Vol 27, No 4 (2019)

Original researches
Adaptation reactions of hemodynamic systems on artificially modulated stress in healthy individuals
Smolyakov Y.N., Kuznik B.I., Kalashnikova S.A., Nolfin N.A., Fedorenko E.V., Mikhahanov M.M.

Aim. To study the influence of artificially created stress on hemodynamic parameters  of peripheral microcirculation and variability of the heart rhythm in somatically healthy young individuals.

Materials and Methods. In the study 30 individuals were involved (of them 16 men)  with the mean age 18.2±1.1 years. An artificial stress was created using Stroop method. Assessment of characteristics of hemodynamics of microcirculation (HM) was performed by the method of dynamic scattering of light from erythrocytes. The signal was integrated in the form of three hemodynamic indexes: HI (Hemodynamic Indexes). Low frequency index (HI1) was determined by a slow interlayer interaction, high frequency area (HI3) characterized fast shearing of layers. HI2 took intermediate position (precapillary and capillary blood flow). Variability of cardiointervals isolated from pulse component, was assessed by method of variation pulsometry (Heart Rate Variability, HRV).

Results. In the course of study, increase in the heart rate (HR) in the stage of testing was  observed that confirms a high extent of stress load. In hemodynamics, redistribution of blood  flow was noted toward slow shear velocities (near-wall blood flow). After cessation of stress load,  hemodynamic parameters declined and returned to previous values. Parameters characterizing variability of rhythm – LF (sympathetic component), HF (vagal activity), CVI (non-linear  parasympathetic index) showed a tendency to growth; here, LF/HF ratio did not change.

Conclusion. In result of the carried out study it was possible to formulate a multifactor  picture of variation of parameters of microcirculation and of autonomic regulation of cardiac rhythm specific of reactions of adaptation to induced stress. The quantitative criteria of the  obtained shears may be integrated into stress indexes to be used in clinical practice. A portable mDLS sensor may be supplemented with specific assessment criteria and used for monitoring  of adaptive reactions induced by stressful situations, and for taking early diagnostic and prognostic decisions in the clinical practice, and for self-control of a patient.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):443-450
Test with external peripheral vascular occlusion in evaluation of ergoreflex in patients with chronic obstructive pulmonary disease
Kosyakov A.V., Abrosimov V.N.

Aim. To evaluate changes in the cardiointervalogram (CIG) in the test with external peripheral vascular occlusion in patients with chronic obstructive pulmonary disease (COPD) and in individuals without diseases of the respiratory system.

Materials and Methods. The study included 105 men, of them 64 patients with COPD (age 64.98±8.67) and 41 volunteers without diseases of the respiratory system (age 61.68±9.21). The autonomic status was examined and alterations in CIG in the test with occlusion were evaluated on Varicard hardware and software complex (OOO Ramena, Russia).

Results. The obtained data showed the autonomic imbalance with predomination of the activity of sympathetic division of the autonomic nervous system (ANS) in patients with COPD as compared to the control group (p<0.05). A study of ergoreflex by analysis of changes in CIG showed reduction of the activity of sympathetic division of the ANS in the test with external peripheral vascular occlusion in individuals without diseases of  the respiratory system. In patients with COPD, changes in CIG in the test were less expressed and not always achieved statistically significant level (p>0.05).

Conclusions. Differences in the results of the test with external peripheral vascular occlusion in patients with COPD and volunteers without diseases of the respiratory system are attributed to hyperactivation of ergofeflex in patents with COPD.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):451-457
Possibilities of use of metformin for correction of endothelial dysfunction and adaptation reserves of an organism in patients with metabolic syndrome
Nizov A.A., Suchkova E.I., Grivenko A.I., Nikiforova L.V.

Aim. To study possibilities of pharmaceutical correction of clinical laboratory parameters, of endothelial dysfunction and non-specific adaptation reserves in patients with metabolic syndrome (MS) through use of metformin.

Materials and Methods. The three-month program involved 53 patients with MS rando-mized to two comparable groups. Patients of the control group were kept on individual low-calorie diet and practiced graduated exercises. Patients of the studied group, besides the mentioned program of modification of the lifestyle, took metformin. In all participants, anthropometric and clinical laboratory parameters were twice evaluated, total body composition, condition of vascular endothelium and non-specific adaptation reserves of an organism were analyzed. The extent of endothelial dysfunction was evaluated by the level of endothelin-1 and by parameters of photoplethysmographic examination, non-specific adaptation reserves – by the method of analysis of the cardiac rhythm variability.

Results. Metformin in complex with dietary therapy and physical exercises proved to be a safe medical drug for correction of components of MS and of endothelial dysfunction. Use of metformin in patients with MS in combination with dietary therapy and graduated physical exercises as compared to use of the program of modification of the lifestyle alone, leads to reduction in the body mass, waist circumference (in women) and of the total fat mass. Introduction of metformin into the program of complex therapy of patients with MS, provides more evident correction of the parameters of carbohydrate metabolism, reduction of endothelin-1 and stiffness index of the aortic wall, enhancement of parasympathetic regulation, than modification of the lifestyle alone.

Conclusion. Use of metformin in the complex therapy of metabolic syndrome in comparison with the program of modification of the lifestyle, promotes a more significant reduction of the clinical laboratory parameters, of endothelial dysfunction and improves non-specific adaptation reserves of an organism.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):458-467
Analysis of behavioral risks in adolescents with health limitations and with different anxiety levels
Voitovich A.A.

Aim. To assess peculiarities of lifestyle of adolescents with health limitations having diffe-rent levels of anxiety.

Materials and Methods. In the research 89 adolescents with health limitations were  involved studying at an educational institution of secondary professional education. The leading causes of disability (the main disease) were mental and behavioral disorders. Anxiety levels  of the adolescents (State Trait Anxiety Inventory), the extent of nicotine addiction (Fagerstrom test) were studied, social factors, duration of night sleep were assessed, organization of leisure was analyzed.

Results. Low state anxiety (SA, <30 points) was found in 76.2% of the examined adolescents, moderate SA (33-34 points) – in 23.8%, 51.4% had a high level of trait anxiety (TA).  A moderate negative correlation relationship was established between SA and TA of students  (r=–0.72, p=0.02). Assessment of the lifestyle of adolescents found the existence of the family disadvantages (each sixth student grew in a social institution); reduction in the night sleep duration (<7 hours) in 30.8% of students; low physical activity (only 18.9% of students attended additional physical culture and sports classes). Nicotine addiction was found in more than 90% of  students, 61.2% of students used strong drinks at least once in life. A correlation was established between living in a hostel (r=–0.56, p=0.031), duration of night sleep (r=–0.61, p=0.028), organization of passive rest (r=–0.52, p=0.04) and the level of SA.

Conclusion. The conducted research identified the following risk factors for justification of programs for prevention of development of desadaptation: factor of family disadvantages, bad habits, reduced duration of night sleep, low physical activity.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):468-474
Systemic approach to сhild psychiatry: insights in etiopathogenesis and organization of assistance
Bebchuk M.A.

Aim. Integration of information on systemic approach published in literature, and of the own practical experience in rendering psychotherapeutic assistance to children with different forms of phobic anxiety disorders (PAD) aimed at improvement of effectiveness of treatment, of social adaptation of patients with PAD, and at search for organization forms of medical assistance to the given category of children’s population.

Materials and Methods. Into the study 61 children of 8-17 years old were involved living at home and admitted to G.E. Sukharevskaya Research and Practical Center of Mental Well-Being of Children and Adolescents in 2018 for different mental disorders including PAD. In the study, analysis of medical histories and protocols of classes with a family psychologist were used.

Results. On the basis of the parameters of family functioning three groups of phobic anxiety syndromes were isolated: disorders of the structural aspect (limits, hierarchy, coalitions, triangles), disorders of communication sphere, or of family history. The working systemic hypotheses were illustrated with ten classic examples.

Conclusion. Systemic hypotheses of formation of PAD in children permit to construct treatment and rehabilitation strategies directed at improvement of patient’s state through creation of conditions for a prolonged stable remission in the family. Inclusion of classes with a family psychologist/psychotherapist into the plan of treatment and rehabilitation permits to shift the  accent of help to a child to the outpatient environment.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):475-486
Advantages of modern methods of prevention of thrombotic complications in patients with critical ischemia of lower limbs after reconstructive operations
Katelnitskiy I.I., Katelnitskiy I.I., Livadnyaya E.S.

Aim. To evaluate and improve the results of reconstructive operations in patients with obliterating atherosclerosis with critical ischemia of the lower limbs through reduction of the rate of thrombotic complications by improvement of diagnosis of risk factors for thrombosis on the basis of coagulogram and Thrombodynamics T-2 test data.

Materials and Methods. In the I group of patients (n=48) reconstructive operations were  performed on the arteries of lower limbs and anticoagulant therapy with unfractionated heparin (UFH) with control of hemostasiogram before the operation, in 6 hours and 6 days after the operation and with additional control of APTT 30 minutes before introduction of UNH. In the II group (n=34) reconstructive operations were performed with selection of anticoagulant therapy using parameters of hemostasiogram and laboratory-diagnostic system Thrombodynamics Recorder T-2 with control before the operation, in 6 hours, 6 days after the operation and with additional control of APTT in 30 minutes before introduction of UFH.

Results. Analysis of the data of coagulogram and Thrombodynamics T-2 test showed  statistical significance of APTT, fibrinogen, delay and initial speed of clot growth, a combination of which permits a possibility for correction of heparin therapy for prevention of thrombosis.

Conclusions. The dynamics of the parameters of Thrombodynamics T-2 test in selection of UFH dose proves high effectiveness of this method for selection of adequate doses of anticoagulant drugs for prevention of postoperative thromboses in patients with critical ischemia of the lower limbs.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):487-494
Long-term results of coronary artery bypass graft surgery after stenting of obstructed artery with bare metal stent in patients with acute coronary syndrome and multivessel disease
Bocharov A.V.

Non-optimal long-term results of endovascular interventions using bare metal stents and their wide use in Russia in acute coronary syndrome (ACS) make it important to study the influence of the mentioned interventions on the results of coronary artery bypass graft surgery (CABG) performed after stenting of the obstructed artery in patients with ACS and multivessel disease.

Aim. To study the results of CABG performed at our department in early periods of ACS after stenting of an obstructed artery with bare metal stents versus  the results of use of drug coated stents of the 2nd generation, on the basis of the data of NORSTENT study.

Materials and Methods. The work presents the results of a two-year observation of stepwise treatment of 97 patients with ACS and multivessel disease who were performed stenting of an obstructed artery for life-saving indications followed by CABG not later than in 90 days. Patients of the main group had three-vessel disease of coronary arteries with severity of damage 26.0±3.2 points on SYNTAX scale. The time from the moment of stenting to complete revascularization was 64±17 days. Clinico-demographic parameters of the main group were comparable with those of the comparison group (data of NORSTENT study).

Results. During observation time two cases of acute myocardial infarction occurred. Repeat revascularization was required in 14 patients (14.4%). The rate of MACCE was 0.1443. Odd ratio (OR) of the risk of MACCE occurrence was 1.61 (95% CI [1.14;2.78]).

Conclusion. Surgical revascularization of the coronary bed in early periods after stenting of the obstructed artery with bare metal stents in patients with ACS and multivessel disease has 1.6 times (95% CI 1.14;2.78) higher risk for initiation of adverse cardiovascular events, in comparison with endovascular revascularization with use of drug coated stents of the 2nd generation.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):495-502
More on choice of places for insertion of tested samples of polymer implants in study of reaction of tissues of macroorganism
Lipatov V.A., Severinov D.A., Naimzada M.

Aim. Assessment of different methods of implantation and autopsy of portions of tissue at the sites of insertion of polymer implants.

Materials and Methods. Samples of new vessel prostheses (OOO Lintex, Saint Petersburg) were implanted into the subcutaneous layer of the abdominal wall and paravertebral area of 30 rats. Morphological changes at the sites of insertion of implants, and also variation of the values of criteria developed by the authors were evaluated. The results obtained in studies, were evaluated by experts on the basis of the evidence of artefacts in microphotographs, of expected probability for damage to the implant bed in the experiment and in autopsy, of expected technical complexity of getting a sample of the implant and of the periprosthetic capsule in autopsy.

Results. The total score of evaluated tissue reactions reached the highest meanings (59) in the group of laboratory animals where the tested samples were implanted into the subcutaneous tissue of the back, which determines this method as least preferable. Variability and error of the method of subcutaneous implantation was higher in the group with implantation of samples into the paravertebral area, since the values of standard deviation (m) in histological examination of this group (from 0.89 to 3.64) exceeded deviations in animals with implantation of the tested prosthetic implants into the abdominal wall (from 0.25 to 2.54).

Conclusion. Implantation in the area of the abdominal wall is characterized by lower variability of standard deviation (m) of the morphometric parameters, by lower number of artefacts and by almost complete absence of technical complications in autopsy of the studied material, which, in the opinion of the authors, gives preference to this method in experimental research.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):503-511
Clinical cases
Cardioesophageal carcinoid: multidisciplinary approach to diagnosis
Kazakova S.S., Aftaeva E.V., Kurkova E.A.

Cardioesophageal carcinoid is a rare neuroendocrine neoplasm. Diagnosis and treatment are especially difficult in case of proximal localization of the gastric lesion (in the region of cardia) which requires a complex multidisciplinary approach. The clinical presentation of gastric  carcinoid is in most cases nonspecific, and the tumor is accidentally detected in endoscopic exa-mination for the pain syndrome, dyspepsia, anemia, etc. Thus, all said above makes tumors of cardioesophageal zone a rather actual problem. In this article, on an example of patient K., of 61 years of age, possibilities of a complex approach to diagnosis and treatment of a complicated case of cardioesophageal carcinoid are shown.

Conclusion. Diagnosis of carcinoid tumors is difficult and requires a multidisciplinary  approach. The algorithm of diagnostic search and treatment tactics should suggest an individual approach in each clinical case which permits to make a correct diagnosis and to successfully reali-ze a required complex of medical measures.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):512-519
Statutory regulation of subsidized pharmaceutical provision in Russian Federation
Nagibin O.A., Manukhina E.V., Komarov I.A.

At present in the Russian Federation (the RF), an organized system of pharmaceutical provision of benefit-entitled citizens is used. With this, statutory regulation is under continuous improvement through adoption of new regulatory acts and amendments to already existing ones [1]. The basis of this process is equal opportunities and rights of all individuals for free provision with medical drugs. Nevertheless, there exist benefit-entitled categories of citizens for whom additional approaches to organization of pharmaceutical provision were adopted.

Aim. Analysis of statutory regulation applicable to the existing benefit-entitled citizens.

Conclusion. The established normative framework regulating pharmaceutical provision of benefit-entitled citizens both on the federal and regional levels, permits patients to receive the necessary life-saving medicinal therapy. With this, an obligatory condition for receiving such  assistance is presence of a certain diagnosis or a certain social status. Far not all patients are included into the list of benefit-entitled citizens. Hence, the existing statutory regulation of healthcare requires further improvement.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):520-529
Hygienic aspects of influence of environmental factors on formation of schoolchildren’s health
Devrishov R.D., Kolomin V.V., Filyaev V.N., Kudryasheva I.A.

In the article materials showing the growing influence of both school and extra-school factors on health of children and adolescents are presented. Special attention is given to the main classes of school-related diseases.

Aim. To justify reasonability of studying this problem in Astrakhan within the frames of complex approach to application of health-saving technologies.

Conclusion. Problems described in the article are characteristic of practically any region of Russia, in this connection a significant number of studies are carried out in Astrakhan region devoted to issues of protection of children’s health and to investigation of exposure of children to environmental factors. With this, absence of works on evaluation of complex use of health-saving technologies in terms of their influence on health of schoolchildren, permits to consider such hygienic studies actual.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):530-535
Modern level of rendering palliative and in patient kinds of geriatric assistance by nursing staff
Chaikina N.N.

In the world, a share of elderly and old individuals in the total population is constantly growing. This change in the demographic situation in the modern society certainly arouses a justified interest for the medico-social problems of this category of the population. A special role in this problem is assigned to the medium-grade medical personnel, since a statistically average patient ˃60 years of age suffers from a number of different chronic diseases, including cognitive disorders, senile dementia, syndrome of nutrition deficit, serious disorders in the musculo-skeletal system, etc. Salvation of these and other essential problems requires elaboration of complex targeted programs and special training of the nursing staff for work in hospitals, hospices, palliative beds, etc. In the ‘ageing’ society it is necessary to find appropriate rational forms of organization of medical assistance for aged group of patients and modern ways of interdepartmental interactions that would correspond to the principles of restructure of the healthcare systems. At present in Russia there exist several specialized geriatric and gerontological centers that render different kinds of medical care to the older generation. Integrated character, availability and effectiveness of medico-social assistance for individuals of older age groups is the aim of well-developed geriatric service. Development of such kind of support is also beneficial from the economical point of view in the sense that it permits to reduce duration of repeat stay in hospital, the number of ambulance calls, etc. The mentioned measures will help optimize treatment and diagnosis of age-related diseases and will permit to actualize the term ‘healthy ageing’. In the article, the problems of rendering medical assistance for the older age groups of population are considered with accentuation on the increased role of nursing personnel in realization of medical and social help to the elderly population within the three-level system on an example of the Voronezh region.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):536-545
Ryazan physiologist of the Russian scale
Lapkin M.M., Byalovsky Y.Y., Kozeevskaya N.A.

(to the 90th anniversary of A.F. Belov)

I.P. Pavlov Russian Medical Biological Herald. 2019;27(4):546-549

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