I.P. Pavlov Russian Medical Biological Herald

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

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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 29, No 1 (2021)

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Original researches
Clinical and Genetic Characteristics of Phenylketonuria in Ryazan Region
Yakubovskii G.I., Serebriakova O.B., Yakubovskaya A.G., Ruban N.V., Lyakhovets A.A.

Aim. This investigation seeks to determine the incidence of phenylketonuria in the Ryazan region, assess the spectrum of mutations in the PAH gene (phenylalanine hydroxylase), investigate the interrelationship between the disease’s clinical course, the phenylalanine blood level, and the patient’s genotype.

Materials and Methods. The incidence of phenylketonuria was studied based on the data of massive neonatal screening for the period from 2000 to 2019. Molecular genetic examination of mutations was conducted in 39 patients using the allele-specific multiplex ligation method. The interrelationship between the phenylalanine blood level on the fifth day of life and retest, the disease’s clinical course, and the patient’s genotype was assessed according to the medical record data of 33 patients under dispensary observation in a medico-genetic clinic. The patients were divided into two groups. The first group (n=21) had two «severe» mutations (residual activity of phenylalanine hydroxylase <10%). The second group (n=12) had one «severe» and one «mild» mutation (the residual activity of the enzyme >10%).

Results. The incidence of phenylketonuria in the Ryazan region was one in 5054 newborns, exceeding the Russian Federation’s average parameters. Eighteen mutations were discovered in the PAH gene. The most frequent was the R408W mutation (56.4% alleles). The second most frequent mutations were the IVS10-11G>A (6.4%) and P281L (5.1%). The R158Q and Y418C mutations occurred with a frequency of 4.1% and Е280К mutation of 2.7%. All the rest of the
mutations occurred as single cases. Investigation of the interrelationship between the phenylalanine blood level, the disease’s clinical course, and the patient’s genotype revealed a reliably higher content of amino acid in the first group on retest (32.1±1.7 mg/% vs. 17.7±1.5 mg/% in the second group, р<0.001) and predomination of more severe forms of phenylketonuria (90.5% vs. 41.7%, respectively, р<0.001). Disorders in neuropsychic and speech development were present in 28.6% of patients in the first group but were absent in the second group.

Conclusion. By conducting the study, the incidence of phenylketonuria was determined in the Ryazan region. The spectrum of mutations in the PAH gene was defined. The interrelationship between the disease’s clinical portrait, the phenylalanine blood level, and the patient’s PAH genotype was revealed.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):5-12
Anatomical peculiarities of the sphenoidal sinus based on computed tomography data: structural types and correlation with maxillary sinuses
Zeleva O.V., Zelter P.M., Kolsanov A.V., Pyshkina Y.S., Kramm E.K.

Detailed knowledge of anatomy and topography of sphenoidal and maxillary sinuses may help to improve surgical approaches, better predict postoperative complications, increase safety of surgical techniques, and, consequently, avoid inflammatory reactions. This also helps to determine the cause of inflammatory changes.

Aim. This study aimed to analyze structural types of sphenoidal and maxillary sinuses by examining computed tomography (CT) images of the paranasal sinuses, to determine the frequency of the interposition of the internal carotid artery, and to identify sex- and age-related peculiarities and regularities in the extent of pneumatization and contents in the sphenoidal and maxillary sinuses.

Materials and Methods. CT images of 50 patients who were receiving treatment in the otolaryngology unit of the Clinic of SamSMU were analyzed. Toshiba Aquilion 32 CT scanner was used.

Results. Patients were divided into three groups according to Hamberger classification of the pneumatization of the sphenoidal sinus by taking into account the topographic relation to the sella turcica using CT data: the presellar type was identified in 10% (n=5) of the cases, the sellar type in 22% (n=11), and the postsellar type in 68% (n=34). The postsellar type is the most common structural type of the sphenoidal sinus. Moreover, patients were divided into groups by the type of pneumatization of the maxillary sinuses. No correlation was found between the pneumatizations of sphenoidal and maxillary sinuses. Moderate negative correlation was observed between age and structural type of the sinuses, and moderate positive correlation was found between the contents of the sinuses. Interposition of the internal carotid arteries was identified in 3 (6%) patients.

Conclusions. Our data revealed that the postsellar type is the most common structural type of sphenoidal sinuses. The extent of pneumatization of the sphenoidal and maxillary sinuses is independent of each other. Anatomical peculiarities of the sphenoidal sinus in the form of the interposition of the internal carotid arteries are not very rare and should be taken into account in planning surgical interventions.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):13-20
Influence of different concentrations of fibrinogen on the properties of a fibrin matrix for vascular tissue engineering
Matveeva V.G., Khanova M.Y., Glushkova T.V., Antonova L.V.

Aim. To evaluate the potential utility of fibrin matrices containing 10, 20, and 25 mg/ml of fibrinogen (fibrin-10, fibrin-20, and fibrin-30, respectively) in vascular tissue engineering (VTE).

Materials and Methods. Fibrinogen was isolated using the method of ethanol cryoprecipitation and polymerized using a solution of thrombin and CaCl2. The fibrin structure was studied in a scanning electron microscope, and the physical and mechanical properties of the material were tested on a Zwick/Roell test machine. The metabolic activity of endothelial cells (EC) on the fibrin surface was evaluated by the MTT assay, and the viability of fibroblasts in the thickness of fibrin and possibility for migration by in fluorescent and light microscopy. Percent of fibrin shrinkage was determined from the difference in the sample volumes before and after removal of moisture.

Results. The fiber diameter did not differ among all fibrin samples, but the pore diameter in fibrin-30 was smaller than those in fibrin-10 and fibrin-20. A possibility for migration of fibroblasts into the depth of the fibrin matrix and preservation of 97-100% viability of cells at a depth 5 mm was confirmed. The metabolic activity of EC on the surface of fibrin-20 and fibrin-30 exceeded that on collagen, fibronectin, and fibrin-10. All fibrin samples shrank in volume to 95.5-99.5%, and the highest shrinkage was seen in fibrin-10. The physical and mechanical properties of fibrin were inferior to those of human A. mammaria by a factor of 10.

Conclusion. Fibrin with fibrinogen concentrations of 20 and 30 mg/ml maintains a high metabolic and proliferative activity of EC on the surface and also a high viability of fibroblasts in the matrix. Its availability, ease of preparation, and a number of other favorable properties make fibrin a promising material for VTE. However, the problem of insufficient strength requires further investigations.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):21-34
Certain aspects of psychomotor activity in different styles of cognitive activity of an individual
Belskikh I.A., Belogurova A.I.

Aim. This investigation studies the parameters of the psychomotor components of the types of the nervous system (NS) of personality in different styles of cognitive functioning.

Materials and Methods. One hundred medical university students (mean age 22.01±1.84 years, 15 males and 85 females) were examined. Experimental research methods: 1. Express method for determining the properties of the NS – computer modification of the tapping test of E.P. Ilyin – Psychomotor test of the NS (Neurosoft, Ivanovo). Criteria of strength, endurance, and lability of nervous processes in connection with the intensity of work. 2. Assessment of cognitive functioning – a method of discrimination of the properties of concepts (cognitive style concrete/abstract conceptualization).

Results. All participants were ranked to 4 poles of cognitive style: 1 – abstract subjectivity of conceptualization (4.9%); 2 – abstract realism of conceptualization (10.1%); 3 – concrete subjectivity of conceptualization (9.5%); 4 – concrete realism of conceptualization (5.3%). In the group of studied individuals, a descending graph of movement speed dominated (61%), which corresponds to a weak type of NS; 10% of participants had a strong type of NS characterized by a convex graph type; a flat type was identified in 14% of patients. This type indicates a medium strength of the NS. Intermediate and concave types were diagnosed in 15% of participants, which corresponds to a moderately weak type of NS. In the statistical analysis of psychomotor NS parameters participant groups with different poles of conceptualization expression according to the criteria of E.P. Ilyin, the data obtained showed an interrelationship between a strong type of NS and a subjective concrete conceptualization. It was an expressed style of realistic abstractness and a weak type of NS.

Conclusion. The maximum frequency of the tapping test, being a parameter of the speed aspect of psychomotor activity, allows using this criterion to assess the overall activity and the style peculiarities of the cognitive activity, expressed in different types of conceptualization. Peculiarities of cognitive activity, expressed in the increased subjectiveness of conceptualization, correlate with functional mobility enhancement of the cortical processes, increase in information processing speed, and the effectiveness of integrative brain activity.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):35-44
Parameters of autonomic regulation in patients with focal frontal and temporal epilepsy
Medvedeva J.I., Zorin R.A., Zhadnov V.A., Lapkin M.M.

Aim. This study aimed to investigate the mechanisms of autonomic regulation and  autonomic support in focal frontal and temporal lobe epilepsy.

Materials and Methods. Thirty-six individuals were examined (19 men and 17 women; mean age 33.7±1.4 years) in the control group (without history of epileptic seizures) and 68  patients (32 men and 36 women, 34.1±1.5 years) with focal epilepsy (36 patients with frontal lobe epilepsy, of which 32 had temporal lobe epilepsy). Physiological parameters of heart rate  variability and of skin sympathetic evoked potentials were evaluated.

Results. Predomination of sympathetic influences in both groups of patients was found.  According to the analysis of skin sympathetic evoked potentials, a high activity of the  suprasegmental autonomic centers was determined in patients with epilepsy. Based on the results of the correlation analysis, the initial state in patients with temporal lobe epilepsy was  characterized by greater intrasystemic tension that reflects the high level of physiological  costs. The logit regression analysis model makes it possible to distribute patients with focal  epilepsy into groups with different disease courses on the basis of the parameters of the autonomic support of the activity.

Conclusion. In patients with focal epilepsy, predomination of sympathetic influences was  observed, as well as greater activity of the suprasegmental centers of the autonomic regulation. Intrasystemic ratios of autonomic regulation parameters demonstrate an increase in the intrasystemic tension and a limitation of functional reserves in patients with temporal lobe epilepsy. A complex of parameters of autonomic support allows, based on the logit regression analysis, to distribute patients into groups with different courses of focal epilepsy.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):45-53
Content of some vitamins in the diet and blood serum of professional football players
Radzhabkadiev R.M., Beketova N.A., Vrzhesinskaya O.A., Kosheleva O.V., Keshabyants E.E., Denisova N.N., Kobelkova I.V., Vybornaya K.V., Lavrinenko S.V., Zhilinskaya N.V.

Aim. This study evaluates the vitamin status of football players based on the data of actual nutrition and concentration of biomarkers in blood serum in the competition period of sports

Materials and Methods. The research involved 22 football players (men aged 24±5 years, body mass index – 22.9±0.2 kg/m2). Intake of С, В1, В2, РР, A vitamins and beta-carotene was evaluated using the 24-hour nutrition reproduction method. Concentrations of ascorbic acid, riboflavin, retinol, tocopherols, beta-carotene in blood serum were determined in fasting condition on the next day after a competition.

Results. A reduced intake of vitamin A and beta-carotene relative to the recommended level was found in 86.0% of examined individuals, and of vitamins В1, В2, РР, and C in 77.2, 68.1, 36.3 and 63.6%, respectively. A study of biomarkers of provision with vitamins showed a reduced
riboflavin concentration in blood serum relative to the norm (<5 ng/ml) and the optimal level
(<10 ng/ml) in 45.4% and 100% of the examined athletes, respectively. The beta-carotene level did not reach the optimal level (<21.5 µg/dl) in each second athlete, and there were no deficits of vitamin A and vitamins-antioxidants C and E. No statistically significant (Spearman) correlations were found between the individual intake parameters of В2, С, А vitamins, and beta-carotene and the respective biomarkers’ blood serum concentration. A positive relationship was found between the blood serum concentrations of ascorbic acid and beta-carotene (r=0.592, р=0.004).

Conclusion. The data obtained to justify the necessity to optimize the B vitamins and the beta-carotene status of football players in the period of competitions. The traditional approaches to the realization of this task, including enrichment of the diet with vitamin-mineral complexes, should rest on the results of the evaluation of the individual provision of an organism with
micronutrients and take into account the enhanced demand for group B vitamins in athletes
engaged in high-energy-consuming kinds of sports.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):54-65
Carotid Cross-Clamp intolerance during carotid endarterectomy in regional anesthesia
Majd P., Galkin P., Tayeh M., Herzmann T., Gores M., Kalmykov E., Ahmad W.

During surgical endarterectomy, carotid cross clamping is needed for arteriotomy and plaque removal. Carotid cross clamping reduces the blood flow to the circle of Willis, and some patients show intolerance to the temporary occlusion of the internal carotid artery (ICA).

Aim. This study demonstrates locoregional anesthesia’s safety in patients with carotid cross clamping intolerance (CCI) and the risk factors that predict this condition.

Materials and Methods. All patients who underwent surgical carotid endarterectomy between January 2019 and December 2020 (n=53, 29 were male, age (median with range) – 78 (56-90) years) were identified in a retrospective review. The indication for surgical treatment was made for a stenosed ICA of 70-99% or in the case of symptomatic stenosis.

Surgical technique. An incision is made at the front edge of the sternocleidomastoid muscle. The common carotid artery (CCA) is identified and isolated from the surrounding tissues with sharp dissection and continued toward the bifurcation. Next, the internal and external carotid arteries can be isolated. Heparin (5000 U) is administrated intravenously, and the systolic arterial pressure is increased and kept over 160 mm Hg. In the next step, the cross clamping tolerance test is performed for 60 s. During clamping, the patient is neurologically meticulously observed. In the case of CCI, the operation proceeds with the insertion of a temporary shunt. The arteriotomy is started in the CCA and continues to the ICA. The plaque is completely removed, and the arteriotomy incision is covered with a patch. Before completing the suture, the clamps are partially removed to flush out the debris using the blood flow. Now, the external and common artery can be released. Finally, the clamp of the ICA can be removed.

Results. Eight patients had cross clamping tolerance test intolerance. In all these cases, the surgical procedure was continued with a shunt. The further operation course remained uncomplicated. The in-hospital mortality was nil, and a transient ischemic attack occurred in only one case.
Coronary artery disease (CAD) [odds ratio (OR) 12.65, 95% confidence interval (CI) 1.43-112.50], a history of cerebrovascular events [OR 10.50, 95% CI 1.83-60.30], and contralateral stenosis of 70% or more [OR 26.66, 95% CI 2.29-304.37] presented a significant association with the CCI and the need to shunt. The remaining factors showed no significant association with intolerance.

Conclusions. Regional anesthesia is a safe method for identifying patients with CCI and safely performing the surgical procedure. Contralateral stenosis of the ICA and a history of cerebrovascular events are significant factors to predict CCI.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):66-72
Eversion carotid endarterectomy with transposition of the internal carotid artery according to A.N. Kazantsev. Hospital and long-term results.
Kazantsev A.N., Chernykh K.P., Zarkua N.E., Abdullaev A.D., Povtoreiko A.V., Bagdavadze G.S., Kalinin Е.Y., Zaitseva T.E., Chikin A.E., Linets Y.P.

Aim. This study provides an analysis of the results of eversion carotid endarterectomy (CEE) with transposition of the internal carotid artery (ICA) over the hypoglossal nerve, according to A.N. Kazantsev.

Materials and Methods. The given prospective open study covering the period from
January 2017 to May 2020 involved 311 patients who underwent eversion CEE with transposition of ICA over the hypoglossal nerve, according to A.N. Kazantsev. Transposition was performed in the following way: after standard isolation of the carotid arteries, their compression, arteriosection, and removal of atherosclerotic plaque, ICA was extracted in the area above the hypoglossal nerve and was implanted to the same position. The condition of the patient was controlled on repeated visits to the clinic every six months. Hemodynamics in the reconstruction zone were studied using multispiral computed tomography with angiography of carotid bifurcation with 0.6 mm steps and processing the obtained results in Sim Vascular and Open Foam programs in DICON format. The follow-up period was 18.3±7.1 months. In case of development of restenosis, reCEE was performed with patch plasty of the reconstruction zone. For histologic examination, the restenosis area was stained by the van Gieson method.

Results. In the hospital follow-up period, one case of myocardial infarction was noted
that developed due to the stent’s thrombosis in the anterior descending artery deployed two years before. When studying the hemodynamic properties of carotid bifurcation in the postoperative period using computer modeling, in all cases, no changes or obstacles to blood flow were formed in the ICA in the area above the hypoglossal nerve. In the long-term follow-up period, two cases of lethal outcome were recorded connected with the onset of an oncological disease. In one case, due to recurrence of the pulmonary artery thromboembolism. In two cases, the cause of myocardial infarction was thrombosis/occlusion of venous anastomoses (in one patient to the circumflex
artery, in the other – to the right coronary artery). In four cases, repeated acute cerebrovascular accidents developed due to restenosis after CEE. In cases of significant restenosis (n=8), reCEE was performed with plasty of the reconstruction zone with a patch. The average restenosis period was 8.2±3.6 months. No cardiovascular complications and cases of hypoglossal nerve traumatization were identified. Intraoperatively, it was confirmed that restenosis was formed in the bifurcation zone, in front of the perimeter of the primary arteriosection. According to the results of histological examination, the main cause of all restenoses was hyperplasia of the neointima.

Conclusion. The eversion CEE with the transposition of the ICA, according to A.N. Kazantsev, creates conditions for additional maneuvers in case of restenosis and implementation of reCEE. The ICA’s placement over the hypoglossal nerve during primary CEE allows more confident isolation of carotid artery bifurcation from scar tissues with a zero risk of damage to the hypoglossal nerve. Such a course of the operation makes it possible to apply a clamp on the ICA and perform arteriotomy in any location without the threat of injury to the nerve structures.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):73-88
Radiofrequency obliteration in treatment of venous angiodysplasia
Sapelkin S.V., Druzhinina N.A., Chupin A.V., Golovyuk A.L., Abrosimov A.V.

Aim. This study aimed to investigate potential use of radiofrequency obliteration (RFO) of angiomatous tissues in patients with venous malformations.

Materials and Methods. A single-center study retrospectively involved 42 clinical cases [57.1% of men (n=24), aged 18-44 years; 42.8% of women (n=18) aged 18-56 years] of venous angiodysplasia, with a total of 46 interventions using RFO. Clinical manifestations of the disease were primarily characterized by pain syndrome (71.4%), cosmetic defect (100%), and edema syndrome (95.2%).

Results. Clinical improvement was possibly achieved with the reduction of the intensity of manifestations of angiomatous processes in 37 patients (88.1%). Stable and partial obliterations of caverns in the zone of exposure to radiofrequency were recorded in 37 (88.0%) and 5 (12.0%) patients, respectively. In caverns with small diameter, obliteration was achieved in 100% of the cases. Postoperative complications included bleeding (2.4%), burns in the zone of electrode introduction (2.4%), lymphorrhea (2.4%), and hypesthesia (2.4%). With this, according to the results of duplex scanning performed on control visits, no significant disease progression was observed. In the same patient, several complications could occur. All complications regressed within a month and required no treatment in hospital conditions.

Conclusion. RFO showed advantage as a minimally invasive treatment method of venous angiodysplasias. Results suggest that RFO can be recommended for use in patients with >1 cm depth of lesion with caverns of medium and large diameter as an independent treatment method and in combination with standard resection methods.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):89-98
Pregnancy and delivery in women with undifferentiated connective tissue dysplasia: clinical and morphological aspects
Saryeva O.P., Vahromeev A.P., Parejshvili V.V.

Aim. This study aimed to identify peculiarities of the course of pregnancy, delivery, and morphology of the placenta in women with undifferentiated connective tissue dysplasia (UCTD).

Materials and Methods. The main group included 60 pregnant women with UCTD, and the control group was composed of 30 somatically healthy women with physiological course of pregnancy. All patients were examined as regards the use of general clinical and laboratory methods. Moreover, 65 placentas were subjected to complex morphological examinations, including organometry, macro- and microscopic examinations, and immunohistochemistry.

Results. Pregnancy and delivery in women with UCTD encounter various complications, such as threat of premature birth and miscarriage, pre-eclampsia, prenatal amenorrhea, and placental insufficiency manifested as fetal growth restriction syndrome and confirmed in the course of morphological examination. The structural basis of chronic placental insufficiency is associated various pathologies of the umbilical cord and disorders in maturation of the villous chorion with the underlying weak adaptive and compensatory processes. Connective tissue dysplasia in fetal membranes is manifested as disorders in histo- and cytoarchitectonics and in increased expression of matrix metalloproteinase-9 by amniocytes and cytotrophoblast cells.

Conclusion. UCTD produces unfavorable effect on the course of pregnancy and delivery. The results of the clinical and morphological examinations demonstrate the multiorgan characteristics of injuries in the mother-placenta-fetus system, which necessitates further studies for the determination of complex prophylactic measures.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):99-108
Management of young girls with labial adhesion in the clinical and diagnostic Center of N.V. Dmitrieva Regional Children’s Clinical Hospital
Tazina T.V., Duzhnikova N.B., Aleshkina O.S.

Aim. This study aimed to compare the effectiveness of conservative treatment methods, namely, estriol-containing cream and non-hormonal drug, in girls with labial adhesion (LA) in the clinical and diagnostic center of N.V. Dmitrieva Regional Children’s Clinical Hospital.

Materials and Methods. A retrospective analysis of pediatric clinical cases of labial adhesion (n=300) was carried out in N.V. Dmitrieva Regional Children’s Clinical Hospital in the period from 2016 to 2018. The study included 150 girls diagnosed with labial adhesion who were treated with estriol-containing cream (study group) and 150 girls with the same diagnosis (control group) who were treated with a non-hormonal gel containing onion extract 10 g, heparin 5000 IU, and allantoin. The age of the participants ranged from 4 months to 2 years and 2 months. Informed consent was obtained from the girls’ parents for the examination of the child, use of estriol-containing drug or a drug of non-hormonal composition, and processing of personal data. Recovery was considered the absence of recurrent synechiae for 2 years, improvement as not more than one recurrence not earlier than 6 months after the previous treatment, and no effect as two or more recurrences earlier than 6 months.

Results. In the main group, recovery, improvement, and no effect were achieved in 108 (72%), 39 (26%), and 3 (2%) girls, respectively. In the control group, recovery, improvement, and no effect was achieved in 30 (20%), 75 (50%), and 45 (30%) girls, respectively.

Conclusion. The results revealed the effectiveness and safety of using estriol-containing drugs in young girls diagnosed with labial adhesion.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):109-116
Clinical cases
A clinical case of successful treatment of complete abruption of the trachea from the larynx
Mikheev M.V., Trushin S.N.

Tracheobronchial injuries as a consequence of chest blunt trauma are rare. Blunt traumas of the cervical part of the trachea are a rarer pathology presenting a serious diagnostic problem for a clinician. Traumas of the larynx and the trachea account for 40 to 80% of lethality. The trachea’s cervical part is vulnerable despite that it is covered with the neck muscles, spine, clavicles, and mandible. In cut/stab wounds, the trachea’s cervical part is often damaged together with the adjacent structures. In blunt trauma, under a direct action of a traumatizing agent, the mobile
trachea displaces toward the spine, accompanied by damage to the tracheal cartilages, its membranous part, and the soft surrounding tissues with preservation of the integrity of the skin.

Tracheal ruptures along the distance up to 1 cm from the cricoid cartilage account for not more than 4% of all tracheal ruptures. A complete tracheal rupture and its abruption from the larynx are extremely rare pathology. Because of severe respiratory disorders, most victims die at the site where their injury occurred.

This article presents a clinical case of the successful treatment of patient Z., 41 years of age, with complete tracheal abruption from the larynx. The cause of tracheal damage was blunt neck trauma in a traffic accident. A peculiarity of this clinical case was that the victim arrived at a specialized thoracic surgery unit with a functioning tracheostomy two days after the trauma.

Conclusion. Tracheal trauma is a potentially fatal condition. Therefore, early diagnosis of tracheobronchial damage is essential since it permits timely surgical intervention and diminished risk of lethal outcome. When dealing with patients with trauma of the head, neck, and chest with non-corresponding clinical data and the absence of effective recommended standard therapeutic measures, a clinician should become alert and exclude the tracheal and bronchial damage.

X-ray computed tomography and fibrotracheobronchoscopy are strongly recommended as reliable methods to diagnose tracheobronchial damages. In a surgical intervention, it is necessary to perform the primary suture on the trachea, avoid preventive tracheostomy, and delay interventions associated with poorer prognosis and a high complication rate.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):117-124
Death from amniotic fluid embolism in early postpartum period: a case report
Protsenko E.V., Kulida L.V.

This paper presents the case of a 40-year-old woman who died from amniotic fluid embolism on the third day after operative delivery (IV) at 38 weeks of gestation. Histological examination was conducted using staining with hematoxylin and eosin and Schiff reagent. The basis for the postmortem diagnosis was the presence of solid and liquid components of amniotic fluid in the uterine and pulmonary vessels with the absence of morphological substrate of other critical obstetric states.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):125-129
Acute myeloid leukemia in a chronic lymphocytic leukemia patient: diagnostic challenge (clinical case).
Fernandes M., Martins J., Campos M., Magalhães C., Eremina Y.O.

Chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML) coexistence in the same patient has been rarely reported, more frequently due to treatment with chemotherapeutic agents. Blood parameter changes in cancer patients may be interpreted as disease progression or iatrogenic effects related to aggressive treatment, leading to delayed diagnosis. In our article, we call attention to the possibility of AML development in CLL patients and its diagnostic challenge.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):130-133
Role of lipid metabolism and systemic inflammation in the development of atherosclerosis in animal models
Kotlyarov S.N., Kotlyarova A.A.

Systemic inflammation makes a significant contribution to the pathogenesis of atherosclerosis and has been the subject of numerous studies. Works aiming to analyze the mechanisms of atherosclerosis development often include experiments on animals. A primary task of such research is the characterization, justification, and selection of an adequate model.

Aim. To evaluate the peculiarities of lipid metabolism and systemic inflammation in chronic obstructive pulmonary disease (COPD) in the development of atherosclerosis in animal models.

Materials and Methods. Analyses of cross-links between species-specific peculiarities of lipid metabolism and the immune response, as well as a bioinformatic analysis of differences in Toll-like receptor 4 (TLR4) in mice, rats, and rabbits in comparison with its human homolog, were carried out. A search for and analysis of the amino acid sequences of human, mouse, rat, and rabbit TLR4 was performed in the International database GenBank of National Center of Biotechnical Information and in The Universal Protein Resource (UniProt) database. Multiple alignments of the TLR4 amino acid sequences were implemented in the Clustal Omega program, version 1.2.4. Reconstruction and visualization of molecular phylogenetic trees were performed using the MEGA7 program according to the Neighbor-Joining and Maximum Parsimony methods.

Results. Species-specific differences of the peculiarities of lipid metabolism and the innate immune response in humans, mice, and rabbits were shown that must be taken into account in analyses of study results.

Conclusion.Disorders in lipid metabolism and systemic inflammation mediated by the innate immune system participating in the pathogenesis of atherosclerosis in COPD possess species-specific differences that should be taken into account in analyses of study results.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):134-146
Calcific aortic valve stenosis: potentials and complications of surgical treatment
Smirnova E.A., Terekhina A.I., Filonenko S.P., Muranchik E.N.

Aim. The study aim is to discuss different approaches to the selection of a method of surgical correction of pronounced aortic stenosis (AS). Indications, contraindications, advantages and probable complications of transcatheter aortic valve implantation (TAVI) are considered. A description of a clinical case is given, and probable causes of unfavorable outcomes are discussed.

AS is the most common valvular disease, and its frequency increases significantly with age. It is one of the leading indications for heart surgery. A peculiarity of the clinical presentation of AS is a long asymptomatic period that varies from patient to patient. With the appearance of the first clinical manifestations, the prognosis of the disease sharply worsens. For a long time, surgical replacement of the aortic valve remained «the gold standard» of treatment of patients with symptomatic AS. An increase in the number of elderly patients and those in old age with many comorbid diseases who have received cardiopulmonary bypass is linked with an increased risk of postoperative complications, which are became a determining factor for the development of alternative methods of surgical correction of aortic valve pathology.

Conclusion. At present, TAVI has considerable advantages over surgical replacement; is a method of choice for elderly and inoperable patients as well as patients at high, intermediate, and low risk from surgery; and requires a multidisciplinary approach.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):147-160
Significance of physical activity on the clinical course of bronchial asthma: a literature review
Tribuntceva L.V., Budnevsky A.V., Shkatova Y.S., Ivanchuk Y.S., Tokmachev R.E.

This article contains a literature review of the results of experimental and clinical studies of the influence of physical exercise on the clinical course of bronchial asthma (BA) and presents the pathophysiological mechanisms of this influence. A high prevalence of sedentary lifestyle among patients with BA, its cause, and consequences are considered. Some studies have shown that patients with BA more rarely perform physical activity, and their physical exercises are less intensive and/or take shorter time. Effects of different variants of physical exercise on patients with BA are also discussed. Regular aerobic and mixed exercises of moderate intensity reliably lead to an improvement of the quality of life, reduction of exacerbations, use of inhalators «on demand», nocturnal symptoms, and sleep; to a reduction of the hyperresponsiveness of the bronchi, eosinophil count in the sputum, levels of interleukin-6, and monocyte chemotactic factor-1; and to an increase in the level of interleukin-10. SOCS-JAK-STAT plays a role in the mechanism underlying the influence of aerobic exercises on inflammation, remodeling, and hyperresponsiveness of the airways by decreasing the expression of Th2 cytokines, chemokines, adhesion molecules, growth factors, NF-kB, and P2X7 receptors by the epithelium of the airways and by an increase in interleukin-10 level.

Conclusion. Data available in the literature are obtained on small cohorts of foreign patients. Clinical data devoted to the influence of aerobic exercises on control of BA and parameters of the respiratory functions are contradictory. Further investigations are required in this field.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):161-170
Letter in edition
Substance-induced or substance-associated primary psychoses? Continuing the discussion. A response to I.А. Fedotov, et al
Cherro M., Jatchavala C., Handuleh D., Ransing R., Shoib S., Őri D., Ojeahere M.I., Soler-Vidal J., Pereira-Sanchez V.

This letter to the editor continues the discussion about the similarities and differences between secondary psychosis and schizophrenia, which was initiated by the authors of the article «Substance-induced psychosis and schizophrenia: the interaction point» (Fedotov I.A., Quattrone D., Shustov D.I. Substance-induced psychosis and schizophrenia: the interaction point. I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):593-604. doi:10.238 88/PAVLOVJ2020284593-604).

I.P. Pavlov Russian Medical Biological Herald. 2021;29(1):171-176

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