-induced pathomorphism.

Materials and Methods. The pathology was induced by intramuscular injection of 0.5 ml of 2% synestrol and 0.5 ml of 2.5% progesterone to virgin female rats on the 1st, 7th, 14th, 21st, 28th and 35th days of the experiment. For examination, histological preparations of inguinal mammary glands were made. The preparations were described and studied using morphometric analysis.

Results. In the result of the experiment, pronounced macro- and microscopic alterations of mammary glands were found. Microscopic picture was similar to that observed in fibrocystic mastopathy in women. Almost all the morphometric parameters underwent reliable alterations in correspondence with the given pathology.

Conclusion. A model of fibrocystic disease of mammary gland was obtained that may be used for further study of morphogenesis and methods of correction.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):429-436
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Interrelation between markers of system of hemostasis and hemocoagulation disorders in patients with tuberculosis of respiratory organs and comorbid diabetes mellitus after surgical intervention on respiratory organs
Chitorelidze G.V., Serebryanaya B., Lepeha L.N., Papkov A.V., Bagirov M.A.
Abstract

The relevance of the work is determined by the necessity to study markers of coagulation system of blood and hemocoagulation disorders in patients with pulmonary tuberculosis and comorbid diabetes mellitus in different stages of postoperative period.

Aim. To determine the interrelation between markers of system of hemostasis  and signs
of development of intravascular blood coagulation in patients with pulmonary tuberculosis
and comorbid diabetes mellitus (TB-DM) depending on the volume of surgical intervention on
the respiratory organs.

Materials and Methods. The extent of changes of markers of the system of hemostasis
was determined in 89 patients with TB-DM before and after surgical treatment. Parameters of
coagulation system of blood: concentration of fibrinogen, the level of soluble fibrin-monomer complexes, compensatory potentials by the level of fibrinolysis, activity of fibrinolytic system and of anticoagulation system (antithrombin III) were determined; parameters of prothrombin activity were studied. Besides, operation material of lungs was prepared for morphological examination.

Results. A general tendency to increase in the parameters of hypercoagulation syndrome was identified in all the study groups starting from the 3rd-5th day and reaching maximum on the 7th-10th and 14th-17th days of the postoperative period, with compensatory activation of fibrin-stabilizing factor and of fibrinolytic system. Changes in the markers of hemostasis were most prominent in the group of patients after lobectomy. Microthrombotic lesions of the vessels
of pulmonary microcirculation with partial or complete obturation of the lumen were morphologically visualized. 

Conclusion. On the basis of the data obtained a conclusion can be made about the existence of pronounced hypercoagulation syndrome with phenomena of intravascular coagulation of blood in this category of patients, which evidently requires timely prevention and treatment of thromboembolic complications. The results obtained may be used  for development of measures aimed
at prevention of hemocoagulation complications in patients with TB-DM after the conducted
surgical treatment.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):437-448
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Morphological and immunohistochemical parameters of chronic placental insufficiency in preeclampsia
Kulida L., Rokotyanskaya E., Panova I., Malyishkina A., Protsenko E., Maisina A.
Abstract

Aim. To determine the morphological parameters of chronic placental insufficiency in pregnancy complicated by preeclampsia, also in women with chronic arterial hypertension (CAH).

Materials and Methods. The analysis of history data, peculiarities of pregnancy and childbirth in women with hypertensive disorders was carried out. A review histology of 40 placentas in moderate preeclampsia, 40 placentas in severe preeclampsia, and 35 placentas of women with CAH and associated preeclampsia was performed. The control group consisted of 20 placentas of women with uncomplicated pregnancy without hypertensive disorders. Immunohistochemical examinations were performed on paraffin sections according to standard methods using primary goat antibodies to annexin V (R-20, sc-1929) and rabbit antibodies to erythropoietin (H-162, sc-7556) in a working dilution 1:200 with Super Sensitive IHC polymer detection system.

Results. Based on the results of pathomorphological examination of placentas of women with hypertensive disorders, two forms of chronic placental insufficiency were identified. The defining form of placental insufficiency in women with CAH and associated preeclampsia was fetoplacental insufficiency, and in preeclampsia of moderate severity and in severe one – utero-placental form of chronic placental insufficiency. Based on the study of the dynamics of expression of annexin V and erythropoietin, morphological parameters of the placental compensatory potential and placental hemostasis disorders in hypertensive disorders in pregnant women were determined.

Conclusion. Diagnostic morphological criteria for fetoplacental insufficiency in women with hypertensive disorders are a combination of maternal and fetal malperfusion with obliterative angiopathy of stem villi vessels; in the utero-placental form – obliterative angiopathy of spiral arteries, placental hypoperfusion with the development of local hypoxia and hemostatic disorders in the form of thrombosis of the intervillous space and villi infarcts.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):449-461
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Status and dynamics of parameters of use of bed capacity of oncological profile in Russian Federation
Evdakov V.A., Banteva M.N., Manoshkina E.M., Melnikov Y.Y., Rugol L.V.
Abstract

In the Russian Federation (RF) a steady growth of morbidity with oncologic diseases is observed. An important factor of reduction of negative influence of oncopathology on the parameters of public health is provision of the population with specialists and beds of oncological profile, as well as their effective use.

Aim. To determine the status and identify dynamics of the main parameters of use of beds of oncological profile of the state healthcare system of RF, federal districts and constituent entities of RF in comparison with tendencies of parameters of morbidity with malignant neoplasms, and also of provision of the population with medical personnel in the period from 2010 to 2019.

Materials and Methods. Using the data of the Federal statistical observation forms (№30, 47, 14LC, 7) based on the calculation of absolute and relative parameters by the descriptive statistics method, the analysis of the main parameters of the use of bed resources of «oncology» profile was carried out in comparison with the parameters of morbidity with malignant neoplasms and provision of the population with medical personnel in 24-hour and day-stay hospitals in the Russian Federation, federal districts and constituent entities of the Russian Federation in 2010-2019.

Results. During the study period, with the underlying increase in the morbidity of the population with diseases of «neoplasm» class (primarily, malignant) in the Russian Federation, there was found a regular increase in: the absolute number of oncological beds for 24-hour stay by 5.216 beds (+16.8%), provision with these beds from 2.17 to 2.47 per 10 000 population (+13.8%), hospitalization rate from 6.1 to 9.6 per 1000 population (+57.4%); and a decrease in: average stay in an oncological bed by 3.7 days (-30.6%, from 12.1 to 8.4 days), and the average bed occupancy by 15 days per year (-4.3%, from 345 to 330 days). Mortality in cancer beds increased from 0.76% in 2010 to 0.95% in 2019 (by 25.0%). There was an increase in the provision of the population with oncological beds in day-stay hospitals – by 3.4 times, in day-stay hospitals of polyclinics – by 63.6%.

Conclusion. With the underlying growth of oncological morbidity in the country, the bed capacity of the oncological profile of 24-hour and day hospitals has significantly increased, with a high level of disproportional development of the bed capacity both between federal districts and between the subjects of the Russian Federation.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):462-478
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Mortality from all causes in patients with myocardial infarction with elevation of st segment depending on the type of reperfusion therapy (data of ryazan region, 2018-2020)
Parshikova E., Filippov E.
Abstract

Aim. To assess mortality from all causes in patients with past myocardial infarction with
elevation of ST segment (STEMI) depending on the type of reperfusion therapy.

Materials and Methods. Of 1456 patients hospitalized with acute coronary syndrome with elevation of ST segment, 848 cases were randomly selected for analysis. Acquisition of information of the end point (death from any causes) continued within 18 months. The present data were obtained by 01.10.2020, median of observation was 20.8 [17.4;23.6] months.

Results. The highest 18-month mortality (42.3%) was seen in the group of patients who did not receive reperfusion therapy. With this, mortality rate for 30 days in the group of thrombolytic therapy (TLT) and in the group without reperfusion did not show any significant differences (20.3% vs 26.2%, р>0.05). Hospital, 30-day, 12-month, 18-month mortality from all causes in the group of percutaneous coronary intervention (PCI) made 8.4, 10.6, 16.6 and 18.3%, respectively, and was significantly lower compared to the group who did not receive reperfusion (19.5, 26.2, 36.2 and 42.3%, respectively, р<0,05). The most significant differences in the frequency of the end point were recorded on achievement of 18-month limit: in the group without reperfusion mortality was 42.3%, that was higher (р<0.05) compared to the given parameter in the group with TLT (27.1%), PCI (18.3%) and TLT+PCI (13.1%).

Conclusion. During 18 months of observation, the lowest mortality from all causes was observed in the group with use of pharmacoinvasive approach and primary PCI, the highest mortality was in the group of patients who did not receive reperfusion therapy.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):479-487
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Evaluation of endothelial function, of elasticity of vessel wall and their influence on one-year prognosis of patients with myocardial infarction with obstructive and non-obstructive coronary arteries
Fomina O., Yakushin S.S.
Abstract

Aim. To carry out comparative analysis of the state of the endothelial function (EF), elasticity of the vessel wall and their influence on one-year prognosis of patients with myocardial infarction (MI) with obstructive and non-obstructive coronary arteries (CA).

Materials and Methods. In the first stage, 206 patients were selected diagnosed with MI, of them 103 patients with MI with non-obstructive CA (MINOCA) according to the results of coronaroangiography, and 103 patients with MI with obstructive CA (MIOCA). Using the method of random numbers, 59 patients were selected (34 patients of the first group and 25 of the second group), in whom EF and elastic properties of the arterial wall were evaluated. Patients of both groups were initially comparable in age, gender, clinical and anamneustic characteristics, and also in frequency of application of the main groups of medical drugs that influence prognosis. One-year prognosis of the two groups of patients was studied depending on the presence/absence of functional and morphological alterations of the vessel wall.

Results. In evaluation of EF in patients MINOCA, the occlusion index by amplitude (OIA) below threshold values was recorded in 22 of 34 (64.7%) cases of MINOCA and in 22 of 25 (88.0%, р<0.05) cases of MIOCA. Here, the average values of OIA were 1.7 (1.5; 2.3) and 1.4 (1.2; 1.8), respectively (р<0.05). The values of phase shifts between the channels below the norm were equally frequent in two groups (88.2 and 88.0%, р>0.05), and comparison of the average values of this parameter did not show any statistically significant difference. The calculated augmentation index normalized to the pulse rate 75 beats per minute (AIp75), in the study groups was 12.5 (9.9; 17.9) and 18.8 (12.9; 20.8), respectively (р>0.05). Reduction of the elasticity of the vessel wall in the group with MINOCA was noted in 82.4% of patients, in the group MIOCA – in 100% of cases (р<0.05). No statistically significant differences were found in the frequency of cardiovascular events between the groups during a year (р>0.05).

Conclusion. Functional alterations of the vessel wall (endothelial dysfunction and reduction of elasticity of the vessel wall) in patients with MINOCA were recorded almost in 2/3 of cases, however, their incidence in MIOCA was still higher (88.0%). The one-year prognosis in the study groups MINOCA and MIOCA showed no differences.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):488-496
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Training of students of higher medical educational institutions in endovideosurgery skills
Lipatov V.A., Severinov D.A., Naimzada M.Z., Dragovoz I.S.
Abstract

Aim. Evaluation of basic skills in endovideosurgery of students of higher medical educational institutions (HMEI) before and after taking an elective course «Basics of Surgical Technique».

Materials and Methods. Basic skills in endovideosurgery were investigated in students
of the General Medicine Faculty before and after taking an elective course «Basics of Surgical Technique» organized on the base of the simulation hall of the experimental surgery and oncology laboratory of Research Institute of Experimental Medicine at Kursk State Medical University.
The training course included the following exercises on box trainers: Peg Transfer, Pattern
Cut, Intracorporal (single interrupted) Suture. After achievement of satisfactory results, final
assessment was conducted in the form of examination in practical skills and abilities on laboratory animals – biological models (Wetlab). Manipulations conducted by students were assessed using Global Operative Assessment of Laparoscopic Skill (GOALS).

Results. The average values of the assessed parameters increased: criteria «manipulations with tissues» from 2.8 to 4.0 points (42.9%), «perception of depth» from 2.4 to 3.6 points (50%), «movement effectiveness» – by 54.5% (from 2.2 to 3.4 points), «bimanual orientation» – by 60% (from 2.0 to 3.2 points). Criterion «independence» increased by 66.7% (from 1.8 to 3.0 points).

Conclusion. After the elective course «Basics of Surgical Technique», all average values
of the studied parameters increased. The results obtained evidence effectiveness of the methods
of training in basics of endovideosurgery within the frames of the elective course, which permits to develop skills in endosurgical technique at the stage of getting higher medical education.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):497-505
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Clinical cases
A case of successful surgical treatment of patient with rare vascular anomaly – hypoplasia of infrarenal abdominal aorta
Kharazov A.F., Kul'bak V.A., Basirova N.M.
Abstract

Aim. To demonstrate a case of treatment of a patient with a rare vascular anomaly – hypoplasia of infrarenal abdominal aorta.

On a clinical example of female patient U., 41 years of age, with critical ischemia of the lower limbs and diagnosis «hypoplasia of the abdominal aorta» made on the basis of the clinical and instrumental data, the manifestations, diagnostics and potentials of the successful surgical treatment of the given pathology were demonstrated.

Conclusion. Clinical manifestations of hypoplasia of the aorta depend on localization of the lesion and involvement of renal arteries. The commonest clinical sign is arterial hypertension and symptoms associated with the elevated arterial pressure. Hypoplasia of the aorta may also be manifested by hypertrophy of the upper limbs in combination with poor development of muscles of the lower limbs. More aged individuals present with arterial insufficiency leading to clinically significant ischemia of the lower limbs. Thus, in the case described, the patient already had ischemic trophic ulcers of the lower limbs. Without treatment, secondary arterial hypertension and cardiac failure may lead a patient to early death. Today, irrespective of the etiology, the only effective method of treatment of this disease is surgery. In case of our patient, resection of the hypoplastic segment of the aorta and its prosthetics were performed. This permitted to restore circulation in the lower parts of the body and further led to complete healing of trophic ulcers of the shin and to normalization of the systemic arterial pressure.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):506-513
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Improvement of results of surgical treatment of giant hernias of inguinofemoral region by choice of method of hernioplasty (clinical case)
Leonchenko S.V., Stavtsev M.L.
Abstract

Aim. Description of a clinical case pf patient K., 71 years old, as an illustration of the possibility to improve treatment of giant hernias in the inguinofemoral region. The patient was hospitalized with the diagnosis: bilateral giant irreducible inguinoscrotal hernia. The specificity of this case was implementation of the operation of hernioectomy from preperitoneal access with prosthetics of the posterior surface of the anterior abdominal wall with polypropylene (prolene) mesh on both sides. In a month after discharge from hospital the condition remained satisfactory, postoperative scar was normotrophic, testicles painless to palpation with a small amount of fluid in the dartos, skin of scrotum contracted.

Conclusion. Hernioectomy from preperitoneal access with prosthetics of the posterior surface of the anterior abdominal wall with polypropylene (prolene) mesh in patients with giant, irreducible and recurrent hernias possesses a number of peculiarities in comparison with traditional methods, since it permits: 1) to fix endoprosthesis to permanent anatomical structures with simultaneous repair of all the defects of the transverse fascia; 2) to operate outside the zone of scar tissue in recurrent hernias; 3) to perform an adequate revision of the organs of the hernial sack in irreducible hernias; 4) to perform operations on patients with distinct comorbid pathology and contraindications to general anesthesia.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):525-529
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A patient with heartburn practicing self-treatment, on an outpatient visit
Krylova I., Matʼkova I.
Abstract

More than 40% of adult Russians periodically feel heartburn. Progression of the disease leads to a number of complications shortening patients’ life. However, patients try to cope with problems by themselves, without receiving adequate early treatment. Only when the life quality worsens, which evidences progression of the disease, they turn to a doctor. Success of treatment depends on the level of the patient’s compliance, life-long complete and regular adherence to treatment recommended by the doctor. With this, an outpatient with a chronic disease should provide the most part of the required medical service by himself. However, patients often change the therapeutic measures on their own impairing the result of treatment.

The given below clinical case of patient Zh., 38 years old, with heartburn and existing risk factors of other non-infectious diseases is a typical illustration of the interaction of a general practitioner and an outpatient practicing self-treatment. Facing the situation of necessary regular medical monitoring and life-long complex intervention, the patient uses only easy-to-follow doctor’s recommendations and understandable for him treatment methods.

Conclusion. On an example of this clinical case, a possible necessary and sufficient plan o f informing outpatient is presented containing information of the tactics of his behavior for full realization of medical recommendations. For successful adaptation of an outpatient with chronic health problems and harmonic attitude to the disease, the doctor should be maximally specific about necessary and adequate measures for correction of the patient’s behavior for the fullest realization of therapeutic recommendations. Recommendations should contain understandable information of basic medicinal and non-medicinal therapy in remission (the essential vital stereotypes – work-rest regime, type and regime of nutrition, physical activity and principles of monitoring the condition), of signs of exacerbation and methods of therapy «on demand» and also information of symptoms requiring urgent assistance, of risks of self-treatment, of visiting the doctor in case new or vivid symptoms appear, of the dates of planned examinations by the doctor. These recommendations are not applicable to patients with severe and manifest course of the disease, with disharmonic attitude to the disease, and in case of inadequate organization capacities and low compliance of the patient.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):514-524
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A case of successful surgical treatment of patient with adrenal cyst using 3-d modeling
Andreev I., Kolsanov A., Katorkin S., Shestakov E., Lichman L.
Abstract

Aim. Demonstration of potentials of preoperative planning and implementation of surgical resection in patients with adrenal cysts.

A clinical observation of a successful surgical treatment of a rare pathology – cyst of the right adrenal is presented. The choice of surgical treatment tactics is determined by the size of tumor and clinical presentation of the disease. The surgical treatment was accomplished laparoscopically which permitted to reduce the time of recovery and rehabilitation of the patient. In this clinical observation, the benefit of using 3D-modeling of the surgical area was shown for visualization of topographic and anatomic peculiarities and facilitation of the intraoperative navigation with the help of Avtoplan program developed by Samara State Medical University.

Conclusion. Preoperative 3D-modeling permits to prepare to surgical intervention taking into account individual anatomic peculiarities of a patient, and to determine the optimal volume of the operation.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):530-535
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Reviews
Molecular-genetic bases of development of acute pancreatitis
Imaeva A., Nurgaleeva A.K., Gallyamova L.F., Mustafin T.I., Safinova L.S., Khusnutdinovna E.K.
Abstract

Acute pancreatitis is included into the three most common diseases of organs of the abdominal cavity following acute appendicitis and cholecystitis, with the middle share in this group of 10-16%. As before, acute pancreatitis is characterized by high morbidity and mortality. Many researchers confirm growth of severe forms of the disease with destructive changes in the pancreas.

Aim. A review of literature sources devoted to study of etiology, pathogenesis, classification, diagnosis and molecular-genetic bases of acute pancreatitis. Factors that play a role in development of the disease (episodes of infringement of the diet, cholelithiasis, vascular diseases, abuse of alcohol) are elucidated. Mechanisms of development of acute pancreatitis depending on the etiology, are described in detail, modern classification of acute pancreatitis is given. The main methods of diagnosis of the disease including both laboratory and instrumental ones, are described. Data of the methods of determination of severity of patients’ state based on evaluation of all the most important physiological systems, are presented. In terms of modern understanding of mechanisms of development of acute pancreatitis, the results of investigation of the probability for genetic predisposition to the studied disease are given that opens the ways for optimization of therapy and diagnosis. The results of both individual and large-scale genetic studies of acute pancreatitis are described. Research works with isolation of certain candidate genes whose protein products participate in the pathogenesis of acute pancreatitis, are presented.

Conclusion. A complex approach to diagnosis of acute pancreatitis with identification of different mutations in the studied genes, and also determination of the influence of epigenetic phenomena in the individuals of risk groups will permit to improve the results of the prophylactic, diagnostic and therapeutic activity in acute pancreatitis.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):536-547
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Extended therapy and secondary prevention of venous thromboembolic complications
Petrikov A., Prostov I.I.
Abstract

Venous thromboembolic complications (VTEC) are acute and time-limited diseases. However, the recurrence rate after a first episode of VTEC is high and potentially life-threatening. Developed deep vein thrombosis (DVT) and thromboembolism of pulmonary artery (TEPA) are inevitably associated with use of anticoagulant therapy (ACT). A peculiarity of the modern clinical management of patients with VTEC is determination of duration of ACT.

Aim. To study possibilities of prolonged anticoagulation therapy and secondary prevention of venous thromboembolic complications taking into consideration modern variants of drug therapy, on the basis of literature data.

Search for literature was conducted in Medline and Elibrary databases including materials published in 2020. Randomized clinical and observational studies and meta-analyses, concerning prolonged therapy and secondary prevention of VTEC with vitamin K antagonists (VKA), peroral anticoagulants (POAC), sulodexide and aspirin, were analyzed. As it is evidenced by patho-physiological and epidemiological data, risk of VTEC recurrence in most patients is not resolved after the first 6 months of treatment with anticoagulants. In such situations it is reasonable to prolong anticoagulation for an indefinite period of time. However, sometimes a limiting factor for prolonged therapy with anticoagulants is bleedings caused by prolonged anticoagulation, sometimes leading to lethal outcome. Therefore, duration of treatment in the long-term period after an acute episode may rest on the balance between the risk of development of recurrence of venous thrombosis and bleeding, evaluated with the help of scales. The main achievement of recent years regarding prolonged therapy and secondary prevention of VTEC, are POAC, which in fact are new and alternative drugs that permitted the emergence of serious evidential basis in the range of means for treatment of this category of patients, sulodexide drug has appeared characterized by the minimal rate of development of large and clinically significant bleedings.

Conclusion. The emergence of serious evidential basis for POAC with improved safety profiles, different pharmacokinetic profiles and dosage regimens, including sulodexide that has been actively used in recent years for secondary prevention of VTEC, will permit clinicians to differentially approach treatment of different clinical variants of venous thrombosis, to improve the results of therapy taking into account evaluation of the individual risk and comorbid diseases, and compliance of patients.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):548-566
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Protective mechanisms of lungs
Shustova S.A., Miroshkina T.A.
Abstract

Respiratory system maintains a close contact with the environment and is constantly exposed to numerous pathogenic factors. In response to action of pathogen, different strategies of specific and non-specific defense have been formed: barrier functions of the epithelium, defense reflexes (coughing, sneezing), muco-ciliary clearance, resident and recruited cells, secretion of a number of proteins and peptides with protective functions.

Aim. To systematize modern concepts of the protective mechanisms of lungs on the basis of the data of the relevant literature.

In the work, the mechanisms and clinical significance of muco-ciliary clearance, resident alveolar and recruited macrophages, epithelial cells, neutrophils, lymphocytes and platelets are analyzed.

Conclusion. The presented mechanisms can counteract the action of various pathogenic agents with sufficient effectiveness. However, in some cases an organism develops insufficient, excessive or perverted response to permeation of pathogens. This results in damage to the lung tissue by exogenous agents and/or by self immune system. Knowledge of protective mechanisms realized in the respiratory system, is necessary for understanding pathogenesis of respiratory diseases and for choice of the optimal treatment tactics.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):567-577
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Therapygenetics: how is effectiveness of psychotherapy related to genotype?
Faustova A., Wang M.
Abstract

Effectiveness of psychotherapy and of clinico-psychological interventions depends on different factors: skills and characteristics of a specialist; diagnosis and extent of severity of symptoms; social and personal peculiarities of patient/client; parameters of psychotherapeutic contact. Therapygenetics is a trend of applied research at the interface of molecular genetics and psychotherapy, which considers molecular-genetic predictors of success/failure of psychotherapeutic interventions.

The aim of the article is analysis and summarization of the current research works in the field of therapygenetics, substantiation of their theoretical and practical significance for psychiatry, psychotherapy and clinical psychology, discussion of the existing limitations and requirements to the design of the respective applied research works. By the moment, contra-dictory, but at the same promising positions in therapygenetics can be outlined. In the given article the results of therapygenetic research performed mostly in accordance with methods of identification of candidate genes, are systematized. Gene-environment correlations in psycho-therapy of anxiety and depressive disorders in children and adults are described. Scarce studies of genetic predictors of effectiveness of psychotherapy in posttraumatic stress-related disorders are summarized. While planning a therapygenetic study, the following methodological, methodical and organizational aspects should be taken into consideration: sufficient representativeness of an experimental sample both from the point of view of socio-demographic characteristics and from the point of view of the diagnosis and used therapy; existence of the control group; use of assessment scales and semi-structured diagnostic interviews for assessment of functioning of respondents; universalization of protocols of assessment of the results of application of methods of psychotherapy; use of polygenomic search for associations; observance of confidentiality and provision of respondents with minimally effective ways of rendering psychological assistance.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):578-592
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Substance-induced psychosis and schizophrenia: the interaction point
Fedotov I.А., Quattrone D., Shustov D.I.
Abstract

One of the most severe complications of narcotic drugs misuse are induced psychotic disorders. Their frequency is varies from 5.2 to 100% and depends on the type of drug. This review provides current data and discussion on the similarities and differences between induced psychosis and schizophrenia. Possible interaction of pathogenic pathways, the possibility of differentiation at the clinical level and the main difficulties in clear diagnostic are discussed. The problem of transformation of induced psychoses into schizophrenia and the significance of differentiated treatment are also considered.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):593-604
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Reticulocyte haemoglobin content: 2020 update
Eremina Y.O., Magalhães C.
Abstract

The hemoglobin content of reticulocytes (Hb-ret) is an effective real-time hemoglobin synthesis status indicator that permits diagnosis and monitoring of iron deficiency and iron deficiency anemia in all age groups with or without underlying diseases, including beta thalassemia. Hb-ret is less invasive than bone iron examination, less expensive than iron biochemical tests and might be available even in local laboratories. This review covers reports published mainly in 2020 and some other studies dedicated to clinical application of Hb-ret measured by Sysmex hematology analyzers.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):605-612
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