Vol 26, No 1 (2018)

Morphology and pathological anatomy
Distribution of nadph-diaphorase positive structures of olfactory bulb of rats in ontogenesis
Varentsov V.E., Rumyanceva T.A., Myasishcheva T.S.
Abstract

Aim: to identify peculiarities of distribution of NADPH-diaphorase (NADPH-d) positive structures in olfactory bulbs of rats of different age.

Materials and Methods. The study was conducted on 22 white male rats. The object of research was olfactory bulbs of newborn rats – 1-3 days, suckling period – 7, 14, 21 days, infantile – 30 days, juvenile – 60, and mature – 180 days. The study was conducted on cryostat serial sections of olfactory bulbs (20 µm). Nitroxidergic structures were identified by histochemical labelling of NADPH-d (by Hope method). In a standard section, the area of NADPH-diaphorase-positive cells (100 in each case), surface area of glomeruli, the number of positive neurons surrounding a glomerulus, were measured.

Results. In result of study it was found that in the olfactory bulb of rats of the studied age only groups of superficial and deep short-axon neurons and periglomerular neurons showed positivity to NADPH-d. The end product of reaction was distributed in somas and extensions of a part of cells with the density of distribution depending on the layer of the olfactory bulb and on the age of animals. Besides, positivity to the enzyme was also found in the central parts of glomeruli with distribution of diaphorase depending not on age, but rather on localization of glomeruli.

Conclusion. Age-related transformations of positive subpopulation of neurons of olfactory bulb indicate active participation of NO in the processes of postnatal differentiation, growth and development of olfactory bulb.

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):5-20
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Pharmacology, clinical pharmacology
Possible ways of pharmacological correction of ischemic liver damages using agonist of peripheral imidazoline receptors c7070
Dovgan A.P., Povetkin S.V., Batishcheva G.A., Dolzhikov A.A., Pokrovsky M.V., Urozhevskaya Z.S.
Abstract

A comorbid condition both in diabetes mellitus and in metabolic syndrome is fatty dystrophy of the liver that further progresses to hepatic necrosis. In the article variants of pharmacological correction of ischemia-reperfusion of the liver with agonists of imidazoline receptor are proposed.

Materials and Methods. The experiment was conducted on 70 rats of both sexes divided into 7 groups (n=10): intact group; pseudo-operated animals (incision of the abdominal wall without ligation of hepatic vessels); animals subject to ischemia/reperfusion without drug correction; animals subject to ischemia/reperfusion of the liver + metformin (50 mg/kg); animals subject to ischemia/reperfusion of the liver + moxonidine (1 μg/kg); animals subject to ischemia/reperfusion of the liver+С7070 (10 mg/kg). For evaluation coefficients were used calculated from the level of hepatic transaminases: alaninaminotranspherase (ALT), aspartataminotranspheras (AST), – and also from morphometric ratios of the areas of necrosis and deep ischemia of the liver on the basis of histological examination.

Results. Agonist of peripheral imidazoline receptors C7070 reduces ischemic-reperfusion damages to the liver to a significantly larger extent than moxonidine and metformin. Hepatoprotective effect of C7070 was removed by preliminary introduction of peripheral imidazoline receptor blocker. ALT/AST coefficients for C7070, moxonidine and metformin were 72.8/62.13; 44.99/34.20 and 36.88/21.02, respectively. Coefficients of morphological hepatoprotective activity of the drugs were: С7070 – 82.61, moxonidine – 72.33, metformin – 38.96.

Conclusion. Agonists of imidazoline receptors reliably and significantly reduce functional and morphological manifestations of ischemia/reperfusion of the liver.

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):21-35
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Hygiene, ecology, epidemiology, healthcare organization, history of medicine
Revisited the classifier of the main dental treatment-diagnostic activities and technologies
Uspenskaya I.V., Yurina S.V.
Abstract

Starting from 1988 to the present time, dentists’ labor accounting is carried out by measuring the volumes of their work, expressed in standard units of labour input. This system of accounting is aimed at providing maximum assistance during one visit, reducing unproductive time, increasing preventive work.

The article deals with the organization and payment for primary dental care provided on an outpatient basis within the framework of the compulsory health insurance program. An assessment is made of the conformity of the "Classifier of basic health services for primary health specialized dental care, provided in outpatient settings, expressed in standard units of labour input (SULI)» to the standard time spent per 1 SULI, taking into account the new standard indicators.

Scale of cost units as per 1 SULI was defined on the basics of the most common dental practice of the day: a five-day 33-hour work week of a dentist-therapist. On the average, the standard time spent on 1 SULI is 9.9 minutes. This proves that the normative time spent on 1 SULI corresponds to the indices of the “Classifier…”, and that it is defined regarding the time norms, spent by a dentist-therapist on 1 visit (44 minutes).

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):36-46
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P. K. Anokhin is the founder of theory of functional systems (to 120th birthday anniversary of academician Pyotr Kuzmich Anokhin)
Lapkin M.M., Kiryushin B.A., Kozeevskaya N.A.
Abstract

The article is dedicated to 120th birthday anniversary of a well-known Soviet scientist, the author of theory of functional systems, academician of Academy of Medical Sciences of the USSR and Academy of Sciences of the USSR, Pyotr Kuzmich Anokhin (1898-1974). In the article the main milestones of his life, of his scientific and pedagogical activity are considered.

P.K. Anokhin was among the talented pupils of academician I.P. Pavlov. Having gained a substantial physiological knowledge under his guidance, Anokhin very early showed his worth as an independent original researcher developing a new important section of physiology.

P.K. Anokhin is one of leading physiologists of the XX century. He inherited the best traditions of the classic Russian physiology and created his scientific school.

P.K. Anokhin focused his research work on investigation of neurophysiological mechanisms underlying the activity of the nervous system, but the main direction of his theoretical and experimental work was a study of an organism as an integral formation. The theory of functional systems proposed by P.K. Anokhin is widely recognized in the world science, and he is the founder of the systemic approach in physiology and biology.

Results of his research, his many-sided heritage and productive ideas proposed and developed by him during more than 50 years of his activity are used not only in physiology, but also in other fields of knowledge: biology, mathematics, pedagogics, philosophy…Works of P.K. Anokhin gained him recognition and acknowledgement in the international science which is evidenced by numerous references to his works in the modern scientific medical literature.

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):47-58
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Internal medicine
Management of patients with ulcerative colitis with account of microbiological examination of bioptate of colon wall
Davydova O.E., Andreev P.S., Katorkin S.E., Lyamin A.V., Kiseleva I.V., Lichman L.A., Bistrov S.A.
Abstract

Ulcerative colitis (UC) is a common disease with the evident tendency to annual increase in incidence. The disease mostly affects young individuals of active working age. The peak of incidence of the disease is observed at the age of 20-29 and 50-55 years.

The aim of study was optimization of diagnostics and management of patients with ulcerative colitis by correction of antibacterial therapy on the basis of the data of microbiological examination of the microflora of the wall of colon.

Materials and Methods. 35 Patients with ulcerative colitis from 28 to 61 years of age with the average age 37.6 years who underwent outpatient and stationary treatment in colonoproctology and gastroenterology departments of SamSMU clinics in the period from January to May 2017 were examined. Of them, 18 were males (48.6%) and 17 females (51.4%).

Results. Significant species diversity of microflora was identified that requires exact species identification and development of standard procedures for isolation of microorganisms from bioptates of patients with ulcerative colitis with the aim of administration of antibacterial treatment. In analysis of sensitivity of the isolated strains to antibiotics 45% of the isolated microorganisms were found to have signs of resistance to 1-2 groups of medical drugs, and 33% showed signs of resistance to 3 and more groups. Only 22% of strains were found to be sensitive to all tested preparations. Eradication of such flora presents certain difficulties, and in our opinion, requires administration of combined therapy after examination of bioptate.

Conclusions. All patients with ulcerative colitis require examination of the microbial composition of the intestinal wall for optimization of diagnostics and treatment. 105-106 titer of microorganisms, their wide species diversity may support inflammation in the colon and prevent relief. It is necessary to continue study of microbiological composition of the colonic wall in the comparative aspect for optimization of diagnostics and management of patients with ulcerative colitis.

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):59-69
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Psychology, clinical psychology, neurology, psychiatry, narcology
Depersonalization and psychosensory disorders amongst young people who do not seek psychiatric help appeal for psychiatrysts (prevalence, clinical features and classification)
Ruzhenkova V.V., Ruzhenkov V.A., Bykova A.A., Kolosova M.A.
Abstract

The importance of this study is justified by the high occurance frequency of this phenomenon amongst young people in the clinical structure of mental disorders and as well as in the framework of psychological defense mechanisms in psychiatrically healthy population. The question of the limits of depersonalization remains unresolved, as there is no single point of view regarding the syndromological affiliation, rendering it ambiguous to evaluate it as a productive or negative disorder.

Aim. This study was aimed at verifying the prevalence and clinical structure of depersonalization symptoms amongst young people.

Materials and Methods. A continuous sample consisting of 96 medical students – 68 (71%) female and 28 (29%) male, from 18 to 23 (19±1.2) years was studied using medico-social, clinico-psychopathological, psychometric and statistical methods.

Results. Depersonalization symptoms were found amongst 94% of respondents. Different forms of autopsychic depersonalization were identified in the different psyche spheres – effector-volitional sphere, thinking and self-awareness (except the depersonalization in emotional sphere – «pathological insensitivity», which were previously identified). The validity of their separation was confirmed by cluster analysis. Along with depersonalization disorders, in more than half of the cases, a variety of psychosensory disorders were observed.

Conclusions. Depersonalization phenomena along with various psychosensory disorders are widespread amongst adolescents without obvious mental disorders or gender preference. Therapy is useful if depersonalization obstructs social functioning and coupled with anxiety and depression.

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):70-85
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Surgery
Metabolic syndrome in patients with anal fistulae
Muhabbatov D.K., Gulov M.K., Hamroev B.M.
Abstract

Aim of work: to study the incidence of components of metabolic syndrome in patients with anal fistulae, to analyze combinations of different components of metabolic syndrome and types of pararectal fistulae.

Materials and Methods. A clinical examination of 508 patients (85.2% – men; 21.5% at the age of 20-39 years, 43.9% – 40-59 years, 34.6% – ≥60 years) with anal fistulae (of them 48.0% were transsphincteric and 29.3% – extrasphincteric fistulae) who underwent treatment in the department of coloproctology of municipal clinical hospital №5 of Dushanbe in the period from 2010 to 2015, was conducted with the aim of identification of components of metabolic syndrome.

Results. In 282 patients (55.5% of the total number of patients with anal fistulae, 90.8% of them being men) components of metabolic syndrome were identified: obesity – in 229 patients (45.1% of the total patients with anal fistulae), arterial hypertension – in 115 patients (22,6%), type 2 diabetes mellitus – in 58 patients (11.4%), IHD – in 8 patients (1.6%). In the presence of components of metabolic syndrome the recurrent forms of fistulae were recorded in 16.3% of cases (in the absence – in 12.8% of cases), and complicated forms – extrasphincteric (29.3%) predominated over intrasphincteric forms (22.7%); in control group the proportion of the mentioned forms was 24.8% and 29.2%, respectively. Transsphincteric forms were most common in both groups (48.0% and 46.0%).

Conclusions. Components of metabolic syndrome in different combinations were identified in more than half (55.5%) the patients with anal fistulae (obesity – 45.1%, arterial hypertension – 22.6%, 2 type diabetes mellitus – 11.4%, IHD – 1.6%). A tendency was recorded to a more common recurrence of anal fistulae and to a more complicated forms of anal fistulae in patients with components of metabolic syndrome.

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):86-95
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Obstetrics and gynecology
Pregnancy course and outcome peculiarities in women with gestational diabetes mellitus
Yankina S.V., Shatrova N.V., Berstneva S.V., Pavlov D.N.
Abstract

Gestational diabetes mellitus (GDM) is a serious medical and social problem, because it greatly increases the frequency of adverse pregnancy outcomes for mother and fetus. The frequency of GDM in the general population of different countries varies from 1% to 14% and average 7%, in Russia this figure is estimated at 4.5%.

Aim. To evaluate the prevalence of GDM in Ryazan Regional clinical perinatal center for the last 3 years and examine its influence on the course and outcome of pregnancy.

Materials and Methods. The analysis of the birth history data and exchange cards of 1690 pregnant women from 2015 to 2017 at Ryazan Regional clinical perinatal center.

Results. GDM was diagnosed in 193 women (prevalence – 11.4%), with 62 pregnant women on the basis of the results of oral glucose tolerance test performed in the period of 24-30 weeks. It was established that the course of pregnancy and delivery in patients with GDM was characterized by a high percentage of complications (late gestosis – 18.1%, anemia – 11.3%, swelling – 11.9%, early toxicosis – 4.6%, poly-hydramnios – 12.4%, chronic pyelonephritis – 5.1% and threatened miscarriage – 3.6%). Pregnancy outcome study revealed that the majority – 60.6% of pregnancies ended in natural births. Preterm birth was noted in 15% of cases, of which 2 cases were of perinatal fetal death. The frequency of delivery by cesarean section – 39.4%. The frequency of childbirth large fetus was 21.8%, higher than in women with normal blood glucose levels.

Conclusions. The prevalence of GDM in Ryazan Regional clinical perinatal center for the last 3 years was 11.4%. Complications during pregnancy were observed in 153 women (79.2%) of with GDM. The most frequent complications were; late gestosis, pregnancy anemia, edema, early toxemia, polyhydramnios, chronic pyelonephritis, and threatened miscarriage. In pregnant women with GDM, adverse outcomes of pregnancy were more common than in women with normoglycemia. Significant differences were obtained in the frequency of premature birth, macrosomia of the fetus and asphyxia during childbirth.

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):96-105
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Reviews
Principles of drug therapy for acute bacterial rhinosinusitis: from evidence-based medicine to practice
Pshennikov D.S., Angotoeva I.B.
Abstract

The problem of treatment of acute rhinosinusitis (ARS) is extremely important due to high prevalence of the disease. According to statistical data the ARS affects from 6% to 15% of population and does not show any tendency to reduction. These figures are associated with a high rate of acute respiratory viral infection (ARVI) which directly leads to rhinosinusitis. But, however, despite the fact that practically every individual experiences from 2 to 5 episodes of ARVI every year, only 0.5-2% of them are complicated with acute bacterial rhinosinusitis (ABRS). Despite this low percentage of bacterial infection, in 80% of cases systemic antibacterial treatment is prescribed which further worsens the problem of bacterial resistance in the world. The main difficulty in determination of therapeutic approach to ABRS is associated with absence of reliable methods of differential diagnostics of viral and bacterial etiology of the disease. Because of low sensitivity and specificity, none of additional visualization methods of ABRS diagnosing such as radiography, ultrasonography, computed tomography, can be used as a routine laboratory method. Thus, the main method of differential diagnostics of viral and bacterial ARS remains analysis of clinical data which leads to a high rate of diagnostic errors and to polypragmacy.

Nowadays there exists a wide range of medications for treatment of ABRS in the pharmacological market. The choice of therapeutic approach by our international colleagues is mostly based on the requirements of evidence-based medicine. Russian scientists, besides evidence-based medicine principles take into account the pathogenesis of the disease.

In this article different groups of medications for treatment of ABRS are presented. Some of them do not meet the requirements of evidence-based medicine so far, but they are included to the Russian standards and are used for management of ABRS.

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):106-116
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Acromegaly and comorbid conditions. New possibilities of diagnosis and treatment (literature review)
Zhulidova A.U., Dubinina I.I.
Abstract

Based on the data published in Russian and foreign reference sources, an analysis of clinical-hormonal peculiarities, modern methods of treatment of acromegaly combined with polyendocrinopathies (diabetes mellitus, diffuse and nodular goiter, hypocorticoidism) and cardiovascular diseases was conducted. According to different authors, a decline in the quality and duration of life of patients is associated with significant changes in the endocrine system caused by contrainsular and stimulating effect of somatotropic hormone (STH) and insulin-like growth factor 1 (IGF-1) on organs and tissues. Secondary diabetes mellitus was identified in 16-46% of patients, nodular goiter in 30-70%, secondary adrenal insufficiency in 11-20% of patients. The most common cause of acromegaly is an active pituitary tumor – somatotropinoma, rarely STH is overproduced by neuroendocrine cells, located endo- and extracranially. Recent achievements in neuroendocrinology provided significant improvement of management of patients. The aim of treatment for acromegaly is to achieve clinical and biochemical remission of the disease. At present three basic methods of treatment for acromegaly are used: surgical (endonasal transsphenoidal adenomectomy), drug therapy, radiation therapy and stereotactic radiosurgery (cyber knife). Differential and combined use of modern medical drugs in the form of monotherapy and in a combination with surgical and radiation treatment permits to achieve both clinical and hormonal remission of acromegaly improving in this way the quality and duration of life of patients. In the given review of literature modern concepts of etiology, pathogenesis, clinical peculiarities, modern methods of diagnosis and treatment of this disease are presented.

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):117-132
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Application of silicone implants in mammoplasty (literature survey)
Khodjamurodova D.A., Saidov M.S., Khodjamuradov G.М.
Abstract

In the article literature data concerning indications to placement of silicone breast implants in plastic surgery are presented. Peculiarities of preoperative preparation of patients aimed at prevention of postoperative complications are considered. The technique of surgical intervention, advantages and disadvantages of different methods are described. Difference in choice of surgical approach and positioning of implant relative to mammary gland are considered. Recommendations are given on selection of the type of implant, on determination of the volume of supposed silicone breast-implant prostheses, and also on the choice of optimal access for their insertion. The early and long-term complications and measures proposed by the authors for their elimination are studied. According to different studies, the commonest complication of the augmentation mammoplasty is contracture of the fibrous capsule surrounding the implant that requires surgical correction. One of main complications of all kinds of augmentation mammoplasty is secondary ptosis of mammary gland. A common complication of the augmentation mammoplasty is incorrect position of implants such as their asymmetry and location on different levels. In case of tubular breast a double inframammary fold may result unless tubularity of areola is corrected. Authors think that a significant number of unsolved problems concerning augmentation mammoplasty, optimal surgical approach, existence of the immediate and long-term complications are reasons for further study of augmentation mammoplasty. Increased dissatisfaction of patients with long-term results of augmentation mammoplasty, necessity to prevent such complication as fibrous contracture, create an urgent need for search of new methods. Thus, application of silicone implants in augmentation mammoplasty requires further study with the aim of optimization of the final aesthetic and clinical result.

I.P. Pavlov Russian Medical Biological Herald. 2018;26(1):133-149
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