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Vol 28, No 4 (2020)

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Original researches

Parameters of macrophage reaction and humoral immunity in patients with implant-associated in-flammation after primary endoprosthetics of knee joint

Galashina E.A., Gladkova E.V., Blinnikova V.V., Shpinyak S.P., Ulyanov V.Y.

Abstract

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

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

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):421-428
pages 421-428 views

Modeling of fibrocystic mastopathy in experiment on animals

Anisimova S.A., Svirina Z.A., Maksaev D.A.

Abstract

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

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

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

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):429-436
pages 429-436 views

Interrelation between the system markers of hemostasis and hemocoagulation disorders in patients with tuberculosis in respira-tory organs and comorbid diabetes mellitus after surgical interven-tion on respiratory organs

Chitorelidze G.V., Serebryanaya B.A., Lepekha L.N., Papkov A.V., Bagirov M.A.

Abstract

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

Aim. This study was conducted to identify the interrelation between the system markers of hemostasis and the signs of intravascular blood coagulation development in patients with pulmonary tuberculosis and comorbid diabetes mellitus (TB-DM) in terms of the volume of surgical intervention on respiratory organs.

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

Results. The parameters of the hypercoagulation syndrome increased in all the study groups from days 3 to 5 and reached the maximum on days 7 to 10 and 14 to 17 of the postoperative period. The compensatory activation of the fibrin-stabilizing factor and the fibrinolytic system was also observed. The most prominent changes in the hemostasis markers were found in the group of patients after lobectomy. Microthrombotic lesions of the vessels of pulmonary microcirculation with a partial or complete obturation of the lumen were morphologically visualized.

Conclusion. Hypercoagulation syndrome with intravascular blood coagulation was observed in this category of patients. This finding indicated that thromboembolic complications require timely prevention and treatment. This study may be used as a basis for developing measures that can prevent hemocoagulation complications in patients with TB-DM after surgical treatments.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):437-448
pages 437-448 views

Morphological and immunohistochemical parameters of chron-ic placental insufficiency in preeclampsia

Kulida L.V., Rokotyanskaya E.A., Panova I.A., Malyishkina A.I., Protsenko E.V., Maisina A.I.

Abstract

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

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

Results. The results of the pathomorphological examination of the placentas of women with hypertensive disorders showed two forms of chronic placental insufficiency. The defining form of placental insufficiency in women with CAH and associated preeclampsia was fetoplacental insufficiency while that in preeclampsia of moderate and high severity was the uteroplacental form of chronic placental insufficiency. On the basis of the study of the dynamics of the expression of annexin V and erythropoietin, the morphological parameters of placental compensatory potential and placental hemostasis disorders in hypertensive disorders in pregnant women were determined.

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):449-461
pages 449-461 views

Status and dynamics of parameters of use of bed capacity of oncological profile in Russian Federation

Evdakov V.A., Banteva M.N., Manoshkina E.M., Melnikov Y.Y., Rugol L.V.

Abstract

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

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

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

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):462-478
pages 462-478 views

Variations in all-cause mortality in patients with myocardial infarction with elevation of the st segment according to the type of reperfusion therapy received (data of Ryazan region, 2018-2020)

Parshikova E.N., Filippov E.V.

Abstract

Aim. To assess variations in all-cause mortality in patients with past myocardial infarction with elevation of the ST segment (STEMI) according to the type of reperfusion therapy received.

Materials and Methods. Among 1456 patients hospitalized with acute coronary syndrome with elevation of the ST segment, 848 cases were randomly selected for analysis. Acquisition of information of the endpoint (i.e., death from any cause) was conducted over 18 months. The published data were received on January 10, 2020, and the median observation time was 20.8 months (17.4; 23.6).

Results. The highest all-cause mortality observed after 18 months (42.3%) was found in the group of patients who did not receive reperfusion therapy. The 30-day mortality rates in the group receiving thrombolytic therapy (TLT) and the group without reperfusion therapy did not show significant differences (20.3% vs. 26.2%, р>0.05). The hospital, 30-day, 12-month, and 18-month all-cause mortality rates in the group receiving percutaneous coronary intervention (PCI) were 8.4%, 10.6%, 16.6%, and 18.3%, respectively; these values are significantly lower compared with the corresponding rates in the group that did not receive reperfusion (19.5%, 26.2%, 36.2%, and 42.3%, respectively; р<0.05). The most remarkable differences in the frequency of the endpoint were recorded at the end of the 18-month period. Specifically, mortality in the group without reperfusion mortality (42.3%) was significantly higher (р<0.05) compared with those in the groups who received TLT (27.1%), PCI (18.3%), and TLT + PCI (13.1%).

Conclusion. The lowest all-cause mortality recorded over 18 months of observation was noted in the group treated by the pharmaco-invasive approach (TLT + PCI). The highest mortality over the same period was observed in the group of patients who did not receive reperfusion therapy.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):479-487
pages 479-487 views

Evaluation of the endothelial function, and elasticity of vessel walls and their influence on the 1-year prognosis of patients with myocardial infarction with obstructive and non-obstructive coronary arteries

Fomina O.A., Yakushin S.S.

Abstract

Aim. This study was conducted to analyze the state of the endothelial function (EF) and elasticity of vessel walls and their influence on the 1-year prognosis of patients with myocardial infarction (MI) with obstructive and non-obstructive coronary arteries (CA) comparatively.

Materials and Methods. At the first stage, 206 patients diagnosed with MI were selected. Among them, 103 patients had MI with non-obstructive CA (MINOCA) as indicated by coronaroangiography, and 103 patients had MI with obstructive CA (MIOCA). Through the random number method, 59 patients were selected (34 patients in the first group and 25 patients in the second group), and the EF and elastic properties of their arterial walls were evaluated. The patients in both groups were initially comparable in terms of age, gender, clinical, and medical history and the frequency of application of the main groups of medical drugs that influenced prognosis. The 1-year prognosis of the two groups of patients was studied on the basis of the presence/absence of the functional and morphological alterations of the vessel wall.

Results. The evaluation of the EF of patients with MINOCA showed that the occlusion index by amplitude (OIA) was below the threshold values in 22 of 34 (64.7%) cases of MINOCA and 22 of 25 (88.0%, р<0.05) cases of MIOCA. Their average values of OIA were 1.7 (1.5; 2.3) and 1.4 (1.2; 1.8), respectively (р<0.05). The values of the phase shifts between the channels below the norm were equally frequent in the two groups (88.2 and 88.0%, р>0.05). The comparison of the average values of this parameter did not show any statistically significant difference. The calculated augmentation indices normalized to the pulse rate of 75 beats per min (AIp75) in the study groups were 12.5 (9.9; 17.9) and 18.8 (12.9; 20.8), respectively (р>0.05). The elasticity of the vessel wall decreased in 82.4% of patients with MINOCA and 100% of patients with MIOCA (р<0.05). The frequency of cardiovascular events did not significantly differ between the groups for 1 year (р>0.05).

Conclusion. Functional changes in the vessel walls (endothelial dysfunction and reduction of vessel wall elasticity) of patients with MINOCA were recorded in almost 2/3 of the cases; however, the incidence in patients with MIOCA was still higher (88.0%) than that in patients with MINOCA. The 1-year prognosis in the study groups had no differences.

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):488-496
pages 488-496 views

Training of students of higher medical educational institutions in endovideosurgery skills

Lipatov V.A., Severinov D.A., Naimzada M.Z., Dragovoz I.S.

Abstract

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

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

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):497-505
pages 497-505 views

Clinical cases

A case of successful surgical treatment of patient with rare vascular anomaly – hypoplasia of infrarenal abdominal aorta

Kharazov A.F., Kulbak V.A., Basirova N.M.

Abstract

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

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):506-513
pages 506-513 views

A patient with heartburn practicing self-treatment, on an outpatient visit

Krylova I.A., Matʼkova I.N.

Abstract

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

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):514-524
pages 514-524 views

Improvement of results of surgical treatment of giant hernias of inguinofemoral region by choice of method of hernioplasty (clinical case)

Leonchenko S.V., Stavtsev M.L.

Abstract

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):525-529
pages 525-529 views

A case of successful surgical treatment of patient with adrenal cyst using 3-d modeling

Andreev I.S., Kolsanov A.V., Katorkin S.E., Shestakov E.V., Lichman L.A.

Abstract

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

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):530-535
pages 530-535 views

Reviews

Molecular-genetic bases of development of acute pancreatitis

Imaeva A.K., Nurgaleeva A.K., Gallyamova L.F., Mustafin T.I., Safinova L.S., Khusnutdinovna E.K.

Abstract

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

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):536-547
pages 536-547 views

Extended therapy and secondary prevention of venous thromboembolic complications

Petrikov A.S., Prostov I.I.

Abstract

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

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

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):548-566
pages 548-566 views

Protective mechanisms of lungs

Shustova S.A., Miroshkina T.A.

Abstract

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

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

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):567-577
pages 567-577 views

Therapygenetics: how is effectiveness of psychotherapy related to genotype?

Faustova A.G., Wang M.

Abstract

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

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):578-592
pages 578-592 views

Substance-induced psychosis and schizophrenia: the interaction point

Fedotov I.А., Quattrone D., Shustov D.I.

Abstract

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

I.P. Pavlov Russian Medical Biological Herald. 2020;28(4):593-604
pages 593-604 views

Reticulocyte haemoglobin content: 2020 update

Eremina Y.O., Magalhães C.

Abstract

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

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

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