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Vol 29, No 2 (2021)

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Original researches

Effects of metabotropic glutamate receptor antagonists on a rat model of maximum electroshock

Bashkatova V.G., Sudakov S.K.


AIM: This study aimed to investigate the effect of metabotropic glutamate (mGlu) receptor antagonists on the development of seizure caused by maximum electric shock (MES) and the content of lipid peroxidation (LPO) products in the brain of rats.

MATERIALS AND METHODS: Experiments were carried out on male Wistar rats (n = 87) with a mass of 180–210 g. In this work, MES was administered. Selective antagonists of I and V subtype mGlu receptors were administered 1 h before MES was administered. Control rats were injected an equivalent amount of saline. The intensity of LPO processes was assessed in terms of the level of secondary products reacting with thiobarbituric acid via a spectrophotometric method.

RESULTS: MES led to the development of pronounced clonic–tonic seizures and increased the level of LPO products in the cerebral cortex of rats by more than threefold. A selective antagonist of subtype V mGlu receptors almost completely stopped the tonic phase of rat seizures and largely prevented the intensification of LPO processes caused by MES. Tonic convulsions were observed in 44% of the experimental animals after the administration of a selective subtype I mGlu receptor antagonist. This antagonist also partially reduced the content of LPO products caused by the effect of MES.

CONCLUSION: Thus, mGlu receptors are involved in the development of MES-induced seizures in rats. The most pronounced weakening of convulsive manifestations and the prevention of an increase in the level of LPO products caused by MES were observed in the block of subtype V mGlu receptors. The obtained data confirmed the possibility of using subtype V metabotropic receptor antagonists as anticonvulsants for the treatment of epilepsy with generalized convulsive seizures.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):193-200
pages 193-200 views

Experimental study on disorders in the activity of macrophages in the acute period of different severities of cerebral stroke

Kulchikov A.E., Morozov S.G., Musin R.S., Grinenko E.A.


BACKGROUND: The development of immunosuppression in the acute phase of cerebral stroke may lead to infectious and inflammatory complications. However, data on the functional activity of macrophages are insufficient to understand the pathogenesis of stroke.

AIM: This study aimed to investigate the functional activity of macrophages in the acute period of experimental cerebral stroke (ECS) of different severities.

MATERIALS AND METHODS: In an experimental study on 45 Wistar rats, the functional and spontaneous metabolic activity of macrophages in the spleen and abdominal cavity and the induced metabolic activity of peritoneal macrophages were evaluated through the reduction of nitro blue tetrazolium via spectrophotometry. The spontaneous and induced adhesive activity and the inhibition of the modified adhesive activity of peritoneal macrophages were examined via crystal violet staining by using a colorimetric method. ECS was modeled by the rotational movements of mandrel-knife inserted into the region of capsula interna (c.i.) on the left by guiding a needle–cannula with the subsequent damage of vessels and the formation of mild (local incision of vessels in the region of c.i.), moderate (additional introduction of autologous blood in the area of c.i.), and severe (cutting of vessels from c.i. to pia mater with the subsequent introduction of autologous blood into the damaged area) hemorrhage. Data were evaluated in 72 h after different severities of ECS were modeled.

RESULTS: In 72 h after ECS with different severities was modeled, the functional and spontaneous metabolic activity of splenic macrophages significantly decreased compared with those in the control group. The functional, spontaneous, and induced metabolic activity of peritoneal macrophages significantly reduced compared with those in the control group. The adhesive activity of peritoneal macrophages significantly increased compared with that of the control group. These disorders exacerbated in animal models with a more severe degree of stroke.

CONCLUSION: In the acute period of ECS, the functional activity of macrophages decreased, whereas their adhesive activity increased. These phenomena enhanced in more severe models of stroke.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):201-212
pages 201-212 views

Experimental study on the proliferating activity and differentiation of renal stem cells in superinvasive opisthorchiasis

Uruzbaev R.M., Bychkov V.G., Vikhareva L.V., Molokova O.A.


AIM: This study aimed to identify the replication potential of the kidneys in different forms of opisthorchiasis in laboratory animals.

MATERIALS AND METHODS: An experiment was conducted on 60 Syrian male hamsters. The first group was set as the control (n = 10), the second group (n = 25) was infected with metacercariae (Opisthorchis felineus), and the third group (n = 25) was a model of a superinvasive form of opisthorchiasis infection with 50 O. felineus larvae and repeated infection with 50 metacercariae in 14 and 25 days. The hamsters were withdrawn from the experiment on days 7, 15, and 30 via an overdose of narcosis and decapitation. The kidneys were isolated and histologically examined through histochemical and immunohistochemical staining methods. Microscopy was conducted, and results were statistically analyzed.

RESULTS: The quantitative characteristics, proliferation tendencies, and differentiation of regional stem cells were identified. In the cortical and medullary substance of the kidneys, CD117, Oct4, and CD34 markers were expressed, and CD31-positive stem cells further differentiated to progenitor cells. Epithelial structures developed in the form of tubules. In the glomeruli, vasculogenesis occurred, and the number of vascular loops increased.

CONCLUSION: O. felineus secretome initiated the activation of stem cells in the renal tubules and pericytes of a microcirculatory network. The transitional epithelium of the renal pelvis and the initial parts of the ureter proliferated. Under the action of the secretome of parasites, stem cells proliferated directly in glomerular loops.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):213-218
pages 213-218 views

Pathophysiological mechanisms of resistive breathing

Byalovsky Y.Y., Rakitina I.S.


AIM: This study aimed to explore the pathophysiological mechanisms of resistive breathing by using a model of a conditioned respiratory reflex to external resistance to breathing.

MATERIALS AND METHODS: Inspiratory resistive loads were used 11, 28, 54, and 78 cmAq/l/s to model a conditioned respiratory reflex. External respiration was parametrized on the basis of the analysis of motor and ventilatory outputs. Conditioned signals were pure sounds exceeding the threshold of perception by 10 db at 2000 Hz frequency. All the test persons were divided into two groups (large and small groups) according to the initial reinforcement value. (1) In the large group (37 individuals), the conditioned reflex was formed from 11 cmAq/l/s that was subsequently increased stepwise in the load to 76 cmAq/l/s. (2) In the small group (18 individuals), the initial reinforcements were different gradations of resistive loads, with a stepwise transition to the other parameters of an unconditioned stimulus. The period of the isolated application of a conditioned signal (CS) was 20 s, the interval between signals was not fixed, varying from 2 min to 4 min. Six to eight combinations of the conditioned and unconditioned stimuli were used for 1 day of the experiment.

RESULTS: The increase in the added respiratory resistance was associated with the pronounced reduction of pulmonary and alveolar ventilation, that is, with the hypoventilation type of resistive load realization. Changes in ventilation during the isolated application of a conditioned signal had an alternative character. In particular, as the reinforcement factor increased, a pronounced shift to hyperventilation was noted.

CONCLUSION: The reinforcement value of the conditioned reflex changed stepwise, thereby significantly restructuring the proportion between the effectiveness of the adaptive activity in the realization of external resistance to inspiration (the time of stay under a certain load) and its physiological cost (totalities of the deviations of physiological and energy parameters).

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):219-226
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Assessment of the radiation safety of drinking water and surface water bodies used for recreational purposes in the Voronezh region

Mekhantyev I.I., Stepkin Y.I.


AIM: This study aimed to assess the radiation safety of surface water bodies used for recreational purposes and drinking water used by the population of the Voronezh Region (VR).

MATERIALS AND METHODS: The fond materials of the Rospotrebnadzor Administration in VR in 2015–2019 were used. The following parameters were analyzed: total α and β activities and specific activity of radioactive substances in the water of open reservoirs (137Сs, 210Po, 226Ra, and 228Ra) and in the sources of drinking water (210Po and 222Rn). The annual effective dose was calculated on the basis of the probable consumption of drinking water from the centralized drinking water supply systems. The content of radionuclides in the water of open reservoirs was analyzed in three control points and in drinking water found in 2,036 water intake artesian wells of the centralized drinking water supply systems. Then, 100% of the sources were surveyed in terms of total α and β activities. The radiation safety of bottled drinking water from nine manufacturers was assessed on the basis of the data of the Federal State Sanitary and Epidemiological Surveillance. Water in open reservoirs and drinking water, including water packaged in containers, were laboratory controlled on the basis of an accredited testing laboratory center (Center for Hygiene and Epidemiology in the VR) by using MKS-01A Multirad spectrometric installation (Akvilon, Russia). UMF-2000 α- and β-radiometers were utilized to measure small activities (NPP, Doza, Russia).

RESULTS: According to the regional databases of Rospotrebnadzor Administration regarding water from open water bodies for the population (three monitoring points: Tikhaya Sosna, Sukhaya Khvorostan, and Usman rivers) in 2015–2019, values did not exceed the intervention limit that was registered in terms of the content of the controlled radioactive substances (210Ро, 234U, 222Rn, and 137Сs) and the total α and β activities. Water from artesian wells used for drinking and domestic purposes fully met the requirements of radiation safety. The average annual effective radiation doses (AAERD) of the population in the VO in 74 settlements within the zones of radioactive contamination due to the Chernobyl disaster ranged from 0.05 mSv/year to 0.12 mSv/year, which was significantly lower than the threshold value (1 mSv/year). The analyzed drinking water samples, water packaged in containers, and the samples produced in the region were in compliance with sanitary and epidemiological requirements, including those for 90Sr and 137Cs radionuclide contents.

CONCLUSION: Radiation monitoring in the VR revealed that the content of technogenic radionuclides (137Cs and 90Sr) and other standardized parameters of radiation safety in water of open reservoirs and drinking water did not exceed the threshold values.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):227-232
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Completed cases of provision of medical care and lethal outcomes in insured individuals with respiratory diseases in the Ryazan region

Manukhina E.V., Yurina S.V., Gladkih S.I.


AIM: This study aimed to investigate the dynamics of the volume of medical care (MC) provided to the population within the territorial program of compulsory medical insurance (CMI). This study also aimed to examine the lethal outcomes of insured individuals with respiratory diseases (RD) for 5 months in 2020 and 5 months in 2019 in the Ryazan Region during the COVID-19 pandemic.

MATERIALS AND METHODS: Analysis was carried out on the basis of the paid registers of the accounts submitted by medical organizations to medical insurance organizations. These accounts were grouped in accordance with the order of the Federal CMI Fund No 104 «On Establishment of the Form and Procedure for Reporting on Cases of Providing MC and the Results of Expertise of the Quality of MC» dated June 04, 2018. In this study, all the completed cases of the treatment of the insured individuals with RD (ICD-10 codes: J00-J99) in the medical organizations of the Ryazan Region in 2019–2020 within the compulsory medical insurance were selected. The obtained data were statistically analyzed using the Microsoft Excel application package (Microsoft, USA) and descriptive statistics.

RESULTS: The completed treatment cases of the insured individuals with RD in 2020 were categorized according to the age of patients, nosological form, and conditions for the provision of MC. They had different dynamics of growth/decline relative to the same period in 2019. In the structure of the cases of the MC provision, RD accounted for 13.2% (third place). This tendency was observed in the group of patients aged > 60 years (7.8%). In patients aged 18–60 years, the proportions of RD (18.0%) and diseases of the digestive system (18.1%) were higher than those of the diseases of the circulatory system (14.2%). The total number of cases of the MC provision to patients with this pathology for 5 months in 2020 decreased by 12.9% compared with that for 5 months in 2019 (11.3% in the age group of 18–60 years and 16.6% in individuals aged >60 years). Despite the 38.3% decrease in the number of hospitalizations, the number of the completed cases of specialized MC for pneumonia increased by 27.7% (43.9% in the age group of 18–60 years and 11.4% in the age group of > 60 years). The comparative analysis of 5 months in 2020 and 2019 showed a 57.1% increase in deaths among patients aged > 60 years in the provision of specialized MC and a 20.0% reduction among individuals aged 18–60 years.

CONCLUSION: The number of insured individuals seeking MC for RD increased during the COVID-19 pandemic, and the level of hospital lethality was low. Therefore, the organizational level of MC in the region was high, and medical organizations were adequately prepared for emergency situations with the preserved provision of high-quality MC.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):233-238
pages 233-238 views

Polymorphism of CYP3A4 isoenzyme gene in patients with chronic rheumatic heart disease

Petrov V.S., Nikiforov A.A., Smirnova E.A.


AIM: This study aimed to identify the associations of CYP3A4 isoenzyme gene polymorphism with the parameters of echocardiography (EchoCG), spirometry, and endothelial function of patients with chronic rheumatic heart disease (CRHD).

MATERIALS AND METHODS: A total of 128 patients with CRHD (15.6% men and 84.4% women) were examined. A392A, A392G, and G392G polymorphic markers were genotyped through polymerase chain reaction (PCR) with an SNP-EXPRESS electrophoretic scheme (NPF Litekh, Russia) to detect results after DNA was isolated from leukocytes in venous blood. EchoCG was implemented on an Affinity 50 apparatus (Philips, the Netherlands), endothelial function was assessed with an AngioScan01 apparatus (AngioScan-Electronics, Russia), and respiratory function was examined using a SpiroLab II spirometer (MIR Medical, Italy).

RESULTS: The distance in a 6 min walk test did not show any significant differences among the groups: A392A − 327.47 ± 6.71 m, A392G − 303.63 ± 26.19 m, G392G − 338.87 ± 20.12 m (p=0.505). The area of the mitral opening was as follows: A392A − 1.74 (1.67; 1.81) cm2, A392G − 1.68 (1.45; 1.92) cm2, and G392G − 1.65 (1.67; 1.81) cm2 (p = 0.214). As for the EchoCG parameters, the group of G392G homozygotes had the lowest linear dimensions of the left ventricle (the end diastolic dimension − 4.83 (4.72; 4.95) cm, the end systolic dimension − 2.97 (2.79; 3.14) cm, the right ventricle (2.45 [2.32; 2.58] cm), of the right atrium (4.09 [3.56; 4.62] cm), and the criteria of left ventricular hypertrophy (thickness of the interventricular septum 0.88 [0.81; 0.95] cm, and the posterior wall − 0.88 (0.81; 0.95 cm). No statistically significant differences were found in the occlusion index amplitude among the groups, that is, single nucleotide replacements of CYP3A4 had no influence on the system of low-resistance arteries. Conversely, the values of the phase shift between channels (reflecting the condition of large arteries) significantly differed. The G392G polymorphism showed the worst parameters, and minimal changes were observed in the A392A group. Contour analysis demonstrated the highest augmentation index values in the G392G group, reflecting the maximal stiffness of vessels. The CYP3A4 polymorphism had no effect on the parameters of respiratory function in the studied cohort of patients. Spirometry revealed that the obstructive and restrictive parameters were not significant although homozygotes demonstrated the highest forced vital capacity of the lungs (76.5% [71.1% and 82.0%]) and forced expiratory volume for 1 s (84.6% [79.0% and 90.3%]). The maximal parameter of the vital capacity of the lungs in homozygotes for A392A (85.6% [82.3% and 88.8%]).

CONCLUSION: Patients with CRHD homozygous for G392G had the minimum parameters of hypertrophy and dimensions of the left ventricular cavity. They also had the lowest values for the cavities of the right heart. CYP3A4 polymorphism had no effect on the parameters of respiratory function in the studied patients with CRHD.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):239-244
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Clinical effectiveness of bioflavonoids in the treatment of secondary lower limb lymphedema

Kalinin R.E., Suchkov I.A., Maksaev D.A.


AIM: This study aimed to investigate the effectiveness of the application of a combination of the preparation of micronized purified flavonoid fraction (MPFF) and elastic compression in patients with acquired lymphostasis.

MATERIALS AND METHODS: Sixty patients with stage II secondary lower limb lymphedema according to М. Foeldi were included. The patients were divided into two groups through randomization with the envelope method. The first group (n = 30) was subjected to a conservative treatment (MPFF, 1000 mg/day) coupled with elastic compression (3rd class compression stockings). The second group was given compressive therapy (third-class compression stockings). The patients were physically examined through the measurement of the circumference of the limb at different levels.

RESULTS: In the first group, the circumference of the lower third of the shin decreased by 8.15% (p = 0.005) after 1 month and by the end of treatment – by 10.6% (p < 0.001), of the middle third of shin – by 3.15% (p = 0.001) and 4.78% (p < 0.001), and of the upper third–by 4.08% (p < 0.001) and 5.99% (p < 0.001). By the end of the observation period (3 months), the circumference of the lower third of the shin in the second group (29.68 ± 4.67 cm) was significantly greater than that in the first group (26.65 ± 2.92 cm, p = 0.035). No adverse reactions were observed in the MPFF group.

CONCLUSIONS: The volume of the lower limbs of patients with acquired lymphedema decreased after using a combination of MPFF and elastic compression to a larger extent than after the isolated use of elastic compression. Patients taking MPFF had a positive clinical effect without adverse reactions. Therefore, MPFF could be used in the pharmacotherapy of secondary lymphedema of the lower limbs.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):245-250
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Genetic predictors of an unfavorable course of obliterating atherosclerosis of lower limb arteries

Kalinin R.E., Suchkov I.A., Chobanyan A.A., Nikiforov A.A., Shumskaya E.I.


AIM: This study aimed to determine the influence of −250G>A polymorphism in the LIPC gene and –1607insG in the MMP-1 gene on the course of obliterating atherosclerosis of lower limb arteries (OALLA).

MATERIALS AND METHODS: Seventy-six individuals were included in this study. In the first group (n = 34), patients with an unfavorable (progressive) course of OALLA and developed critical ischemia of the lower limbs within 5 years from the onset of the disease were included. In the second group (n = 34), patients with a conventionally favorable (non-progressive) course but did not develop critical ischemia of the lower limbs within 5 years from the onset of the disease and did not have a progressive degree of chronic ischemia. In the control group, healthy volunteers (n = 8) without signs of atherosclerosis in all vascular pools were included. In all the patients, LIPC-250G>A and MMP-1-1607insG were genotyped. The difference in the observed and expected frequencies was evaluated via a Pearson χ2 test with correction for likelihood.

RESULTS: Significant differences (p = 0.013) in the −250G>A polymorphism of the LIPC gene were found between the observed and expected frequencies compared with those in patients with OALLA and healthy volunteers. The assessment of the first and second groups revealed differences in the observed and expected frequencies (р = 0.004). Heterozygous carriage (GA genotype) was associated with an increased risk of the development of the unfavorable course of OALLA (hazard ratio = 2.133 with 95% confidence interval = 1.214–3.748). In the analysis of the −1607insG polymorphism of the MMP-1 gene, statistically insignificant data were obtained compared between the first and second groups (р = 0.128) and between the groups of patients with OALLA and healthy volunteers (р = 0.38).

CONCLUSIONS: The heterozygous carrier of LIPC −250G>A was associated with an increased risk of an unfavorable OALLA course. This research on this polymorphism could be applied to patients with the newly diagnosed atherosclerosis of the arteries of the lower extremities to determine the prognosis of the disease course, especially in young patients with early manifestation and individuals with a burdened hereditary history. The −1607insG polymorphism of the MMP-1 gene had no effect on the course of OALLA.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):251-256
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Causes, diagnosis, and treatment of postoperative obstructive jaundice

Gulov M.K., Ruziboyzoda K.R.


AIM: This study aimed to analyze the causes, diagnosis, and clinical treatment of postoperative obstructive jaundice (POOJ) in routine surgical practice.

MATERIALS AND METHODS: Twenty-four patients with POOJ that developed in the organs of the hepatobiliary system after surgical interventions were included in this study. The patients were subjected to the following procedures to diagnose the causes of POOJ and choose the treatment methods: general clinical examination, biochemical blood tests, dynamic postoperative ultrasound examination of the abdominal organs, video laparoscopy, computed tomography, magnetic resonance imaging, fistulocholangiography, endoscopic retrograde cholagiopancreatography, and percutaneous transhepatic cholangiostomy.

RESULTS: POOJ occurred in 18 cases after they had different variants of surgical interventions on the biliary tract after traditional (n = 6) and video laparoscopic cholecystectomy (n = 12). POOJ also developed in 6 cases after they underwent surgery on the liver: atypical (n = 2) and anatomical (n = 2) resection of the liver. This condition manifested after the opening and draining of liver abscesses under US control (n = 2). POOJ was treated with different methods to alleviate the developed complications. After surgical interventions on the liver and biliary tract in 6 cases, relaparotomy, sequestrectomy with sanation, drainage of the abdominal cavity (n = 4), and right-sided hemihepatectomy (n = 2) were performed. In 6 other cases, on days 3–4 of the development of POOJ after laparoscopic operation (n = 2), relaparotomy was performed, clips and ligature were removed from the choledoch with the formation of Roux-en-Y hepaticojejunostomy. Minimally invasive methods of POOJ correction were applied to 12 cases. Of the 12 cases, 5, 2, and 1 were subjected to endoscopic papillosphincterotomy with lithoextraction, endoscopic papillosphincterotomy with lithoextraction coupled with nasobiliary drainage, and relaparoscopy and redrainage of the common bile duct, respectively. In 4 cases, percutaneous transhepatic cholangiostomy was performed at the first stage. At the second stage, after POOJ resolution, the following procedures were implemented: redrainage of the common bile duct (n = 2) and dilatation of the orifice of the right hepatic duct with reconstruction of hepaticojejunostomy on the hidden transhepatic drainage.

CONCLUSION: POOJ is still encountered in clinical practice in a sufficient number of cases. Treatment results largely depend on the time of diagnosis and the choice of optimal surgical strategies. The main causes of POOJ are tactical and technical diagnostic and treatment errors. POOJ is diagnosed on the basis of the data of modern radiation and laboratory and instrumental examination methods. Surgical tactics for POOJ are individually active and dependent on the severity, time, and causes of development. They also depend on the general condition of patients. Along with minimally invasive interventions for POOJ, early relaparotomy is less dangerous than passive expectation tactics.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):257-266
pages 257-266 views

Possibilities of the early diagnosis and prognosis of complicated clinical forms of chronic pancreatitis

Tarasenko S.V., Natalskiy A.A., Peskov O.D., Bogomolov A.Y., Nikiforov A.A., Avilushkina E.O., Tarakanov P.V.


AIM: This study aimed to improve the methods for the diagnosis of complicated clinical forms of chronic pancreatitis (CP) by evaluating the clinical significance of the polymorphisms of the genes of cationic trypsinogen (PRSS1), pancreatic secretory trypsin inhibitor (SPINK1), transmembrane regulator of cystic fibrosis (CFTR), and alcohol dehydrogenase (ADH) in patients with complicated and uncomplicated forms of CP.

MATERIALS AND METHODS: The study was carried out on the clinical base of the Department of Hospital Surgery, Ryazan State Medical University, Center for Surgery of Liver, Pancreas, and Biliary Tract in Ryazan in 2014–2019. A total of 108 patients of both genders aged 25–65 years were examined. Of these patients, 38 were surgically treated for complicated CP, 20 had complicated CP without surgery, and 50 had uncomplicated CP (control group). A comparative clinical study with the control group of patients was performed, and the genotype was simultaneously determined on days 1 and 10 under controlled laboratory parameters. DNA was isolated from the leukocytes of the whole blood by using a DNA-expressing blood reagent (OOO NPF Litekh, Russia) for further analysis.

RESULTS: No polymorphism of cationic trypsinogen PRSS1 gene and cystic fibrosis-2 CFTR2 gene was found. The predictive value of these polymorphisms was insignificant. For the polymorphism of CFTR1 cystic fibrosis-1 gene, the odds ratio was 0.444, but this finding was not significant. Among patients with the complicated clinical forms of CP, mutations were observed in the PRSS1 cationic trypsinogen gene (c2 = 6.453, p = 0.012) and ADH (c2=14.176, p = 0.001). Conversely, they were not detected in the CFTR-1 gene (c2 = 0.873, p = 0.351), CFTR-2 (c2 was not determined), and SPINK1 (c2 = 0.873, p = 0.351). The polymorphisms of the ADH and PRSS1 genes of cationic trypsinogen were associated with more evident structural changes in the parenchyma and ductal system of the pancreas. They also had a higher likelihood of complications, severe disease course, and a lower efficiency of conservative treatment. The polymorphism of the ADH gene increased the risk of the development of the cystic form of CP (c2 = 5.898, p = 0.016).

CONCLUSION: The polymorphism of ADH and cationic trypsinogen genes should be determined and used for the complex diagnosis of CP to specify indications for the surgical treatment of patients with CP.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):267-276
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Experimental study on an alternative to suturing the laparotomy wound with a mesh thread

Fedoseev A.V., Cherdantseva T.M., Inyutin A.S., Glukhovets I.B., Lebedev S.N., Muraviev S.Y.


BACKGROUND: Incisional ventral hernias (IVH) in abdominal surgery remain relevant because the frequency of their formation after laparotomy reaches 10%–30.7%.

AIM: This study aimed to develop a method for the primary closure of a laparotomy wound via mesh endoprosthesis, which is superior to laparorrhaphy with traditional suture materials in terms of morphophysical properties.

MATERIALS AND METHODS: Laparorrhaphy with a mesh thread was developed (Patent for invention RUS No 2714439 02/14/2020) as an alternative to preventive prosthetics with narrow indications to avoid herniation. An experimental work was conducted to investigate the wound process in the suture area on days 14 and 60 and determine the effectiveness and safety of the proposed method.

RESULTS: Video laparoscopy data showed that no cases of adhesions were observed between the internal organs and the area of laparorrhaphy on days 14 and 60 of the postoperative period. Defects in the area of the application of sutures on the aponeurosis of the white line were absent. In the wound, the mesh thread fully integrated into the regenerating tissue, including at the site of the knot. The tissue also grew through the meshed cells. On day 14, the strength of the regenerating tissue with the sutured mesh thread was greater than that sutured without it (11.198 ± 1.499, p < 0.01). This finding was confirmed by the larger area of granulations and fibrosis in cases of mesh suture than that of the checkerwise-reinforcing suture, suture with a mesh thread, and suture with a strip of mesh endoprosthesis. Another peculiarity of the connective tissue newly formed in the area of the mesh endoprosthesis in the form of the mesh thread was that collagen fibrils were arranged concentrically. By contrast, the mesh strip had collagen fibrils arranged in a longitudinal orientation parallel to the endoprosthesis. On day 60 of the experiment, all the series showed signs of maturation of the connective tissue in the form of the predomination of fibrils in cellular elements and their compaction. The area of fibrosis and granulations still prevailed in cases of the mesh suture, where neocollagenogenesis in the cells of the endoprosthesis was more pronounced than that after the application of a reinforcing suture, a mesh thread, and a strip of mesh endoprosthesis.

CONCLUSION: The absence of wound complications and negative impact on the surrounding tissues indicated the safety of using the mesh suture. The strengthened characteristics associated with the peculiarities of the wound process showed that the mesh suture was effective in preventing the occurrence of postoperative hernia. Therefore, this method could be used in clinical practice.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):277-286
pages 277-286 views

Pathomorphology of gravid endometrium in patients with recurrent miscarriage in early periods with underlying chronic endometritis and the presence of low-functional alleles in folate cycle genes

Peretyatko L.P., Fetisova I.N., Fateeva N.V., Kuznetsov R.A., Fetisov N.S.


AIM: This study aimed to identify the peculiarities of pathomorphological alterations in the gravid endometrium and polymorphism of the folate cycle genes in female patients with recurrent early miscarriage and underlying chronic endometritis.

MATERIALS AND METHODS: The uterine mucosa of women who had uncomplicated pregnancies and decided to have an artifactual abortion within 5–12 weeks (control group, n = 36) and patients with recurrent miscarriage with underlying chronic endometritis (main group, n = 83) was histologically examined. The polymorphism of the folate cycle genes MTHFR С677Т (rs 1801133), MTHFR A1298C (rs 1801131), and MTRR A66G (rs 1801394) was studied in the female patients of the main group and women with the preserved reproductive function (comparison group, n = 52) through real-time polymerase chain reaction (PCR).

RESULTS: Fibroblast-like cells (FLCs) of the stroma sequentially differentiated into predecidual cells from 5 weeks to 12 weeks of uncomplicated pregnancy. In the case of recurrent miscarriage against background chronic endometritis, defect was observed in the differentiation of FLCs of the endometrial stroma. This finding was associated with a decrease in the morphometric parameters of the cells and an increase in the frequency of the occurrence of the low-functional allele 677T in the methylenetetrahydrofolate reductase gene.

CONCLUSION: The course and outcome of pregnancy in the first trimester were negatively affected by the structural inadequacy of endometrial stromal cells in recurrent miscarriage and chronic endometritis combined with the presence of the MTHFR 677T allele in a woman’s genotype.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):287-292
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Clinical cases

Case report of a massive pseudoaneurysm of the anterior tibial artery

Dorn A., Galkin P., Kalmykov E., Majd P.


The majority of arterial pseudoaneurysms treated in our department of vascular surgery are consequences of catheter-associated medical procedures and located in the groin region. Clinical signs, combined with the recent history of a percutaneous intervention, ensure quick diagnosis and therapy. However, pseudoaneurysms can develop after any artery of the body is injured. No consensus on the therapeutic strategy is achieved because of the rare nature of this injury. This study provided an overview of the methods described in previous studies and contributions to their clinical experience.

A case of a young man whose injury was not recognized immediately and who presented months after the accident with a pseudoaneurysm of unusual location and size was reported. Sonographic diagnosis was confirmed through computed tomography angiography, and open surgical repair was performed with satisfactory results.

Conclusion. This case is a reminder that seemingly minor accidents can cause arterial injury, and patients should be carefully examined to avoid delayed diagnosis and therapy.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):293-298
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Rare clinical case of the diagnosis of idiopathic pulmonary artery hypertension

Ignatenko G.A., Grekov I.S., Grushina M.V., Dubovyk A.V.


In this work, a rather rare (morbidity of about 1–2 cases per 1 million of adult population per year) and interesting clinical case of the diagnosis of idiopathic pulmonary artery hypertension (IPAH) was described. This case was also known as Ayerza disease or Ayerza–Arilago syndrome. At the initial stage, this pathology was characterized by an asymptomatic course that caused certain difficulties in making a correct diagnosis. In general, this disease had a poor prognosis. The main cause of death was decompensated right ventricular failure. The occurrence of complications could be significantly reduced and the life quality of such patients could be improved by the timely diagnosis and correct approach.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):299-304
pages 299-304 views


Review of dura mater substitutes in neurosurgical practice

Mai R.B., Popov V.E., Osidak E.O., Domogatsky S.P., Nalivkin A.E., Mishina E.S.


AIM: This study aimed to summarize the accumulated experience and compare available materials for the plasty of dura mater (DM) defects. The growing number of patients with craniocerebral traumas and an increasing amount of neurological surgeries for tumor processes and congenital malformations resulted in an increased amount of DM defects and associated complications. Despite the development of high-efficiency medical products, the percentage of postsurgical CSF leakage remains high and reaches 32% in case the defect is in infratentorial locations. Suitable substitute materials should be developed for the repair of dural defects because of complications such as pseudomeningocele, postsurgical inflammatory processes, CSF leakage, implant rejection, and cicatrical adhesion. In this article, basic materials, including auto- and allografts, biological substances, and synthetic materials, for the repair of dural defects were reviewed. Their positive and negative properties depending on the kind and location of lesions and on the type of material used were discussed. The main characteristics to be fulfilled by an ideal dura mater substitute were analyzed. Composite materials were considered a promising trend in modern bioengineering.

CONCLUSION: An ideal material for the repair of DM defects should have the following properties: plastic, nonimmunogenic, watertight, highly porous, high surface area of fibers, cell growth stimulating, supportive for the survival of cells until they completely integrate with host tissues, conveniently replaceable, and adhesive. No ideal transplant materials can meet all the above demands. Biological, synthetic, and host tissues only supplement one another. Relevant studies have yet to be performed to obtain a more versatile and time and cost effective material that can satisfy all the requirements of modern neurosurgery. The existing results of preclinical studies have demonstrated that composite materials are similar to synthetic materials in terms of the strength and properties of biological tissues for the migration and proliferation of cells. In the future, they may become a promising alternative to biological substitutes.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):305-314
pages 305-314 views

Natural and anthropogenic biogeochemical province of the biosphere over Cherepovets

Artemenkov A.A.


AIM: This study aimed to summarize information on the formation of the natural and anthropogenic biogeochemical province of the biosphere over Cherepovets, develop biogeochemical standardization, and prevent environmentally conditioned human diseases.

The migration of biogenic elements through food chains is analyzed. A significant flow of toxic elements entering the natural environment in the course of human industrial activity leads to the formation of anthropogenic biogeochemical provinces. In these geochemical zones and landscapes, the natural endemic environment interacts with chemical elements. As a result, biogeochemical cycles are altered, and vital elements are replaced with toxic metals. With these changes, intracellular biochemical reactions are disrupted. In this study, information on Cherepovets biogeochemical province formed in the 1960s was examined in the presence of intense industrialization. Data on high concentrations of heavy metals in the soil horizons of the given province were examined. Toxic elements actively accumulated in plants growing in the Cherepovets territory and vegetables growing in household plots within the city and the nearest 10 km zone. Metals accumulated in soil, different components of land ecosystems, and organs and tissues of carnivores.

CONCLUSION: A high load in the Cherepovets biogeochemical province poses certain risks to the health of the population and causes the development of endemic diseases, microelementoses, and exogenous toxicoses in humans.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):315-324
pages 315-324 views

COVID-19-induced psychosis: new challenges for early career psychiatrists

Maiti T., Essam L., Orsolini L., Ramalho R., El Halabi S., Nguyen V., Gürcan A., Jakhar J., Pinto da Costa M., Ojeahere M.I., Shoib S., Fedotov I.A.


The COVID-19 pandemic and its impact on mental health has remained immense and global in all senses. Various types of induced psychiatric disorders, both new episodes and exacerbation of the preexisiting ones has been reported - starting from adjustment disorder to full psychotic illnesses.

Various clinical symptoms, including systematized delusions, affective symptoms and self harm ideas has been mentioned needing upto prolonged admission and in patient care. Various etiopathogenetic models, incluing direct neural infection to cytokine storms or unmasking of the hidden vulnerabilities has been proposed however this needs further research. Traditional antipsychotic pharmacological agents has been proven to work well though special attention to pharmacological interactions is needed with caution for co morbid conditions and chance of side effects.

We collaborated in worldwide Task Force of early career psychiatrists and prepared the definition of our point of view.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(2):325-331
pages 325-331 views

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