Vol 27, No 1 (2019)

Original researches
Peculiarities of energy production in glial cells of sympathetic ganglia
Gorelikov P.L.

Aim. To determine the energy profile of satellite gliocytes in the cranial cervical sympathe-tic ganglia (CCSG) in normal functioning of nicotinic cholinergic synapses (nChS) and in their pharmaceutical deprivation.

Materials and Methods. Deprivation of CCSG in rabbits was implemented by using cholinolytic dimecolinum. The activity of H- and M-isoforms of lactate de-hydrogenase (LDH) was determined in gliocytes offrozen sections by integral cytophotomentry using Brumberg and Pevzner method.

Results. In satellite gliocytes a considerably higher activity of M-isoforms of LDH in comparison with that of H-isoforms was found which evidences predomination of anaerobic mechanisms of energy metabolism over aerobic ones in the studied cells. The relationship between the levels of activity of (Н/М) isoforms of LDH in gliocytes with experimental deprivation of nChR exhibited a complete inversion as compared to glial cells of CCSG with normal functioning of synapses.

Conclusion. Satellite gliocytes of cranial cervical sympathetic ganglion, like any other somatic cells, possess initially programmed aerobic system of energy production which transforms into anaerobic system under influence of impulses arriving through nicotine-sensitive cholinergic synapses.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):5-9
Blood glucose level in rats with different behavioral activity in the dynamics of repeated stress exposures
Abramova A.Y., Koplik E.V., Alekseyeva I.V., Pertsov S.S.

Aim. To study the effect of repeated stress on blood glucose level in rats with various behavioral characteristics and with different resistance to the development of adverse consequences of negative emotiogenic exposures.

Materials and Methods. The animals were initially subjected to open field test to calculate the index of activity. Daily 4-h immobilization of rats in individual plastic cages for 8 days was used as a model of stress. Blood glucose concentration was measured with a glucometer (control measurement and on the 1st, 3rd and 8th days of repeated stress).

Results. The basal level of glucose in behaviorally active (stress-resistant) rats was lower than in passive (stress-predisposed) specimens. Repeated exposure of rats to stress resulted in development of hyperglycemia. However, the dynamics of blood glucose concentration was different in specimens with different parameters of behavior. The increase in glucose concentration in active animals was most pronounced after a single exposure. By the 3rd and 8th days of stress exposures, glucose level in these rats progressively decreased (as compared to the 1st day), but remained above the basal level. Passive specimens were characterized by the increase in blood glucose concentration after a single and, particularly, after three-time restraint stress. Glucose content in these animals slightly decreased by the 8th day (as compared to the previous periods), but was above the basal level.

Conclusion. The dynamics of abnormalities in carbohydrate metabolism (in particular, changes in blood glucose level) during chronic emotiogenic exposures differed in specimens with different resistance to stress factors. These data illustrate the importance of an indivi-dual approach to studying the pathophysiological mechanisms of progression and development of stress-induced disorders.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):10-19
Etiological structure and antibacterial therapy of purulent meningitis in neurological patients
Kubrakov K.M., Semenov V.M., Marshalko O.V., Migunova V.A.

Purulent meningitis is one of the most severe forms of inflammatory brain lesions. Mortality rate in purulent meningitis amounts 10.0-25.0%.

Aim. To study the etiological structure and resistance to antibacterial drugs, to optimize the algorithm of etiotropic therapy of purulent meningitis in neurological patients.

Materials and Methods. The data on etiology and resistance of causative agents of purulent meningitis in 54 neurological patients (28 of them are male; the average age is 47 (33.5; 58) years) for the period of 2010-2018 are presented in the article. The cerebrospinal fluid (CSF) study included general, biochemical, bacteriological analyses as well as the study of the D-lactate level. Identification of microorganisms and determination of resistance to antibacterial therapy was performed using identification test systems (ID) and strips (ATB) using the automatic microbiological analyzer ATB Expression (Bio Merieux, France). The combined test BD Directigen Meningitis Combo Test (Becton Dickinson, USA) was also used for the direct quantitative determination of antigens against H. influenzae, S. pneumoniae, N. meningitidis, E. coli. Statistical processing of the results was performed using Statistica 10.0 (Stat Soft Inc., USA) with the calculation of the sign frequency, 95.0% confidence interval (95.0% CI), median, upper and lower quartiles (Me [LQ; UQ]).

Results. 83.33% of meningitis cases in neurological patients have been established to be manifested by purulent inflammatory processes, which is confirmed by the results of the CSF analysis and the level of D-lactate (p<0.05) in it. The inoculability of pathogens from CSF was 61.90% (95.0% CI 46.59-77.22%). At the same time, microorganisms were isolated in the monoculture. Gram-positive microflora constituted 88.46% (95.0% CI 75.30-100.0%) among the isolated pathogens. The main pathogens of purulent meningitis in the studied patients’ sample were Str. pneumoniae (34.62%) and S. aureus (26.92%); 96.15% of the isolated strains are sensitive to the most commonly used antibacterial drugs to treat meningitis.

Conclusions. The etiological structure of purulent meningitis in neurological patients has been established. The resistance of pathogens to antibacterial drugs has been studied. The algorithm of etiotropic antibacterial therapy has been optimized.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):20-29
Analysis of dynamics of intensity of community immunity to diphtheria in different age groups of vaccinated population of the ryazan region in 2015-2017
Kotelevets E.P., Maksimova O.A.

Aim. To study the level of anti-diphtheria antitoxic antibodies in blood serum of vaccinated individuals over the period of 2015-2017.

Materials and Methods. The study was conducted on the base of the Center of Hygiene and Epidemiology of the Ryazan region. The evaluation of antitoxic immunity against diphtheria was performed on the basis of the results of annual serological examination of at least 100 samples of blood sera for the content of diphtheria antitoxin in each age indicator group. In the study reaction of passive hem agglutination was used with standardized erythrocyte diphtheria antigen. Blood serum samples of individuals of indicator groups of the population with a documented history of vaccination were investigated. On the basis of the results of serological monitoring, the analysis of the state of anti-diphtheria antitoxic immunity in children (3-4 years, n=300), teenagers (16-17 years, n=302) and adults (30-39 years, n=323; 40-49 years, n=305) of the Ryazan region in 2015-2017 was carried out.

Results. The level of protection among children, teenagers and adults in the studied period was 97.0 and 95.6%. The intensity of anti-diphtheria immunity was also high: 93.3-95.6% of the examined persons had medium and high antibody titers. Protective level of anti-diphtheria antibodies in 2015 was revealed in 97.3%, in 2016 – in 93.3% and in 2017 – in 98.3% of the examined samples.

Conclusion. Analysis of the results of serological monitoring showed a positive dynamics of growth of the number of seropositive individuals with intense anti-diphtheria immunity. The data of serological monitoring correspond to the official statistical data of Directorate of Rospotrebnadzor in the Ryazan region on the high level of coverage of the population with vaccination. According to previously published epidemiological studies, in such conditions the incidence of diphtheria in the population is sporadic.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):30-34
Prevalence rate of Helicobacter pylori infection among population of Ryazan region
Zhestkova T.V., Butov M.A., Lymar Y.Y., Papkov S.V.

Aim. Determination of the prevalence of Helicobacter pylori (H. pylori) infection among the population of the Ryazan region.

Materials and Methods. 833 individuals (809 adults and 24 children) were examined for presence of IgG class antibodies using the enzyme immunoassay (2017-2018). The criteria for inclusion into the study were: a desire of a patient to undergo examination for the presence of antibodies to H. pylori in blood. Criteria for exclusion: past treatment for helicobacteriosis. The presence of helicobacteriosis was determined by enzyme immunoassay for quantitative detection of IgG class antibodies (anti-H. pylori IgG) using BCM Diagnostics Helicobacter pylori IgG (USA) test system and for qualitative determination of IgG antibodies to H. pylori in blood serum on IMMULITE 2000 (Germany; test IMMULITE® 2000 H. pylori IgG). Sensitivity of the used test systems was >95.0%, specificity >98.0%.

Results. High contamination of adult residents of Ryazan with H. pylori – 65.6% was found (70.6% of males, 64.4% of females). Prevalence of H. pylori infection among adults in 2017 was 64.4% and in 2018 – 70.2%, however, the observed increase in the number of infected individuals was not statistically significant (p<0.05). The highest prevalence of H. pylori infection was observed in individuals ≥40 years of age (67.2%). Gender-related differences in the prevalence of Helicobacter pylori infection were revealed in individuals of 40 years and older. H. pylori infection in males of ≥40 years was 75.2%, against 65.5% in females of the same age (p<0.05). In children of 4-16 years, the share of individuals with positive serological test with anti-H. pylori IgG reached 20.8%. All H. pylori infected children were above 9 years of age. Individuals with positive serological tests received consultation of a gastroenterologist, and on indications underwent additional examination with administration of eradication treatment. In patients with indefinite results the examination was repeated after a week and/or the presence of H. pylori antigen in feces was determined.

Conclusion. The data obtained indicate a high level of infection with H. pylori in the adult population in the Ryazan region – 65.6%. The incidence of detection of anti-H. pylori IgG in the population was maximal in individuals ≥40 years (67.2%).

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):35-40
Evaluation of vitamin status of the population of the russian arctic according to the data on vitamin consumption and serum level
Beketova N.A., Vrzhesinskaya O.A., Keshabyants E.E., Kobelkova I.V., Denisova N.N., Kodentsdova V.M.

Aim. To compare the calculated data of A, B2, D vitamins and beta-carotene consumption with diets and biomarkers of vitamin status of 178 residents of Tazovsky and Gyda settlements of Yamal-Nenets Autonomous Area.

Materials and Methods. The actual nutrition was studied by frequency (according to the frequency of food consumption for the previous month) and 24-hour (daily) reproduction methods. Vitamin status was assessed by serum vitamin concentration.

Results. A statistically significant relationship between serum beta-carotene level and its consumption with rations was established. There was no significant relationship between the level of fish consumption and vitamin D sufficiency.

Conclusion. Vitamin intake data provide a framework to reveal deviations from optimal nutrition and to identify risk groups with vitamin deficiency, but they do not always make it possible to carry out an objective assessment of individual
vitamin sufficiency. Thus, in individuals with a clear lack of vitamin A in the diet on the previous day before taking blood, blood retinol level was in the normal range.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):41-48
Comparative analysis of parameters of cardiointervalometry, ergoreflex and data of 6 minute walk test in patients with chronic obstructive pulmonary disease
Abrosimov V.N., Kosyakov A.V., Dmitrieva M.N.

Aim. To study the relationship between parameters of cardiointervalometry and ergoreflex, and 6-minute walk test data in patients with chronic obstructive pulmonary disease (COPD).

Materials and Methods. The study included 103 men, of them 63 patients with COPD, 40 patients of the control group. Functional assessment of external respiration and a 6-minute walk test were performed using Spiropalm 6MWT equipment (Cosmed, Italy). The autonomic status and the influence of the ergoreflex on it were assessed by the method of cardiointervalometry before, during and after the test with external peripheral vascular occlusion using Varicard hardware and software complex (LLC Ramena, Ryazan, Russia).

Results. When performing a 6-minute walk test, significant differences were obtained between the groups of patients with COPD and of the control group in the majority of the studied parameters (p<0.01). In 18 of 63 patients with COPD, the level of SpO2 in 6-minute walk test decreased by≥ 4% (p<0.01). The obtained result is of considerable importance for assessment of exercise tolerance in patients with COPD. In tests with external peripheral vascular occlusion in patients with COPD and of the control group, the index of activity of regulatory systems (IARS) increased in both groups. However, after completion of the test, the index in patients with COPD decreased below the initial values (p<0.05), and in patients of the control group the changes were even more pronounced (p<0.01). Patients with COPD were divided into groups depending on the distance covered in 6-minute walk test. Analysis of the data revealed a moderate positive correlation between the covered distance and the forced expiratory volume in the 1st second (FEV1, R=0.45, p<0.01).The maximum level of the total effect of the autonomic regulation of blood circulation was recorded in patients who covered the minimum distance (227.77±48.13 m) in 6-minute walk test. Besides, a moderate negative correlation between IARS and the results of 6-minute test was recorded (R=-0.34, p<0.01).

Conclusions. 1. For assessment of the functional status of patients in 6-minute walk test it is important to take measurement of saturation throughout the whole test. 2. The change in IARS values in the test with external peripheral vascular occlusion can be regarded as a reduction of the influence of reflex from the lower limb ergoreceptors on the functional condition of patients. 3. Patients with COPD showed a marked autonomic imbalance. IARS showed a moderate negative correlation with the distance covered in 6-minute walk test. 4. Maximum value of IARS was obtained in patients with the minimal distance covered in 6-minute walk test.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):49-58
Сomplex assessment of the degree of chronic obstructive pulmonary disease copd severity on out-patient visit
Nizov A.A., Ermachkova A.N., Abrosimov V.N., Ponomareva I.B.

Аim. Analysis of the possibility and reasonability of a comprehensive assessment of clinical condition of patients with chronic obstructive pulmonary disease (COPD) on outpatient visit in conditions of a small territorial municipal polyclinic.

Materials and Methods. The study was carried out on the base of municipal Outpatient clinic №12 (total adult population 7177 people) of Ryazan from October 2012 to December 2014. In history taking, positive family history, existence of unfavorable factors that could provoke development and progress of the disease, coughing episodes in history, phase of the disease, medicinal treatment were evaluated. This was followed by a screening epidemiological examination (questionnaire). In result, an observation group was formed (n=50, aged 19-81 years, mean age 56.1±2.3 years) from patients with chronic respiratory symptoms (cough, dyspnea) seeking medical care, where screening spirography, evaluation of the degree of severity of COPD according to GOLD 2014 were conducted, and four observation groups (A, B, C, D) were formed.

Results. COPD was confirmed in 100% of patients of the observation group, of them the 1st stage COPD was found in 18.7% of cases, 2nd – in 43.3% of cases, 3rd– in 30.0%, 4th – in 8.0%. The number of exacerbations was 1-8 per year. The most common concomitant diseases were ischemic heart disease (53.2%), arterial hypertension (74.3%), chronic gastroduodenitis (34.5%). A combination of 2 or more chronic diseases was observed in 31% of cases. Depending on the degree of airflow rate limitation, symptoms (mMRC results), history of exacerbations, patients were divided into the following groups according to GOLD 2014: group A – 59 patients (39.3%), group B – 30 patients (20.0%), group C – 29 patients (19.0%), and D – 32 patients (21.7%). There were no statistically significant differences between the groups in age, gender and smoking status (p>0.05).

Conclusion. The analysis showed a possibility and convenience of using stratification of patients with COPD by the degree of severity of the disease (according to GOLD 2014) with the aim of individualization of further management of such patients.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):59-65
Results of treatment for Boerhaave syndrome
Mikheev A.V., Trushin S.N.

Background. Spontaneous rupture of the esophagus (Boehaave syndrome, BS) is a rare pathology in the surgical practice. Esophageal rupture makes no more than 2-3% of all cases of damage to the esophagus and is associated with a significant number of diagnostic errors and with high mortality.

Aim. The aim of the study was to analyze the quality of diagnostics and the results of treatment of patients with spontaneous rupture of the esophagus.

Materials and Methods. We performed a retrospective analysis of medical histories and of treatment results of 10 patients with Boerhaave syndrome hospitalized in the department of thoracic surgery of the Ryazan Regional Clinical Hospital, Ryazan in 2007-2018.

Results. Four of ten patients were transferred from other medical institutions. At the primary care stage six patients were misdiagnosed; two of them underwent diagnostic laparoscopy for suspicion of acute pancreatitis and perforated gastric ulcer. The average time from the onset of the disease to surgery was 71.7±23.4 hours. Closure of the esophageal perforation was performed in all cases. Regarding the timing of surgery, all patients with Boerhaave syndrome were divided into 2 groups: patients with early intervention (4 patients operated within 24 hours); patients with late intervention (5 patients operated after 48 hours from the onset of the disease). One patient underwent surgical treatment within 24 hours in a medical facility outside the Ryazan region. In nine out of ten patients the rupture was localized in a typical place in the lower third of the esophagus along the left lateral wall. In the postoperative period eight patients had complete or partial esophageal suture failure, which required prolonged inpatient treatment (54.7±12.1 days). Postoperative mortality was 10% (1 patient of 10) and was caused by the progressive multi-organ failure and the development of cerebral ischemic stroke.

Conclusion. The quality of diagnostics of Boerhaave syndrome remains unsatisfactory: due to rare occurrence of this pathology, most specialists of primary care settings, including surgeons, are not well acquainted with the etiopathogenesis and peculiarities of clinical presentation of Boerhaave syndrome. Diagnostic and treatment errors in rendering primary medical assistance reaches 60%. Results of surgical treatment directly correlate with the time from the moment of perforation and development of septic complications. Even with early surgical intervention performed within 24 hours from the moment of perforation, esophageal suture failure may occur in up to 75% of cases. Thus, the success of treatment is determined by early diagnosis, timely hospitalization in a specialized facility, and adequate surgical intervention.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):66-74
Clinical cases
Trauma of parenchymal organs of abdominal cavity and of retroperitoneal space in newborns
Soloviev A.V., Shatskaya E.E.

A great role in the pathogenesis of traumas in newborns is assigned to hypoxia and hypoxic hemorrhages, and also to mechanical impacts during deliveries. This is associated with objective difficulties in diagnosis of traumas of organs of the abdominal cavity and of the retroperitoneal space in newborns.

Aim. To present and analyze clinical cases of trauma of parenchymal organs of the abdominal cavity and of the retroperitoneal space in newborns. In clinics of children’s surgery seven children with pathology of adrenals, three with trauma of the liver and one with rupture of spleen have been observed within the recent 10 years. No damages to the stomach, pancreas, duodenum, small and large intestine, kidneys and urinary bladder were recorded. In the article clinical cases of trauma of adrenals, liver and spleen are presented.

Conclusion. Damages to parenchymal organs of the abdominal cavity and of the retroperitoneal space in newborns are very rare. More commonly adrenals are affected, less commonly liver and spleen. The diagnosis of a parenchymal organ in newborns is a reason for immediate transferal of the child to a surgical hospital.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):75-79
Ethical and legal aspects of in vivo experimental biomedical research
Lipatov V.A., Kryukov A.A., Severinov D.A., Saakyan A.R.

In XXI century in vivo experiments came into a common use in connection with development of biological and medical scientific fields. In the first part of the work historical and techni-cal aspects of use of animals in in vivo experiments are considered. In the work the problem of choice of a kind of laboratory animal for experimental purposes is discussed, and also the number of animals in the experimental groups is substantiated for further statistical processing of the primary information and determination of the reliability of differences in interpretation of the obtained results. According to the data of analyzed literature sources, modern researchers keep to the non-violence strategy and ahimsa principle (from Lat. ahimsᾱ – causing no harm). Here, the dominating point of view is the necessity for in vivo experiments for further development of the biomedical science. This is possible provided suffering of animals are minimized with their minimal number in an experiment. The choice of the animal species first of all depends on the task faced by an experimenter. Besides, in each research a thorough choice of a specific animal is required based on the information of its health, maintenance and feeding, anatomical and physiological peculiarities, age, genetic characteristics. Chronic and acute surgical experiments are usually conducted on large vertebrate animals: dogs, European rabbits, house cats, while the action and effectiveness of pharmacological drugs are more conveniently studied on small laboratory animals: house mice, common rats, guinea-pigs, golden hamsters.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):80-92
Modern position of anticoagulants in acute pulmonary embolism: achievements, limitations, prospects
Terekhovskaya Y.V., Okorokov V.G., Nikulina N.N.

Pulmonary embolism (PE) is the third most common cardiovascular disease after myocardial infarction and stroke, and one of the leading causes of death in Europe.

Aim. Analysis of the modern scientific base concerning the possibilities and limitations of use of anticoagulant therapy (ACT) at different stages of medical care in PE depending on risk stratification. The article reflects the position of modern Clinical guidelines, the results of recent studies and some controversial and unresolved issues of the ACT for PE.

Conclusion. Currently, a sufficient evidence base has been obtained in favor of the fact that the ACT increases the survival rate of patients with past PE even taking into account an increase in the frequency of hemorrhagic complications; the choice of therapy schemes for PE is based on the stratification of the risk of patients; the schemes of the ACT for the acute period, for the subsequent prevention of relapses of PE are developed, the evidence of the expediency of its further prolongation (a study of rivaroxaban at a dose of 10 mg for prolonged therapy) is obtained. Use of direct oral anticoagulants (DOAC) in patients with past PE has a more optimal efficacy/safety profile compared to vitamin K antagonists (VCA). However, not all the issues of the ACT for PE are solved, therefore the prospects for the study and application of the ACT in PE include: reasonability of obtaining substantiated data on use of DOAC after thrombolysis, in patients with reduced renal function, with antiphospholipid syndrome, with neoplastic diseases, and also for determination of exact periods of extended therapy. It is necessary to search for additional prognostic factors for PE, to study and register specific antidotes for DOAC (currently in the Russian Federation a specific antidote to dabigatran – Idarucizumab-registered); to increase the share of DOAC in the ACT as drugs with a proven best profile efficacy/safety compared to VCA.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):93-106
To the question of «competence» in forensic medicine and forensic medical examination
Boyko I.B.

In the article a problem concerning the concept of «competence» in application to forensic medicine as an educational discipline and as forensic examination, which is the most common type of legal enquiry, is first considered. Modern concepts of the role of law in the forensic medicine, of the subject of this medical field and of possibilities of forensic examination are given. The author comes to the conclusion that, unfortunately, nowadays the question of forensic medicine still belongs to the category of debatable questions. This fact does not permit to agree with a widely spread opinion stating that forensic medicine has completed its formation as a scientific discipline, besides, this opinion has negative consequences for the activity of law enforcement authorities first of all the activity associated with investigation of criminal cases, consideration of civil matters, cases of administrative violations, since the «competence» of forensic medicine in itself determines the competence of specialists in the field of forensic medicine. And, as it is known, the latter often determines the court judgment.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):107-113
To the 60th anniversary of Professor Elena Nikolaevna Yakusheva
I.P. Pavlov Russian medical biological herald B.

February 24, 2019 marks the 60th anniversary of the birth of Yakusheva Elena Nikolaevna - doctor of medical sciences, professor, head of the department of pharmacology with a course of pharmacy FDPO.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):114-116
In memory of Professor Abrosimov Vladimir Nikolaevich
I.P. Pavlov Russian medical biological herald B.

On January 22, 2019, the domestic medical community suffered a serious loss - Abrosimov Vladimir Nikolaevich, Doctor of Medical Sciences, Professor, Head of the Department of Therapy and Family Medicine of the FDPO with a course of medical and social examination of the Federal State Budget Healthcare Institution of Ryazan State Medical University of the Russian Ministry of Health, Honored Doctor of the Russian Federation, member correspondent of the Euro-Asian Academy of Medical Sciences, chief freelance pulmonologist of the Ministry of Health of the Ryazan Region.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(1):117-121

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