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Vol 29, No 4 (2021)

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Original researches

Role of the GRIN1 gene polymorphism in the formation of post-traumatic epilepsy

Gazaryan L.M., Selyanina N.V., Karakulova Y.V., Sosnin D.Y.

Abstract

Introduction: NMDA receptors are involved in the pathogenesis of seizures, as it subunit is coded for by the GRIN1 gene. Different GRIN1 mutations are known in patients with different forms of epilepsy and encephalopathy. However, no data are available on the participation of the GRIN1 gene and its polymorphisms in the development of post-traumatic epilepsy (PTE).

Aim: To determine the influence of single-nucleotide rs1126442 polymorphism of GRIN1 on the risk of PTE formation.

Materials and methods: A total of 140 patients were examined, which included 69 patients with PTE and 71 patients with genetic epilepsy. All patients underwent a comprehensive examination, with evaluation of history, neurological status, electroencephalography (EEG) and neuroimaging results, and genotyping of blood samples by real-time polymerase chain reaction. The control sample for genetic examination was venous blood from 60 healthy individuals.

Results:  Focal seizures with transition to bilateral and tonic–clonic seizures were predominant in the PTE group. Neuroimaging revealed dystrophic, cystic, and cystogliotic alterations and signs of external hydrocephaly. EEG recorded interictal and ictal epileptiform activity and slowing of theta waves. Genotyping by rs1126442 polymorphism of GRIN1 revealed predominance of heterozygous G/A and homozygous A/A genotypes in patients with PTE in the codominant (odds ratio (OD)=3.43; 95% confidence index (CI) 1.56–7.55; p=0.0047), dominant (OR=3.24; 95% CI 1.57–6.68; p=0.0011), and superdominant (OR=2.90; 95% CI 1.36–6.22; p=0.0048) inheritance models. The carriage of heterozygous G/A rs1126442 genotype of GRIN1 was associated with an epileptiform activity in the EEG of all patients with epilepsy (OR=2.40; 95% CI 1.11–5.20; p=0.024).

Conclusion: The carriage of heterozygous G/A genotype and homozygous A/A rs 1126442 genotype of GRIN1 in the dominant and codominant inheritance models is associated with a high risk of development of epilepsy after craniocerebral trauma. The carriage of heterozygous G/A rs 1126442 genotype of GRIN1 is associated with an epileptiform activity in EEG.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):449-456
pages 449-456 views

Technical condition of buildings of outpatient medical organizations (units) in the Russian Federation

Evdakov V.A., Melnikov Y.Y., Smyshlyaev A.V.

Abstract

Introduction: The current material and technical conditions of the buildings of the state healthcare system of the Russian Federation (RF) is associated with the availability of medical care to the population. The reduction of this parameter influences the quality of life of the population. To improve the provision of the RF population with outpatient medical care, a profound material and technical restructuring and modernization of primary care setting is necessary.

Aim: To analyze the main parameters of the technical condition of buildings of medical organizations of outpatient care (MOOC) in the RF for 2012–2019.

Materials and methods: The study used data from Federal statistical observation form No. 30 "Information about a Medical Organization" in the RF for 2012–2019. Data were analyzed statistically using descriptive and analytical statistics and analysis of dynamic series. Absolute and relative parameters of the technical condition of MOOC buildings were calculated. Trend analysis was the main methods used.

Results: In 2012–2017, the number of MOOC buildings in disrepair and requiring demolition tended to decrease from 215 to 96 units. In 2012–2019, the number of MOOC buildings requiring reconstruction decreased from 511 to 179. In 2012–2018, the number of MOOC buildings requiring full repair decreased from 4,347 to 2,378. However, in 2019, the number sharply increased to 4,113. In 2014–2019, the number of MOOC buildings located in adapted premises increased from 6,723 to 8,126 units. In 2014–2019, the number of MOOC buildings located in rented areas decreased from 1,443 to 1,414. In 2012–2019, the number of MOOC buildings with hot water supply, central water supply, central heating, central sewer drainage, telephone communication, and autonomous power supply increased.

Conclusion: The total number of MOOC in the study period increased by 7.9%. The number of buildings requiring repair and modernization in 2012–2019 tended to decrease. Not all parameters show a positive tendency, and the modernization of healthcare is structurally incomplete.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):457-464
pages 457-464 views

Peculiarities of the rate of adaptive restructuring of heart rate variability of natives of different generations living in the coastal and intracontinental climatic zones of the Magadan region

Averyanova I.V., Maksimov A.L.

Abstract

Introduction: Currently, young Caucasian populations of different generations are living in the Magadan region (MR). The study of heart rate variability (HRV) in these samples will add to the modern understanding of the physiological mechanisms of adaptive restructures in those living in coastal and continental zones of the MR.

Aim: To study restructures of HRV in young Caucasians who were representatives of the zeroth, first, second, and third generations living in the coastal and continental zones of MR, with significant differences in the extremality of natural environmental factors.

Materials and methods: TThe study involved 870 young men aged 17–21 years. HRV parameters were analyzed using a Varikard device.

Results:  Compared with individuals of the same age living in the coastal zone, residents of the continental climatic zone were characterized by more evident predomination of the parasympathetic division of the autonomic nervous system. A tendency to the enhancement of the parasympathetic influence from the zeroth to subsequent generations was observed in both young men living in the coastal and continental zones.

Conclusion: The direction of adaptive shifts in the restructuring of HRV characteristics varied depending on the climatic zone where the examined individuals lived: in the continental climate of the MR, adaptive restructuring of HRV parameters occurs faster and already completed at the first generation in comparison with migrants, with no significant differences between representatives of the first and second generations. In young men living in coastal zones, restructures occur more slowly and continue upto the representatives of the third generation.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):465-473
pages 465-473 views

Prevalence and risk of chronic diseases in medical personnel of mobile ambulance teams

Bolobonkina T.A., Dementyev A.A., Minaeva N.V.

Abstract

Introduction: Medical workers of mobile ambulance teams (MATs) are at a high risk of exposure to harmful working conditions, leading to the development of chronic diseases (CDs).

Aim: To study the prevalence and risks of the development of CDs according to the results of a sociological survey among medical workers of MATs.

Materials and methods: The method used for the sociological research was based on a specially designed questionnaire using Google Forms electronic service. The survey was participated by 176 medical workers. The average age of the respondents was 40.58 ± 14.01 years, of which 143 were women and 33 were men.

Results:  Of the majority of the respondents (63.6%), 51.5% were 18–25 years old with working period <5 years, who had CDs; 89.5% were 51–60 years old, and 100% were ≥61 years old. The most common forms of CDs were diseases of the musculoskeletal system, digestive organs, respiratory organs, urogenital system, and circulatory system, and the prevalence ranged from 25.6 to 15.3 per 100 respondents. In the total cohort, 74.8% had chronic morbidity. The medical personnel of general ambulance teams had significantly higher relative risk (RR) of CDs (2.449 [95% confidence interval, CI 1.701–3.525]) than those of specialized ambulance teams. Gender and occupational differences in the development of musculoskeletal pathologies were found, with higher RRs among women (RR 4.510 [95% CI 1.155–17.610]) and medical personnel of MATs (RR 1.874 [95% CI 1.041–3.374]).

Conclusions: The prevalence of certain CDs among medical workers of MATs depends on the duration of contact with occupational factors, gender, and age of the workers.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):483-488
pages 483-488 views

Pharmacoepidemiology of the administration of antihypertensive drugs by doctors in the Voronezh region in comparison with the results of the PYTHAGOR IV study

Kartashova E.S., Batischeva G.A., Zhdanova O.A., Sharapova Y.A.

Abstract

Background: To examine the pharmacoepidemiology of treatment for arterial hypertension (AH) in Russia, the PYTHAGOR study has been conducted since 2001, including PYTHAGOR I–II (2001–2002), PYTHAGOR III (2008), and PYTHAGOR IV (2013). Increasing the role of doctors of outpatient care in the pharmacotherapy of patients with AH creates prerequisites for conducting new pharmacoepidemiological studies.

Aim: To investigate the structure of prescriptions of antihypertensive drugs (AHD) by outpatient doctors at the regional level in comparison with the results of PYTHAGOR IV pharmacoepidemiological study.

Materials and methods: In 2018, a survey was conducted in the Voronezh region among 104 doctors, including 58 general practitioners (55.8%), 37 therapists (35.6%), and four cardiologists (3.8%). The average age of the doctors was 45.7 ± 13.5 years, the accumulated period of work was 21.0 ± 13.7 years, and the period of work in an outpatient clinic was 16.6 ± 12.4 years.

Results:  In the structure of doctors’ pREFERENCES in selecting free combinations of AHD, doctors preferred angiotensin-converting enzyme inhibitors (iACE; 90.3%), but they were prescribed more rarely than that in PYTHAGOR IV study (93.8%). The remaining AHD groups were used by doctors of the VR more often than in the PYTHAGOR IV study: beta-adrenoblockers, 89.4% (PYTHAGOR IV, 73.1%); diuretics, 88.4% (73.2%); calcium antagonists (CА), 86.5% (67.3%); angiotensin II receptor blockers (ARB), 81.7% (62.1%); imidazoline receptor agonists, 57.6% (13.3%). In the selection of fixed combinations of AHD: iACE or ARB with a diuretic was used in 71.9% and 36.4%, respectively, and iACE with CA in 46.2%. In the PYTHAGOR IV study, these combinations were used more rarely, i.e., in 33.3%, 28.0%, and 24.1%, respectively.

Conclusion: The data obtained indicate adherence of doctors to modern clinical guidelines for the pharmacotherapy of AH.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):475-482
pages 475-482 views

Variability of arterial pressure and cardiac rhythm in patients with coronary heart disease and diabetes mellitus: Effect of sodium-glucose co-transporter 2 inhibitor

Kotskaya A.V., Salaychuk E.V., Kudinov V.I., Terentyev V.P., Lankina M.S.

Abstract

Introduction: A factor that worsens the course of coronary heart disease (CHD) in patients with type 2 diabetes mellitus (DM2) is cardiovascular autonomic neuropathy (CAN), in which the risk of sudden death increases fivefold. The prevalence of CAN in patients with both CHD and DM2 may reach 60%. Classic cardiovascular tests (CCT) do not permit identification of CAN at the preclinical stage. A modern method of treatment for DM2 uses sodium-glucose co-transporter 2 inhibitors, which have confirmed cardioprotective effects.

Aim: To analyze the prevalence of alterations of arterial pressure variability (APV) and of heart rhythm variability (HRV) in patients with both CHD and DM2 and the effect of empagliflozin on these parameters.

Materials and methods: A total of 210 patients aged 64.5 ± 6.7 years (103 men) with both CHD and DM2 were examined (group1). Anthropometric and biochemical parameters were analyzed, electrocardiogram and arterial pressure were monitored daily, and CCT was performed. For comparison, 64 patients with CHD with no alterations in the carbohydrate metabolism were examined (group2, n=64, aged 66.4 ± 2.3 years). Further, among patients in group1, patients with impaired HRV and APV were selected, but they had CCT scores < 4.0, and they were divided into group1G (n=22) where empagliflozin was added (10–25 mg/day) and group1C (n=20) where the previous therapy was continued.

Results:  CAN was detected in 22% of patients with CHD and DM2, and all patients had impaired HRV and ADV. Deviations of HRV and APV parameters with normal CCT scores (< 4.0) were detected in 43% of the patients. Within 6 months of treatment with empagliflozin, the HbA1c level decreased from 8.38% ± 0.56% to 6.9% ± 0.26% (p< 0.05); in the groupwithout empagliflozin treatment, it decreased from 8.28% ± 0.32% to 7.30% ± 0.29% (p< 0.05). In the empagliflozin group, the average heart rate per day decreased from 86.7 ± 2.4 to 76.7 ± 2.1 beats/min (p< 0.05), the circadian index increased from 1.19 ± 0.02 to 1.30 ± 0.01 (p< 0.05), the SDNN increased from 106.1 ± 2.21 to 114.03 ± 2.34 ms (p< 0.05), and the systolic arterial pressure variability index decreased from 22.9% ± 1.7% to 16.4% ± 1.9% at daytime (p< 0.05) and from 16.8% ± 2.2% to 12.3% ± 2.6% at nighttime (p< 0.05).

Conclusion: The identified alterations of HRV and APV parameters may be manifestations of CAN, and CCT score < 4.0 may indicate the preclinical stage. Positive dynamics of HRV and APV was recorded with empagliflozin therapy, which improved the functional condition of the autonomic nervous system.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):489-496
pages 489-496 views

Hemostasis system in patients with bradycardias after the implantation of dual-chamber pacemakers

Kalinin R.E., Suchkov I.A., Povarov V.O., Mzhavanadze N.D., Jurina O.N.

Abstract

Introduction: As with many other surgical interventions, the implantation of a pacemaker may be associated with adverse outcomes in the immediate or distant period. The search for probable risk factors of adverse outcomes may promote the development of effective and safe management methods of patients with pacemaker postoperatively. One of the important directions in this field is the investigation of the effect of pacemaker implantation on the hemostasis system of these patients.

Aim: To evaluate the effect of the implantation of dual-chamber pacemaker on the hemostasis system of patients with different kinds of bradyarrhythmias and to determine probable risk factors for unfavorable outcomes in this groupof patients.

Materials and methods: The study was performed with the financial support of the Russian Foundation for Basic Research within the Scientific Project No. 19-315-90109. The prospective study (ClinicalTrials.gov ID, NCT04499612) enrolled 61 patients (men, 45.9%) with a mean age of 71.5 ± 8.8 years. The groupwho received surgical treatment included 23 patients with atrioventricular (AV) block and 25 patients with sick sinus syndrome (SSS), and the groupwith conservative treatment included 13 patients with AV blocks and SSS, but without indications for pacemaker implantation. Anticoagulant therapy was given to one patient with AV block, 12 patients with SSS, and five patients with conservative therapy. All the remaining patients received antiplatelet therapy. The surgical groupunderwent ultrasound examination of the veins of the upper and lower extremities and sampling of peripheral venous blood before and 7 days after pacemaker implantation to determine the level of fibrinogen (FI) and activity of blood coagulation factors VIII (FVIII) and IX (FIX), antithrombin III (AT III), and protein C. In the conservative group, a similar examination was conducted only on inclusion in the study.

Results:  In patients with AV block, a significant increase in blood fibrinogen was noted at 7 days after surgery (р=0.042). In the intergroupcomparison, the activity of AT III after the implantation was higher in the surgical groupthan in the conservative group(р=0.018 and р=0.006, respectively). After surgery, the activity of FVIII and FIX was lower in patients with SSS on anticoagulant therapy than in patients with antiplatelet therapy (р=0.048 and р=0.015, respectively). Based on the receiver operating characteristics analysis, the risk factors for lethal outcomes were reduced activity of AT III in patients with AV block and increased activity of FIX in patients with SSS.

Conclusions: The balance of the hemostasis system in patients with AV blocks on antiplatelet therapy was shifted toward hypercoagulation within at least 7 days after pacemaker implantation. The use of anticoagulants in patients with SSS caused a shift toward hypocoagulation. The reduced activity of AT III in patients with AV block and increased activity of FIX in patients with SSS are prognostic factors for lethal outcomes.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):497-504
pages 497-504 views

Magnetic resonance imaging in the diagnosis for predictors of ventral hernia recurrence

Fedoseev A.V., Shklyar V.S., Lebedev S.N., Inyutin A.S.

Abstract

Introduction: The problem of surgical treatment of patients with ventral hernias remains actual over years. This is due to significant number of patients with this pathology as well as a steadily high percentage of recurrence of the disease after reconstructive operations (24%–44%).

Aim: To identify the interrelation between the constitutional peculiarities of patients and the condition of the anterior abdominal wall tissues as predictors of the formation and recurrence of ventral hernias, based on the results of magnetic-resonance study.

Materials and methods: To assess the connection between the body constitution, the age and the morphological structure of the anterior abdominal wall, we examined 71 patients who were referred for magnetic-resonance examination of the abdominal cavity. In the work, the age of the patients was defined (WHO classification (2015)), and the body mass index. To reveal the signs of undifferentiated connective tissue dysplasia (CTD), the chart by T. Milkovska–Dmitrova and A. Karkashev (1985) was used. For statistical processing of the data and construction of the graph, Statistica 13.3, SPSS 14.0 for Windows Evaluation Version, MS Excel 2016 statistic packages were used.

Results:  Fatty degeneration of muscle tissue (DMT) prevails among elder individuals (rxy=-0.540; p< 0.05). Obesity is accompanied by diastasis of abdominal rectus muscles (rxy=0.806, p< 0.05) and fatty degeneration (rxy=0.568; p< 0.05). Connective tissue dysplasia is closely associated with the rectus muscle diastasis (rxy=0.948; tСт=3.834; p< 0.05) and distension of the umbilical ring (rxy=0.934; T-test=3.703, p< 0.05). Latent aponeurosis defects are also most characteristic of patients with connective tissue dysplasia; however, this dependence was not statistically confirmed in the studied cohort (rxy=0.258; T-test=0.734, p> 0.05).

Conclusion: Вefore planning surgical intervention for ventral hernia, we recommend MRI examination of the anterior abdominal wall tissues be performed in patients for determination of the volume of the intervention to prevent recurrence.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):505-512
pages 505-512 views

Optimal periods for coronary artery bypass surgery on working heart in patients with stenosis of left main coronary artery and acute coronary syndrome

Staroverov I.N., Staroverov I.N., Churakov S.O., Lonchakova O.M.

Abstract

Introduction: The treatment strategies of patients with stenosis of the left main coronary artery (LMCA) and acute coronary syndrome (ACS) is being debated. One of the key problems is the selection of the optimal time for coronary artery bypass surgery (CABS) in these patients.

Aim: To analyze different periods of revascularization of the myocardium by CABS on a working heart in patients with LMCA stenosis and ACS.

Materials and methods: A prospective analysis of treatment of 112 patients with LMCA stenosis (> 50%) and ACS was performed. Patients were divided to three groups depending on the time of surgical treatment: upto 7 days after occurrence of ACS, 18 (16.1%, group1) patients; 8–14 days, 38 (33.9%, group2) patients; > 14 days, 56 (50%, group3) patients. The average time of ACS-CABS in all patients was 15 days. The groups were comparable in terms of the main preoperative parameters, except for EuroSCORE II and GRACE scale that were predominant in the early periods of CABS.

Results:  LMCA subocclusion (stenosis > 90%) with coexistence of anginal syndrome at rest was observed in more than half of patients with surgery upto 7 days (56%, p=0.019). The surgery duration, blood loss through drains, number of days in the resuscitation unit, duration of artificial lung ventilation, and use of vasopressor support were not significantly different. The revascularization index was higher in surgeries conducted within 7 days than in surgeries performed within 8–14 days (2.33 ± 0.59 versus 1.89 ± 0.65, p=0.02). The evaluation of the dynamics of the functional parameters of the myocardium showed a greater increase in ejection fraction in group1 when compared with group3 after surgery (p=0.036). In the evaluation of the end-diastolic volume of the left ventricle, the average reductions were 16 mL, 14 mL, and 8.5 mL, respectively, without any significant differences among the groups. The rate of intrahospital lethality was highest in group3 (.4%), followed by group2 (2.6%). No fatal outcomes were noted in surgeries conducted in upto 7 days (p> 0.050).

Conclusion: Early CABS performed upto 7 days have similar immediate results to delayed ones and considerably improves the contractile ability of the myocardium in patients with ACS and LMCA stenosis.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):513-520
pages 513-520 views

Role of brain-derived neurotrophic factor in coping with the consequences of psychotraumatic events

Faustova A.G., Krasnorutskaya O.N.

Abstract

Background: Psychological trauma may cause noticeable damage to the hippocampus, amygdala, and prefrontal cortex. Brain-derived neurotrophic factor (BDNF) demonstrates neuroprotective properties in relation to organic brain damage caused by ischemia and craniocerebral traumas. To date, no sufficient evidence suggests that BDNF provides the viability of the nervous system in the process of overcoming the negative consequences of psychotraumatic events.

Aim: To analyze the relationshipbetween the individual psychological manifestations of the "resilient phenotype" and the BDNF level in the blood serum of individuals who have psychological traumatic experience and demonstrate effective coping.

Materials and methods: In 33 respondents (26 women, 7 men; mean age, 26.3 ± 7.46 years) who had psychological traumatic experience in the previous 3 years, the BDNF level (determined by quantitative enzyme-linked immunosorbent assay), personality, and behavioral correlates of psychological resilience were explored (using psychological survey). Correlation and multiple regression analyses were used in the mathematical and statistical processing of empirical data.

Results:  The BDNF level in the blood serum of individuals with a past psychotraumatic event serves as a predictor of the level of expressiveness of resistance to stress (t=2.093, р=0.045), maladaptive states (t=2.511, р=0.018), manifestations of post-traumatic growth ("Personal Strength", t=2.911, р=0.007; "New Opportunities", t=2.242, р=0.032), and psychological well-being (t=−3.106, р=0.004).

Conclusion: The practical significance of the study is attributed to the formation of evidence base for clinical psychology, improvement of approaches to diagnostics, and provision of clinical and psychological assistance to those affected by psychotraumatic events.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):521-530
pages 521-530 views

Diagnostic potentials of modern radiothermometry in oncomammological practice

Kulikov E.P., Demko A.N., Volkov A.A., Budanov A.N., Orlova N.S.

Abstract

Background: Radiothermometry (RTM) is a breast examination method that permits, besides visualization of the pathological foci, to evaluate the quality of metabolism, which is important for the determination of the biological subtypes of breast cancer (BC) and the possibility of the evaluation of the degree of tumor aggressiveness before immunohistochemical analysis.

Aim: To study the potentials of modern RTM in the differential diagnosis of benign and malignant breast pathologies and in different biological subtypes of BC.

Materials and methods: Overall, 118 patients with different breast pathologies were examined using РТМ 01 РЭС computerized diagnostic complex. Measurements were performed in nine points: directly on the breast ― for the visualization of tumor, in two control points (in the region of the epigastrium and sternal xiphoid process), and in one point in the axillary zone on both sides ― for the identification of probable metastases. The examination time was 15–20 min for each woman. RTM results were compared with histological, ultrasound, mammographic, and clinical data.

Results:  The sensitivity and accuracy of RMT in the differential diagnosis of breast pathology were 96.9% and 74.5%, respectively. The specificity of RTM in the differentiation of aggressive and non-aggressive BC subtypes appeared to be low at 6.6%. In the evaluation of the temperature difference between the pathological and normal tissues, a tendency to a non-increase in the temperature above the tumor in comparison with the unaffected tissue was noted; however, no significant differences between the mean values for the healthy and affected breasts were obtained. No correlations were found between the proliferative index of BC and frequency of thermoasymmetry or extent of its evidence (r < 0.3).

Conclusion: RTM demonstrated effectiveness in the differential diagnosis of benign and malignant alterations of the breast; thus, it is not a method of choice in the evaluation of the spread and biological subtype of BC.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):531-538
pages 531-538 views

Clinical cases

Clinical case of an unusual course of coronavirus infection in patient with chronic disseminated pulmonary tuberculosis and human immunodeficiency virus infection

Dobin V.L., Gorbunov A.V., Muratov Y.N.

Abstract

Introduction: The coronavirus 2019 (COVID-19) pandemic demonstrated a negative influence on many underlying diseases, their course, and prognosis. A combined course of active tuberculosis, human immunodeficiency virus (HIV) infection, and COVID-19 is a rare case in the routine clinical practice; therefore, it is of scientific and practical interest. In a 41-year-old patient with severe chronic disseminated pulmonary tuberculosis and HIV infection, presence of tuberculosis mycobacteria, resistance to streptomycin and isoniazid, chronic respiratory failure, cachexia, and immunodeficiency, COVID-19 was manifested only by the detection of SARS-Cov-2 virus from the nasopharynx and did not influence the treatment and prognosis of tuberculosis.

Conclusion: The described case of a combination of active tuberculosis with HIV infection and COVID-19 demonstrated that effective treatment of specific tuberculosis process is quite possible.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):539-544
pages 539-544 views

Reviews

Success and unsolved issues of embolization of the uterine arteries in uterine fibroid

Antropova E.Y., Sharafutdinov B.M., Ryzhkin S.A., Mazitova M.I.

Abstract

Introduction: According to the clinical recommendations of the Healthcare Ministry of Russia (2021), uterine artery embolization (UAE) in uterine fibroid is an alternative to surgical treatment in case of high surgical risk and absence of contraindications in women who do not desire pregnancy. The advantages of UAE are associated with lesser blood loss, shorter hospital stay, and recovery of the working capacity. Here, we present an analysis of the literature and our 14-year clinical experience in performing UAE in uterine fibroid. Screening and primary diagnosis of uterine fibroid and indications and contraindications of UAE in the current publications were analyzed. Different methods of EUA implementation were described, and the advantages of the transradial access (TRA) are demonstrated on the basis of the actual clinical experience.

Conclusion: The results obtained in the use of TRA revealed the reduction of radioscopy time and surgery time in general, which are beneficial in terms of the reduction of radiation exposure. Besides, an argument for the given access is a considerably lower frequency of serious complications at the access site. The main obstacles to the introduction and wide use of TRA are based on the lack of specialist experience, absence of specialized training programs, and use of unsuitable and traumatizing instruments. One of the unsolved questions is the absence of an anesthesia protocol, which must be developed with the participation of both gynecologists and specialists on X-ray endovascular diagnostics and treatment.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):545-556
pages 545-556 views

Chronicles

P. K. Anokhin’s answer to E. A. Asratyan’s review of “Biology and neurophysiology of conditioned reflex” monograph. Echo of Pavlovian session

Sherstnev V.V.

Abstract

The article presents previously unpublished documents, comments, and materials that were directly related to significant events in the life and performance of a Russian scientist and academician P. K. Anokhin, such as the Lenin Prize award and the Pavlovian session. The text of P. K. Anokhin’s answer to the review of a corresponding member of the USSR Academy of Sciences E. A. Asratyan of P. K. Anokhin’s monograph “Biology and Neurophysiology of Conditioned Reflex” submitted to the competition for the Lenin Prize, was published. In 1972, P. K. Anokhin was awarded the Lenin Prize for the monograph “Biology and Neurophysiology of Conditioned Reflex”. P. K. Anokhin answered the accusatory statements of the reviewer concerning the “danger” of the functional system for the Pavlovian doctrine and the analytical nature of the scientific method of I. P. Pavlov and answered critical questions about the “synthetic” and “systemic” approach and the priority in the development of the theory of systems and feedback.

The work presented literature facts that the statements and questions of Asratyan were consistent with his accusatory comments about P. K. Anokhin at the Pavlovian session — the scientific session of the USSR Academy of Sciences and of the USSR Academy of Medical Sciences, dedicated to the physiological doctrine of academician I. P. Pavlov, which was held in Moscow in July–August 1950. At the session, P. K. Anokhin was accused of “revision” of the ideological foundations of Pavlov’s teachings and of detraction of the significance of Pavlov’s theory of the higher nervous activity.

After the Pavlovian session, P. K. Anokhin was dismissed from the post of the director of Institute of Physiology of the USSR Academy of Medical Sciences, dismissed from the Presidium of the USSR Academy of Medical Sciences, and appointed Professor of the Department of Physiology of Ryazan Medical Institute. Over the years, E. A. Asratyan persistently criticized P. K. Anokhin as the “opponent of I. PPavlov’s teaching” and actively rejected the theory of functional systems.

Conclusion: The presented documents have not lost their significance even now. These documents are important for understanding the ideological essence of the systemic approach and of the theory of functional systems and are interesting for the history of Russian physiological science and medicine.

I.P. Pavlov Russian Medical Biological Herald. 2021;29(4):557-565
pages 557-565 views


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