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Vol 30, No 2 (2022)

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Original researches

Safety and Effectiveness of Using Double-Ended Allograft in the Repair of Large Defects of Bi-Epiphyseal Bones in Experiment

D’yachkov A.N., Migalkin N.S., Stogov M.V., Soldatov Y.P., Dyuryagina O.V., Tushina N.V.


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.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):139-148
pages 139-148 views

Development and Validation of the Quantitative Determination of Atorvastatin in HepG2 Cell Line Using High-Performance Liquid Chromatography with Mass-Spectrometric Detection

Erokhina P.D., Myl’nikov P.Y., Ganina S.O., Konyakhin E.A., Shchul’kin A.V., Slepnev A.A., Yakusheva E.N.


INTRODUCTION: Organic anion transporting polypeptide 1B1 (OATP1B1) is a transporter protein that plays an important role in the pharmacokinetics of substances (its substrates), regulating their penetration into hepatocytes. The functional activity of this protein is evaluated by the transport of marker substrates, for example, atorvastatin, on cell lines overexpressing OATP1B1, such as HepG2 (human hepatocellular carcinoma).

AIM: To develop and validate the technique of the quantitative determination of atorvastatin in HepG2 cell line using high-performance liquid chromatography (HPLC) with tandem mass spectrometry (MS/MS).

MATERIALS AND METHODS: The study was performed on HPLC chromatograph with an MS/MS detector. The conditions of the chromatographic analysis were as follows: pre-column Selectra C18 Guard Cartridges SLC-18GDC46-5UM, chromatographic column UCT Selectra C18 4.6 mm × 100 mm 5 µm, 100 А column, flow velocity of 0.3 mL/min, and column thermostatic control of 35°C. The volume of introduced samples was 2 µL, and the analysis time was 10 min. Gradient elution mode was used: the ratios of 0.1% formic acid solution and acetonitrile were 35% and 65% for 0 and 0.3 min, 5% and 95% for 0.6 and 5 min, and 35% and 65% for 5.05 and 8 min, respectively. The retention time of atorvastatin was 4.53 min. Atorvastatin detection conditions were as follows: positive ionization mode; spray voltage,3500 V; detection mode, multiple reaction monitoring 559.30 m/z → 466.20 m/z, 559.30 m/z → 440.20 m/z; collision energy, 17 V; source fragmentation, 0; and gas pressure-inducing dissociation, 2 mTorr.

RESULTS: The developed bioanalytical method was validated by the following parameters: linearity, selectivity, accuracy, precision, lower limit of quantity determination, sample transfer, sample stability, and matrix effect. The confirmed range of the technique in cell lysate was 0.5–200 nmol/L.

CONCLUSION: The results validated the technique for the quantitative determination of atorvastatin in the lysate of HepG2 cell line by HPLC-MS/MS.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):149-158
pages 149-158 views

Use of "Lean" Technologies in the Medical Examination of the Adult Population in the Ryazan Region

Uspenskaya I.V., Selyavina O.N.


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.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):159-166
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Accessibility of Medical Assistance to Patients with Diseases of the Circulatory System in the Voronezh Region

Chernykh E.A., Chernov A.V.


INTRODUCTION: The current burden of circulatory diseases on the health care system, both at the federal and territorial levels, and its projected growth make it necessary to develop a network of healthcare organizations, playing a key role in ensuring the accessibility and quality of medical assistance to the population. The Russian Federation approved the national project "Health Care", which includes eight federal projects, including the project "Control of Cardiovascular Diseases". The reduction of the mortality rate from circulatory system diseases to 450 per 100,000 of the population by 2024 is a priority goal. The National Plan of Action for the Elimination of Child Labor has been adopted. Its achievement depends largely on the availability of affordable health care.

AIM: To assess the accessibility of medical assistance to patients with circulatory system diseases in Voronezh according to the main characteristics of the total number of medical organizations providing medical care in ambulatory and in-patient conditions.

MATERIALS AND METHODS: Analytical and statistical methods of research were used in the analysis.

RESULTS: Between 2011 and 2019, the number of hospital organizations in Voronezh decreased by 8.3%, which is related to structural and functional changes in the number of beds, as reflected in a reduction, and the association of medical organizations. The number of medical organizations providing outpatient care has also been reduced from 176 to 119, or by 32.4%. During the study period, a decrease was noted in the number of beds and number of days of operation per year and increase in the rate of turnover of beds in cardiology, therapy, and neurology.

CONCLUSION: Increasing the accessibility of medical care to patients with circulatory system diseases considering its organizational component is aimed at building in-house organizational and informational cooperation between cardiologists and primary care physicians and specialized health care.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):167-174
pages 167-174 views

Effects of the Wear of the Water Supply Network on the Epidemiological Safety of Drinking Water in Small Towns in the Ryazan Region

Solov'yev D.A., Dement'yev A.A., Lyapkalo A.A., Litvinova A.A., Korshunova E.P.


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.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):175-182
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Assessment of the Clinical Profile and Approaches to the Diagnosis and Treatment of Patients Hospitalized with Acute Decompensation of Heart Failure

Smirnova E.A., Sedykh E.V., Gorbova A.V., Zheronkina V.V., Kurtikova O.V.


INTRODUCTION: Acute decompensation of heart failure (ADHF) is one of the leading diagnoses for hospitalization in therapeutic/cardiologic hospitals worldwide and is associated with a poor prognosis.

AIM: To study the prevalence, clinical diagnosis, approaches to diagnosis, and treatment of patients hospitalized for ADHF.

MATERIALS AND METHODS: A retrospective analysis of 202 medical records of inpatients hospitalized for ADHF in the first cardiology unit of Regional Clinical Cardiologic Dispensary in 2019 was performed. The clinical and instrumental characteristics of the patients, factors that led to hospitalization, and approaches to the diagnosis and treatment were examined.

RESULTS: The prevalence of ADHF was 11.2%, the mean age of the patients was 68.4 ± 10.8 years, and 49.0% were men. The most common causes of ADHF were atrial fibrillation (AF, 31.7%), uncontrolled arterial hypertension (AH, 20.8%), С4–С5 stage chronic kidney disease (CKD, 19.4%), and “non-adherence” of clinical prescriptions (14.4%). Among the most commonly registered etiological factors of chronic heart failure (CHF) were AH (89.6%), AF (67.3%), and coronary heart disease (CHD, 64.9%). The left ventricular ejection fraction (LVEF) was preserved in 48.7% of the patients, intermediate in 21.4%, and reduced in 29.9%. In 2019, in real clinical practice, levels of natriuretic peptides were not determined, and blood electrolytes were not determined often enough (71.8%). The frequency of the administration of angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blockers (ARB-II)/neprilysin receptor antagonists (NRA) and beta-adrenoblockers (BAB) did not depend on the LVEF, which were 84.2% and 76.2%, respectively. Mineralocorticoid receptor antagonists (MCRA) were more commonly used in CHF with low LVEF at 89.2% against 78.7% among all patients (p < 0.05). On hospital discharge, ACE inhibitor/ARB-II/NRA therapy was recommended in doses of 21.1%, BAB in 7.6%, and MCRA in 72.0% of target values.

CONCLUSIONS: The prevalence of ADHF in all patients hospitalized in Cardiologic Hospital of Ryazan Regional Vascular Center was 11.2%. The most common causes of ADHF in patients with CHF were LVEF and AH, AF, and CHD, and the most frequent factor of CHF decompensation was AF. On hospital discharge, the drugs that improve the prognosis of CHF were prescribed at insufficient doses.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):183-192
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Common Hematological Disorders in Patients with Schizophrenia: In-Patient Case — Control Study

Ransing R., Kamble A., Kulkarni R., Khairkar P., Patil S., Pevekar K., Misha K., Gangane N.


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.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):193-202
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Functional Capaсities of Limb Muscles in Patients with Partial Damage to the Cervical Spinal Cord

Kachesova A.A., Shchurova E.N., Sayfutdinov M.S., Prudnikova O.G.


INTRODUCTION: In the long-term course of traumatic spinal cord disease (TSCD), neuroplastic adaptive and maladaptive changes occurred on different structural levels of the nervous system, which leads to a shift in the activation and strength characteristics of the limb muscles. The standard neurological assessment is approximate; therefore, objective instrumental studies of the motor sphere of patients with partial damage to the cervical spinal cord have not lost their significance.

AIM: To study the activation and strength characteristics of the limb muscles of patients with partial injury of the cervical spinal cord in the long-term course of the disease (type B on the American Spinal Cord Injury Association (ASIA) scale).

MATERIALS AND METHODS: The study enrolled 28 patients with fractures of the cervical spinal cord vertebrae in the late period of the TSCD of ASIA type B. The amplitude of motor responses (M-responses) of the upper and lower limbs was assessed using electroneuromyography. The strength of the upper limb muscles was evaluated using manual dynamometers.

RESULTS: M-responses were absent in 9% and 64% in the upper and lower limbs, respectively. The amplitude of the most recorded M-responses of the upper and lower limb muscles was reduced relative to the norm. The reduction was not uniform, with significant differences in different leads. The average values of the amplitude asymmetry of M-responses did not exceed the norm. Moreover, 61% of the patients could perform hand-grip functions and hold the wrist dynamometer. Only 59% of the patients could make an effort and the results of strength measurement were obtained, whereas in 41% of cases, zero values were obtained. Statistical analyses revealed a clear relationship between the motor deficiency index of the upper limb and hand-grip strength.

CONCLUSION: The degree of preservation of M-responses and evident asymmetry of evoked electrical activities of the upper and lower limb muscles indicate the existence of a certain level of neurotrophic interaction in the “muscle fiber–motor neuron” system. The level of reduction of the hand-grip strength and its relationship with the motor deficiency index allows discussion about the partial preservation of the voluntary control of the motor function of the upper limbs.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):203-212
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Predictors of Long-Term Complications of Femoropopliteal Bypass with Autovenous Graft

Zakeryaev A.B., Vinogradov R.A., Sukhoruchkin P.V., Butayev S.R., Bakhishev T.E., Derbilov A.I., Urakov E.R., Baryshev A.G., Porkhanov V.A.


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.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):213-222
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Differential Approach to Surgical and Endovascular Treatments of Pulmonary Thromboembolism in Patients with Neurological and Neurosurgical Problems

Fedorov S.A., Medvedev A.P., Tselousova L.M., Kudykin M.N., Pichugin V.V., Zhurko S.A., Chiginev V.A., Gamzaev A.B., Trofimov N.A., Gamayunov S.V., Deryabin R.A.


INTRODUCTION: Pulmonary embolism (PE) is one of the most threatening complications in patients with neurological and neurosurgical problems. The high epidemiological threshold values and mortality in the considered group of patients attracted the interest of researchers in the methods of early diagnosis and selection of methods of reperfusion of the pulmonary arterial bed.

AIM: To analyze clinical and hemodynamic results of the surgical and endovascular treatment of PE of the high and intermediate–high risks in the group of patients with neurological and neurosurgical problems.

MATERIALS AND METHODS: This study involved 24 patients with PE of high and intermediate — high-risks. The first group involved seven patients with neurosurgical problems who underwent thromboembolectomy from the main and lobular branches of the pulmonary artery in conditions of parallel perfusion of the artificial circulation. The duration of perfusion was 26.0 ± 7.4 min. The second group consisted of 17 patients with acute hemorrhagic stroke, in whom endovascular mechanical fragmentation of thromboemboli was performed using a modified Pig-Tail type catheter introduced by puncture through the subclavian or jugular vein. The first clinical manifestations of PE appeared 4.78 ± 2.02 days after the neurosurgical intervention and 8.45 ± 2.6 days after the onset of stroke. The initial systolic pressure in the pulmonary artery was 67.24 ± 5.15 mm Hg in the first group and 70.53 ± 4.53 mm Hg in the second group. Both groups had American Society of Anesthesiologist physical status IV and V classes of surgical risk and Pulmonary Embolism Severity Index class V (130–174 points).

RESULTS: The hospital survival rates were 100% and 82.36% in the first and second groups, respectively (three lethal cases due to progressing right-ventricular failure in the first 18 h after the procedure). On discharge, signs of reverse remodeling of the right heart chambers and reduction of the mean and systolic pressure in the pulmonary artery to 21 ± 2.16 and 31 ± 4.12 mm Hg, respectively, were noted in the first group and to 46 ± 5.23 and 57 ± 3.16 mm Hg, respectively, in the second group.

CONCLUSION: Surgical treatment of PE is effective and safe with predictable results. Endovascular catheter — induced destruction of the thromboembolus substrate is an alternative to the surgical treatment of patients with a high-risk of open surgery and absolute contraindications for thrombolytic therapy.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):223-232
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Glomus-Saving Autografting of the Internal Carotid Artery in the Peracute Period of Ischemic Stroke with Underlying COVID-19

Altymukhamedova L.D., Rotanova A.I., Katykhina V. ., Chesnokova A.A., Korotkikh A.V., Zharova A.S., Pivovarov A.A., Buksayev D.S., Kazantsev A.N.


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.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):233-242
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Clinical cases

Biomarkers of Apoptosis and Cell Proliferation in Diagnosing the Progression of Atherosclerosis in Different Vascular Pools

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


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.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):243-252
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Simultaneous Treatment of Multifocal Gastric and Sigmoid Colon Carcinoma from Laparoscopic Access: A Case Report

Zaytsev O.V., Ignatov I.S., Ogorel'tsev A.Y., Bizyayev S.V., Evsyukova M.A., Li Y.B., Yudin M.A., Snegur S.V., Bragina I.Y., Korobova E.G.


INTRODUCTION: The number of patients with multifocal carcinoma (MFC) in the Russian Federation is growing annually. MFC is associated with the prolongation of the life span of the population, increase in the incidence of common morbidities, and improvement of instrumental diagnostic methods. Surgical treatment is indicated for gastric and colorectal MFC at the early stages. Laparoscopic access with several advantages over the open access is preferred. This article describes a clinical case of simultaneous surgical treatment of gastric and colorectal cancer through a laparoscopic approach in an 81-year-old patient.

CONCLUSION: The described clinical case shows that the modern diagnostic methods and surgical equipment permit not only the early identification of tumors of the gastrointestinal tract but also their successful simultaneous surgical treatment in patients with comorbidities.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):253-260
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Dynamics of the Alterations of Cognitive Functions in Patients with Past Interventions on the Carotid System

Kalinin R.E., Suchkov I.A., Pshennikov A.S., Zorin R.A., Solyanik N.A., Egorov A.A., Krylov A.A., Yudin V.A., Kovalev S.A.


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.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):261-270
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Comparative Assessment of the Results of Different Techniques of Carotid Bifurcation Reconstruction

Beloyartsev D.F.


INTRODUCTION: Nowadays, to restore the patency of the carotid artery bifurcation in atherosclerotic stenoses, three main methods of reconstruction are used, namely, classic carotid endarterectomy (cCEAE), prosthetic repair of the internal carotid artery, and eversion carotid endarterectomy (eCEAE). The study conducted a comparative analysis of the immediate and long-term results of using these methods in the case of stenosis of the carotid artery bifurcation.

CONCLUSION: As regards the immediate results, the analysis of literature does not permit allow making an unambiguous conclusion about the evident advantages of a particular method of intervention. Thus, several authors obtained better results with the use of eCEAE, whereas others did not find any significant differences between eCEAE and cCEAE, if it was not a question about using a straight seam, and this can be referred to both meta-analyses and original studies. Regarding the long-term results, practically all literary sources indicate more optimal results with the use of the eversion technique. The results of the analysis imply the preference for eCEAE if the character of the lesion of the carotid bifurcation and anatomical interrelations in the surgical wound allow it.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):271-278
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Justification of Choice of Thromboprophylaxis Method in Patients with High-Risk Surgical Profile: A Literature Review

Katel’nitskiy I.I., Nemirovich M.V., Prostov I.I., Livadnyaya E.S.


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.

I.P. Pavlov Russian Medical Biological Herald. 2022;30(2):279-286
pages 279-286 views

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