Vol 32, No 4 (2024)

INTRODUCTION: Uveal melanoma (UM) is an oncological disease, which develops metastases mainly to the liver. One of treatments for this pathology is isolated hepatic chemoperfusion (IHCP). The implementation of this method requires surgical isolation of the liver from the systemic circulation and the use of a heart-lung machine. Due to a small number of observations of this treatment method in the world, the optimal vascular access for its implementation has not been determined so far.

AIM: To analyze the in-hospital results of IHCP in patients with UM metastases performed from three different vascular accesses.

MATERIALS AND METHODS: Over three years, 38 IHCP procedures were performed of the Kostroma Clinical Oncological Dispensary. Depending on the vessels into which the cannula for perfusion with Melphalan was inserted, patients were divided into 3 groups: group 1 with cava-porto-arterial access (perfusion into the inferior vena cava, portal vein, and common hepatic artery), n = 14; group 2 with cava-arterial access (perfusion into the inferior vena cava and common hepatic artery), n = 21; group 3 with a forced access, n = 3. The study took into account major complications: death, bleeding; and minor complications: tumor lysis syndrome, abscess of the left lobe of the liver, peritonitis, a systole, deep vein thrombosis of the lower limbs, hydrothorax, acute liver failure, anasarca, polyserositis, ischemic cholangiopathy, thrombosis of the common hepatic artery, detachment of the common hepatic artery intima. A combined endpoint was the achievement of at least one of the listed complications. In case of several complications in one patient, they were not summed up and were considered as ‘1’.

RESULTS: In the postoperative period, the highest number of bleedings including those requiring revision, was noted in groups 1 and 3. The combined endpoint in the total sample made 42.11% and was lowest in group 2. Fatal outcomes were recorded in 3 cases (2 in group 1 and 1 in group 2), and were caused by increasing liver failure.

CONCLUSION: The lowest number of complications IHCP was identified with cava-arterial access. Further continuation of the study is necessary to investigate the immediate and remote outcomes of IHCP.

INTRODUCTION: Currently, a promising trend to accelerate wound process seems to be the use of NH₂-Gly-L-His-L-Lys-COOH (GHK) tripeptide, which acts on the tissue regeneration, possesses antioxidant, immunotropic and anti-inflammatory effects. At the same time, the disadvantage of all peptides is their rapid degradation by proteolytic enzymes. One method to increase the stability of peptide molecules is the incorporation of D-isomers of amino acids in their structure. It was previously found by us that GHK-D-Ala produces a more marked effect on regenerative processes in the wound and facilitates increase in the number of fibroblast cells and macrophages in the wound with the underlying decrease in the number of granulocytes and lymphocytes; a significant effect of D-Ala-GHK and GHK-D-Ala on the parameters of the inborn immunity and lipid peroxidation was shown.

AIM: To evaluate the healing dynamics and bacterial contamination of an infected wound when using Glycyl-Histidyl-Lysine (GHK) peptide and its structural modifications with D-alanine (D-Ala).

MATERIALS AND METHODS: The experiments were conducted on Wistar rats. In the work, GHK peptide and its structural analogues D-Ala-GHK and GHK-D-Ala were used; they were administered intracutaneously around the wound at doses of 0.5 µg/kg and 1.5 µg/kg every 24 hours for 3^rd, 7^th and 10^th days. The wound area with calculation of the relative wound healing coefficient (RWHC), the healing rate, the time of perifocal edema disappearance, wound cleansing, appearance of granulation and onset of marginal epithelialization were assessed. Bacterial contamination was determined by counting colonies on the nutrient media after inoculation of wound biopsy material on them.

RESULTS: On day 3^rd, RWHC increased 3.2–5.3 times (p < 0.05–0.01) after the use of D-Ala-GHK and GHK-D-Ala peptides at both doses with no effect after the injection of GHK. On day 7^th, the reduction of the wound area reached statistically significant differences in all experimental groups. By day 10^th, the use of peptides resulted in decrease in the wound area most evident after the injection of GHK-D-Ala peptide (by 93%, p < 0.001) in all groups. On days 7^th–10^th, GHK-D-Ala increased the healing rate 4.7–5.3 times (p < 0.05-0.01) with no significant changes after the injection of GHK and D-Ala-GHK. Also, GHK-D-Ala at both doses resulted in the earliest disappearance of perifocal edema, wound cleansing, emergence of granulation and the onset of marginal epithelialization in all experimental groups. Significant reduction in bacterial contamination was observed after administration of all peptides on days 7^th and 10^th, being most pronounced after the use of GHK-D-Ala.

CONCLUSION: The application of GHK peptide and its structural analogues D-Ala-GHK and GHK-D-Ala in infected skin wounds accelerated wound healing against the background reduction of bacterial contamination. The most pronounced changes of these parameters were observed after administration of GHK-D-Ala peptide, which indicates the importance of protecting GHK molecule against the impact of carboxypeptidases. A promising continuation of the research in this direction can be the development of local means with antibacterial effect for stimulation of the regeneration processes in the wound.

INTRODUCTION: The move of medical education that requires personal presence for formation of most clinical competencies of a future doctor, to the distance format in the period of COVID-19 (Coronavirus Disease 2019) pandemic, has become a challenge. A study of perception of the new education format by students seems important to obtain feedback on the learning process, especially in the time of global pandemics.

AIM: To study the attitude of medical students to the learning process in the period of COVID-19 pandemic.

MATERIALS AND METHODS: A qualitative cross-sectional observational study was conducted using a questionnaire developed at the Faculty of Medical Sciences of the University of Kragujevac Rectorate (Serbia). The survey was conducted online via the anketolog.ru resource. The reference to the survey was posted in the University-Student system. Participation in the study was voluntary and anonymous. A total of 694 students of Sechenov University took part in the survey.

RESULTS: In general, students positively assessed the adaptation of the teachers to the education process in the circumstances concerned, availability of the learning materials, as well as interaction with the teachers, among other things, at exams, noting the flexibility and possibility to more rationally organize their personal time in the distance education format, and also reduce of expenditures in the study process. However, most students believe that online education cannot completely replace the traditional form in terms of obtaining knowledge, especially in acquiring clinical skills, and also note a decrease in motivations and concentration in distance learning, and inconveniences of using the existing online education platform.

CONCLUSION: The research materials can serve as the basis for developing recommendations for improving the online education mechanisms.

INTRODUCTION: There is an objective demand for models of sustainable recreational environmental management based on modern ecodiagnostics, landscape-environmental design and rehabilitation of the population. Achievements in molecular biology have expanded understanding of the role of environmental factors in pathophysiology of chronic dermatoses (CD). Of importance is analysis of the influence of environmentally friendly recreational urban landscapes on reducing the morbidity and increasing the inter-remission period in patients with chronic skin diseases.

AIM: To develop a universal model of landscape-environmental planning of the sustainable nature management territories for environmental recreation and rehabilitation of patients with CD.

MATERIALS AND METHODS: An analytical assessment of scientific opinions and methodological approaches to landscape-environmental planning is given. A system analysis of scientific publications, a comparative analysis of existing regulatory legal acts permitted to identify and evaluate problems of ecodiagnostics of recreational landscapes and rehabilitation of people with CD. A method of making a final environmental diagnosis of the territory was determined. A reconnaissance survey and route tours of the forest park of Ryazan were conducted, areas suitable for rehabilitation of urban residents including patients with CD, were identified. A survey was conducted among 112 patients with CD to elicit their perception of the rehabilitation urban landscape.

RESULTS: A universal model for planning territories of sustainable nature management for environmental recreation and rehabilitation has been developed. To make a final ecological diagnosis of the territory, ‘Method for diagnosing the suitability of land plots and for toxic monitoring of territories for health resort recreation and medical and environmental recreation using human and animal cell cultures’ has been proposed. An algorithm for developing an individual program of environmental rehabilitation of persons suffering CD has been summarized. An analysis of the survey questionnaires showed that 101 people (90.2%) noted the beneficial effects of the surrounding nature, reduction of stress and improvement of skin condition; 68 (60.7%) respondents suggested making improvements to the surrounding urban environment.

CONCLUSION: Well-equipped and comfortable green urban landscapes have a positive effect on the treatment and rehabilitation of patients with dermatological diseases. The use of a universal methodological model in planning urban recreational areas are relevant and timely. Actualization and modernization of landscape-environmental planning is an innovative task that offers an opportunity for multiplicative use of the developed model in public healthcare.

INTRODUCTION: It is reasonable that the realization of the state project of medical examination of adult population (MEAP) be assessed simultaneously with the assessment of the quality of medical care, and be integrated into the internal control of quality and safety of medical activities. The process approach is effective in realization of quality control of medical care provided as part of MEAP.

AIM: To develop and introduce the methodology of assessing MEAP quality, to assess the results of expertise conducted at the initial stage of MEAP introduction, and on the basis of the results of introduction of measures that improved MEAP organization.

MATERIALS AND METHODS: To assess the quality of MEAP, the ‘Expert Assessment Card for a Medical Examination Case’ was developed and introduced using the integrated quality assessment method. The assessment was carried out according to the blocks of the Card developed by I. V. Uspenskaya and O. N. Selyavina in accordance with the adopted assessment scale (0–0.5–1). The expertise of MEAP cases was carried out twice: in 2013 at the initial stage of realization of MEAP according to the new procedure, and in 2018 on the basis of the results of the realization of measures to improve the organization of MEAP.

RESULTS: Comparative analysis of defects identified at the initial stage of the medical examination in 2013 and as a result of the work performed for the introduction of the quality control system of medical examination cases in 2018, revealed a marked decrease (by 27.0%) in the defects in determining risk factors for chronic non-communicable diseases and indications for prescribing II stage MEAP measures. For other defects, a marked decrease by 5.2%–17.3% was revealed. Nevertheless, the leading positions were retained by defects in prescribing stage II measures (34.5% of the analyzed expert cards) and in determining risk factors for chronic non-communicable diseases (26.5% of the analyzed expert cards), which requires continuation of the work on MEAP control quality as part of the internal control of quality and safety of the medical activities.

CONCLUSION: Expert integration of the assessment of organization and introduction of MEAP and of the internal system of control of the quality and safety of medical activities led to a reliable reduction of the number of defects according to the results of expert assessment of medical examination cases.

INTRODUCTION: Primary cardiac tumors are rare, 75% of them are benign, half of which are myxomas. Despite histological benignity, untimely diagnosed myxoma can have serious complications. Myxoma is characterized by non-specific symptoms, however, a typical triad of atrial myxoma symptoms is distinguished: (1) symptoms of mitral valve obstruction manifested by heart failure and weakness, (2) symptoms of embolism and (3) systemic manifestations.

AIM: Illustration of the variety of clinical manifestations, discussion of diagnostic difficulties, formation of clinical alertness in the observation of left atrial myxoma.

MATERIALS AND METHODS: Left atrial myxoma in a 49-year-old male patient debuted at the age of 44 with the development of a transient cerebrovascular disorder in the right carotid system manifested by dysarthria and paresis of the facial muscles; at that time, no echocardiographic (EchoCG) examination was conducted. Several years later, the clinical presentation of heart failure manifested: shortness of breath when walking, edema of lower limbs. EchoCG revealed a sizable mass in the left atrium 33 mm × 55 mm fixed to the interatrial septum, prolapsing into the left ventricle and partially stenosing the left atrioventricular opening. Dilation of both atria, of the right ventricle, pronounced pulmonary hypertension, 2-degree regurgitation on the tricuspid valve, 2-degree regurgitation on the pulmonic valve, hydropericardium and hydrothorax on the right were found. The clinical case was also characterized by the developed bilateral thrombosis of the superficial femoral vein with signs of flotation. The development of venous thrombosis in a patient with cardiac myxoma can probably be considered as a systemic manifestation of the tumor disease. After compensation for the heart failure and implantation of a cava filter, the tumor was surgically removed, the morphological picture corresponded to cardiac myxoma with hemorrhages of various ages.

CONCLUSION: The case demonstrates the need for performing EchoCG in a transient ischemic attack, in ischemic stroke, to screen for intracardiac masses capable of frustrating cerebral circulation by cardioembolic mechanism, especially at a young age in the absence of other cardiovascular risk factors. The clinical picture consistently showed all the symptoms of the classic triad of cardiac myxoma: embolic syndrome, symptoms of mitral valve obstruction and systemic manifestations. The prognosis for patients with cardiac myxoma depends on the severity of thromboembolic syndrome and severity of heart failure. Timely diagnosis and surgical removal of cardiac myxoma provide a favorable prognosis.

INTRODUCTION: Cardiovascular diseases hold a leading position in the structure of mortality in the world. Laser technologies permit to improve the outcomes of endovascular and surgical treatment of various forms of the coronary heart disease and diseases of peripheral arteries. Despite the development of technologies, laser angioplasty and endarterectomy are associated with a number of complications and often require additional intervention.

AIM: To analyze currently available data on the use of lasers in treatment of arterial pathology.

According to the results of analysis of the modern literature, the use of lasers confidently occupies its niche in endovascular treatment of acute coronary syndrome, chronic occlusions of the coronary and peripheral arteries, permits to optimize the results of stenting and balloon angioplasty. One main disadvantage of laser angioplasty is that in most cases the procedure combines with stenting and/or balloon angioplasty and requires more contrast agent and longer operation time. Large-scale studies on the open laser endarterectomy have not been conducted.

CONCLUSION: Further study of the effect of laser on an atherosclerotic plaque and vessel wall in the open endarterectomy is a promising trend that may probably reduce the incidence of perioperative complications and improve long-term results of surgical treatment of diseases of peripheral arteries.

INTRODUCTION: The use of an autologous vein conduit in bypass operations is the leading trend in vascular and cardiac surgery. In the context of a high risk of repeated interventions and of limited availability of high-quality venous resources, it is important that the autovenous conduit remain functional as long as possible.

AIM: To study the dynamics of conclusions from the modern research works on harvesting, preservation and quality assessment of autovein grafts in the postoperative period.

The graft patency after open and endoscopic harvesting is comparable. Unsatisfactory results in terms of the long-term patency of an endoscopically harvested autovein may be associated with a long period of training in endoscopic techniques. They facilitate fast healing of postoperative wounds on the leg and reduce pain syndrome. The no touch open harvest technique, the use of low pressure when distending an autovenous graft, and ligation of the tributaries are factors that reduce the risk of postoperative hyperplasia of intima, thus contributing to a long-term functioning of the shunt and reducing the number of reinterventions. The preferable method of harvesting an autovenous graft for bypass surgeries in the lower limbs is an open bridging method. Keeping the autovenous graft in the whole autologous blood before the bypass surgery is also believed to reduce the risk of autograft injury, but randomized studies with a greater number of observations are required. Control of the graft quality before and after application of anastomosis and initiation of blood flow helps to improve the immediate and long-term bypass patency, and is performed using ultrasound imaging, measurement of blood flow transit time, angiographic examination, introduction of indocyanine green, and thermal imaging.

CONCLUSION: This review presents a modern multicomponent analysis of the role of mechanical, thermal, environmental and organic factors in the formation of the properties of an autovein conduit, essential for maintaining its maximal patency as of an arterial bypass, and the methods of intraoperative patency control.