Open Access Open Access  Restricted Access Access granted  Restricted Access Subscription or Fee Access

Vol 31, No 1 (2023)

Cover Page

Full Issue

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


Morphologic, Hemostasiologic and Hemostatic Aspects of Systemic Application of Exogenous Fibrin Monomer in Model of Posttraumatic Bleeding with Underlying Intake of Warfarin

Vdovin V.M., Shakhmatov I.I., Bobrov I.P., Orekhov D.A., Teryayev V.V., Chernus' V.E., Momot A.P.


INTRODUCTION: Earlier, an ability of exogenous fibrin monomer (FM) introduced at low doses to considerably limit posttraumatic blood loss was established by us on an experimental model of warfarin coagulopathy in vivo. However, the morphologic peculiarities of fibrin formation in the wound area were not considered.

AIM: To compare morphologic, hemostasiologic and hemostatic data based on the results of systemic application of exogenous FM to interpret their effects in the model of posttraumatic bleeding with the underlying intake of warfarin.

MATERIALS AND METHODS: In the work, Chinchilla male rabbits were used. A comparative analysis of hemostasiologic effects and of morphologic picture of the surface of the liver in the wound area was conducted after a dosed trauma, with a preliminary systemic introduction of FM (0.25 mg/kg intravenously) or a concentrate of prothrombin complex factors (40 IU/kg intravenously) with the underlying intake of warfarin by animals (0.4–0.5 mg/kg/day per os for 2 weeks).

RESULTS: Introduction of FM in warfarinised animals in the conditions of a dosed experimental liver injury promoted a hemostatic effect comparable with that of a concentrate of prothrombin complex factors. Both hemostatic drugs led to intense fibrin formation that reduced posttraumatic blood loss. The use of FM was associated with increase in the thickness of thrombotic deposits and fibrin fibers in the wound surface in comparison with placebo by 4.0 and 1.6 times, respectively (р < 0.000001). This process actively involved platelets, which led to 1.7 times reduction of their quantity in the lumen of the blood vessels in the wound vicinity (р < 0.0002). No effect of FM on systemic hemostatic reactions in venous blood was found, in contrast to concentrate of prothrombin complex factors.

CONCLUSION: Exogenous FM can produce a local hemostatic effect in the conditions of dosed experimental trauma and coagulopathy induced by warfarin intake. The hemostatic effect was mediated by intense thrombosis on the wound surface with the active recruitment of platelets in the process. The peculiarities of the demonstrated effects of FM may be mediated though the mechanisms of its action that have not yet been identified, which necessitates continuation of the research in this direction.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):5-18
pages 5-18 views

Physiological Peculiarities of Puberty Period of Adolescents Whose Mothers Were Under High Risk of Terroristic Attack

Temirkhanova K.T., Deryagina L.E., Pyatibrat E.D., Pyatibrat A.O.


INTRODUCTION: The importance of the study is determined by increasing instability of the society and involvement of civilian population in military conflicts.

AIM: To determine peculiarities of sexual development of adolescents whose mothers experienced life-threatening stress in the period preceding pregnancy.

MATERIALS AND METHODS: To evaluate the evidence of the secondary sexual signs, hormonal status, anthropometric data and immunity parameters, 2,980 medical records and data of preventive examinations of schoolchildren of the Republic of Dagestan were analyzed. The observation group included 1,416 schoolchildren whose mothers experienced a life-threatening mental trauma, and the control group included 1,564 adolescents whose mothers did not face life-threatening situations.

RESULTS: The data of a comparative analysis of the regulation of physiological development of sons of women who suffered a life-threatening mental trauma, show multidirectional changes in the concentration of gonadotropic hormones with higher concentrations of estrogens, low levels of androgens, manifested by retardation of the formation of secondary sexual signs, reduced physical strength and endurance in puberty in comparison with boys of the control group. Daughters of mothers who experienced a life-threatening stress, in contrast to girls of the control group, were characterized in puberty by higher levels of luteinizing, follicle-stimulating hormones, earlier development of mammary glands and growth of pubic hair. At the same time, in transition from the prepubertal to pubertal period, these girls were characterized by earlier reduction of the activity of adrenal cortex in these girls, early menarche in the pubertal period and retardation of stabilization of the menstrual cycle rhythm.

CONCLUSION: The adolescents being the offspring of women, who experienced a psychogenic life-threatening trauma, are characterized by disorders in physiologic maturation: boys — by retardation, girls — by acceleration and disharmony of the pubertal development.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):19-28
pages 19-28 views

Influence of Atmospheric Air Pollution on Frequency of Congenital Anomalies (on an example of a region)

Kiryushin V.A., Bobotina N.A., Demchenko M.A., Motalova T.V.


INTRODUCTION: Atmospheric air pollution is the underlying factor of a great number of human diseases in both industrialized and developing countries. Studies show that exposure to atmospheric pollutions in pregnancy can be associated with an increased risk of congenital anomalies (CAs).

AIM: To analyze the impact of atmospheric air pollutants in Ryazan city on the incidence of CAs in newborns.

MATERIALS AND METHODS: The data of monitoring of CAs by Ryazan Regional Perinatal Center; information on atmospheric air pollution of the Federal Service for Hydrometeorology and Environmental Monitoring, of Ryazan Center for Hydrometeorology and Environmental Monitoring, of Rospotrebnadzor of the Ryazan region are presented. The statistical analysis was conducted using free R computing environment (ver. 4.1.2).

RESULTS: In 2019, the prevalence of CAs in Ryazan was 24.09 per 1,000 newborns; in the period 2010–2021, the absolute number of recorded CAs grew by 244.57%. The most common congenital anomalies were Q21.0 Ventricular septal defects (28.5%, 95% CI: 20.8–36.2%) and Q62.0 Congenital hydronephrosis (7.3%, 95% CI: 2.9–11.7%). Correlation was recorded with such air pollutant as sulfur dioxide (SO2) in the second month of pregnancy (AOR 1.39; 95%; CI 1.05–1.83, p < 0.05) and the third month of pregnancy (AOR 1.59; 95% CI 1.17–2.16, p < 0.05). No statistically significant relationship was established between CAs and carbon monoxide (CO), nitrogen dioxide (NO2) and ozone (O3, p > 0.05).

CONCLUSION: The study confirms the association between atmospheric air pollution and frequency of CAs. In particular, SO2 has a negative effect in the second and third months of pregnancy. In this context, it is important that the authority bodies of the region and governmental regulatory agencies direct their efforts to reduction of the pollution of the environment which should help reduce the frequency of CAs in children.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):29-36
pages 29-36 views

Combined Effect of Multimorbidity and Increased Body Mass Index on Control of Bronchial Asthma and Quality of Patients’ Life

Tribuntseva L.V., Avdeyev S.N., Budnevskiy A.V., Prozorova G.G., Kozhevnikova S.A.


INTRODUCTION: Bronchial asthma (BA) is a serious medical and social problem due to its increasing prevalence, significant burden on healthcare and the persisting high level of disability and mortality.

AIM: To study a combined effect of multimorbidity and increased body mass index (BMI) on BA control and quality of life (QL) of patients to determine the possibilities of optimization of personalized program of patient management.

MATERIALS AND METHODS: Two hundred thirty seven patients with BA were divided to 3 groups: 1 — with normal body weight (n = 59; 24.9%); 2 — with overweight (n = 69; 29.1%); 3 — with obesity (n = 109; 46.0%). The level of multimorbidity was analyzed by Charlson comorbidity Index (CCI) and the cumulative illness rating scale (CIRS); BA control — by ASTTM and ACQ-5; QL — by AQLQ. The average number of groups of comorbid diseases (according to CIRS) was 7.44 ± 0.95, while 13.5% of patients had 1–2 groups of comorbid diseases, 33.8% — 3–4 groups, 46.8% ≥ 5 groups. In the group of obesity, 82.6% of patients had ≥ 5 groups of diseases. The average score of CIRS index was 7.44 ± 0.95 points, the maximum score was 19, the minimum was 2. In the first group, the average value of CIRS index was 4.68 ± 0.31 points, in the second — 5.62 ± 0.43 points, in the third — 10.1 ± 1.9 points (p1, 2 = 0.001, p1, 3 < 0.0001, p2, 3 < 0.0001).

RESULTS: Ten patients (4%) had fully controlled BA by АСТ™ and 33 (14%) — by ACQ-5. In the group with obesity, controlled BA was not detected (÷2 = 34.128; p = 0.0002), (F = 41.362; p < 0.001). With increase in the number of comorbid diseases, the control of BA reliably decreased; thus, in groups 2 and 3 with the existence of ≥ 5 groups of comorbid diseases, asthma had uncontrolled course with the lowest parameters in patients with obesity (р < 0.05). Analysis of BA by AQLQ showed negative influence of the disease on the severity of symptoms, motor activity, general QL of patients with obesity. The data obtained are confirmed by the correlation analysis.

CONCLUSION: Multimorbidity negatively influences control of BA: increase in CCI and CIRS parameters considerably impairs control of BA. Increase in BMI is a significant additional risk factor of impairment of BA control. Multimorbidity in combination with obesity significantly impairs QL of patients with BA according to AQLQ. The absence of control of BA according to АСТ™ and ACQ-5 influences the quality of life of patients with BA. The evaluation of multimorbidity and BMI must be included in the personalized program for management of patients with BA to take into account multivariate assessment of treatable signs of the disease.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):37-48
pages 37-48 views

Prognosis for Patients after Pulmonary Embolism and its Determining Factors (Results of 12-Month Follow-Up)

Terekhovskaya Y.V., Akhmedova N.E., Leonenko D.I., Nikulina N.N.


INTRODUCTION: Pulmonary embolism (PE) is a cardiovascular disease with high mortality: according to autopsy data, PE is the cause of death in every tenth deceased person. Despite a relatively long history of studying PE, the literature data on this problem are scattered, incomplete and often do not represent the Russian population.

AIM: To evaluate 12-month survival rate of patients after a past episode of PE and to establish predictors of fatal outcome.

MATERIALS AND METHODS: The work was carried out within the Russian SIRENA register. The study included 107 patients (age median and interquartile range 63 (52–74) years), who underwent inpatient treatment in Regional Clinical Cardiologic Dispensary of Ryazan (hospitalization from 01.05.2018 to 31.05.2019; inclusion period 13 months). In the period of hospitalization, the information was taken from the data of medical records and objective examinations, and after the discharge — through telephone control. Follow-up period from the moment of hospitalization was 12 months; response — 84.5%.

RESULTS: The 12-month survival rate of patients with PE was 77.1%; recurrence of venous thromboembolism developed in 6.5% of patients, bleeding — in 22.4% of patients. The only statistically significant predictor of the development of a fatal outcome after discharge from hospital was the presence of cancer, including that in history (relative risk (RR) 4.4; 95% confidence interval (CI) 1.4–14.5; p = 0.014). The leading predictors of death from the moment of hospitalization within 12 months were high risk based on the integral assessment of severity and of early death risk (RR 9.9; 95% CI 1.2–79.5; p = 0.031), age ≥ 65 years (RR 5.1; 95% CI 1.7–15.2; p = 0.003), hospitalization with other than PE primary diagnosis (RR 4.5; 95% CI 1.9–10.8; p = 0.001), impaired filtration function of kidneys (RR 4.3; 95% CI 1.7–11.1; p = 0.003). Besides, a statistically significant increase in the risk of death during this period was associated with history of atherosclerotic diseases, stroke, heart failure, oncology, hemodynamic instability in the acute period, the need for loop diuretics during hospitalization and the presence of S1Q3 syndrome.

CONCLUSION: The mortality rate of patients with PE in one of the regional vascular centers of Ryazan in 2018–2019 generally agrees with the data of the previous international studies. The leading predictors of fatal outcome within 12 months from the moment of hospitalization include a severe condition of a patient at the time of hospitalization, age ≥ 65 years, untimely diagnosis of PE and reduction of filtration function of kidneys.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):49-58
pages 49-58 views

Prevalence, Predictors and Morphological Patterns of Acanthosis Nigricans Between Obese Non-diabetic Patients on Second Generation Antipsychotics Versus Non-obese Insulin Dependent Diabetes mellitus: A Nested Case-Control Study

Vidyasagar P., Kamble A., Khairkar P., Shravya B., Sumera Y., Matety A.R., Reddy V., Biswas R., Ransing R.


INTRODUCTION: There is no study in literature for analyzing acanthosis nigricans (AN) in psychotropic induced obesity or hypercholesterolemia.

AIM: To assess the prevalence and explore the predictors and morphological patterns in AN in patients on antipsychotics induced hypercholesterolemia versus those with diabetes mellitus.

MATERIALS AND METHODS: 491 schizophrenia patients on second generation antipsychotics were screened. 26 out of 491 patients have AN and cholesterol > 200 mg/dl but non-diabetic. We used Mann–Whitney U-test, Pearson’s ÷2 test, Fischer Exact and Spearman’s correlation coefficient.

RESULTS: In the group of antipsychotics induced hypercholesterolemia having developed AN in 5.29% (26 out of 491) of individuals, we observed significance of Burke’s knuckle (p < 0.001), knee (p = 0.002), elbow (p = 0.042) compared to patients without hypercholesterolemia. Interestingly Burke’s neck severity (p < 0.001), neck texture (p = 0.001) and axilla (p = 0.007) index also showed marked differences on Mann–Whitney U-test and Wilcoxson W-test. On Spearman’s correlation coefficient antipsychotics induced hypercholesterolemia was found to affect most positively and significantly as the emergence of AN specifically for neck texture (ρ = 0.413, p = 0.003) compared to other bodily regions.

CONCLUSION: About 5.29% prevalence of AN in the group having obesity secondary to psychotropic drugs which was significantly less than what even non-obese, insulin dependent diabetic patients who almost had 13.55% prevalence, close to three times. This suggests that diabetes is strongly linked with occurrence of AN lesions and might reflect the continuity in the paradigm of metabolic syndrome as its definitive predictor of severity while obesity is the initiation of phase shift in the process.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):59-68
pages 59-68 views

Pleiotropic Effects of Alpha-Lipoic Acid in Treatment of Diabetic Neuropathy in Patients with Type 2 Diabetes Mellitus

Uryasyev O.M., Baranov V.V., Demina P.L.


INTRODUCTION: Type 2 diabetes mellitus is an urgent problem due to its widespread prevalence and disability of patents in result of macro- and microvascular complications. Diabetic neuropathy (DN) considerably impairs the quality of life of patients. Use of alpha-lipoic acid (ALA) prevents the development of oxidative stress and improves oxidation of fatty acids.

AIM: To study the influence of alpha-lipoic acid on the variability of glycemia, lipid spectrum, ‘positive’ and ‘negative’ neurological symptoms in patients with DM2 and DN.

MATERIALS AND METHODS: The prospective study included 39 patients with DM2 and DN in the clinical stage: patients of group 1 (n = 20) were administered intravenous drip infusion of ALA 600 mg once a day for 2 weeks in hospital conditions followed by intake of 600 mg once a day per os for 2.5 months on an outpatient basis; patients of group 2 (n = 19) did not receive ALA preparations. In all the patients, parameters of lipid and carbohydrate metabolism were studied, pain, tactile, temperature, vibration sensitivity and muscle strength of lower extremities were evaluated.

RESULTS: In patients of group 1, after 12 weeks of using ALA, decrease in ‘positive’ symptoms in the lower legs and feet, improvement in vibration (0.6 ± 0.5 points, p = 0.0095), tactile (0.7 ± 0.6 points, p = 0.037), temperature sensitivity (0.2 ± 0.4 points, p = 0.027), and also decrease in the average value of glycemia (8.7 [7.4; 9.2] mmol/l, p = 0.0078), decrease in glycated hemoglobin with the achievement of the target value (7.5 ± 0.1%, p = 0.046) and improvement of lipid spectrum (total cholesterol — 5.9 ± 0.1 mmol/ l, p = 0.043) were recorded; low density lipoproteins — 3.6 ± 0.1 mmol/l, p = 0.0076; high density lipoproteins — 1.2 ± 0.1 mmol/l, p = 0.034).

CONCLUSION: In patients with type 2 diabetes mellitus with diabetic neuropathy in the clinical stage who received preparations of alpha-lipoic acid in complex treatment, reduction of neurologic deficit, of ‘positive’ neurologic symptoms was achieved in 12 weeks; with that, improvement of lipid spectrum and of glycemic control was found, which may be considered as pleiotropic effects associated with acceleration of mitochondrial biosynthesis.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):69-78
pages 69-78 views

Peculiarities of Brain Hemodynamics and Heart Rhythm Variability in Young Men in Performing Modeled Cognitive Activity with Unequal Effectiveness

Kulagin P.A., Lapkin M.M., Trutneva E.A.


INTRODUCTION: Purposeful cognitive brain activity of an individual depends on blood supply to the cells of the cerebral cortex (CC), and on their autonomic innervation.

AIM: To identify peculiarities of the brain hemodynamics and heart rhythm variability (HRV) in young men performing cognitive tasks with unequal effectiveness.

MATERIALS AND METHODS: The study involved 42 practically healthy young men (mean age 19.40 ± 1.20 years). The brain hemodynamics was studied using Reo-Spektr-2 rheograph (Neurosoft, Russia) in the initial condition of relative rest and in modeled purposeful cognitive activity. Synchronously with record of rheoencephalogram, rhythmocardiogram was recorded using Varicard 2.51 hardware-software complex (Ramena, Russia). Purposeful cognitive activity was modeled in Physiotest program for psychophysiological studies with use of behavioral model: Schulte Table Test in a two-color Schulte–Gorbov modification. In statistical data processing, cluster and correlation analyses were used.

RESULTS: Based on the effectiveness of Schulte–Gorbov Table Test, the sample of subjects was divided to two clusters (n = 28 and n = 14). Comparison of clusters in the initial condition of relative physiological rest and during cognitive activity revealed differences in rheoencephalographic parameters, which reflects unequal hemodynamic supply of the brain in representatives of the given clusters. Differences in HRV parameter were found reflecting the different levels of tension of adaptation mechanisms in the initial condition and in cognitive activity. The results of the correlation analysis demonstrated different dependence between the parameters of rheoencephalogram, HRV and parameters of the effectiveness of Schulte-Gorbov Test in representatives of different clusters.

CONCLUSIONS: (1) ‘High-effective’ subjects are characterized by shorter time of propagation of the rheographic wave and longer time of slow blood filling of the right vertebral artery basin, and by higher rheographic index asymmetry coefficient in the basin of the left internal carotid artery and of vertebral arteries of both hemispheres during cognitive activity compared to ‘low-effective’ subjects. (2) Physiological support of purposeful activity of an individual with unequal effectiveness of salvation of cognitive tasks is characterized not only by different levels of brain hemodynamics and activity of autonomic regulatory mechanisms, but also by certain type of correlation relationships of these parameters with parameters of purposeful behavior, in particular, with the total time of fulfilment of the task and efficiency coefficient.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):79-88
pages 79-88 views

Evaluation of Effectiveness of New Samples of Chitosan-Based Local Hemostatic Agents After Liver Resection in Experiment

Lipatov V.A., Fronchek E.V., Grigor'yan A.Y., Severinov D.A., Naimzada M., Zakutayeva L.Y.


INTRODUCTION: Chitosan-based local hemostatic agents are most promising in terms of effective stoppage of bleeding, additional properties (for example, antibacterial effect) and stimulation of regeneration. New forms of them are being developed for different types of organ damage.

AIM: To evaluate the hemostatic effect of samples of new chitosan-based local hemostatic agents on a liver resection model.

MATERIALS AND METHODS: An in vivo experiment was performed on 60 white male rats of Wistar line of 200 g–250 g mass. The animals were divided to 4 study groups of 15 animals, respectively, depending on the kind of hemostatic agent and additional introduction of an anticoagulant that enhanced bleeding. As study materials, hemostatic collagen sponge (control groups No. 1.1 and 1.2) and also samples of new chitosan-based hemostatic agents — Сhitocol-Hemo® (Evers, Russia) were used. The rats under general anesthesia underwent midline laparotomy followed by laparopexy by dissecting the falciform ligament of the liver and placement of a gauze turunda between the diaphragm and the left liver lobule with displacement of the latter into the wound. After this, a sterile gauze turunda of the known mass was placed under the left lateral lobe of the liver, and resection of this lobe was performed at 10 mm distance from the edge. The bleeding was stopped by application of the tested materials. The mass of blood loss (gravimetric parameters) and the time of bleeding were evaluated. The reliability of the differences was determined using nonparametric Mann-Whitney test.

RESULTS: In animals that were not administered the anticoagulant before modeling of the liver trauma, statistically significant differences were found only in such parameters as increase in the sample mass after impregnation with blood, in percent. Here, the value of this parameter in the group with use of hemostatic collagen sponge (2262.9) was three times that in the group using hemostatic Сhitocol-Hemo® (722.7) p = 0.000003. The differences between the groups with heparin therapy were of similar character (p = 000003).

CONCLUSION: The hemostatic effect of the sample of Сhitocol-Hemo® hemostatic agent was confirmed in an acute experiment on a model of liver injury in rats on the basis of measurement of the mass of blood lost, of blood absorbed by the sample, and also of bleeding time. This hemostatic effect is probably provided due to positive physicochemical characteristics (porous structure, stroma/pores ratio and composition of the agent.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):89-96
pages 89-96 views

New Pharmacological Approach to Improvement of Quality of Life of Patients after Coronary Artery Bypass Grafting through Stimulation of Neoangiogenesis

Oleynik B.A., Evdakov V.A., Plechev V.V., Izhbul'din R.I.


INTRODUCTION: Despite the increased volume of rendered high-tech assistance and objective improvement of the condition of the majority of operated patients, the parameters of physical activity and working capacity in this category of patients remain low.

AIM: To study the effect of 5-oxymethyluracil with angiogenic properties on the quality of life of patients in the early and long-term period after coronary artery bypass grafting (CABG).

MATERIALS AND METHODS: The randomized prospective study included two groups of patients: the main group (n = 87) which in the perioperative period of CABG (5 days before and 14 days after surgery), in addition to standard therapy, received the drug 5-oxymethyluracil), and the control group (n = 81) which received standard therapy. The groups were comparable in gender, age, basic clinical and functional characteristics and peculiarities of surgical intervention. The quality of life of patients was determined by the Seattle Angina Questionnaire (SAQ) before CABG surgery (upon admission to the vascular surgery department) and after surgery (after 2 months and 16–18 years). There were no statistically significant differences in the preoperative parameters of quality of life in the control and main groups.

RESULTS: In the long-term period of surgical revascularization of the myocardium (16–18 years after the operation) the severity of angina according to SAQ was: in the control group — 33.30 (20.00-60.00), in the main group — 60.00 (33.30-70.00; р = 0.0407). Other scales of SAQ, including physical activity, stability of anginal course, satisfaction with treatment and perception of the disease, did not demonstrate any differences between the studied groups in 2 months or 16–18 years after CABG.

CONCLUSION: Perioperative use of 5-oxymethyluracil influenced the improvement of only one parameter of quality of life according to the SAQ questionnaire — the severity of angina, with statistically significant differences between the groups in the long-term period of CABG (16–18 years after surgery). According to SAQ questionnaire, there was no effect on the remaining parameters of the quality of life with the underlying perioperative use of the studied drug in all follow-up periods.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):97-108
pages 97-108 views

Evaluation of Overall Survival Rate of Patients with Metastatic Colorectal Cancer Depending on Choice of Treatment, Location of Primary Focus and RAS Genes Mutation Status

Shiryayev N.P., Cheporov S.V., Malashenkо V.N., Kesel'man Y.A., Akimova A.E., Milafetnova V.V.


INTRODUCTION: Morbidity with colorectal cancer (CRC) in the Yaroslavl region (YR) accounts for 13.4% of all cases identified in 2021, and ranks third after skin cancer and lung cancer. In the mortality structure, CRC makes 14.2% and is the second leading cause of death. Locally advanced and metastatic forms of the tumor process are identified in more than half the patients.

AIM: To evaluate the overall survival rate of patients with metastatic CRC (mCRC) in the territory of the YR depending on the volume of surgical treatment, chemo- and targeted treatment regimens and the presence of RAS genes mutations.

MATERIALS AND METHODS: On the base of the Yaroslavl Regional Clinical Oncology Hospital, the data of 291 patients with mCRC who underwent treatment in the period from 2015 to 2022, were analyzed. The mean age of patients was 63.0 ± 8.6 years. There were 52% of men (n = 151), and 48% of women (n = 140). The patients were divided to two groups depending on the status of RAS genes mutations: group I (n = 145) — patients with the identified mutation; group II (n = 146) — patients with ‘wild-type’ mutation. The patients were additionally divided to three subgroups depending on the type of treatment: subgroup A (58.1%; n = 169) — removal of the primary focus (PF) in combination with antitumor chemotherapy (CT); subgroup B (31.6%; n = 92) — CT without surgical treatment; subgroup C (10.3%; n = 30) — removal of the PF and resection of liver metastases in combination with CT.

RESULTS: The overall survival rate (OSR) depending on the type of treatment was in subgroup A — 21.0 (95% confidence interval (CI) 18.6-23.3) months; in subgroup B — 11.2 (95% CI 9.9–12.5) months; in subgroup C — 21.0 (95% confidence interval (CI) 18.6–23.3) months. OSR with RAS mutation: in subgroup 1A — 17.7 (95% CI 13.8–21.7) months; in subgroup IB — 11.1 (95% CI 8.3–13.2) months; in subgroup IC — 13.2 (95% CI 4.07–22.7) months. OSR with ‘wild-type’ mutation: subgroup IIA: Cetuximab — 33.6 (95% CI 26.7–40.4) months, Panitumumab — 23.8 (95% CI 19.7–27.9) months (p = 0.01); subgroup IIB: Cetuximab — 22.3 (95% CI 17.0–27.5) months, Panitumumab — 15.2 (95% CI 10.7–19.6) months (p = 0.012); subgroup IIC: Cetuximab — 27.5 (95% CI 17.8–37.1) months, Panitumumab — 38.8 (95% CI 13.9–63.6) months (p = 0.013).

CONCLUSIONS: In patients with mutation in RAS genes, the best OSR values were noted in case of surgical removal of the PF in combination with palliative drug therapy. In patients with ‘wild-type’ mutation of RAS genes the best OSR parameters were recorded in surgical removal of the PF and of metastases in the liver in combination with palliative polyCT and Panitumumab. The lowest OSR was found in the subgroup of patients with use of CT without surgical treatment in the presence of RAS mutation. High OSR parameters were found with mutation in G13codon, and with use of surgical treatment with mutation in A146 codon.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):109-118
pages 109-118 views

Systemic Inflammatory Response Syndrome and Serum Procalcitonin in Odontogenic Maxillofacial Infection

Kabanova A.A., Pokhoden'ko-Chudakova I.O., Kabanova S.A.


INTRODUCTION: The systemic inflammatory response syndrome (SIRS) is a progressive, pathophysiological process which may be caused by a variety of clinical precursor events including local or generalized infection, or non-infective inflammatory process.

АIM: To determine the development of systemic inflammatory response syndrome (SIRS) and serum procalcitonin level in patients with odontogenic infection of the maxillofacial area.

MATERIALS AND METHODS: The prospective observational study evaluated on 158 medical patients from 2015 to 2018 at the Department of maxillofacial surgery, Faculty of Stomatology, Vitebsk state medical University. The patients were divided into 3 groups: 1 group (96 people) had acute purulent odontogenic osteomyelitis of mandible complicated by the cellulitis of one space cellular spaces, group 2 (36 patients) had acute purulent odontogenic osteomyelitis of mandible complicated by the cellulitis of 2–4 cellular spaces, group 3 (26 people) — had acute purulent odontogenic osteomyelitis of the mandible complicated by Ludwig's angina. Blood tests of all patients were performed. Based on the blood test, breath rate, heart rate and body temperature SIRS was determined.

RESULTS: Acute odontogenic osteomyelitis, complicated by cellulitis, is characterized by the development of SIRS. In case of one cellular space cellulitis SIRS developed in 9.0% of patients, in case of 2–4 cellular spaces cellulitis — in 36.0%, in case of Ludwig's angina — in 80.0%. PCT blood level in healthy group was 0.009 (0.006–0.018) pg/ml. All patients’ groups had significantly higher PCT blood level compared with the healthy group: 1 group — 0.034 (0.019–0.050) pg/ml, U = 23, р = 0.01; 2 group — 0.11 (0.06–0.24) pg/ml, U =12, р = 0.003; 3 group — 0.41 (0.30–1.15) pg/ml, U = 17, р < 0.001.

CONCLUSION: Odontogenic maxillofacial infection is accompanied by SIRS. The search for significant diagnostic criteria for the development of life-threatening conditions should continue.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):119-125
pages 119-125 views


Two Rare Anatomical Variants of Femoral Triangle Vessels in One Patient: Case Report

Kalinin R.E., Suchkov I.A., Klimentova E.A., Shanayev I.N., Khashumov R.M., Korbut V.S.


INTRODUCTION: The upper third of thigh — the area of the femoral triangle, or Scarpa’s triangle, is of great importance both in anatomy and vascular surgery. It is the place of passage of the main vessels of the lower extremities: the femoral artery, femoral vein and their largest tributaries which are easily accessible in this region due to their superficial location. To note, in the vascular surgery, the femoral vessels are divided to common and superficial ones depending on the level of their location relative to deep femoral vessels. This division is extremely important in the functional aspect, since deep femoral vessels may significantly compensate for the blood flow in case of impaired patency of the superficial femoral vessels. Besides, an important tributary of the common femoral vein is the great saphenous vein forming saphenofemoral junction. Classic anatomy describes vessels of the upper third of thigh as single trunks with permanent topography. At the same time, in the literature there are commonly encountered reports of duplication of the superficial femoral vein, two trunks of the deep femoral artery, and relatively rare reports of atypical saphenofemoral junctions (about 0.02%). The work describes anatomical variants of the FT vessels in one patient: atypical saphenofemoral junction on the right and duplication of the common femoral vein on the left, two trunks of the deep femoral artery on both sides.

CONCLUSION: The anatomical variants of FT vessels described in the article, are rare. It is important that clinicians know about them to avoid errors in diagnosis or surgical treatment.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):127-136
pages 127-136 views

Suture Failure of Duodenum after Surgery for Complications of Duodenal Ulcer

Pashkin K.P., Natal’skiy A.A., Motyrova E.V., Lun’kov I.A., Matrosov V.I., Mishin D.V., Peskov O.D.


INTRODUCTION: The incidence of failure of intestinal sutures in the early postoperative period reaches 26%. The failure of the duodenal sutures leads to formation of high duodenal fistulas, the treatment of which is one of the most complicated surgical tasks. The article describes a clinical case of failure of duodenal suture after surgery for a duodenal ulcer complicated with bleeding. The failure of the duodenal suture could be provoked by hypoproteinemia and anemia, despite the attempts of their compensation. The presented case demonstrates complexity of the clinical course of this pathology and the possibility of successful application of draining surgery with creation of a controllable duodenal fistula, the subsequent healing of which led to recovery of the patient. To create the controllable duodenal fistula, we used a method of external-internal triple drainage of the duodenal zone (retrograde duodenostomy, gastroenteroanastomosis with a short loop, nasogastral probe). At the initial stage, after surgery, the patient received full parenteral feeding, after restoration of the intestinal peristalsis, feeding was continued through a nasointestinal probe. Infusion therapy, transfusion of blood components were conducted, drugs suppressing gastric and pancreatic secretion, were used. On the 35th postoperative day, the discharge through the duodenal fistula and the nasogastral probe significantly decreased, and completely stopped on the 54th day (immediately after X-ray of stomach with barium sulfate as contrast substance). The patient was discharged with improvement for outpatient follow-up at the place of residence on the 60th day after surgery. In the follow-up period – no complaints, good appetite, rapid gaining of weight, complete rehabilitation. In one-year follow-up, no long-term complications and consequences for health were observed.

CONCLUSION: A choice of the surgical treatment method of duodenal suture failure remains a subject of discussion. In the presented clinical case, draining surgery with creation of a controllable duodenal fistula proved to be effective. The complete closure of the residual fistula of the duodenum was facilitated by stomach X-ray with use of barium sulfate.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):147-154
pages 147-154 views

Role of Myocardial Bridging in Myocardial Ischemia: Case Report

Solov'yeva A.V., Gurbanova A.A., Maksimtsev I.A., Lazareva O.Y., Maksimtseva E.A.


INTRODUCTION: Myocardial bridging (MB) is considered a benign pathology, however, its existence is often associated with angina pectoris, myocardial infarction, ventricular tachycardia and sudden cardiac death. The clinical significance of MB is determined by the dynamic stenosis of the coronary artery, which depends on the rate and strength of heart contractions and is poorly visualized by instrumental methods, which impairs timely diagnosis and early administration of the adequate treatment. A clinical case of a combined damage to the coronary bed in a 58-year-old patient is presented: MB of the anterior interventricular artery (AIVA) causing dynamically significant narrowing of the tunnel artery and hemodynamically insignificant atherosclerotic lesion of the coronary arteries. MB was typically located in the mid-segment of the AIVA. The diagnosis of the anomaly of the coronary bed was established after coronary angiography: MB of AIVA led to stenosis of the tunnel segment to 80% and was the cause of angina attacks. Stenting of the AIVA with a drug-coated stent was performed. The effectiveness of the stenting can be referred to a peculiar feature of this case, since in the treatment of this pathology the preference is given to myotomy and coronary artery bypass grafting as more effective methods. The follow-up period was 7.5 years; after stenting of the tunnel segment of the AIVA the anginal attacks did not recur.

CONCLUSION: The described clinical case demonstrates the role of MB in the development of myocardial ischemia. With timely diagnosis of the coronary blood flow disorders, successful revascularization and adequate pharmacotherapy in accordance with the current clinical recommendations, the prognosis is good.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):137-146
pages 137-146 views


Review of Factors Affecting Remission in Narcological Patients

Agibalova T.V., Nobatova V.N., Tuchina O.D., Leonov E.V., Pinegin A.R., Tukhvatullina E.I.


INTRODUCTION: Achievement of a sustained remission in patients with substance dependence syndrome is the main criterion of the quality of narcological treatment and a priority treatment task. The article presents a review of factors that influence remission in patients with mental and behavioral disorders resulting from use of psychoactive substances. Studies performed in the recent 15 years, consider the main five groups of factors for development and failure of remission: biological (gender, age, genetic parameters, organic lesions of the brain, etc.), narcological (course of the disease, age at the first use of a drug), personality and pathopsychological (cognitive disorders, comorbid mental disorders, mental trauma, etc.), social (employment, family and social situation, social support, etc.) and therapeutic factors (duration and methods of treatment, therapeutic alliance, etc.)..

CONCLUSION: There are basic factors of favorable prognosis of the course of narcological diseases that are confirmed from study to study: late onset of the disease, absence of a comorbid dependence syndrome and of a severe mental disorder, involvement in long-term treatment and rehabilitation programs that continue after remission.

I.P. Pavlov Russian Medical Biological Herald. 2023;31(1):155-163
pages 155-163 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies