Vol 28, No 4 (2020)

Nowadays, hormonal imbalance is proven to be a factor that influences initiation of malignant and benign breast tumors. To study the aspects of participation of sex hormones in damage to organs and tissues, it may be necessary to model a common women’s pathology – fibrocystic disease of mammary glands characterized by the most pronounced effects of this pathogenetic factor, on experimental animals.

Aim. To create a model of fibrocystic disease of mammary gland with the subsequent possibility of studying morphological manifestations of the disease in natural and drug-induced pathomorphism.

Materials and Methods. The pathology was induced by intramuscular injection of 0.5 ml of 2% synestrol and 0.5 ml of 2.5% progesterone to virgin female rats on the 1^st, 7^th, 14^th, 21^st, 28^th and 35^th days of the experiment. For examination, histological preparations of inguinal mammary glands were made. The preparations were described and studied using morphometric analysis.

Results. In the result of the experiment, pronounced macro- and microscopic alterations of mammary glands were found. Microscopic picture was similar to that observed in fibrocystic mastopathy in women. Almost all the morphometric parameters underwent reliable alterations in correspondence with the given pathology.

Conclusion. A model of fibrocystic disease of mammary gland was obtained that may be used for further study of morphogenesis and methods of correction.

Aim. To determine the morphological parameters of chronic placental insufficiency in pregnancy complicated by preeclampsia and in women with chronic arterial hypertension (CAH).

Materials and Methods. Historical data and peculiarities of pregnancy and childbirth in women with hypertensive disorders were analyzed in this work. A review histology of 40 placentas in moderate preeclampsia, 40 placentas in severe preeclampsia, and 35 placentas of women with CAH and associated preeclampsia was performed. The control group consisted of 20 placentas of women with uncomplicated pregnancies and without hypertensive disorders. Immunohistochemical examinations were performed on paraffin sections according to standard methods using primary goat antibodies to annexin V (R-20, sc-1929) and rabbit antibodies to erythropoietin (H-162, sc-7556) in a working dilution of 1:200 with the Super Sensitive IHC polymer detection system.

Results. The results of the pathomorphological examination of the placentas of women with hypertensive disorders showed two forms of chronic placental insufficiency. The defining form of placental insufficiency in women with CAH and associated preeclampsia was fetoplacental insufficiency while that in preeclampsia of moderate and high severity was the uteroplacental form of chronic placental insufficiency. On the basis of the study of the dynamics of the expression of annexin V and erythropoietin, the morphological parameters of placental compensatory potential and placental hemostasis disorders in hypertensive disorders in pregnant women were determined.

Conclusion. The diagnostic morphological criteria for fetoplacental insufficiency in women with hypertensive disorders are a combination of maternal and fetal malperfusion with obliterative angiopathy of stem villi vessels. For the uteroplacental form, the criteria are the obliterative angiopathy of spiral arteries, placental hypoperfusion with the development of local hypoxia, and hemostatic disorders in the form of thrombosis of the intervillous space and villi infarcts.

Aim. To assess variations in all-cause mortality in patients with past myocardial infarction with elevation of the ST segment (STEMI) according to the type of reperfusion therapy received.

Materials and Methods. Among 1456 patients hospitalized with acute coronary syndrome with elevation of the ST segment, 848 cases were randomly selected for analysis. Acquisition of information of the endpoint (i.e., death from any cause) was conducted over 18 months. The published data were received on January 10, 2020, and the median observation time was 20.8 months (17.4; 23.6).

Results. The highest all-cause mortality observed after 18 months (42.3%) was found in the group of patients who did not receive reperfusion therapy. The 30-day mortality rates in the group receiving thrombolytic therapy (TLT) and the group without reperfusion therapy did not show significant differences (20.3% vs. 26.2%, р>0.05). The hospital, 30-day, 12-month, and 18-month all-cause mortality rates in the group receiving percutaneous coronary intervention (PCI) were 8.4%, 10.6%, 16.6%, and 18.3%, respectively; these values are significantly lower compared with the corresponding rates in the group that did not receive reperfusion (19.5%, 26.2%, 36.2%, and 42.3%, respectively; р<0.05). The most remarkable differences in the frequency of the endpoint were recorded at the end of the 18-month period. Specifically, mortality in the group without reperfusion mortality (42.3%) was significantly higher (р<0.05) compared with those in the groups who received TLT (27.1%), PCI (18.3%), and TLT + PCI (13.1%).

Conclusion. The lowest all-cause mortality recorded over 18 months of observation was noted in the group treated by the pharmaco-invasive approach (TLT + PCI). The highest mortality over the same period was observed in the group of patients who did not receive reperfusion therapy.

Aim. Evaluation of basic skills in endovideosurgery of students of higher medical educational institutions (HMEI) before and after taking an elective course «Basics of Surgical Technique».

Materials and Methods. Basic skills in endovideosurgery were investigated in students
of the General Medicine Faculty before and after taking an elective course «Basics of Surgical Technique» organized on the base of the simulation hall of the experimental surgery and oncology laboratory of Research Institute of Experimental Medicine at Kursk State Medical University.
The training course included the following exercises on box trainers: Peg Transfer, Pattern
Cut, Intracorporal (single interrupted) Suture. After achievement of satisfactory results, final
assessment was conducted in the form of examination in practical skills and abilities on laboratory animals – biological models (Wetlab). Manipulations conducted by students were assessed using Global Operative Assessment of Laparoscopic Skill (GOALS).

Results. The average values of the assessed parameters increased: criteria «manipulations with tissues» from 2.8 to 4.0 points (42.9%), «perception of depth» from 2.4 to 3.6 points (50%), «movement effectiveness» – by 54.5% (from 2.2 to 3.4 points), «bimanual orientation» – by 60% (from 2.0 to 3.2 points). Criterion «independence» increased by 66.7% (from 1.8 to 3.0 points).

Conclusion. After the elective course «Basics of Surgical Technique», all average values
of the studied parameters increased. The results obtained evidence effectiveness of the methods
of training in basics of endovideosurgery within the frames of the elective course, which permits to develop skills in endosurgical technique at the stage of getting higher medical education.

More than 40% of adult Russians periodically feel heartburn. Progression of the disease leads to a number of complications shortening patients’ life. However, patients try to cope with problems by themselves, without receiving adequate early treatment. Only when the life quality worsens, which evidences progression of the disease, they turn to a doctor. Success of treatment depends on the level of the patient’s compliance, life-long complete and regular adherence to treatment recommended by the doctor. With this, an outpatient with a chronic disease should provide the most part of the required medical service by himself. However, patients often change the therapeutic measures on their own impairing the result of treatment.

The given below clinical case of patient Zh., 38 years old, with heartburn and existing risk factors of other non-infectious diseases is a typical illustration of the interaction of a general practitioner and an outpatient practicing self-treatment. Facing the situation of necessary regular medical monitoring and life-long complex intervention, the patient uses only easy-to-follow doctor’s recommendations and understandable for him treatment methods.

Conclusion. On an example of this clinical case, a possible necessary and sufficient plan o f informing outpatient is presented containing information of the tactics of his behavior for full realization of medical recommendations. For successful adaptation of an outpatient with chronic health problems and harmonic attitude to the disease, the doctor should be maximally specific about necessary and adequate measures for correction of the patient’s behavior for the fullest realization of therapeutic recommendations. Recommendations should contain understandable information of basic medicinal and non-medicinal therapy in remission (the essential vital stereotypes – work-rest regime, type and regime of nutrition, physical activity and principles of monitoring the condition), of signs of exacerbation and methods of therapy «on demand» and also information of symptoms requiring urgent assistance, of risks of self-treatment, of visiting the doctor in case new or vivid symptoms appear, of the dates of planned examinations by the doctor. These recommendations are not applicable to patients with severe and manifest course of the disease, with disharmonic attitude to the disease, and in case of inadequate organization capacities and low compliance of the patient.

Aim. Demonstration of potentials of preoperative planning and implementation of surgical resection in patients with adrenal cysts.

A clinical observation of a successful surgical treatment of a rare pathology – cyst of the right adrenal is presented. The choice of surgical treatment tactics is determined by the size of tumor and clinical presentation of the disease. The surgical treatment was accomplished laparoscopically which permitted to reduce the time of recovery and rehabilitation of the patient. In this clinical observation, the benefit of using 3D-modeling of the surgical area was shown for visualization of topographic and anatomic peculiarities and facilitation of the intraoperative navigation with the help of Avtoplan program developed by Samara State Medical University.

Conclusion. Preoperative 3D-modeling permits to prepare to surgical intervention taking into account individual anatomic peculiarities of a patient, and to determine the optimal volume of the operation.

Venous thromboembolic complications (VTEC) are acute and time-limited diseases. However, the recurrence rate after a first episode of VTEC is high and potentially life-threatening. Developed deep vein thrombosis (DVT) and thromboembolism of pulmonary artery (TEPA) are inevitably associated with use of anticoagulant therapy (ACT). A peculiarity of the modern clinical management of patients with VTEC is determination of duration of ACT.

Aim. To study possibilities of prolonged anticoagulation therapy and secondary prevention of venous thromboembolic complications taking into consideration modern variants of drug therapy, on the basis of literature data.

Search for literature was conducted in Medline and Elibrary databases including materials published in 2020. Randomized clinical and observational studies and meta-analyses, concerning prolonged therapy and secondary prevention of VTEC with vitamin K antagonists (VKA), peroral anticoagulants (POAC), sulodexide and aspirin, were analyzed. As it is evidenced by patho-physiological and epidemiological data, risk of VTEC recurrence in most patients is not resolved after the first 6 months of treatment with anticoagulants. In such situations it is reasonable to prolong anticoagulation for an indefinite period of time. However, sometimes a limiting factor for prolonged therapy with anticoagulants is bleedings caused by prolonged anticoagulation, sometimes leading to lethal outcome. Therefore, duration of treatment in the long-term period after an acute episode may rest on the balance between the risk of development of recurrence of venous thrombosis and bleeding, evaluated with the help of scales. The main achievement of recent years regarding prolonged therapy and secondary prevention of VTEC, are POAC, which in fact are new and alternative drugs that permitted the emergence of serious evidential basis in the range of means for treatment of this category of patients, sulodexide drug has appeared characterized by the minimal rate of development of large and clinically significant bleedings.

Conclusion. The emergence of serious evidential basis for POAC with improved safety profiles, different pharmacokinetic profiles and dosage regimens, including sulodexide that has been actively used in recent years for secondary prevention of VTEC, will permit clinicians to differentially approach treatment of different clinical variants of venous thrombosis, to improve the results of therapy taking into account evaluation of the individual risk and comorbid diseases, and compliance of patients.

Effectiveness of psychotherapy and of clinico-psychological interventions depends on different factors: skills and characteristics of a specialist; diagnosis and extent of severity of symptoms; social and personal peculiarities of patient/client; parameters of psychotherapeutic contact. Therapygenetics is a trend of applied research at the interface of molecular genetics and psychotherapy, which considers molecular-genetic predictors of success/failure of psychotherapeutic interventions.

The aim of the article is analysis and summarization of the current research works in the field of therapygenetics, substantiation of their theoretical and practical significance for psychiatry, psychotherapy and clinical psychology, discussion of the existing limitations and requirements to the design of the respective applied research works. By the moment, contra-dictory, but at the same promising positions in therapygenetics can be outlined. In the given article the results of therapygenetic research performed mostly in accordance with methods of identification of candidate genes, are systematized. Gene-environment correlations in psycho-therapy of anxiety and depressive disorders in children and adults are described. Scarce studies of genetic predictors of effectiveness of psychotherapy in posttraumatic stress-related disorders are summarized. While planning a therapygenetic study, the following methodological, methodical and organizational aspects should be taken into consideration: sufficient representativeness of an experimental sample both from the point of view of socio-demographic characteristics and from the point of view of the diagnosis and used therapy; existence of the control group; use of assessment scales and semi-structured diagnostic interviews for assessment of functioning of respondents; universalization of protocols of assessment of the results of application of methods of psychotherapy; use of polygenomic search for associations; observance of confidentiality and provision of respondents with minimally effective ways of rendering psychological assistance.

The hemoglobin content of reticulocytes (Hb-ret) is an effective real-time hemoglobin synthesis status indicator that permits diagnosis and monitoring of iron deficiency and iron deficiency anemia in all age groups with or without underlying diseases, including beta thalassemia. Hb-ret is less invasive than bone iron examination, less expensive than iron biochemical tests and might be available even in local laboratories. This review covers reports published mainly in 2020 and some other studies dedicated to clinical application of Hb-ret measured by Sysmex hematology analyzers.