Vol 27, No 2 (2019)

Original researches
The main risk factors and their impact on the hiv/tuberculosis epidemic
Zagdyn Z.M.

With the HIV epidemic progression, an increase of HIV/tuberculosis co-infection in relation to a number of interrelated risk factors is becoming actual everywhere.

The aim of the descriptive analytical study is a comprehensive and interdisciplinary assessment of risk factors that increase or decrease the spread of the dual HIV/tuberculosis infection at the current stage in the North-West of Russia, as a pilot region.

Materials and Methods. Research methods included socio-demographic, economic and epidemiological analysis, ranking, correlation and expert assessment. The basis of the socio-demographic and economic analysis was information from the state statistics on the regions of North-West of Russia, of the epidemiological analysis – reporting forms of Rosstat on tuberculosis, HIV-infection and HIV/tuberculosis coinfection, including data on the economic and human resources of the tuberculosis control system, information from analytical reports on supervising activities in the regions of the North-West of Russia during 2007-2017. The correlation dependence between the studied parameters was determined by the Spearman coefficient.

Results. In the North-West of Russia, there is a statistically significant relationship between the spread of HIV/tuberculosis co-infection and the epidemiological factor in general (0.627, p<0.039) and the HIV epidemic, as a mono-disease in particular (0.731, p<0.011). The tuberculosis epidemic does not play a significant role in the complex of epidemiological factors (0.332, p>0.319) and does not make a statistically significant contribution to the HIV/tuberculosis epidemic (0.127, p>0.710). The penitentiary system also has no statistically significant relation with the HIV/tuberculosis epidemic (0.233, p>0.490), however, the tuberculosis epidemic, as monoinfection (0.619, p<0.042) is significantly associated with the correctional system. Conclusion. To improve the HIV/tuberculosis epidemic situation, it is necessary to strengthen of HIV tackling measures, especially in the penitentiary system and strengthen the economic and human resources of the tuberculosis control system.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):137-149
Functional activity of p-glycoprotein in blood-brain barrier during experimental par-kinson's syndrome
Chernykh I.V., Shchulkin A.V., Mylnikov P.Y., Gatsanoga M.V., Gradinar M.M., Yesenina A.S., Yakusheva E.N.

Background. P-glycoprotein (Pgp, ABCB1-protein) is a membrane transporter with broad substrate specificity that is localized in hepatocytes, enterocytes, epithelial renal tubules, and also in tissue barriers, including blood-brain barrier (BBB). Increased Pgp activity in BBB is one of the reasons for the pharmacoresistance of a number of CNS diseases.

Aim. Analysis of Pgp functional activity in BBB during experimental Parkinson's syndrome.

Materials and Methods. The work was performed on 90 Wistar rats, divided into 3 series (n=30 in each). The 1 series (control) was subcutaneously injected sunflower oil once a day for 7 days, and Pgp activity in BBB was assessed on the 8th day. The 2 and 3 series (pathology control) − were administered rotenone at a dose of 2.5 mg/kg once a day for 7 and 28 days respectively to simulate parkin-sonism. At the end of the experiment Pgp activity was estimated. To confirm Parkinson's syndrome, in addition to the clinical picture, level of dopamine in midbrain and striatum was determined using enzyme-linked immunosorbent assay. Pgp functional activity in BBB was assessed by the degree of penetration of its marker substrate fexofenadine into the brain after its intravenous administration at a dose of 10 mg/kg. The content of fexofenadine in the blood plasma and in brain tissue was estimated by the area under pharmacokinetic curve of the substance (in the blood or brain tissues) − AUC0-t(plasma) or AUC0-t(brain) respectively. To assess the BBB permeability the ratio AUC0-t(brain) / AUC0-t(plasma) was calculated.

Results. Rotenone administration led to the development of parkinsonism typical picture: muscle stiffness, hypokinesia, gait instability. There was a decrease in dopamine level in the striatum after 7 days by 69.6% (p=0.095), after 28 days − by 93.9% (p=0.008), in midbrain − by 72.7% (p=0.095) and 68.7% (p=0.032) respectively. Fexofenadine AUC0-t(plasma) and AUC0-t(brain) after its intravenous administration to control rats were 266.2 (246.4; 285.6) μg/ml*min and 5.9 (5.8;6.6) µg/g*min respectively, AUC0-t(brain) /AUC0-t(plasma) − 0.020 (0.019; 0.022). When rotenone was for 7 days administered − fexofenadine AUC0-t(brain) increased 2.02 times (p=0.0163), AUC0-t(brain) / AUC0-t(plasma) − 2.4 times (p=0.0283). 28 days administration of rotenone led to augmentation of AUC0-t(brain) of fexofenadine by 1.75 times (p=0.0283), AUC0-t(brain) / AUC0-t(plasma) − by 2.27 times (p=0.0163).

Conclusions. The development of Parkinson’s syndrome, caused by the administration of rotenone, inhibits Pgp functional activity in BBB, which is confirmed by the accumulation in the brain marker substrate of the transporter − fexofenadine.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):150-159
Condition of microcirculatory and hemostasis systems in rats after moderate hypothermia
Lycheva N.A., Shakhmatov I.I., Sedov A.V., Makushkina D.A., Vdovin V.M.

Hypothermia produces a generalized impact on an organism, with involvement  of all organs and systems into the response. It was shown that hypothermia promotes multi-organ dysfunction syndrome, which makes it important to study the influence of hypothermia on condition of hemostasis and microcirculatory systems.

Aim. To study the condition of the hemostasis system and the microcirculatory bed in different periods of moderate hypothermia in rats.

Materials and Methods. The current study was performed on 50 male Wistar rats. Condition of microcirculatory blood stream in all animals was assessed with laser Doppler flowmetry. Condition of hemostasis system was studied according to routine protocols and an integrated method of examination – thromboelastography. Statistical analysis was performed using Statistica 6.0 software package (StatSoft, USA) with calculation of Mann-Whitney nonparametric test.

Results. Analysis of the experimental data showed that moderate hypothermia produced a pronounced modulating influence on the microcirculatory system. Vasodilatation occurred immediately after reaching the stage of hypothermia, suggesting the beginning of decompensation in the experimental animals. The highest risk for hemodynamic pathologies was observed 5 days after cessation of cooling and was characterized by a massive reduction in the vascular tone, intensification of hemodynamics against the background appearance of thrombinemia markers in the blood stream and pronounced inhibition of fibrinolysis. Enhanced hemodynamics of the nutritional vascular bed with the underlying progressive prothrombotic condition is a potent risk factor for thrombosis and multiple organ dysfunction syndrome. Vasospasm that developed 2 weeks after recovery of the body temperature, indicated a profound modulation of vasculature and preservation of high-level sympathetic input, as well as increasing rigidity of blood vessel walls. Rising fibrinogen concentrations confirm a progressive inflammatory reaction.

Conclusion. A moderate degree of hypothermia produces a pronounced modulating effect on the microcirculation. The established regularities make it possible to form a clear understanding of the course and development of the pathological reaction in the body of victims and to give recommendations on the use of pharmacological medicine for preventive therapy. Thus, a period has been established when thrombotic readiness is maximal, and use of anticoagulant and antiplatelet drugs is required, together with drugs that improve rheological properties of blood.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):160-171
Risk factors for development of myocardial infarction in women with preserved reproductive function
Seliverstova D.V.

Aim. Identification of risk factors (RF) for myocardial infarction (MI) among women with preserved menstrual function.

Material and Methods. 121 Female patients under 55 years of age, who were hospitalized with MI in the cardiology departments of Ryazan in the period 2010-2016, were studied. All patients were divided into 2 groups. The first group included women with a regular menstrual cycle without menopausal symptoms (n=60, mean age 48.0±6.1 years). The second group consisted of postmenopausal women (n=61, mean age 49.8±4.3 years). Of a cohort of studied  women a group of women was isolated (n=18 from group 1 and n=15 from group 2) who, during hospitalization with MI in 2015-2016, filled in questionnaires on nutrition and physical activity.

Results. In women of group 1 such risk factors as burdened heredity for cardiovascular diseases (58.3%, p=0.02) and smoking (46.7%, p=0.03) were more common than in women of group 2. Only women of group 1 took oral contraceptives before the onset of MI (15%, p=0.005). The most common RFs were: arterial hypertension (˃80% of patients in both groups; overweight and obesity (78.3% of women from group 1 and 83.6% from group 2); type 2 diabetes mellitus  (23.3% in group 1 and 24.6% in group 2). According to the results of the questionnaire on food habits, insufficient use of fruit and vegetables was detected among all patients of both groups. In analysis of the results of the International Physical Activity Questionnaire (IPAQ), 72.2% of patients in group 1 experienced insufficient physical activity, and 53.3% of patients in group 2 showed pronounced hypodynamia. Biochemical analysis of blood revealed increased average levels of total cholesterol, low-density lipoproteins and triglycerides, with high-density lipoproteins within the normal range in both groups.

Conclusion. The most common risk factors for myocardial infarction in women with preserved menstrual function in comparison with postmenopausal women were: positive heredity for cardiovascular diseases, smoking and taking oral contraceptives. Besides, a wide spread of arterial hypertension, dyslipidemia and diabetes mellitus, overweight and obesity, low physical activity and lack of fruit and vegetables in the diet of women in both groups should be noted.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):172-180
Peculiarities of physical development and of level of nutrients in children with autistic spectrum disorders
Bavykinа I.A.

Aim. To study the state of physical development and the level of calcium and iron in children and adolescents with autistic spectrum disorders taking into account the characteristics of eating behavior.

Materials and Methods. 64 children aged 2.5 to 15 years with autistic spectrum disorders were assessed for physical development according to WHO standards, and for iron and total calcium in the blood. Parents of children were surveyed on issues related to the peculiarities of eating behavior in their children.

Results. In 21.9% of children and adolescents with autistic spectrum disorders, alteration of nutritional status was manifested by an increase in the body mass index and in 18.7% – by a decrease in it. 1st-2nd degree obesity was found in 12.5%, 1st degree protein-energy insufficiency in 6.2% of the examined children. Laboratory tests revealed a decreased level of serum iron in 37.3 % of children, and of total calcium in 45.1%. At the same time, in children being kept on gluten-free diet for a long time, iron level increased with age, in contrast to those who did not use diet therapy (p<0.05). The vast majority of children with autistic spectrum disorders exhibited a selective appetite (73.4%) with predomination of easily digestible carbohydrates in their diet.

Conclusion. No significant alterations in the parameters of physical development of children with autistic spectrum disorders were found in comparison with the population. With this, in children with autistic spectrum disorders lower parameters of serum iron and calcium were observed that could be corrected by following a diet.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):181-187
Gender peculiarities of heart rate variability and hemodynamic basis of students’ educational activity
Biryukova E.V., Vasilyuk N.A., Andrianov V.V.

Aim of this study is to analyze gender peculiarities of physiological and psychophysical basis of students’ academic activity.

Materials and Methods. 32 medical students (16 men and 16 women, 19-22 years) were examined. Students were proposed an alternative method of a colloquium on normal physiology in the form of a computer test. The test consisted of 30 questions, time of testing was not limited. The test was considered to be done if the number of correct answers was 50% or more. Examination of students’ heart rhythm, hemodynamic, and psychological parameters was conducted before and immediately after the test. Cardio-intervalogram was recorded within 5 minutes using Varicard hardware-software complex. The Students t-test, Mann-Whitney analysis, Wilcoxon analysis were used to determine the significance of differences between parameters among and within groups of men and women. Relationships of the studied parameters were determined using Spearman’s method of rank correlation.

Results. It was demonstrated that fulfilment of  the test by men was associated with reduction of hemodynamic parameters, with reduction of parasympathetic component and activation of sympathetic suprasegmental and central mechanisms of regulation of heart rhythm. Women showed stability of hemodynamic parameters and increase in suprasegmental influences on the dynamics of heart rhythm with lower average values. In correlation analysis conjugated pairs were found with the two components being different psychophysiological and physiological parameters, time and effectiveness of fulfilment of the test. The total number of conjugated and stable parameters were higher in women than in men both before and after computer testing.

Conclusions. Gender peculiarities of hemodynamic  basis of academic activity of students were found. The described dynamics can be considered a manifestation of a higher stability and relatively lower mobility of regulatory mechanisms in women.  

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):188-196
Comparative efficiency of suturing of defect of kidney after resection with a mesh implant on pigs models
Filimonov V.B., Vasin R.V., Sobennikov I.S., Petryaev A.V.

Aim. Improvement of the quality of the kidney resection.

Materials and Methods. A total of 50 laparoscopic kidney resections were performed on pig models. In 25 cases, resection was carried out according to the standard method of hemostasis of the kidney resection bed using U-shaped hemostatic sutures vicryl 3-0. In 25 cases, the kidney resection bed was sutured according to the author's method of hemostasis of the kidney resection bed using a polypropylene mesh.

Results. The mean operative time was comparable in the comparison groups, intraoperative blood loss was 30% lower in the group of pig models operated on with a prolene implant. The mean weight ratio of the resected kidney to the contralateral kidney was 77.3% after the classic resection of kidney and 85.6% after the resection with use of a prolene implant.

Conclusion. Laparoscopic kidney resection using a mesh implant is a highly efficient method of kidney resection, providing high-quality hemostasis with less traumatization of healthy renal parenchyma. The proposed method is recommended for further study.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):197-202
Thrombosis risks of permanent vascular access
Staroverov I.N., Noshchenko N.S., Shubin L.B.

Aim. To identify the factors affecting the occurrence of thrombosis of permanent vascular access and to determine their significance.

Materials and Methods. The results of treatment of 168 patients with native arteriovenous radio-cephalic fistula were analyzed. The results of treatment were traced within 1 year. According to the results of treatment, patients were divided into 2 groups: the 1st group – patients who did not develop thrombosis of the arteriovenous fistula within 1 year of hemodialysis, and the 2nd group – patients with a dysfunction of permanent vascular access developed due to thrombosis within the first year.

Results. On the basis of the obtained data, the risk factors for thrombosis of permanent vascular access within 6 months were: repeated operations, duration of anticoagulant therapy, correction of anticoagulant therapy, antibiotic therapy. Risk factors for thrombosis of the PVA for the period from 6 months to 12 months were: atherosclerosis, fistula vein diameter, repeated operations, the number of repeated operations, a reason for a repeated operation, duration of anticoagulant therapy, correction of anticoagulant therapy, antibiotic therapy.

Conclusions. The results of the study suggest that the realization of the identified risk factors is not the only cause of complications. For a more detailed consideration of the probability for thrombosis of permanent vascular access in different time intervals, it seems appropriate to use multidimensional mathematical modeling.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):203-208
Condition of platelet factor of hemostasis system in pathogenesis of chronic periodontitis progression
Kondyurova E.V., Vlasova T.I., Trofimov V.A., Vlasov A.P., Adamchik R.A., Akimov V.V., Tashina E.A.

Аim. Тo evaluate the structural and functional condition of platelets as a cellular component of the hemostasis system in chronic generalized periodontitis of different severity, and to establish its role in the progression of the disease.

Materials and Мethods. Clinical studies included 83 patients (47 men and 36 women) with chronic generalized periodontitis, comparable in age and sex, divided into three groups according to the severity of the disease: the first group (n=21) – periodontitis of mild severity; the second group (n=36) – moderate degree of severity; the third group (n=26) – severe periodontitis. Methods of the study included evaluation of the structural and functional characteristics of periodontal tissues, general hygienic condition of the oral cavity, the severity of the inflammatory process according to index parameters; study of microcirculation of periodontal tissues, determination of the evidence of oxidative processes in saliva, blood plasma, platelets, study of lipid composition of platelets.

Results. In chronic generalized periodontitis, pathological changes in the lipid composition of platelet membranes (an increase in the percentage of lysophospholipids and free fatty acids) were associated with systemic activation of oxidative processes and of phospholipase enzyme systems, which was accompanied by an increase in their aggregation activity.The degree of increase in the activity of platelets was associated with the severity of microcirculatory disturbances in the periodontal tissues. The condition of the cellular component of the hemostasis system correlated with the severity of the pathological process in the periodontium. In severe degree of chronic periodontitis, structural and functional changes in platelets were maximal.

Conclusion. In chronic periodontitis, the systemic activation of oxidative processes leads to a modification of the lipid composition of platelet membranes, which contributes to increase in their aggregation activity playing an important role in the induction of hypercoagulation, microcirculation disturbances and progression of inflammation in the periodontal tissues.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):209-218
Computer model for identification of groups of risk for malignant neoplasms of fe-male sex sphere using questionnaire
Malashenkо V.N., Ershov A.M., Ershova Y.V.

Aim. To identify predictors of malignant neoplasms (MN) of female sex sphere, to evaluate their sensitivity and specificity, to calculate prognostic coefficient (PC) and to create a computer program on its basis for automated processing of questionnaire data for arrangement of groups of risk for regular medical check-ups through the Internet (without participation of a physician) or on computers of women’s health clinics.

Materials and Methods. The work was performed in  two steps. The 1st step was an open questioning survey of 226 women, divided into 2 groups: the 1st group included women with MN of the sex sphere (n=125); the 2nd group included conventionally healthy women. The questionnaire included 82 positions: 19 open questions  and 63 questions with a choice of an answer. The second stage consisted in a «blind» questioning of 120 women who visited a women’s health clinic. The questionnaire included 18 earlier identified predictors. A multifactor model was developed on the basis of questionnaire data and also using the material of medical histories and of histological examinations.

Results. Using ROC-analysis of the questionnaire data, 18 significant predictors of MN of female sex sphere were identified. On their basis a formula was derived for calculation of PC for the risk of development of MN of female sex sphere with 72.8% sensitivity and 95% specificity, which was used for creation of a computer model for automated processing of questionnaire data with the aim of identification of groups of risks and for  medical check-ups without participation of physicians through Internet sites of hospitals. Then, in result of closed questioning of women (n=120) by 18 predictors, 70 women got into a group of risk, in 47 of them (67%) MN of sex sphere were identified, 50 fell into a group of conventionally healthy women, of them 45 (90%) were healthy, and 5 (10%) had MN.

Conclusions. 1) Multifactor statistical ROC-analysis of 82 questions and answers permitted to identify 18 predictors of MN of female sex sphere which can be used to scientifically substantiate identification of groups of risk for organization of regular prophylactic measures. 2) The conducted work permitted to create a computer program for automated processing of questionnaires for formation of groups of risk and for regular medical check-ups. We believe that introduction of questionnaire screening through the Internet with subsequent computer processing of the results without participation of physicians with permit to increase the coverage of women’s population of the Russian Federation with prophylactic measures against MN of the female sex sphere and to provide more time for receipt of primary patients, to simplify the work for creation of data base, and to increase the oncological alertness of women’s population.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):219-226
General non-specific reactivity of an organism as a factor of individualization of de-mands, behavior and social activity of individual
Mulik A.B., Ulesikova I.V., Mulik I.G., Bulatetsky S.V., Shatyr Y.A.

Behavioral and social activity, being a component of the general human activity, depends on a number of individual combinations of genotype and phenotype, as well as on environmental conditions. With sufficient elaboration of the general aspects of the physiological mechanisms, systemic organization of the behavioral and social activity of an individual remains an open question of the objective conditionality of the expression and orientation of social activity by individual combination of actualized demands and the psycho-physiological preconditions for their formation.

Aim. To identify regularities of physiological individualization of formation of demands, of behavioral and social human activity.

Materials and Methods. The research was carried out with the participation of 78 men and women aged 18-22 years, students of the Crimean Federal University.

Results. As a result of a complex of experimental studies, the systemic organization of functional, psychophysiological, psychological and social mechanisms of the individual organization of behavioral and social activity of an individual was confirmed. It is determined that anxiety, neuropsychological reactivity, extraversion and neuroticism, as the main preсonditions for behavioral and social activity, are most pronounced in individuals characterized by a high level of general nonspecific reactivity of an organism. The role of the functional and psychophysiological status of the organism in the individualization of demands is substantiated. At the same time, the minimal intensity of actualization of basic demands is characteristic of individuals with a low level of general nonspecific reactivity of an organism. Connections between individual vectors of social activity and basic human demands are specified. The most significant, universal impact on various types of social activity is produced by safety demands, which are the basic human biological demands. The demands for self-realization determine behavioral, social, professional and economic activity of a person. Social and cognitive demands positively affect behavioral and social activity. An insignificant negative relationship is revealed between reproductive demands and social destructiveness.

Conclusion. The cumulative registration of physiological and psychological characteristics provides an opportunity to predict the extent and subject orientation of the individual social activity.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):227-236
Assessment of satisfaction of medical workers of obstetric services of rural areas with working conditions (on example of Ryazan region)
Davydov A.Y., Artemieva G.B., Nagibin O.A.

The Russian Federation is undergoing serious socio-economic changes, including those in the Russian healthcare system. High morbidity and mortality rates increase the population's need for medical care. It also increases the requirements of the society to doctors. Doctors have to solve not only medical, but also complicated legal, psychological, ethical problems.

Aim. To analyze satisfaction of medical workers of obstetric and gynecological service in rural areas with working conditions (on an example of the Ryazan region) on the basis of the results of questioning.

Materials and Methods. Acquisition of statistical material was carried out by the method of questioning of the obstetric and gynecological service workers (n=18) using the questionnaire developed by the authors. The questionnaire included questions concerning the working conditions, satisfaction with salary, organization of work, and also relationship with administration, colleagues and patients. Statistical data processing was carried out using Statistica 10.0 program. The method of descriptive statistics with determination of the arithmetic mean, variance and calculation of 95% confidence interval was used.

Results. It was found that 83.3% of employees of the obstetric and gynecological service of the Ryazan region, including 80.0% of doctors and 84.6% of midwives, were in general satisfied with the work. Here, 61.1% of respondents noted filling in of a large volume of reporting forms and medical documentation. Only 22.2% of the surveyed employees of the obstetric and gynecological service saw the absolute possibility of their professional growth in the medical organization. Relationships with patients were evaluated as full trust and mutual understanding by 72.2% of respondents.

Conclusion. The conducted pilot study clearly demonstrated that satisfaction of healthcare workers with working conditions implies many factors concerning the content and conditions of their professional activities. Improvement of the efficiency of the activity and job satisfaction of medical workers can be achieved by a number of measures based on the principles of quality management system: continuous improvement, leadership, staff involvement, relationship management. Increase in satisfaction of healthcare workers with working conditions is the basis for elimination of shortage of personnel in the healthcare sector, for provision of primary healthcare units including those in remote areas of the country and rural areas, with personnel, and assurance of the quality of medical care. The study showed that workers of the obstetric and gynecological service of the Ryazan region are generally satisfied with the working conditions, are provided with tools enabling them to take clinical decisions, highly appreciate the moral and psychological climate in the team. At the same time, a high percentage of respondents noted filling in a large volume of reporting forms and medical documentation, lack of opportunities for professional growth and low salaries.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):237-244
Ethical and legal aspects of in vivo experimental biomedical research of the conduct. Part II
Lipatov V.A., Kryukov A.A., Severinov D.A., Saakyan A.R.

History of experiments on animals began since the time of the anatomist Andreas Vesalius (XVII century) when experiments on animals (vivisection, from Latin vivus, meaning «alive» and sectio, meaning «cutting», literally «cutting the living tissue») were conducted without anesthesia and were extremely cruel. Nowadays use of laboratory animals considerably differs from that in the time of the first experiments and is regulated by certain legal enactments.

The aim of the second part of our work is analysis of legal aspects of using animals in in vivo experiments, in particular, provision of them with adequate anesthesiological support. Normative acts regulating principles of work with laboratory animals in different stages of an experiment are considered: animal care, inclusion into experiment, implementation of experiment, withdrawal of animals from the experiment and determination of animals’ fate after the experiment. International and Russian regulatory framework on this issue, in particular, such documents as European Convention for the Protection of Vertebrate Animals Used for Experimental and Other Scientific Purposes (March 18, 1986, Strasburg), Directive 2010/63/EU on Protection of Animals Used for Scientific Purposes, etc., are considered.

Conclusion. At present there exists a sufficient amount of normative enactments regulating implementation of in vivo experimental research. However, most of them require further finalization taking into account recent innovations in medical science and technology. The problem of control of execution of the normative enactments which are in most cases advisory rather than mandatory, remains actual.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):245-257
Comparative analysis of endovascular methods for treatment of acute lower limb ischemia
Kutsko E.A.

Acute lower limb ischemia (ALLI) is defined as a sudden decrease in lower limb arterial perfusion, which lasts less than 14 days and threatens a limb viability. This condition is one of the most common emergencies in vascular surgery, requiring immediate diagnosis and treatment, because untimely revascularization of lower limb leads to high amputation rate and mortality in postoperative period.

Currently there exist many methods of lower limb revascularization, however, in fact, they all can be divided into two large groups: open, surgical, and endovascular treatment. The choice between them depends on many factors. Since introduction of Fogarty catheter, balloon thromboembolectomy became a «gold standard» in treatment for ALLI. Nevertheless, at the same time endovascular methods appeared, the first one being catheter-based thrombolysis (CBT). Since its appearance, CBT gradually improved with deeper understanding of indications for its use, improvement of the technique of intervention, appearance of different thrombolytic agents and instruments. Nowadays a number of international guidelines determine CBT as a first line treatment of most patients with ALLI.

Endovascular thrombectomy techniques appeared in the 90s of XX century as an attempt tocombine advantages of open surgery (rapid and, in ideal conditions, complete restoration of limb perfusion) and of endovascular intervention (minimal invasiveness). They include manual aspiration, rheolytic (hydrodynamic), rotational, aspiration thrombectomy and pharmacomechanical thrombolysis. According to numerous studies, these techniques demonstrate quite impressive results and, probably, in the near future one of them can become a new «gold standard» in treatment for ALLI.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):258-273
Local hemostatic agents and ways of their improvement
Budko E.V., Chernikova D.A., Yampolsky L.M., Yatsyuk V.Y.

Recently, local hemostatic agents (LHA) have become increasingly popular abroad and in our country. They act in a targeted way and can be used both in damage to large vessels and in diffuse bleeding. In the article, chemical nature, physical and chemical characteristics of materials and mechanisms of LHA activity are considered, directions of their improvement are shown. LHA are mostly classified by mechanism of action.

To date, the popular groups of hemostatic agents are «mucoadhesive agents» (chitosan, amylopectin) and «coagulation factors concentrators» (zeolites, kaolin). Other authors distinguish the group of «aggregation and adhesion stimulants» (collagen, cellulose). Here, representatives of these groups have common characteristics – very high porosity and hydration ability. Another group includes substances that «promote protein denaturation» (inorganic salts of metals, as well as salts of acrylic acid and its derivatives). Polyacrylates are the basis of adhesives with hemostatic activity. However, most modern LHA are complex drugs and it is just this group that is most promising. All means, from hemostatic sponges produced by Zelyonaya Dubrava (Russia) and Nycomed, Takeda (Austria, Norway), and to hemostatic materials of MedTrade manufacture (Great Britain), Etiguette and Z-Medica (USA), combine sorption and, actually, thrombotic properties. The trademarks often imply original compositions and, especially, technologies: Quick Relief, BioSeal, BallistiClot, Hemaderm, CELOX Gauze PRO, OMNI-STAT Hemostatic Gauze for minor external bleeding. The most effective LHA are those based on chitosan and kaolin in the form of dressings with embedded clot-forming substance, for example, with artificial platelets or other coagulation factors.

I.P. Pavlov Russian Medical Biological Herald. 2019;27(2):274-285

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