Vol 31, No 1 (2023)

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.

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.

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.

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.

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.

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.

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.

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.

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.