Vol 30, No 4 (2022)

INTRODUCTION: To date, many factors that influence the risk and course of abdominal aortic aneurysm (AAA) are not studied. Increasing significance in the etiology and development of AAA is assigned to the existence of some genetic polymorphisms, the role of many of them is not studied either.

AIM: To analyze the existence of association of the abdominal aortic aneurysm with some gene polymorphisms (GPs).

MATERIALS AND METHODS: Gene polymorphisms were analyzed in 20 patients with AAA (study group, SG); 18 men (90%) and 2 women (10%), the mean age 68.1 ± 7.3 years), and in 5 patients without AAA (control group, CG; 4 men (80%) and 1 woman (20%), the mean age 64.2 ± 7.2 years). The frequency of concomitant diseases and risk factors for AAA were determined. The following GPs were studied: : Lys198Asn in the EDN1 gene; C-786T in the NOS3 gene; Leu28Pro in the APOE gene; Val174Ala in the SLC01B1 gene; Thr715Pro in the SELP gene; C807T in the ITGA2 gene; Ser447Ter in the LpL gene; Thr174Met in the AGT gene; Met235Thr in the AGT gene. Statistical analysis was performed using IBM SPSS Statistics 21, correlation analysis ― according to Pearson. The results were considered statistically significant at p < 0.05.

RESULTS: In the SG, correlation relationships were identified in Ser447Ter polymorphism in the LpL gene: direct relationships with Lys198Asn polymorphism (r = 0.63; р < 0.001) in the EDN1 gene, Leu28Pro (r = 0.70; р < 0.001) in the APOE gene and Thr715Pro (r = 0.63; р < 0.001) in the SELP gene; a reverse relationship with С786Т polymorphism (r = -0.35; р = 0.006) in the NOS3 gene. The same amount of relationships were found in Leu28Pro polymorphism in the APOE gene: besides with Ser447Ter in the LpL gene, there is also a direct relationship with Lys198Asn (r = 0.70; р < 0.001) in the EDN1 gene and Thr715Pro (r = 0.63; р < 0.001) in the SELP gene; a reverse relationship with С786Т (r = -0.35; р = 0.006) in the NOS3 gene. Thr715Pro polymorphism in the SELP gene, along with relationships with Ser447Ter (r = 0.63; р < 0.001) in the LpL gene and Leu28Pro in the APOE gene, has an additional direct relationship with Lys198Asn (r = 0.55; р < 0.001) in the EDN1 gene. Thr174Met polymorphism in the AGT gene has a reverse relationship with Leu28Pro (r = -0.35; р = 0.006) in the APOE gene and direct relationship with Val174Ala (r = 0.40; р = 0.002) in the SLC01B1 gene. With this, Met235Thr polymorphism in the AGT gene has a direct relationship with Val174Ala (r = 0.33; p = 0.011) in the SLC01B1 gene and reverse relationship with C807T in the ITGA2 gene.

CONCLUSION: The existence of direct correlations of some gene polymorphisms in patients with abdominal aortic aneurysm has been established, which indicates their probable role in the development of this pathology and may be used as a screening test for determination of the likelihood for its development.

INTRODUCTION: The study of markers of oxidative stress, metabolites of nitric oxide (II) (NO_x) and the balance of carnitine fractions in mitochondria of rat epididymis, permits to evaluate the protective role of L-arginine in experimental hyperhomocysteinemia.

AIM: To study the influence of L-arginine on the parameters of energy metabolism, level of NO metabolites, oxidative modification of proteins and balance of carnitine fractions in mitochondria of the head and tail of rat epididymis in hyperhomocysteinemia.

MATERIALS AND METHODS: In animals of group 1 (n = 8), severe hyperhomocysteinemia (HHcy) was modeled by administration of methionine suspension at a dose of 1.5 g/kg twice daily for 21 days with addition of 1% methionine in drinking water; group 2 rats (n = 8) received suspension base without methionine; animals of group 3 (n = 8) were daily administered L-arginine solution at a dose of 500 mg/kg intragastrically against the background methionine load from day 11 to day 21; group 4 animals (n = 8) were administered L-arginine solution of at a dose of 500 mg/kg for 10 days; group 5 (n = 8) served as a control for group 4 and received drinking water intragastrically. Concentrations of total homocysteine and NO_x were determined in serum. In the mitochondrial fraction of the homogenate of epididymis tissues, the level of oxidatively modified proteins (OMP), the concentration of NO_x, lactate and carnitine fractions, the activity of lactate dehydrogenase (LDH), superoxide dismutase (SOD), H⁺-ATPase, succinate dehydrogenase (SDH) were evaluated.

RESULTS: HHcy was accompanied by reduction of the level of NO_x in blood serum and mitochondria of epididymis head tissues. In mitochondria of tissues of head and tail of epididymis, a marked reduction of all fractions of carnitine, activity of LDH, H⁺-ATPase, SDH, increase in the activity of SOD and in the level of OMP were observed. With modeled HHcy, L-arginine reduced the extent of hyperhomocysteinemia, prevented reduction of NO_x level in the blood serum and epididymis head and reduced the content of OMP of the epididymis mitochondria.

CONCLUSION: L-arginine introduced in combination with methionine, reduces the extent of severity of hyperhomocysteinemia. The positive effect of L-arginine on increase in the concentration of NO_x metabolites in blood serum and mitochondria of epididymis in conditions of methionine load was also confirmed. L-arginine exhibits antioxidant properties, reducing the severity of oxidative stress induced by hyperhomocysteinemia. Differences in the adaptive response to oxidative stress of the mitochondria of the head and tail of epididymis were demonstrated.

INTRODUCTION: Surface water sources play an important role in supply of large cities with water. Their waters are subject to anthropogenic pollution with different chemical compounds which may be significant risk factors for the health of the population. The article presents the results of comparative sanitary-hygienic characteristics of the water quality of the Oka river in places of water intake of utility and drinking water supply system of Ryazan. Being the only surface source of water supply, the Oka river provides 53% of the total water consumption of the Ryazan population, therefore a rational choice of the place of water intake can have a considerable impact on the effectiveness of water conditioning and purification and on the final quality of drinking water.

AIM: To give a comparative sanitary-hygienic characteristic of the water quality of the Oka river in places of the water intake of the utility and drinking water supply system of Ryazan.

MATERIALS AND METHODS: A comparative evaluation of the water quality of the Oka river, as a surface source of water supply, was carried out based on the average long-term values of control parameters (organoleptic, microbiological, chemical) and the proportion of samples that do not meet hygienic standards in the sections of three water intakes in Ryazan in 2012–2019. The average parameters were compared by the method of variance analysis; for paired comparisons, Scheffe and Tamhein criteria were used, taking into account the results of Levene test. The statistical parameters were calculated in SPSS Statistics 19 program.

RESULTS: The chemical composition of the Oka river water was characterized by the greatest pollution with iron (2⁺) and aluminum. The water of Oksky and Borkovskoy water intakes was characterized by higher average concentrations of iron (2⁺) and ammonia, as well as greater contamination with generalized and thermotolerant coliform bacteria, compared with the water of Sokolovsky water intake.

CONCLUSION: A lower initial quality of the water in Oksky and Borkovskoy water intakes may be due to their location in the 'blind' river course characterized by the processes of eutrophication and slowed down water exchange. High concentrations of iron (2⁺) may be associated with supply of stream water from the underground sources or with anthropogenic pollution.

INTRODUCTION: Health protection of railway workers of various professional groups increases the safety of railway transport, the prestige of the profession and reduces morbidity and mortality from the most common causes in this group of patients.

AIM: To analyze the risk factors of sudden death among Russian Railways workers.

MATERIALS AND METHODS: The design of the study is made according to the ‘case-control’ type. Analysis was carried out of all cases of sudden death (SD) of employees of JSCo ‘Russian Railways’ (RR) in the period from 2009 to 2021 (n = 412). The comparison group consisted of 411 employees of RR who were undergoing periodical medical examination. The groups were formed on the basis of age, employment period, gender, profession. To assess the diagnostic significance of the quantitative signs in predicting a certain outcome, the method of analysis of ROC curves was used.

RESULTS: The chances of death for workers of RR increased in case of past myocardial infarction, and also depended on the type of intervention (p < 0.001). The threshold value of the BMI index in the cut-off point, which corresponded to the highest value of Youden index, was 27.1 kg/m². In the group of sudden deaths, there were 1.8 times more smokers and 2 times less individuals with total cholesterol level exceeding 5 mmol/l than in the comparison group (p < 0.001). A prognostic model was developed by ROC-analysis to determine the probability of mortality. The sensitivity and specificity of the model were 79.5% and 91.9%, respectively.

CONCLUSION: A prognostic model was developed to determine the probability of sudden death in Russian railway workers, with the sensitivity and specificity 79.5% and 91.9%, respectively. However, the present study did not permit to reveal predictors of sudden death specific of the workers of RR.

INTRODUCTION: Achievement of absolute sobriety, its maintenance and preservation are the main tasks of the stage of tertiary prophylaxis of narcological patients.

AIM: To perform a comparative analysis of personality- and value-and-meaning-related characteristics of narcological patients with syndrome of addiction to psychoactive substances, with similar characteristics of healthy individuals without significant experience in use of alcohol and other psychoactive substances (absolute and relative abstainers).

MATERIALS AND METHODS: The age, gender, level of education, experience in use of nicotine in the past and present, leading coping strategies, levels of religiosity and magic thinking have been studied.

RESULTS: Two diametrically opposite images of abstainers were identified: on the one end individuals with higher level of education and lower levels of religiosity and magic thinking, and on the other — individuals with lower level of education, but higher levels of religiosity and magic thinking. The group of abstainers is in general characterized by absence of the experience in nicotine use.

CONCLUSION: Taking into account personality- and value-and-meaning-related characteristics helps more accurately determine the goals and directions of psychotherapeutic and rehabilitation measures, to differentiate patients according to rehabilitation programs, increases the level of motivation and adherence to treatment, which in turn leads to a longer and stable remission.

INTRODUCTION: The range of antiseptic agents used in clinical practice, is rather wide. However, only single studies are devoted to comparative characteristics of their effectiveness in the conditions of the oral cavity.

AIM: To choose the optimal antiseptic dental cleaner by experimental study.

MATERIALS AND METHODS: An aqueous solution of Furacilin® (0.02%), chlorhexidine bigluconate (0.05%), Miramistin® (0.01%), cetylpyridinium chloride (0.05%), hydrogen peroxide (3%), Iodinol®, Rotokan®, distilled water were used as washing liquids for elimination of dental plaque. The model of the dentition was created from quartz plates with an imitation of fresh plaque. Biomaterial imitating dental plaque included two solutions: 1) a strong fresh infusion of black tea leaves, cooled to +25°C; 2) oatmeal jelly with temperature from +60°C to +65°C. The authors’ method of screening dental cleaners was used, based on comparing the transparency of the laboratory model of the dentition before and after exposure to the test solution by determination with an amperemeter of strength of the electric current in the photosensor device from the oxyhemograph sensor after white light emitted by a mini-emitter passed through biological material and plates and fell on it.

RESULTS: The cleaning capacity of distilled water is the lowest (p < 0.05–0.001). Rotokan®, Furacilin® and Iodinol® have a low cleaning capacity, and Iodinol® can cause a burn of the gingival cuff in case of high reaction to it, and allergic reactions. Hydrogen peroxide has an average degree of efficiency, but it dries the oral mucosa. Chlorhexidine bigluconate has the highest cleaning effect, Miramistin® and cetylpyridinium chloride are slightly inferior to it (p > 0.05). By the cleaning capacity, chlorhexidine bigluconate solution is significantly superior to hydrogen peroxide (p < 0.05), Iodinol® (p < 0.02), Furacilin® (p < 0.02), Rotokan® (p < 0.01).

CONCLUSION: The described method received the patent for invention of the Russian Federation No. 2019121293. Experimental studies have shown the best cleaning effect of 0.05% solution of chlorhexidine bigluconate.

Atypical hemolytic-uremic syndrome (aHUS) is an ultra-rare (orphan) disease with a progressive course, which is a systemic thrombotic microangiopathy resulting from uncontrolled activation of the alternative complement pathway. There exist the so called ‘obstetric’ thombotic microangiopathies (pre-eclampsia, HELLP syndrome) which are considered as triggers causing development of aHUS in pregnancy in genetically predisposed female patients. Here, the main peculiarity of these pathologies is the improvement of the condition of the puerpera after delivery. In case of ‘non-obstetric’ thombotic microangiopathies, delivery does not lead to regress of symptoms, on the contrary, microangiopathic process progresses with rapid development of multiorgan failure. The development of thrombotic thrombocytopenic purpura and aHUS in pregnancy may induce physiological changes in the organism of a pregnant woman. There occurs a build-up of the activity of von Willebrand factor with a parallel reduction of the activity of ADAMTS 13 enzyme (metalloprotease that cleaves its super-large multimers). This is probably a physiological adaptation of the body to minimize blood loss during childbirth. As a result of the imbalance, the risk of developing thrombotic microangiopathy increases by the end of II — beginning of III trimester. The concept of chronic uncontrolled activation of the alternative complement pathway implies a genetic defect of regulatory proteins with increased formation of C5 convertase, increased release of C5a — a strong chemoattractant, and of membrane–attacking complex C5b–C9, which leads to damage to endothelial cells, exposure of the subendothelial layer and thrombosis. The currently used drug eculizumab is a recombinant humanized monoclonal antibody that binds to the complement C5 protein and suppresses the activation of complement-mediated cell lysis. The article presents a clinical case of the development of aHUS in a patient during pregnancy, the main stages of diagnostic search are considered, routing is determined and the therapy used is justified.

Vertebrobasilar insufficiency (VBI) remains an important problem in the modern medicine since approximately every fourth cerebral infarction occurs in the posterior circulation of the brain. These strokes are accompanied by severe consequences and a high risk of repeated events. The article presents the current concepts for surgical treatment of lesions of the subclavian (ScA) and vertebral (VA) arteries responsible for the development of VBI. In the open surgical treatment of symptomatic lesion of the ScA, primarily of occlusion one, extrathoracic interventions prevail in the form of carotid-subclavian bypass and carotid-subclavian transposition. According to our analysis, the results of carotid-subclavian transposition prove to be more preferable. In the endovascular intervention on the ScA, balloon angioplasty is used with possible stenting. In the analysis, we found no differences in the long-term patency between angioplasty and stenting, although the extent of technical success was higher in the group of stenting. In case of stenosis of the ScA, the world medicine gives priority to endovascular methods. To date, there are no sharply defined criteria permitting to choose between the open and endovascular interventions for treatment of the ScA occlusion, although a probable technical failure of endovascular revascularization and higher long-term patency give priority to open surgery. As for symptomatic stenosis of VA, to date there is no evidence of the advantage of stenting over conservative therapy. Thus, surgical intervention should rather be used in case the drug treatment is ineffective. The same can be said about the open reconstruction of the VA, except for the cases of contraindications for stenting of the VA, for example, its tortuosity.

Aim of this letter is to review Chatbots that answer questions of vaccine-hesitant people, their utility, and their limitations in addressing psycho-social determinants of COVID-19 vaccine hesitancy. The authors propose a conceptual framework that could guide the development of artificial intelligence-based Chatbots and summarise the salient features of the four Chatbots discussed in the literature today, developed to address COVID-19 vaccine hesitancy.