Vol 30, No 2 (2022)

BACKGROUND: The repair of large defects in the long bones remains one of the most pressing problems in traumatology and orthopedics.

AIM: To evaluate the effectiveness and technological safety of the repair of large defects of the long bi-epiphyseal bones including the use of double-ended bone allografts to demarcate the defect cavity from the surrounding tissues and fixation of bone fragments using an external fixation device.

MATERIALS AND METHODS: Experiments were conducted on 14 adult nonpedigree male and female dogs aged 1–2 years. The double-ended allograft was used to demarcate the formed defect of the tibial bones at 1.5 diameter length of the shinbone. The bone fragments were fixed with Ilizarov apparatus adapted for experiments on dogs. The maximal follow-up period was 2 years after the surgery. In the dynamics of the experiment, life-time observations, X-ray examination, and laboratory control were conducted. After euthanasia, the implantation zone was examined histologically.

RESULTS: The visual signs of the restructure of the transplants were identified starting from day 35 after surgery. The bone regenerates in the defect zone completely formed within 3 months after the surgery. This permitted the removal of the external fixation apparatus in 3 months after the surgery. The restructuring of the newly formed part of the bone continued for 2 years after the operation. No significant changes in the laboratory parameters in the dynamics of the experiment were observed. No changes could be evaluated as negative phenomena. No serious unwanted events were recorded either.

CONCLUSION: The proposed technique for the repair of large defects of long bi-epiphyseal bones demonstrated safety and sufficient effectiveness in the speed of regeneration of the defect and quality of the bones formed.

INTRODUCTION: The medical examination of the adult population is an important mechanism to preserve the labor potential of the country through the early detection of diseases and prevention of premature mortality. The active involvement of citizens in preventive measures and an increase in the availability of medical examinations are vectors in increasing the coverage of the population. One of the mechanisms for increasing availability is the use of "lean" technologies, which was realized in the Ryazan region as part of the project "Optimization of the Medical Examination Process".

AIM: To evaluate the optimization of the medical examination of the adult population in the Ryazan region through the use of "lean" technologies.

MATERIALS AND METHODS: The project was implemented based on a multidisciplinary clinical hospital with high planned tasks for the coverage of the adult population indicated for medical examination. In the implementation of the project, problems in the organization of the medical examination of the adult population were identified, maps of the current state and the target state were compiled, solutions to each identified problem were proposed, and a 4-month schedule of measures was made.

RESULTS: The evaluation of the effectiveness of the project "Optimization of the Medical Examination Process" using "lean" technologies reduced the patient stay in the clinic by 1.7 times in the first stage of the medical examination and reduced the duration of this stage from 5 to 1.5 days. In the second stage, the total patient stay in the clinic was reduced two times, and the duration of this stage was reduced from 8 to 2 days. The throughput capacity of the pre-medical reception room of the medical prevention department increased from 48 to 100 people per day with a two-shift working schedule, which permitted fulfilling the planned annual tasks for medical examination by 100.0%.

CONCLUSION: The successful experience of the introduction of the "lean" production principles in the medical examination of the adult population demonstrated increased effectiveness and availability of preventive measures for the population in the region.

INTRODUCTION: The sanitary and epidemiological reliability (SER) of a centralized drinking water supply system (CDWSS) is one of the determining factors of the quality of drinking water, and it is assessed by a special methodology developed by Erisman Federal Scientific Center for Hygiene.

AIM: To conduct a comprehensive hygienic assessment of SER considering microbiological parameters of drinking water quality.

MATERIALS AND METHODS: The study was conducted jointly with the Center for Hygiene and Epidemiology of the Ryazan region (RR) in six district centers of the RR supplied with water from different aquifers. Water samples were taken according to the standard method of Methodological Guidelines (MUK) 4.2.1018-01. Microbiological parameters of drinking water quality were determined in the selected water samples in accordance with the Sanitary Norms and Regulations (SanPiN) 1.2.3685-21. Statistical analysis was performed using Microsoft Excel 2019 and IBM SPSS Statistics 19.

RESULTS: The recorded levels of generalized complex parameter SER of CDWSS were as follows: Skopin, 1.6 points (the most unfavorable situation); Mikhailov, 1.3 points; Ryazhsk, 1.1 points; Kasimov, 0.4 points; and Korablino and Sasovo, 0.3 points each (the least unfavorable situation). In Skopin, Ryazhsk, and Mikhailov, a strong correlation was found between the increased content of the microbiological parameters and the incidence of dysentery and acute intestinal infections of viral etiology in the adolescent population.

CONCLUSION: The lowest levels of SER of the CDWSS were recorded in Skopin, Mikhailov, and Ryazhsk. A direct correlation of high strength was found between the exceedance of the permissible values of the microbiological parameters of drinking water and the incidence of dysentery and intestinal infections of viral etiology among adolescents in these towns.

INTRODUCTION: Although common hematological abnormalities (CHA) such as anemia, macrocytosis, and platelet dysfunction are often present in patients with schizophrenia, empirical data are limited. Thus far, such deviations have been mentioned either in reports or in a series of clinical cases.

AIM: To study the incidence of CHA in patients with schizophrenia.

MATERIALS AND METHODS: This study involved 791 patients with schizophrenia [including those who did not receive medical drugs (n = 115) and patients with chronic schizophrenia (n = 376)] and 504 healthy volunteers. From each participant, blood samples were taken and analyzed for CHA using an automatic Coulter counter. In the three groups, ÷² tests and analysis of variance (ANOVA) were conducted to compare the variables.

RESULTS: The incidence of macrocytosis was nearly the same in the schizophrenia group (patients not receiving medications, 10.5%; patients with chronic schizophrenia, 10.6%) and was significantly higher than that in the control group (4.2%). The platelet count was considerably higher in the chronic schizophrenia group ([282.5 ± 87.9] × 10³/µL) than in the group not receiving medical drugs ([277.0 ± 92.8] × 10³/µL) and control group ([249.6 ± 85.2] × 10³/µL), whereas the differences in the concentration of hemoglobin and leukocytes in the blood were insignificant.

CONCLUSION: Patients with schizophrenia have a higher proportion of macrocytosis in combination with increased platelet count, which shows that the underlying diseases should be diagnosed and treated as early as possible. Moreover, prospective studies with a larger sample size are necessary to determine the etiology of these conditions in patients with schizophrenia.

INTRODUCTION: Atherosclerotic lesion of lower limb arteries often occurs with the development of chronic and later with critical ischemia of the lower limbs. Revascularization in these conditions has always been at the center of attention of vascular surgeons worldwide.

AIM: To analyze long-term complications after femoropopliteal bypass (FPB) with the autovenous graft.

MATERIALS AND METHODS: This retrospective open study was conducted in Scientific the Research Institute — Regional Clinical Hospital No. 1 named after Professor S. V. Ochapovsky (Krasnodar) in the period from January 10, 2016, to December 25, 2019, and included 464 patients who underwent FPB with venous autograft. The following autovenous conduits were used: n = 266, reverse vein (great saphenous vein (GSV)); n = 59, autovein (GSV) prepared in situ; n = 66, autovein (GSV) prepared ex situ; and n = 73, veins of an upper limb. The long-term follow-up period was 16.6 ± 10.3 months.

RESULTS: During the postoperative hospital period, single cases of lethal outcome and myocardial infarction were noted. No ischemic strokes were recorded. Shunt thrombosis developed in 4.5% of the patients, and 2.1% required limb amputation. Postoperative wound revision caused by bleeding was performed in 1.7% of the cases. In the remote follow-up period, adverse cardiovascular events were noted in every fifth patient (21.8%). Shunt thrombosis was diagnosed in 17.4% of cases, and limb amputation was performed in 5.1% of the cases. To identify the factors for poor prognosis, the whole sample was divided to two groups: group 1 (n = 366) included those without long-term complications and group 2 (n = 99) comprised patients with long-term complications. Using the odds ratio (OR), the following predictors of adverse cardiovascular events were identified: degree I obesity (р < 0.0001; OR = 3.24; 95% confidence interval (CI) = 1.93–5.43), degree II obesity (р = 0.0005; ОR = 4.84; 95% CI = 1.71–13.67), and stage IIB chronic lower limb ischemia (CLLI) (р = 0.0006; ОR = 2.24; 95% CI = 1.42–3.52). Protective factors were postinfarction cardiosclerosis (р = 0.04; ОR = 0.51; 95% CI = 0.27–0.95), excessive body mass (р = 0.01; ОR = 0.56; 95% CI = 0.35–0.88), and stage IV CLLI (р = 0.01; ОR = 0.53; 95% CI = 0.32–0.86).

CONCLUSIONS: FPB with venous autograft is characterized by a low frequency of complications in the hospital and long-term follow-up periods, making this technique a method of choice for the open surgical treatment of patients with extended atherosclerotic lesion of the superficial femoral artery. Predictors of adverse cardiovascular events in the long-term period are degree I obesity, degree II obesity, and stage IIB CLLI. Protective factors against the development of long-term surgical complications are postinfarction cardiosclerosis, overweight, and stage IV CLLI. The presented results should be considered when constructing stratification risk scales for adverse cardiovascular events in patients who underwent FPB. Precision management of patients with identified predictors of complications will allow the reduction of the risks for the development of these conditions and increase long-term survival free from shunt thrombosis and limb amputation.

INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 is associated with the development of arterial thromboses of different locations. This pathology is common in patients with multifocal atherosclerosis. The overwhelming majority of published reports are devoted to the surgical treatment of patients with thrombosis of lower limb arteries. Thus far, no studies of revascularization in the case of extended atherosclerotic lesion and thrombosis of the internal carotid artery (ICA) in patients with COVID-19, have been published.

AIM: To analyze the immediate results of glomus-saving autografting of the ICA with its extended atherosclerotic lesion and thrombosis in the peracute period of ischemic stroke in patients with COVID-19.

MATERIALS AND METHODS: The retrospective study (inclusion period 01.01.2017–01.03.2020) involved 49 patients with hemodynamically significant extended atherosclerotic lesion of the ICA in the peracute period of acute cerebrovascular accident (ACVA). From April 1, 2020, to May 15, 2021, 26 patients with hemodynamically significant extended atherosclerotic lesion and floating thrombus in the ICA and a positive result of polymerase chain reaction to SARS-CoV-2 were included. In all cases, brain revascularization was performed in the peracute period of ACVA in the volume of glomus-saving autografting of the ICA.

RESULTS: No adverse cardiovascular events were noted throughout the postoperative follow-up period in both groups. In the examination of the reconstruction zone using color duplex ultrasonography, no data for restenosis/thrombosis were recorded. On day 7 after surgery, in both cohorts of patients, significant regression of neurological deficit on the National Institute of Health Stroke Scale was noted: in the first group, the values during admission and day 7 after revascularization were10.5 ± 3.5 and 6.5 ± 1.5, respectively (р = 0.001); in the second group, the values were 12.5 ± 2.5 and 5.5 ± 1.5, respectively (р = 0.001). In both groups, no cases of unstable difficult-to-control arterial hypertension were noted, and no changes were introduced to the antihypertensive therapy.

CONCLUSIONS: Emergency autografting of the ICA with its extended atherosclerotic lesion and thrombosis in the peracute period of ACVA is an effective and safe method of brain revascularization in patients with COVID-19.

INTRODUCTION: The development and progression of atherosclerosis in different vascular pools remain unclear. Many studies have considered apoptosis to play a key role in the development of atherosclerosis; apoptosis is a programmed cell death with characteristic morphological signs aimed at providing homeostasis in an organism in general and in the vascular wall in particular. However, all studies that have been devoted to markers of apoptosis were mostly experimental and were conducted on either animals or grown cultures of different cells. The study aimed to examine markers of apoptosis (р53, sFas, Вах, and Всl-2) and proliferation (platelet-derived growth factor [PDGF] BB) in the vessel wall in the area of an atherosclerotic lesion in a patient with multifocal atherosclerosis. The clinical case was of interest because it allowed the assessment of biomarkers in both the area of progression of atherosclerotic lesion on an operated limb and the carotid pool in the long-term postoperative period.

CONCLUSIONS: This case demonstrated that a patient with obliterating atherosclerosis of the lower limb arteries had an elevated level of pro-apoptotic markers р53 and Вах and PDGF ВВ as a marker of cell proliferation and migration, against the background reduced level of anti-apoptotic markers Всl-2 and sFas in comparison with their values in the normal arterial wall. The progression of atherosclerotic lesion in two vascular pools was associated with a further increase in the values of proapoptotic markers (р53 and Вах) and decrease in the values of Всl-2 and sFas compared with the initial samples. With this, the values of PDGF ВВ marker remained elevated relative to the initial level.

INTRODUCTION: Among the European population of 715 million people, 1.4 million cases of strokes are recorded annually. Of them, approximately 87% are ischemic strokes, and approximately 20% were accounted for by atherosclerosis of the carotid arteries. To prevent an ischemic cerebral event associated with atherosclerosis of brachiocephalic arteries, different surgical techniques have been developed including carotid endarterectomy (CEAE) and carotid artery stenting (CAS). CEAE and CAS reliably reduce the risk of recurrent stroke associated with atherothrombosis, but with this, the level of alterations of cognitive functions and the restoration of cerebral functional deficit have not been widely studied. At present, no randomized studies and meta-analyses have met all the standards of conducting research concerning alterations in cognitive functions in patients with past interventions on carotid arteries. Some medical centers have performed such interventions, but data are not unambiguous: some authors describe the improvement of cognitive functions, whereas others do not note any differences or even see signs of impairment.

CONCLUSION: This literature review highlights an issue concerning the assessment of the alteration of postoperative cognitive deficit in patients with past CEAE or CAS. Comparisons in the context of cognitive cerebral functions in the postoperative period of endarterectomy or stenting and assessment of neurological status in patients with or without a history of acute cerebrovascular accident, different variants of anesthesia, and CEAE techniques are considered.

INTRODUCTION: Venous thromboembolic complications (VTEC) such as deep and subcutaneous vein thrombosis and pulmonary embolism are the most important clinical problems in many specialties. High-risk factors for thrombus formation include surgical interventions leading to the activation of the hemostatic system. Despite the existing international and Russian clinical recommendations on the treatment and prophylaxis of VTEC containing a detailed description of the methods and algorithms of prophylaxis in patients with different nosologies including patients with polymorbidities, the incidence of VTEC remains high. In the scientific community, there is a continuing discussion of the effectiveness of various approaches to VTEC prophylaxis in different clinical groups of patients. Algorithms available prescribe anticoagulants at standard doses and combinations. However, in patients with comorbidities, isolated conservative anticoagulant therapy may be insufficient for effective VTEC prophylaxis.

CONCLUSION: Currently, there is a need to improve the algorithms of VTEC prophylaxis in patients with comorbid pathologies to elaborate clear indications for the use of both pharmacological and mechanical prevention methods and their combinations.