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Vol 30, No 1 (2022)

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Original researches

Syntopy of Pulmonary Vein Orifices in the Left Atrium of the Human Heart

Gaponov A.A., Noskova M.E., Yakimov A.A.


INTRODUCTION: The syntopy of the left atrial (LA) structures is the least studied aspect of the normal heart anatomy. The morphometric data on the position of orifices of the pulmonary veins in the LA walls relative to the adjacent heart structures and heart vessels are important as reference parameters of heart morphology and are needed in the endovascular treatment of atrial fibrillations.

AIM: To establish the general patterns and topospecific peculiarities of the location of the pulmonary vein orifices relative to the oval fossa and orifices of the venae cavae using morphometric methods of anatomical preparations of conventionally normal adult human heart.

MATERIALS AND METHODS: Fifty–four wet anatomical preparations of the heart without macroscopic signs of hemodynamically significant cardiac pathology were studied. The preparations were obtained from patients aged 35–89 years who died from diseases not related to heart pathology. LA diastole was modeled by filling its cavity with silicone; after it hardened, the distances from the oval fossa and orifices of the venae cavae to the orifices of the pulmonary veins were measured using sliding calipers.

RESULTS: The article presents variation, medians, and extreme values of distances from the oval fossa and orifices of the venae cavae to the orifices of the pulmonary veins at the site of their opening to LA. The significance of differences of morphometric parameters of the topography was evaluated, and their correlation and one–way regression analyses were implemented. The strongest regression dependence was found for LA width and distance from the orifice of the superior vena cava to the orifice of the left inferior pulmonary vein (Y) r2 = 0.45; Х = 19.94 + 0.545Y). The heart dimensions and LA length were not significant predictors for the studied parameters.

CONCLUSION: The right pulmonary veins were located expectedly closer to the orifices of the venae cavae and the oval fossa than the left pulmonary veins. The narrowest was the space between the orifices of the superior vena cava and the right superior pulmonary vein. The farthest from the orifices of both venae cavae was the orifice of the left inferior pulmonary artery. The strongest correlation relationships were characteristic of the distances from the orifices of both venae cavae to the orifices of the homolateral pulmonary veins, which we propose to consider as one of the criteria of the harmoniousness of the structure of the atrial complex.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):5-12
pages 5-12 views

Changes in the Deformability and Resistance of Erythrocyte Membranes under the Action of Gamma-Aminobutyric Acid Derivatives in the Offspring of Rats with Experimental Preeclampsia

Muzyko E.A., Naumenko L.V., Perfilova V.N., Zavadskaya V.E., Varlamova S.V., Tyurenkov I.N., Vasil'yeva O.S.


INTRODUCTION: Preeclampsia is a severe complication of pregnancy associated with the negative consequences for the mother and child. Such complications can be a reduction in the resistance of erythrocyte membranes to damaging agents and alteration of rheological properties of the blood in offspring. Promising compounds for the correction of these negative consequences of preeclampsia are gamma-aminobutyric acid (GABA) derivatives, which showed membrane–protective, antioxidant, and antihypoxic effects in previous studies.

AIM: To evaluate the effect of GABA derivatives Succicard® (4-phenylpiracetam and ethane-1,2-dicarboxylic acid, 2:1), Salifen® (4-amino-3-phenylbutanoic acid and 2-hydroxybenzoic acid, 2:1), and Phenibut® (aminophenylbutyric acid) on the deformability and resistance of erythrocyte membranes in 8- and 14-month-old offspring of rats with experimental preeclampsia (EP).

MATERIALS AND METHODS: The study involved offspring (male and female) of white non-inbred female rats with a normal pregnancy and EP that was modeled by replacement of drinking water with a 1.8% sodium chloride solution during gestation (1–21 days). For 30 days (from day 40 to day 70 of life), pup rats intragastrically received Succicard® (22 mg/kg), Salifen® (7.5 mg/kg), and Phenibut® (25 mg/kg), along with a comparison drug Pantogam® (calcium gopantenate) (50 mg/day) once a day. The offspring of the positive and negative control groups were injected with distilled water in a similar mode. In offspring aged 8 and 14 months, the resistance of erythrocyte membranes to the action of hydrochloric acid and their deformability were determined.

RESULTS: In 8-month-old male offspring of rats with EP, a shorter time of achievement of half the maximal amplitude of erythrogram was noted in acid hemolysis relative to the positive control group, and the erythrocyte elongation index was reduced. Relative to the negative control group, Succicard®, Salifen®, Phenibut®, and Pantogam® promoted the prolongation of hemolysis and the erythrocyte elongation index in 8-month-old male rats in the experimental groups. In 14-month-old male and female rats of different ages, no statistically significant differences were found between the groups.

CONCLUSION: Changes in the stiffness and strength of erythrocyte membranes were noted only in male offspring of rats with EP. Succicard®, Salifen®, Phenibut®, and Pantogam® produced membrane-protective effects on the erythrocytes of 8-month-old male rats of the experimental groups.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):13-20
pages 13-20 views

Parameters of B-Cell Immunity and Their Diagnostic Significance in Preeclampsia of Different Severities

Panova I.A., Kudryashova A.V., Panashchatenko A.S., Rokotyanskaya E.A., Malyshkina A.I.


INTRODUCTION: Preeclampsia (PE) is a multisystem pathological condition occurring after 20 weeks of pregnancy. According to some scientists, the pathogenetic mechanisms of PE are based on the abnormal response of the mother’s immune system to factors of placental origin.

AIM: To assess the parameters characterizing the condition of B-cells in female patients with PE and to develop the prognostic criterion for the effective treatment of moderate PE.

MATERIALS AND METHODS: A total of 121 women at 24–36 weeks of gestation were examined. The main group included 69 pregnant women with PE in which 36 had moderate PE (group 1a, 18 women with positive effects of PE treatment; group 1b, 18 women with no effect of PE treatment) and 33 had severe PE. The control group included 52 patients with no hypertensive disorders. In the peripheral blood, the relative content of CD19+ and CD20+ В-lymphocytes and their subpopulations, namely, regulatory B-cells (CD20+IL-10+), memory B-cells (CD19+CD27+IgD±), and plasmocytes (СD19+СD20-СD38+), were evaluated by flow cytofluorometry. Statistical analysis was performed using Statistica for Windows 6.0, Microsoft Excel 2010, and MedCalс programs. The diagnostic significance of the studied parameters was evaluated by ROC analysis.

RESULTS: The comparison of all the studied parameters of the content of B-lymphocytes and its subpopulations did not reveal any significant differences in patients with PE of different severities (p > 0.05 in all cases). In the comparative analysis of women with moderate PE exhibiting either positive or no treatment effects, a low level of CD20+В-lymphocytes and a high level of CD19+CD20-CD38+ plasmocytes were noted in the former. In addition, the presence of > 2.8% of CD19+CD20-CD38+ cells in the peripheral blood predicts a positive treatment effect on moderate PE, while ≤ 2.8% predicts an ineffective treatment and aggravation of the PE.

CONCLUSION: The reduction of plasmocytes and absence of treatment effect on moderate PE may be associated with the migration of plasmocytes to the target organs, which leads to the worsening of the immunopathological process during the course of PE. The content of CD19+CD20-CD38+ cells in the peripheral blood can be used to predict treatment efficacy on moderate PE.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):21-28
pages 21-28 views

Effect of Vildagliptin on the Level of P-Glycoprotein Expression in Normal Conditions and Alloxan–Induced Type 2 Diabetes Mellitus

Titov D.S., Pravkin S.K., Nikiforov A.A., Savost’yanova E.S., Maystrenko M.A.


INTRODUCTION: Vildagliptin is one of the drugs of choice in the treatment of type 2 diabetes mellitus (DM). In the literature review, no study has reported the effect of vildagliptin on the expression level of the transporter protein P-glycoprotein (P-gp, ABCB1 protein).

AIM: To assess the in vivo effects of vildagliptin on the level of Р-gp expression in normal conditions and experimental alloxan-induced type 2 DM.

MATERIALS AND METHODS: Type 2 DM was induced by a single intravenous injection of freshly prepared alloxan monohydrate solution in citrate buffer (pH = 4.0) at a dose of 80 mg/kg. Glucose content (mmol/L) was determined by the glucose oxidase method using Human kit (Germany) and insulin content (µU/mL) by radioimmunoassay technique using Immunotech kit (Czech Republic). As an express method for the determination of glucose levels in the whole blood, OneTouch UltraEasy electrochemical glucose monitor (USA) was used. The level of P-gp expression in rabbit tissues (i.e., jejunum, liver, kidney, and cerebral cortex) was evaluated by the indirect histochemical method. After preliminary treatment, the histological material was embedded in paraffin. Antigens were retrieved before the immune-staining reaction. Then, the sections were incubated with primary antibodies to P-gp (ABCB1 antibody, middle region; 0.1 mL [Aviva Systems Biology ARP51326-P050, USА]). For immune staining, a polymer detection system with a peroxidase label (Leica Microsystems, Germany) was used. The cell nuclei were stained with hematoxylin. Photos of the micropreparation were captured using Canon Power Shot G5 digital camera with 400× magnification. Digital images were analyzed and processed using ImageJ and IHC Profiler plugin designed for quantitative immunohistochemical analysis. The results obtained from healthy animals, animals with alloxan-induced DM, healthy animals administered vildagliptin, and animals with modeled DM administered vildagliptin were compared.

RESULTS: After day 14 of administration to healthy rabbits and day 5 of vildagliptin discontinuation (5 mg/kg), no statistically significant changes in P-gp expression in the aforementioned tissues and the levels of basal and postprandial insulin and blood glucose were noted. After the 14-day therapy of alloxan-induced type 2 DM with vildagliptin (5 mg/kg), a statistically significant recovery of expression of the P-gp expression in the jejunum, liver, and kidney was reduced due to the underlying pathology. In addition, the values of healthy rabbits and statistically significant normalization of the insulin and blood glucose levels were observed. On day 5 of drug cancellation, significant inhibition of P-gp expression in the jejunum, liver, and kidney was noted again, and there was a significant reduction of postprandial insulin and blood glucose. No significant alterations of ABCB1 protein expression in the hematoencephalic barrier were noted during the studied periods.

CONCLUSION: The administration of vildagliptin (5 mg/kg) to rabbits with alloxan-induced type 2 DM promotes the recovery of P-gp expression in the jejunum, liver, and kidney, which were reduced due to the underlying pathology. Meanwhile, its administration to healthy animals had no significant effect on the expression of P-gp.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):29-38
pages 29-38 views

Implementation of the Lean Approach in the Context of the New Model of Medical Organization: Results and Prospects

Fedos'kina A.K., Fedos'kina L.A.


BACKGROUND: Given the aggressive spread of the novel coronavirus disease, more active implementation of the lean production principles is necessary for the construction of a new medical organization (MO) model that can be more effective for the generalization of existing experience and development of ways to overcome arising problems.

AIM: To identify key problems that arise during the formation of a new MO model based on a lean approach and to substantiate recommendations for overcoming them.

MATERIALS AND METHODS: The depth of the implementation of the principles of lean production was examined through a content analysis of the activities of MO positioning themselves as regional leaders. A systematic assessment of the results of their activities was developed based on the criteria of a new MO model providing primary medical and sanitary care. Seven medical institutions from different regions of the Russian Federation, i.e., the Volgograd, Khanty–Mansiysk, Vologda, Belgorod, Kirov, Sevastopol and Vsevolozhsk, and Leningrad regions, were selected as study objects. Their geographical separation allowed identifying systemic problems in the introduction of the lean-manufacturing methodology and to present their generalized assessment. Trends in changing consumer preferences of MO patients were evaluated, the depth of the implementation of the lean approach in Russian MO was analyzed, the problems of creating a new MO model were identified, and the directions of overcoming them were determined.

RESULTS: The content analysis of the depth of the successful implementation of MO activities identified the most frequently realized and completely unrealizable criteria of the new MO model. On this basis, three key problems of the application of the lean production principles in Russian medical institutions were identified: the lack of an integrated approach to the reorganization of activities, high formality of ongoing transformations, and insufficient involvement of all participants in providing medical services. These problems are possibly overcome by the following promising solutions: 1) informing medical staff about the results of already–implemented projects and increasing the level of visualization in management, 2) preferential realization of short–term, but effective projects, at the first stages, 3) application of the cascade principle of educating employees about the principles of lean production, 4) creation of a motivation system that supports continuous improvements, 5) expansion of the interaction between MO of different profiles, and 6) increasing the level of involvement of management, medical staff, and patients in MO processes.

CONCLUSION: The results of this study indicate the high awareness of the need to apply lean thinking in the activities of a modern MO. The degree of implementation of the principles of lean production becomes a determining condition for increasing the efficiency of their activities and competitiveness in the market of medical services.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):39-50
pages 39-50 views

Clinical Manifestations and Diagnosis of Pulmonary Embolism in Routine Clinical Practice: Data from the Ryazan Regional Vascular Center

Yakushin S.S., Nikulina N.N., Terekhovskaya Y.V.


BACKGROUND: Data on the peculiarities of the clinical presentation and characteristics of pulmonary embolism (PE) and problems of its diagnosis in routine clinical practice (CP) are limited. Data obtained long ago are mostly described in terms of venous thromboembolism in general and practically do not include Russian patients with PE. The study was performed within the RusSIan REgistery of pulmoNAry embolism (SIRENA) register.

AIM: To study the peculiarities of the clinical and demographic profile and diagnosis of PE in modern CP in comparison with the results of other PE registers.

MATERIALS AND METHODS: In this registry-based study, medical records were analyzed to obtain information on the demographic profile, clinical presentation, and examination results of patients with PE (n = 107; age, 63 (52–74) years; men, 39.3%) who received inpatient treatment in one of the Ryazan Regional Vascular centers. The study period was 13 months (2018–2019).

RESULTS: The most common concomitant pathologies were arterial hypertension (70.1%), obesity (46.7%), and diabetes mellitus (17.8%). High- and moderate-risk factors were identified in 26.2% and 72.9% of the patients, respectively. Low-risk factors identified in 5.6% of the patients in different combinations did not have a single risk factor for PE development. Clinical manifestations included shortness of breath (93.5%), chest pain (43.0%), severe weakness (59.8%), tachycardia (29.0%), hypoxemia (27.1%), and unstable hemodynamics (18.7%). The most frequent electrocardiographic sign was a T-wave inversion in the right chest leads (52.3%). Right ventricle dysfunction was detected in 38.1% of the cases and elevation of troponin levels in 33.6%. According to the Pulmonary Embolism Severity Index scale, high- and very-high-risk cases accounted for 46.7% of the cases. According to the results of the integrated assessment of PE severity, 34.6% and 14.0% of the patients moved to the lower- and higher-risk classes, respectively. The proportion of moderate-risk cases increased from 23.4% to 62.6%, and the high- and very-high-risk cases reduced from 46.7% to 32.0%.

CONCLUSION: The modern clinical picture of PE is characterized by a higher prevalence of concomitant pathology and reduction of the rates of traditional risk factors. There remain difficulties in PE diagnosis, which are associated with the concomitant pathology, absence of traditional risk factors, and non-specificity of the clinical manifestations and results of additional examinations.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):51-62
pages 51-62 views

Epidemiological and Metabolic Aspects and Risk Factors of Chronic Kidney Disease in Comorbid Pathology of Type 2 Diabetes Mellitus and Primary Hypothyroidism

Berstneva S.V., Uryas’yev O.M., Dubinina I.I., Nikiforov A.A.


INTRODUCTION: The increasing number of patients with diabetes mellitus (DM) and chronic kidney disease (CKD) is one of the most pressing problems of modern medicine. In comorbid pathology — a combination of type 2 DM and thyroid hypofunction — the negative effect of hypothyroidism on carbohydrate metabolism, lipid metabolism, endothelial function, and glomerular filtration rate (GFR) is a risk factor for the formation and progression of diabetic nephropathy and CKD and requires further study.

AIM: To identify risk factors and epidemiological peculiarities of CKD in type 2 DM in combination with thyroid hypofunction and to determine the possibility of using cystatin C levels for the evaluation of the kidney function in this pathology.

MATERIALS AND METHODS: The prospective study involved 203 patients with type 2 DM undergoing inpatient treatment in the endocrinology department of the Ryazan Regional Clinical Hospital: group 1 (n = 76), type 2 DM combined with the primary hypothyroidism, and group 2 (n = 127), type 2 DM without thyroid pathology. Carbohydrate, lipid metabolism, albuminuria (AU), thyroid hormone spectrum, adipokines (leptin, plasminogen activator inhibitor-1, interleukin-6, and tumor necrosis factor-α) were analyzed. The GFR was calculated using the CKD-EPI formula based on the levels of creatinine and cystatin C. Arterial pressure daily monitoring (APDM) was conducted, and intra-abdominal fat thickness was evaluated by ultrasonography.

RESULTS: The incidence of kidney pathology in patients with type 2 DM was 52.22%. In group 1, there was a significant increase in the prevalence of CKD (64.47%, p = 0.006) and of normoalbuminuric CKD (NAU-CKD, 32.89%; p = 0.010). The risk of CKD development in patients with concomitant PH was more than twice that in patients without thyroid pathology with an odds ratio of 2.229 (95% confidence interval (CI) 1.241–4.003) and that for NAU-CKD was 2.474 (95% CI 1.267–4.833). Significant impairment of several metabolic parameters and individual APDM parameters was revealed in group 1 in comparison with group 2. The dependence of AU and GFR on the body mass index and of AU on the intra-abdominal fat thickness was noted. A negative relationship between GFR and leptin was revealed; in group 1, a correlation of interleukin-6 and thyrotropic hormone was found (r = 0.809, p = 0.001). With concomitant PH, cystatin C values were lower, and the GFR (CKD-EPI-cys) was reliably higher.

CONCLUSION: Hypothyroidism is a risk factor for CKD development including NAU-CKD in type 2 DM. Obesity and hormonal activities of the intra-abdominal fatty tissue facilitate AU progression and GFR reduction. The use of cystatin C as a marker of the filtration function of the kidney in patients with hypothyroidism may lead to the underestimation of kidney function; thus, further investigation is required.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):63-74
pages 63-74 views

Predictors of the Effectiveness of Medical Rehabilitation of Patients with Cerebral Palsy

Sheyko G.E., Belova A.N.


INTRODUCTION: Cerebral palsy (CP) is one of the most common causes of disability in children. The use of clinical tools that will allow the prediction of results is necessary for the medical rehabilitation of children with CP. Although clinical and socio-economic factors that determine the prognosis of rehabilitation and further social adaptation of patients with CP are being actively investigated, predictors that help predict the effectiveness of medical rehabilitation measures are not yet identified.

AIM: To determine the predictors of the effectiveness of medical rehabilitation in children with CP using anamnesis, scales, and questionnaire data.

MATERIALS AND METHODS: The study involved 29 children (average age, 5.4 ± 1.1 years) with various forms of CP who underwent medical rehabilitation in inpatient and outpatient conditions within 12 months. Before and after rehabilitation courses, all patients, apart from general somatic-clinical and neurological examinations, underwent tests that use specialized questionnaires and scales and evaluation using the International Classification of Functioning, Disability and Health (ICF) Core Sets for children and adolescence with cerebral palsy. The patients were arranged into groups depending on the presence of improvement determined using the author-developed criterion: reduction of the determinant level relative to “function” and “activity and participation” components of ICF by a minimum of at least one point in three domains. Various uni- and multivariate logistic regression models were used to evaluate the prognostic significance of history, scales, and questionnaire data. Receiver operating characteristic curves were constructed to determine the threshold values of quantitative parameters optimal for predicting a certain treatment outcome.

RESULTS: The Gross Motor Function Measure 88 score of >82.1% before the rehabilitation measures indicated a positive rehabilitation prognosis. ICF domains b760 “control of voluntary movement functions”, d415 “maintaining a body position”, and d710 “basic interpersonal relations” are predictors of the effectiveness of rehabilitation in patients with a CP with determinant level ≤ 1.

CONCLUSION: The results demonstrated that higher parameters of motor and coordination functions and higher levels of interpersonal interactions of children with ICP are significant predictors of the effectiveness of rehabilitation.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):75-86
pages 75-86 views

Potentials of 3D-Modeling in the Preclinical Stage of Root Needle Research

Kuligin A.V., Kazakova L.N., Tereshchuk O.S., Bokov V.V.


INTRODUCTION: At present, the issue of high–quality processing of the root canal (RC) of the deciduous and permanent teeth remains important. However, the procedure is hindered by the complex anatomical shape of the RC and a presence of deltoid branches. A combination of the mechanical and drug treatment of the RC allows achieving the sterility of the tooth cavity, which is very important in the development of chronic periodontitis. However, to achieve sterility during drug treatment, dentists face a new problem of how to avoid damage to periodontal tissues using an antiseptic agent with the apical foramen opened. The technical characteristics of endodontic needles available for use at this stage failed to effectively solve this problem. Thus, the multitude of issues substantiates the need to improve the design of endodontic needles.

AIM: To determine the optimal technical characteristics of endodontic root needles and to develop a new design of an endodontic needle that allows uniform irrigation of the RC delta with minimal probability of damaging the periapical tissues.

MATERIALS AND METHODS: In designing an endodontic needle with the required technical characteristics, parameters that influence the quality of cleaning the RC were analyzed in SolidWorks 16 program. Computer modeling of the biological tooth model was implemented in SolidWorks Flow Simulation program.

RESULTS: Computer modeling was used to improve the endodontic root needle. Technical results were achieved by incorporating in the design all the positive aspects of analogs and eliminating the disadvantages. The designed endodontic needle contained 1 hole on the tip and 168 holes arranged in a checker–wise manner on the lateral surface. All holes have the same diameter of 0.1 mm, which evens out the pressure, reduces the central flow rate to the rate of peripheral flows, ensures uniform irrigation, and minimizes the likelihood of damage to the alveolar process.

CONCLUSION: A new model of an endodontic needle with one hole on the tip and 168 holes arranged in a checker–wise manner on the lateral surface ensures uniform irrigation of the RC surface and the entire perimeter with minimal likelihood of damaging periapical tissues even with the maximal depth of insertion of the needle into the RC.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):95-100
pages 95-100 views

Chronic Endotoxemia and Peculiarities of Systemic Inflammatory Response in Patients with Osteoarthrosis Requiring Primary Arthroplasty of Large Joints

Gladkova E.V., Babushkina I.V., Ulyanov V.Y., Mamonova I.A.


INTRODUCTION: Infectious complications after the primary arthroplasty of large joints in patients with end-stage osteoarthrosis are often associated with self-opportunistic pathogenic microflora in cases of compromised immune response and systemic inflammatory reactions. Thus, the associated pathogenic mechanisms require additional study.

AIM: To examine the peculiarities of signs of endotoxemia and the severity of the systemic inflammatory response (SIR) in patients with osteoarthritis of large joints requiring primary arthroplasty.

MATERIALS AND METHODS: A total of 110 patients (67 women, 43 men, average age 49.2 years, age range 41.1–52.8 years) with stage III–IV primary osteoarthrosis of the knee joints and 30 healthy individuals (control group) (15 men, 15 women, average age 49.4 years, age range 37.2–53.1 years) were examined. Analyses were carried out on blood serum concentrations of the endotoxemia parameter lipopolysaccharide (LPS), acute-phase proteins (C-reactive protein [CRP]), lipopolysaccharide-binding protein (LBP), and markers of the proinflammatory activity of cytokine regulation system (interleukine-1β [Il-1β]) and activation of cell-mediated immunity (neopterin). Correlation relationships between the studied parameters were evaluated depending on the severity of the SIR.

RESULTS: Forty patients were identified (28 women, 12 men) to have signs of high inflammatory activity (CRP concentration ≥ 7.59 g/L and erythrocyte sedimentation rate ≥ 10 mm/h) and evident synovitis based on the ultrasound data of the joint. The parameters in this group were analyzed: LPS, 12.08 (10.77; 12.65) ng/mL; LBP, 26.31 (25.48; 27. 11) µg/mL; Il-1β, 8.4 (7.3; 8.7) pg/mL; and neopterin, 9.36 (8.58; 9.62) pg/mL. These values significantly (р < 0.05, Kruskal–Wallis test) exceeded the values in the moderate SIR activity and control groups. Correlation analysis (Spearman r-test) in patients with signs of enhanced inflammatory activity revealed a moderate positive relationship between LPS and CRP concentrations, and reduction of positive relationships between LPS and Il-1β and in LPS and LBP.

CONCLUSION: Impaired SIR with the underlying excessive proinflammatory activity of the cytokine regulation system, activation of the cell-mediated immunity, and systemic endotoxemia in patients with end-stage osteoarthrosis of large joints requires additional preoperative and postoperative monitoring. The results substantiate the necessity of a detailed investigation of endotoxemia as a probable component of the pathogenesis and sanogenesis of complications following the primary arthroplasty of large joints.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):87-94
pages 87-94 views

Clinical cases

Treatment of Metastatic Brain Lesion Using Osimertinib: A Case Report

Kazakova S.S., Dushina E.V.


INTRODUCTION: The article presents clinico-radiological examination data of a female patient with a metastatic brain lesion identified four years after a right upper lobectomy for lung adenocarcinoma. The results of dynamic magnetic resonance imaging (several examinations with intervals from three months to one year) from the onset of the first neurological signs, progression of the disease, to the regression of the pathological focus were analyzed. The molecular genetic study revealed deletion in exon 19 of the EGFR gene and mutation of the Т790M gene. Consequently, osimertinib, a third-generation tyrosine kinase inhibitor with a higher ability to penetrate the hematoencephalic barrier than the first and second generations, was initiated.

CONCLUSION: The presented clinical case demonstrated the positive therapeutic effect of osimertinib on a patient with a metastatic brain lesion identified four years after the right upper lobectomy for lung adenocarcinoma, which was confirmed by a reduction of the volume of the metastatic focus and an absence of contrast accumulation via magnetic resonance imaging.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):101-107
pages 101-107 views

Intraoperative Finding of a Patient with Uterine Fibroid

Baklygina E.A., Pchelintsev V.V., Pristupa E.M., Verkina E.N.


INTRODUCTION: Most neoplasms in the pelvic cavity of women arise from organs of the reproductive system. However, diseases of the gastrointestinal and urinary tracts and neoplasms of a neurogenic and primary extraperitoneal nature can be also encountered in the pelvis where they may be mistaken as gynecological pathology. Thus, in an intraoperative discovery of previously undiagnosed foci of tumor lesions the surgical approach has to be changed, which can negatively affect the results of surgical treatment. Gastrointestinal stromal tumors (GISTs) refer to the most common tumors of the gastrointestinal tract originating from the mesenchymal anlage. Up to 70% of GISTs are located in the stomach, 20%–40% in the duodenum and small intestine, 5%–15% in the colon, and 2%–5% in the esophagus, with single tumors occurring in the appendix.

CONCLUSION: The article presents a clinical case of a patient who underwent hysterectomy for multiple uterine fibroids and in whom a large GIST of the sigmoid colon was found intraoperatively that was previously mistaken as one of the subserous nodes of uterine fibroids.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):109-114
pages 109-114 views

Potentials of Using Allografts in Surgical Treatment of Popliteal Artery Aneurysms

Kalinin R.E., Suchkov I.A., Karpov V.V., Egorov A.A.


BACKGROUND: The gold standard in reconstructive surgical operations on the infrainguinal arteries is the autovenous conduit from the great saphenous vein. However, in the absence of a suitable autovein, difficulties are encountered in the selection of a suitable material for reconstruction. The use of a synthetic prosthesis as an alternative in the knee joint region is not always possible, especially in the distal position. Unsatisfactory results of using such materials dictate the need to choose a suitable graft. The paper describes two case experiences of using allografts from a deceased donor for the surgical treatment of popliteal artery aneurysms. The cases present their potential for use in emergency clinical situations. In the first case, the patient had previously undergone phlebectomy. In the second case, the saphenous veins of the lower limbs had scattered branches and insufficient diameter for reconstruction.

CONCLUSION: The described cases presented the possible effective use of allografts from a deceased donor in patients with true popliteal artery aneurysms.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):115-122
pages 115-122 views


Role of Microribonucleic acid in the Carcinogenesis of Non-Small-Cell Lung Cancer

Gubenko M.S., Loginov V.I., Burdennyy A.M., Pronina I.V., Khokhlova S.V., Pertsov S.S.


INTRODUCTION: Lung cancer is the most common malignant neoplasm. Despite advances in target therapy, immunotherapy, and chemotherapy, non-small cell lung cancer remains the major cause of cancer-related death worldwide. Tumor development is a complex process that depends on the influence of environmental factors and genetic predisposition. Although oncogenic factors have received much attention, the main mechanisms for oncogenesis are still poorly understood. Thus, studying the oncogenic mechanisms, including those with the involvement of microribonucleic acid (microRNA), is important for the diagnostics and treatment of malignant neoplasms. MicroRNA (miRNA) belong to the class of small non-coding ribonucleic acids that are involved in various cellular biological processes, including epithelial–mesenchymal transition, apoptosis, proliferation, invasion, and metastatic dissemination of cancer cells. Recent publications show that the course of the oncological disease can be predicted by evaluating the expressions of some miRNAs. Therefore, miRNAs serve as promising diagnostic and therapeutic targets in oncological diseases.

CONCLUSION: This review summarizes data on the role in carcinogenesis and prognostic significance of several miRNA (i.e., miRNA-128, -4500, -222, -224, -124, -125b, -127, -129-2, -137, and -375) in non-small cell lung cancer.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(1):123-132
pages 123-132 views

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