Kazan medical journal

Medical peer-review journal for physicians and researchers.

Founders

  • Kazan State Medical University
  • Eco-Vector

Publisher

Editor-in-Chief

  • Ayrat U. Ziganshin, MD, PhD, Professor.

About

Kazan Medical Journal is a peer-reviewed journal for clinicians and medical scientists, practicing physicians, researchers, teachers and students of medical schools, interns, residents and PhD students interested in perspective trends in international medicine.

Missions of the Journal are to spread the achievements of Russian and international biomedical sciences, to present up-to-date clinical recommendations, to provide a platform for a scientific discussion, experience sharing and publication of original researches in clinical and fundamental medicine.

Indexing

  • SCOPUS
  • Russian Science Citation Index
  • BIOSIS Previews
  • Biological Abstracts
  • CNKI
  • Google Scholar
  • Ulrich's Periodical directory
  • Dimensions
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Published bimonthly since 1901, distributed by subscription.


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Vol 105, No 1 (2024)

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Theoretical and clinical medicine

Indicators of heart rate variability and left ventricular deformation parameters in patients with hypertension in combination with left ventricular diastolic dysfunction
Kalinkina T.V., Lareva N.V., Chistyakova M.V., Serkin M.A.
Abstract

BACKGROUND: Currently, there is little data on changes in the parameters of heart rate variability and the appearance of subclinical systolic dysfunction of the left ventricular myocardium in hypertensive patients with the development of diastolic dysfunction.

AIM: To study indicators of heart rate variability and parameters of left ventricular deformation in patients with hypertension depending on the presence of diastolic dysfunction.

MATERIAL AND METHODS: 60 patients with stage I–II hypertension (28 women and 32 men) who were in the cardiology department of the clinical hospital and 30 healthy volunteers (23 men and 7 women) were examined. The mean age of the patients was 42±9.4 years, the age of healthy volunteers was 41.3±3.5 years. All subjects underwent Holter monitoring, echocardiographic determination of left ventricular diastolic dysfunction and global deformity. According to the presence of diastolic function of the left ventricle, patients with hypertension were divided into two groups: the first group included 30 patients without impaired diastolic function of the left ventricle according to the results of echocardiography, the second group included 30 patients with diastolic dysfunction, the third group (control) consisted of healthy volunteers. Correlation analysis was performed using the Spearman test. To compare two samples of continuous independent data, the Mann–Whitney U-test was used with the correction of the obtained p-values using the Benjamin–Hochberg test due to the multiple comparison procedure.

RESULTS: When studying heart rate variability, it was found that the power in the high frequency range in patients of the first group was reduced by 2.1 times compared with the control (p=0.0087), in patients of the second group — by 3.4 times compared with healthy people (p=0.005). An imbalance of vegetative influences and a tendency to increase the balance of sympathetic and parasympathetic activity were found. In the study of the average value of the global deformation, it was found that it is lower by 41% in the second group, and in the third - by 48% compared with the control group (p=0.01 and p=0.0002, respectively). The mean values of the global strain were associated with a decrease in the standard deviation of the values of the normal R–R intervals (r=0.60, p=0.0001), and the end-systolic and diastolic volumes were correlated with the LH/HF index (r=0.51, p=0.0021 and r=0.65, p=0.001, respectively).

CONCLUSION: Heart rate variability and indicators of left ventricular deformation in patients with hypertension are reduced in the presence of its diastolic dysfunction.

Kazan medical journal. 2024;105(1):5-13
pages 5-13 views
Features of various options for anticoagulant therapy for a new coronavirus infection against the background of obesity
Kalinin R.E., Suchkov I.A., Agapov A.B., Povarov V.O., Mzhavanadze N.D.
Abstract

BACKGROUND: When treating a new coronavirus infection, the prevention of venous thromboembolic complications in obese patients is of particular importance.

AIM: To analyze various options for anticoagulant therapy in obese and non-obese patients in the treatment of a new coronavirus infection.

MATERIAL AND METHODS: The patients were divided into two groups: the first group — obese patients — 151 (40.8%) people [average age 63 (56–69) years], the second group without obesity — 219 (59.2%) people [average age 63 (51.5–71.0) years], p=0.998. According to the prescribed anticoagulant and the presence of obesity, patients were divided into subgroups: subgroup 1 — non-obese + low-molecular-weight heparin (n=114), subgroup 2 — non-obese + unfractionated heparin (n=58), subgroup 3 — obesity + low-molecular-weight heparin (n=76), subgroup 4 — obesity + unfractionated heparin (n=66). Venous thrombotic complications and bleeding rates were assessed. Analysis of qualitative indicators was performed using Pearson χ2 and Fisher tests. The distribution of quantitative indicators was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests (p >0.05). Due to the non-normal distribution of indicators, mean values were presented as median (Me) and interquartile range (Q1–Q3), and analysis was carried out using Wilcoxon, Mann–Whitney and Kruskal–Wallis tests.

RESULTS: In nonobese patients, a comparable incidence of deep vein thrombosis was noted on low molecular weight heparin and unfractionated heparin — 1 (0.9%) case versus 3 (5.2%) cases (p=0.102). At the same time, there was a statistically significant difference in the frequency of pulmonary embolism without a source according to autopsy data — 2 (1.8%) versus 4 (6.9%) cases (p=0.004). In obese patients receiving unfractionated heparin, the incidence of this complication was higher and amounted to 9 (13.6%), and in patients receiving low molecular weight heparin — 2 (2.6%) cases (p=0.004). A higher incidence of bleeding was observed in patients with obesity compared to patients without it (10.6 vs 4.7% of cases, p=0.045). When analyzing hemorrhagic complications, it was found that the incidence of major and significant bleeding was higher in patients receiving unfractionated heparin rather than low molecular weight heparin (16.7 vs 5.3% of cases, p <0.001).

CONCLUSION: The use of low molecular weight heparin in obese patients with new coronavirus infection was associated with a low incidence of pulmonary embolism and bleeding compared with patients receiving unfractionated heparin.

Kazan medical journal. 2024;105(1):14-25
pages 14-25 views
Changes in the level of C-reactive protein depending on the severity of localized periodontitis of traumatic etiology
Smirnova A.V., Kuzmina D.A., Semiglazova Y.F., Iordanischvili A.K.
Abstract

BACKGROUND: The significant prevalence and course of inflammatory periodontal diseases are associated not only with the presence of known bacterial agents, but also with changes in the body’s immune system that occur as a result of aging.

AIM: To establish the relationship between the level of C-reactive protein in the blood and the course of localized periodontitis of traumatic etiology.

MATERIAL AND METHODS: During 2016–2019 169 patients with localized periodontitis of traumatic etiology (average age 56.44±0.14 years) of mild (102 people) and moderate (67 patients) severity at the Department of General Practice Dentistry of the North-Western State Medical University named after I.I. Mechnikov were examined. An in-depth dental examination, determination of periodontal indices, assessment of laboratory parameters (determination of high-sensitivity C-reactive protein, assessment and calculation of the entropy of the blood leukocyte formula), complex treatment using splinting with orthopedic structures in the main group (69 patients) and without it in the comparison group (57 people) were carried out. Statistical processing of data was conducted using the Shapiro–Wilk, Pearson, Kolmogorov–Smirnov tests, Fisher’s exact test and χ2 test, and calculation of relative risk.

RESULTS: Oral hygiene was good (hygiene index 0.54±0.18) and satisfactory (hygiene index 0.79±0.21) with mild and moderate severity, respectively. The local Mulleman–Cowell index was increased by 2.7 times (1.43±0.50) with mild severity and almost 4 times (2.31±0.33) with moderate severity of localized periodontitis of traumatic etiology compared with general index (0.52±0.12; 0.64±0.18). In localized periodontitis of traumatic etiology of mode¬rate severity, an increase in the number of monocytes (8.7±2.12×109/l) and band neutrophils (5.4±1.47×109/l), an increase in the relative entropy of the leukocyte blood count (72.3±21.12%) compared with mild severity (62.8±14.9%; p=0.00089) were identified. With C-reactive protein concentrations ranging from 3 to 10 mg/l, the risk of developing localized periodontitis of moderate traumatic etiology increased by 1.74 times compared with C-reactive protein levels of less than 3 mg/l (p=0.0022).

CONCLUSION: In localized periodontitis of moderate traumatic etiology, an increase in the number of band neutrophils and monocytes, as well as the relative entropy of the leukocyte blood count was detected. Preclinical increases in the concentration of C-reactive protein contribute to an increase in the severity of the disease.

Kazan medical journal. 2024;105(1):26-32
pages 26-32 views
Study of risk factors for cataracts in a chronically exposed population cohort
Mikryukova L.D.
Abstract

BACKGROUND: The likelihood of developing cataracts is influenced by many factors, such as age, gender, ethnicity, the presence of somatic pathology (diabetes mellitus, hypertension), dietary habits and lifestyle (obesity, level of education), etc.

AIM: To study the risk of developing cataracts in exposed people in the long term after chronic radiation exposure, taking into account the influence of radiation dose and non-radiation factors.

MATERIAL AND METHODS: The total study group consisted of 14,751 people examined in the hospital of the Ural Scientific and Practical Center for Radiation Medicine from 1955 to 2019. Cataracts were diagnosed in 4,658 people. The statistical methods were based on case-control. To assess the association of the studied factors with the risk of developing cataracts, the odds ratio (OR) and 95% confidence interval (CI) were calculated. Morbidity rates were calculated using medical statistics methods per 1000 people. When studying the incidence of cataracts, individualized indicators of radiation dose to the lens of the eye were used.

RESULTS: The study revealed an increase in the incidence of cataracts as the cohort ages. There was a tendency for the risk of cataracts to increase (OR=1.10; 95% CI=1.00–1.21) with increasing radiation dose. The incidence of cataracts was associated with the presence of arterial hypertension (OR=2.01; 95% CI=1.81–2.22), diabetes mellitus (OR=1.36; 95% CI=1.17–1.58), cerebrovascular diseases (OR=1.14; 95% CI=1.03–1.26), increased body mass index (OR=1.61; 95% CI=1.45–1.78), as well as belonging to Turkic group (OR=1.58; 95% CI=1.44–1.71), living in the city (OR=1.26; 95% CI=1.15–1.38), having no family (OR=1.72; 95% CI=1.63–1.97), employment primarily in mental work (OR=1.34; 95% CI=1.22–1.48).

CONCLUSION: A tendency for the influence of radiation dose on an increase in the risk of cataracts has been established, medical and social factors that increase the likelihood of developing senile cataracts have been identified.

Kazan medical journal. 2024;105(1):33-41
pages 33-41 views
Morphometric features of the human parotid salivary gland depending on the shape of the skull according to radiation research methods
Abduvosidov K.A., Chernyavskii V.I., Smirnova A.D., Belenkaya O.I., Vihareva L.V.
Abstract

BACKGROUND: Intravital study of the parotid salivary gland individual characteristics using radiation research methods can be used by clinicians for more accurate diagnosis and planning of surgical treatment of the parotid salivary gland diseases.

AIM: Study of the parotid salivary glands’ morphometric parameters in people with different shapes of the facial and cerebral skull using radiation research methods.

MATERIAL AND METHODS: An analysis of the database of studies performed using magnetic resonance and computed tomography of 120 patients of different ages was carried out. Based on computed tomography data, cranial diameters were measured and cranial indices were calculated, according to which the studied material was divided into groups depending on the shape of the facial (leptena, mesena, eurienae) and cerebral (brachycranes, dolichocranes and mesocranes) parts of the skull. Based on magnetic resonance imaging data of the same patients, the morphometric parameters of the parotid salivary glands were analyzed in three planes. Groups were compared using the Kruskal–Wallis method, followed by pairwise comparisons using the Mann–Whitney method with the Bonferroni correction.

RESULTS: In the leptene group, the frontal size of the gland was statistically significantly smaller compared to similar sizes in the group of euriens (right p <0.0001, left p <0.0001) and mesenes (right p=0.0057, left p=0.012). The sagittal size of the gland was statistically significantly different between the brachy-, meso- and dolichocranial groups (p <0.0001 on the right and left). A significant tendency was revealed for a decrease in the sagittal size of the parotid salivary glands from 4.27 (3.77; 4.66) cm (right) and 4 (3.8; 4.6) cm (left) in dolichocraniform individuals to 3.57 (3.22; 3.86) cm (right) and 3.37 (3.16; 3.99) cm (left) in individuals with a brachiocranial skull shape. When measuring the frontal size in people with different skull shapes, a statistically significant difference in gland thickness between groups was found (p <0.0001 on the right and left).

CONCLUSION: In people with different forms of the facial skull, there is a difference in the vertical and frontal sizes of the parotid salivary glands, and with different forms of the brain skull, there is a difference in the sagittal and frontal sizes of the glands.

Kazan medical journal. 2024;105(1):42-49
pages 42-49 views
Structural organization of the contralateral salivary glands
Shchipskiy A.V., Mukhin P.N., Akinfiev D.M., Kalimatova M.M., Agalarova A.А.
Abstract

BACKGROUND: It has been established that there are no functional differences between the paired salivary glands, but the presence or absence of structural differences in the contralateral salivary glands remains unknown.

AIM: To determine the presence of features of the contralateral salivary glands’ structural organization, which should be taken into account in the process of differential diagnosis in patients with various diseases of the salivary glands when analyzing sialograms.

MATERIAL AND METHODS: In 60 patients with diseases of the salivary glands, digital subtraction sialography of the parotid (right n=33, left n=26) and submandibular (right n=17, left n=19) glands was performed. The parameters of the paired glands were compared: the number and time of filling of the ducts with the water-soluble non-ionic contrast agent iodixanol. The sample was formed without taking into account gender, age and diseases. Cases with stones or ductal strictures were excluded. The significance of differences was assessed using Student's t-test. The results were considered significant at p ≤0.05.

RESULTS: The contrast time for the parotid glands (n=59) averaged 29.8±8.9 s: on the right — 31.0±8.0 s (n=33), on the left — 28.2±9.6 s (n= 26; t=1.2219); submandibular glands (n=36) — 28.6±11.6 s: on the right — 30.2±14.4 s (n=19), on the left — 27.3±8.3 s (n=17; t= 0.7284). The amount of drug injected into the ducts reflected their volume, which we considered as an accurate characteristic of their structural state. 1.4±0.3 ml of iodixanol (Visipack) was injected into the parotid glands (n=59): on the right — 1.4±0.3 ml (n=33), on the left — 1.4±0.3 ml (n =26; t=0). 1.2±0.3 ml was injected into the submandibular glands (n=35): on the right — 1.2±0.4 ml (n=17), on the left — 1.1±0.3 ml (n=18; t=0.8399). There was no significant difference between the contralateral glands, but there was a significant diffe¬rence between the parotid and submandibular glands (t=3.1247; p ≤0.001). When conducting scientific analysis, data from the contralateral salivary glands could be combined into a single sample. The amount of drug injected into the ducts served as a characteristic of the structural state of the gland.

CONCLUSION: The contralateral salivary glands do not have significant structural differences, and structural changes in the same patient are of the same type.

Kazan medical journal. 2024;105(1):50-55
pages 50-55 views
Features of the spatial orientation of the thoracodorsal nerve bundles
Gorbunov N.S., Kober K.V., Kasparov E.V., Rostovtsev S.I., Lebedeva D.N.
Abstract

BACKGROUND: Studying the spatial arrangement of nerve bundles makes it possible to better understand the characteristics of the occurrence and mechanisms of injuries to peripheral nerves, to develop and perform new reconstructive operations.

AIM: To identify the features of the route, spatial orientation and relationships of the thoracodorsal nerve bundles along its entire length.

MATERIAL AND METHODS: Intrastem dissection of 121 thoracodorsal nerves was performed in the corpses of men and women aged 40–97 years. The obtained indicators of the length (mm) and angles of deviation (degrees) of the thoracodorsal nerve bundles at different levels of their entire path were checked for normality of distribution using the Shapiro–Wilk test. When describing the studied indicators, the median (Me) and quartile intervals (Q1, Q3) were determined, and the significance of intergroup differences was determined using the Mann–Whitney U test.

RESULTS: Along the entire path, the bundles of the thoracodorsal nerve change their spatial position 6 times and their relationship with each other 1 time. The closer the bundles are to the spinal cord and spine, the more changes (85.7%); the further to the periphery, the fewer (14.3%). The bundles of the thoracodorsal nerve are located twice in the horizontal plane, and in the proximal half of the C7 spinal nerve they are twisted relative to each other by 180° [170°; 190°], change places: the sensory ones move from the posterior position to the anterior one, and the motor one — from the anterior to the posterior one. The bundles of the thoracodorsal nerve deviate downward 4 times in the frontal plane at a total angle of 105° [95°; 115°], and in the sagittal plane they change their position 2 times and move from an oblique-anterior (15° [5°; 25°]) to an oblique-posterior (20° [10°; 30°]) position.

CONCLUSION: The route of passage of the thoracodorsal nerve bundles along the entire path from the spinal cord to the latissimus dorsi muscle consists of eight levels of different lengths, 6 times they change their spatial orientation and 1 time their relationship with each other.

Kazan medical journal. 2024;105(1):56-65
pages 56-65 views

Experimental medicine

The role of ubiquitin and heat shock proteins 27 and 70 in the oxidative modification of proteins and the implementation of dexamethasone-induced apoptosis of tumor cells
Nosareva O.L., Stepovaya E.A., Litvinova L.S., Yurova K.A.
Abstract

BACKGROUND: Experimental studies of molecular control of the tumor cell’s redox status, which influences the implementation of apoptosis, are relevant for studying the pathogenesis of tumor growth.

AIM: Studying the molecular mechanisms of the participation of ubiquitin and heat shock proteins 27 and 70 in the oxidative modification of proteins, amino acids and the implementation of dexamethasone-induced apoptosis of Jurkat tumor cells in conditions of decreased antioxidant protection by blocking the synthesis of reduced glutathione.

MATERIAL AND METHODS: The effect of the inhibitor of de novo glutathione synthesis buthionine sulfoximine at a final concentration of 1 mM and/or the apoptosis inducer dexamethasone at a final concentration of 10 μM on the content of hydroxyl radical, protein-bound glutathione, carbonyl derivatives of proteins, oxidized tryptophan and bityrosine, ubiquitin, heat shock proteins 27 and 70, number of annexin V-positive cells and caspase-3 activity in Jurkat tumor cells was studied. Using the Shapiro–Wilk test, the normality of the distribution of indicators was assessed. Statistical hypotheses about the differences between the study groups were tested using the nonparametric Mann–Whitney test with a Bonferroni correction; correlation analysis was performed using the Spearman method at a significance level of p <0.05.

RESULTS: In tumor cells of the Jurkat line, exposure to buthionine sulfoximine and dexamethasone was accompanied by a statistically significant decrease in the content of ubiquitin by 24% (p=0.004), protein-bound glutathione by 93% (p=0.003), oxidized tryptophan by 57% (p=0.003), and heat protein shock 70 by 56% (p=0.004), as well as an increase in the concentration of carbonyl derivatives of proteins by 53% (p=0.004), heat shock protein 27 by 104% (p=0.004), associated with an increase in the number of annexin-positive cells by 1296% (p=0.006) and caspase-3 activity by 258% relative to the values in intact cells. The relationship between an increase in the number of annexin-positive cells and caspase-3 activity with changes in the content of protein-bound glutathione, carbonylated proteins, oxidized tryptophan, ubiquitin and heat shock proteins 27 and 70 in tumor cells with simultaneous exposure to both buthionine sulfoximine and dexamethasone has been proven.

CONCLUSION: Blocking de novo glutathione synthesis and stimulating apoptosis causes activation of reversible and irreversible oxidative modification of proteins and amino acids against the background of increased oxidative stress in Jurkat tumor cells.

Kazan medical journal. 2024;105(1):66-72
pages 66-72 views
The effect of various modes of electrical influence on the skeletal muscles of the lengthened ­segment during distraction of the lower leg according to Ilizarov
Ovchinnikov E.N., Filimonova G.N., Dyuryagina O.V., Tushina N.V., Kireeva E.A.
Abstract

BACKGROUND: When using electrical muscle stimulation in clinical practice, it is important to select the optimal mode of this effect, since muscles largely determine the movement of the limb during the rehabilitation period.

AIM: Study of the tibialis anterior muscle reaction during Ilizarov distraction of the tibia in combination with the direct effect of direct electric current on the regenerated area in the experiment.

MATERIAL AND METHODS: The tibialis anterior muscle and biochemical parameters of blood serum (creatin kinase activity, lactate concentration) of 27 male Soviet chinchilla rabbits aged 12 months, weighing 3.85±0.18 kg, tibia length 11.2±0.13 cm, were studied. The animals were divided into three groups: control (n=9), first (n=9) and second experimental (n=9). The right tibia was fixed with an Ilizarov apparatus, a transverse osteotomy was performed in the middle third of the diaphysis, and from the 5th day, distraction began at a rhythm of 0.125 mm in 4 steps to an amount of 10% of the original length for 26 days. Fixation lasted 40 days, the period without the device was 30 days. For electrical stimulation, wire-electrodes were inserted into the diaphysis, and electrical stimulation of the bone regenerate was performed for 1 minute with a current intensity of 150 mAm. In the first group, electrical stimulation was performed starting from the day of surgery and on days 2, 4, 6, 8, 10 of the experiment. In group 2, electrical stimulation began on the 10th day after surgery and on the 12th, 14th, 16th, 18th, and 20th days of the experiment. In the control group, no electrical stimulation was applied. Using the methods of stereometric analysis of digitized images of tibialis muscle’s cross sections, the volumetric density of myosymplasts, microvessels, endomysium and nuclear component, the numerical density of myosymplasts and microvessels were determined, and the vascularization index was calculated. For statistical processing of data, the Wilcoxon W test and the Mann–Whitney T test were used; numerical data were presented in tables.

RESULTS: A positive effect of electrical stimulation on the muscles of the experimental groups was established in comparison with the control group, where fibrosis of muscle tissue at the end of the experiment was 0.2777±0.0055 mm3/mm3, which was 230% relative to the parameter of the first group (0.1217±0.0121 mm3/mm3) and 370% relative to the second group (0.0752±0.0062 mm3/mm3). An advantage was noted for the second group, where electrical stimulation was carried out from the 5th day of distraction and at the end of the experiment the histostructure of the muscle, characteristic of the intact norm, prevailed.

CONCLUSION: Electrical impact on bone regenerate from the 5th day of distraction stimulates reparative processes in the tibialis anterior muscle and serves as an organ-saving method.

Kazan medical journal. 2024;105(1):73-83
pages 73-83 views
Activity of enzymes destroying extracellular nucleotides in the tissues of rats with the valproate model of autism
Ivanova D.V., Khabirov R.A., Ziganshin A.U.
Abstract

BACKGROUND: Ectonucleotidases hydrolyze extracellular nucleotides and thus can control the effect of these substances on purinergic P1 and P2 receptors.

AIM: To evaluate the activity of ectonucleotidases in the smooth muscle tissues of internal organs of 9-month-old rats with the valproate model of autism using high-performance liquid chromatography.

MATERIAL AND METHODS: Autism was modeled in outbred Wistar rats by administering valproic acid (500 mg/kg) subcutaneously to pregnant females on days 12–13 of pregnancy. The born offspring were used in the study when the rats reached 270±8 days. Animals were guillotined under light ether anesthesia, the bladder, uterus, vas deferens, and duodenum were isolated, and smooth muscle tissue samples were prepared. Total ectonucleotidase activity was determined by incubating tissue samples with adenosine triphosphate (reaction substrate) for 10 minutes with further assessment of the content of the substrate and reaction products (adenosine diphosphate, adenosine monophosphate) in the incubate using high-performance liquid chromatography. Mathematical and statistical processing of the results was carried out using Microsoft Excel and IBM SPSS Statistics 26.0 software. Group comparisons were made using the nonparametric Mann–Whitney U test. Differences were considered significant at p <0.05.

RESULTS: In rats with the valproate model of autism, the activity of ectonucleotidases in the smooth muscle tissues of the vas deferens (609.5±153.9) and uterus (232.7±2) was significantly lower than control values (2114.6±524.3, p=0.040; 539.6±63.5, p=0.010, respectively). In the duodenum (1808.4±184.5) and bladder (1021.3±280.7) we did not find a significant difference compared to the control values (2115.0±393.3, p=0.712; 2302.3±615.8, p=0.274, respectively). This study allows us to evaluate the possible contribution of purinergic transmission to the changes we found earlier in the contractile activity of smooth muscle tissue in rats with the valproate model of autism.

CONCLUSION: In 9-month-old rats with a model of autism, the activity of ectonucleotidases in the smooth muscle tissues of the reproductive organs is reduced; no such changes were found in the tissues of the intestines and bladder.

Kazan medical journal. 2024;105(1):84-89
pages 84-89 views
Effect of human lactoferrin solution on histological changes of rabbit cornea in alkaline burns
Kolesnikov A.V., Nemtsova E.R., Cherdantseva T.M., Kirsanova I.V., Kislyakova T.D.
Abstract

BACKGROUND: Eye burns are a severe injury, accounting for 6.1–38.4% of all ophthalmic diseases. Alkaline burns are the most common and most severe forms of eye burns.

AIM: Evaluation of the effectiveness of drug topical application based on human lactoferrin in alkaline cornea burns of the 3rd degree in the experiment.

MATERIAL AND METHODS: The study was conducted on 42 rabbits. It included two groups: the first (without treatment) — alkaline burns during therapy with water for injection (1 drop 3 times a day) — 21 rabbits, the second (experimental) — treatment with lactoferrin solution (concentration 2.5 mg/ml, 1 drop 3 times a day) — 21 rabbits. Alkaline burns were induced by applying a filter paper disc moistened with 5% sodium hydroxide solution to the cornea. 6 eyes of 3 intact animals served as controls. The effectiveness of the drug was evaluated by the rate of closure of the corneal epithelium defect, the time of suppression of the inflammatory reaction in the area of the defect and the limbus, the degree of restoration of the morphological structure of the cornea, as close as possible to the normal rabbit cornea. The obtained data were processed using the methods of variation statistics, the Statistica 10.0 software package. The significance of differences was assessed by calculating the median and interquartile interval. The critical level of significance for statistical criteria was taken as p=0.05.

RESULTS: From the 3rd day of the study, in the experimental treatment group, there was an acceleration of reepithelialization, restoration of the cornea's own substance, and a more rapid subsidence of inflammation compared to the control group. The thickness of the cornea in the center of the defect in the group without treatment was significantly higher than the values of intact animals at all periods of observation: on the 3rd day after the burn it was 615.99 [450.70–794.07] µm (p=0.000574), reached the maximum by day 7 — it was 1363.16 [907.78–1543.44] µm (p=0.000091), and by day 28 it decreased to 384.38 [376.03–398.14] µm (p=0.0000041). In the group with experimental treatment, the thickness of the cornea in the center of the defect also increased relative to intact animals, starting from the 1st day of pathology, reaching maximum values on the 3rd day — 436.70 [415.57–489.90] µm (p=0.005589). The use of lactoferrin solution in comparison with the first group led to a significant decrease in the thickness of the cornea in the center of the defect on 7th (p=0.039985) and 28th days (p=0.0443).

CONCLUSION: Local application of lactoferrin solution in alkaline burns of the cornea promotes faster regeneration of the epithelium and restoration of the stroma structure of the rabbit cornea.

Kazan medical journal. 2024;105(1):90-98
pages 90-98 views

Reviews

Modern concepts about the pathogenesis of thrombosis of various etiologies
Khismatullin R.R., Litvinov R.I.
Abstract

Thrombosis becomes the cause and complication of many cardiovascular diseases, and their prevalence remains a leader in the structure of morbidity and mortality in Russia and throughout the world. Modern fundamental and clinical research has significantly supplemented traditional ideas about the mechanisms of thrombus formation. First of all, Virchow's triad has been rethought, in which, according to new data, the leading role is assigned to vascular damage, and slowing down blood flow plays a primary role in the formation of only venous, but not arterial, blood clots. In recent years, the mechanisms of endothelial dysfunction underlying thrombosis associated with inflammatory (immunothrombosis) and atherosclerotic (atherothrombosis) damage to the vascular wall have been studied in detail. The cellular and molecular mechanisms of acquired hypercoagulability and hereditary thrombophilia have been deciphered. The traditional concept of dividing blood clots into “red” (venous, consisting of fibrin and red blood cells) and “white” (arterial, platelet) is being revised. It has been shown that red blood cells can occupy most of the volume of not only venous, but also arterial thrombi, and play an important role in thrombus formation reactions. The process of compression (contraction, retraction) of blood clots, caused by contraction of activated platelets, changing the structure of the blood clot and affecting the course and outcome of thrombosis, is being actively studied. A deep understanding of the pathogenesis of thrombosis, taking into account modern concepts, is necessary for effective prevention, early diagnosis and treatment of thrombotic conditions.

Kazan medical journal. 2024;105(1):99-109
pages 99-109 views
Possibilities of magnetic resonance imaging in visualizing the pudendal nerve in normal and pathological conditions
Beloborodov V.A., Stepanov I.A., Ryllo G.A.
Abstract

Until recently, imaging of peripheral nerves was limited from a technical point of view, as there was no established “gold standard” study protocol for the purpose of qualitative visualization of nerve trunks in normal and pathological conditions. With technical advances in magnetic resonance imaging and the advent of specialized high-resolution magnetic resonance neurography, it has become possible to visualize peripheral nerves of varying diameters. A literature search in the Pubmed, Medline, EMBASE, Cochrane Library, and eLibrary databases demonstrated the presence of several studies examining the capabilities of magnetic resonance imaging in visualizing the pudendal nerve in normal and pathological conditions. It must be emphasized that the results of these studies are consistent and largely complement each other. A generalization of the available data on the capabilities of magnetic resonance neurography of the pudendal nerve was the impetus for writing this literature review. Magnetic resonance neurography is a tissue-specific imaging method optimized for assessing the condition of peripheral nerves, including changes in the morphology of their bundle structure, signal, the diameter and length of nerve trunks, which can be caused by both anatomical features and pathological processes. Three-dimensional (3D) imaging is critical for studying the topography of peripheral nerves, identifying areas of compression or traumatic injury, and for preoperative planning. Magnetic resonance imaging in certain modes and sections allows to clearly visualize the pudendal nerve along almost its entire length, determine the nature of its branching and the features of its topographic and anatomical location. The anatomical characteristics of the pudendal nerve and its pathological changes obtained using magnetic resonance neurography can be used in everyday clinical practice by urologists, obstetricians-gynecologists and neurosurgeons for planning surgical interventions.

Kazan medical journal. 2024;105(1):110-117
pages 110-117 views
Microsatellite instability in precancerous changes in the gastric mucosa
Parygina M.N., Rubtsov V.A., Ivanova S.V., Shimanskaya A.G., Kononov A.V.
Abstract

Microsatellite instability is a widely known and sought after tumor marker. Among other things, its prevalence and role in the development of gastric adenocarcinoma are being studied. However, the profile of microsatellite instability during precancerous changes in the gastric mucosa (atrophy, intestinal metaplasia, epithelial dysplasia) remains insufficiently studied. The purpose of this literature review is to assess the possibility of using microsatellite instability status as a diagnostic and predictive marker of precancerous changes and lesions of the gastric mucosa. A systematic review of publications in the PubMed database was conducted using a search query based on the combination of the terms “microsatellite instability” (“MSI”), “stomach/gastric cancer/adenocarcinoma”, “stomach/gastric dysplasia/intraepithelial neoplasia”, “stomach/gastric precancerous lesions” for the period from 1997 to 2023. Review articles were excluded from the search results. The systematic review included 11 relevant publications. Despite the lack of a uniform methodology and diversity in the study groups, all publications demonstrated an increase in the level of microsatellite instability in the range from normal (unchanged) gastric mucosa and/or its precancerous changes to gastric cancer: among precancerous changes in the gastric mucosa, the most common subject of study was intestinal metaplasia, where levels of microsatellite instability ranged from 0 to 53.3%, while its levels in gastric cancer ranged from 32.6 to 76.7%. The results of the studies included in the review may indicate a possible predictive role of microsatellite instability in precancerous changes in the gastric mucosa in relation to the risk of developing cancer.

Kazan medical journal. 2024;105(1):118-127
pages 118-127 views

Social hygiene and healthcare management

Factors and conditions of successful professional adaptation of residents
Ryabova T.V., Marapov D.I., Zhidyaevskij A.G., Galimova L.L., Mukharyamova L.M.
Abstract

BACKGROUND: Residency is the main stage in the training of highly qualified medical personnel. Requirements for the level of training and professional values of future doctors are increasing, approaches to training and assessment technologies are changing, which imposes additional responsibility on all participants in the educational process: teachers, mentors and residents.

AIM: To identify the factors and conditions that affect the professional adaptation of residents in the first months of training.

MATERIAL AND METHODS: The study involved 369 residents studying at Kazan State Medical University, Kazan (Volga region) Federal University, Kazan State Medical Academy, aged 22 to 36 years. Residents were subdivided into groups according to the following criteria: specialty, place of previous training, basis of training (by general competition, target, commercial), gender, age, clinical base of residency. An original questionnaire developed by the authors containing 27 questions was used. Questions of the questionnaire concerned various aspects of the adaptation of residents. Filling the questionnaire was anonymous and was carried out using Internet survey technology via Yandex Forms. Statistical analysis and visualization of the obtained data were performed using the StatTech v. 3.0.9. Categorical data were described with absolute values and percentages. Comparison of percentages in the analysis of multifield contingency tables was performed using Pearson's χ2 test.

RESULTS: Satisfaction with training was considered as one of the indicators of successful adaptation of residents. Based on the results of the 1st and 2nd months of residency training, 48.2% of respondents showed satisfaction with their training. There were no significant differences in the degree of satisfaction among residents of various specialties (p=0.424). Statistically significant differences (method used — Pearson's χ2) were established by the presence of a mentor/curator, as well as cases of disrespectful attitude on the part of the medical staff of the clinical base where they were trained, patients and their relatives, and the administration of the institution (p <0.05). The dependence of the process of residents’ adaptation on the chosen specialty, place of previous training, the basis of training (by general competition, target, commercial), gender, age, clinical base of residency was not found.

CONCLUSION: The conditions for successful adaptation of residents are the presence of a mentor from a medical organization, the accuracy of the instructions received, the frequency of meetings with a teacher/curator, the attention of the head of the department to the work and study of residents, and the motivation for learning from the residents themselves.

Kazan medical journal. 2024;105(1):128-136
pages 128-136 views

Clinical experiences

Experience in the treatment of lymphatic malformations in children
Zykova M.A., Nurmeev I.N., Mirolubov L.M., Valeeva G.R., Morozov V.I.
Abstract

BACKGROUND: In the treatment of lymphatic malformations, the problem of radical removal and a high risk of recurrence remains.

AIM: Improving the efficiency of treatment of children with lymphatic malformations by introducing new surgical methods and optimizing sclerotherapy.

MATERIAL AND METHODS: The results of treatment of 150 patients with lymphangiomas and an experimental study of the effects of sclerosing drugs on the lining of lymphangioma are presented. The study included 67 (44.7%) girls and 83 (55.3%) boys. The patients were divided into three groups. The first group (72 children) consisted of patients with radical removal of lymphangioma. The second group included 70 patients with partial resection of lymphangioma and sclerosis of residual cavities. The third group (8 children) consisted of patients operated on by video endoscopic method. A histological study of micropreparations of lymphangioma after sclerosis with ethanol and sodium tetradecyl sulfate with an exposure of 5 minutes was carried out. Statistical analysis was carried out using the StatTech v. 2.2.0 using methods of parametric and non-parametric analysis. Results were considered statistically significant at p <0.05.

RESULTS: In the first group of patients, 9 (11.1%) relapses occurred, in the second — 12 (12.3%), in the third group — 0 relapses. Treatment combined with sclerotherapy did not lead to a significant increase in the recurrence rate (p=0.541). Types of lymphatic malformations and their location did not significantly affect the risk of recurrence (p=0.232 and p=0.552, respectively). Sclerosis of the lymphangioma lining with 70% ethanol and a liquid form of sodium tetradecyl sulfate caused total desquamation of the endothelium. Sclerosing with the foam form of sodium tetradecyl sulfate led to total desquamation of the endothelium during a 3-minute exposure.

CONCLUSION: The introduction of minimally invasive methods of treatment and the improvement of sclerosis will make the results of treatment of children with lymphangiomas better.

Kazan medical journal. 2024;105(1):137-144
pages 137-144 views
Pathology of the pelvic bones and its correction in bladder exstrophy
Akramov N.R., Zakirov A.K., Khaertdinov E.I., Morozov V.I.
Abstract

There are many studies regarding treatment methods for bladder exstrophy, but it is impossible to single out the only correct one. When treating bladder exstrophy, all defects can be eliminated separately, but the effect of such interventions will be incomplete. When analyzing the anatomy of patients with this pathology, pronounced splitting and divergence of the pelvic muscles is noted due to dysplasia and the wide position of the iliac and pubic bones. Due to the inferiority of the pelvic bones, the functions of all its organs are disrupted. Modern methods of radiation research have made it possible to better understand the main causes of such changes: outwardly rotated iliac bones, retroversion of the acetabulum and femur, shortened branches of the pubic bones, a backward curved acetabulum and flabby sacroiliac joint, increased distance between the triradial cartilages. Such changes are difficult to eliminate with soft tissue plastic surgery, so specialists who use osteotomy of the pelvic bones in the treatment of this pathology have more positive results. Since 1958, in the treatment of children with exstrophy of the bladder, osteotomy has been used in various versions, which makes it possible to restore the pelvic ring, improve the results of soft tissue plastic surgery and urinary continence. The authors noted a high rate of continence success in patients who underwent primary bladder closure without complications such as wound infection, dehiscence, or any degree of bladder prolapse. Thus, correction of the skeletal system serves as a basic element in the correction of bladder exstrophy.

Kazan medical journal. 2024;105(1):145-151
pages 145-151 views

History of medicine

On modern Russian scientific schools in the history of medicine and the criteria for their validity
Albitskiy V.Y.
Abstract

In the second half of the 20th century in the USSR there were two influential schools of medical historians, competing with each other: the school of B.D. Petrov (Department of the History of Medicine of the Research Institute of Healthcare Organization and History of Medicine named after N.A. Semashko) and the school of F.R. Borodulin [Department of the History of Medicine of the First Moscow Medical Institute (Moscow Medical Academy named after I.M. Sechenov)]. With the end of the Soviet era in the history of the country, the influence of these schools also ended. In the 21st century, according to the author, there are also two scientific schools of medical historians functioning in Russia, they were created respectively by Academician A.M. Stochik and Professor V.I. Borodulin. Both schools have no genetic connection with the schools of the twentieth century and successfully continue the development of the scientific history of medicine, interrupted in the 20s of the twentieth century. In his research, the author uses the criteria for the viability of scientific schools proposed by V.I. Borodulin in relation to clinical schools. The decisive criterion is the presence of an original scientific direction developed by the teacher and his students. The author highlights such directions in the work of scientific teams headed by A.M. Stochik and V.I. Borodulin and indicates the leading representatives of these schools. The issues of “registration” of each student in a given school, partial “adjacent” to the school, and affiliated schools are also considered.

Kazan medical journal. 2024;105(1):152-158
pages 152-158 views
85 years of the Department of Epidemiology and Evidence-Based Medicine of Kazan State ­Medical University: from history to modern times
Khasanova G.R.
Abstract

In 2023, it was 85 years since the founding of the Department of Epidemiology and Evidence-Based Medicine at Kazan State Medical University. The article describes the main stages of the history of the department, from its foundation to the present day. The first head of the department in 1938 was V.I. Popov. In addition to successful work in training specialists, the history of the department was marked by extensive scientific activity and work carried out in the direction of the infectious diseases prevention, including as part of eliminating outbreaks. Employees of the department have carried out scientific research devoted to improving the diagnosis of infectious diseases, improving epidemiological surveillance in order to further reduce the incidence and eliminate current infections, including diphtheria, typhus and typhoid fever, tuberculosis, smallpox, viral hepatitis, infection caused by the human immunodeficiency virus, etc. A significant part of the scientific work carried out by the staff of the department concerned the study of post-infectious and post-vaccination immunity, as well as the study of the influence of environmental risk factors on the immunological reactivity of the body. The change in the paradigm of modern epidemiology and the epidemic situation has necessitated modification of the educational process with the inclusion in the program and expansion of teaching in such areas as clinical epidemiology, hospital epidemiology, and military epidemiology. In 2016, the department was renamed the Department of Epidemiology and Evidence-Based Medicine.

Kazan medical journal. 2024;105(1):159-166
pages 159-166 views

Jubilees

Professor Alexey Stanislavovich Sozinov is 60 years old
Kazan medical journal. 2024;105(1):167-169
pages 167-169 views
Professor Albert Sarvarovich Galyavich is 70 years old
Kazan medical journal. 2024;105(1):170-171
pages 170-171 views

Obituary

Professor Vadim Nikolaevich Shvalev
Kazan medical journal. 2024;105(1):172-173
pages 172-173 views

Cochrane Review Summaries

Intermittent catheter techniques, strategies and designs for managing long‐term bladder conditions
Abstract

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systema­tic Review: Prieto JA, Murphy CL, Stewart F, Fader M. Intermittent catheter techniques, strategies and designs for managing long‐term bladder conditions. Cochrane Database of Systematic Reviews. 2021. Issue 10. Art. No.: CD006008. DOI: 10.1002/14651858.CD006008.pub5.

Kazan medical journal. 2024;105(1):174-175
pages 174-175 views
pages 176 views


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