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Vol 12, No 3 (2020)

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Scientometrics — a need or a fashionable trend?

Zemlyanoy V.P., Sigua B.V., Melnikov V.A., Lyubimov N.G.


The papaer presents a review of some publications on the history of the development, formation, functions and capabilities of scientometrics, as well as the state of Russian science and its role on the international arena. The thoughts regarding the role of scientometrics in modern scientific research are stated. To date, scientometrics provides a number of possibilities. First of all, it is a system for monitoring publication activity of scientists around the world. Obviously, the main goal is structuring scientific publications with the following improvement of scientific activity. Howewer, are modern scientometric indicators objective in relation not only to the number, but also to the quality of scientific publications? Is the notorious Hirsch index an ideal parameter for evaluating the performance of researchers? Are there any prospects for scientometrics in the modern scientific world, or is a worthy alternative to currently used methods for assessing scientific activity required? These and many other questions are raised by the authors in this article.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):5-10
pages 5-10 views

Features of profiling methods for the expression of long non-coding RNAs in tumors

Beylerli O.A., Gareev I.F., Izmailov A., Lipatov O.N.


With rapid advances in high-performance genome analysis technology, studying of long non-coding RNAs (lncRNAs) has become a very popular topic in biomedical research. LncRNAs are a group of non-coding RNAs with a length of more than 200 nucleotides. LncRNAs play a fundamental role in cell proliferation and differentiation, and epigenetic regulation. Thus, studying lncRNAs will give a new understanding of gene regulation and will open up new possibilities for treating and diagnosing many diseases, including tumors. The identification of new molecular markers in the form of circulating lncRNAs will improve tumor detection, predicting the course of the disease, treatment planning, and diagnosing at the earliest signs of upcoming neoplastic transformation. Treatment of tumors, especially malignant ones, is also a difficult task. When surgery and chemotherapy are not effective, radiation therapy becomes the treatment of choice. Therefore, the possibility of lncRNAs being innovative therapeutic agents in tumors is a viable idea. However, the possibility of their use in modern clinical practice is limited due to the number of problems associated with significant differences between procedures for processing samples, methods of analysis, and especially strategies for standardizing results. Another problem for conducting studies on the profiling of lncRNAs expression is their large number and the diversity of their functions in tumors. Therefore, the solution of technological problems on the profiling of lncRNAs expression in tumors may open up new possibilities for the use of lncRNAs in modern clinical practice.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):11-20
pages 11-20 views

Original research

Possibilities of nailfold capillaroscopy in the differential diagnosis of immuno-inflammatory and rheumatological diseases

Penin I.N., Maslyanskiy A.L., Konradi A.O., Mazurov V.I.


This article considers capillaroscopic changes in the patients with systemic sclerosis compared to the patients with a group of rheumatological diseases (rheumatoid arthritis, polymyositis, osteoarthritis) and the patients with idiopathic pulmonary hypertension. All the patients diagnosed with systemic sclerosis according to nailfold capillaroscopy had a characteristic combination of capillary disorders (Raynaud’s syndrome): the expansion of all three segments of the capillary loop, the “loss” of capillaries, and the destruction of the nail fold. In the comparison groups, the capillaroscopic picture was represented by single pathological changes that did not add up to the pathognomonic scleroderma patterns, with the exception of the groups with dermato/polymyositis, where 2 patients had significant Raynaud’s syndrome. There were also significant differences in the density of the capillaries in the patients with systemic sclerosis in comparison with the other groups.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):21-26
pages 21-26 views

Secondary risk factors of sudden cardiac death and genes of arterial hypertension

Kachnov V.A., Tyrenko V.V., Kolyubaeva S.N., Myakoshina L.A., Buntovskaya A.S.


Purpose. To study the influence of polymorphisms of arterial hypertension genes and their various combinations on individual risk factors of sudden cardiac death.

Materials and methods. 319 young people from 18 to 24 years of age who are entering military service by conscription were examined. The survey identified 69 individuals with signs of increased risk of sudden cardiac death after being examined for secondary risk factors of sudden cardiac death and taken a blood test to determine the polymorphisms of the genes AGT 521 C>T, GNB3 825 C>T, CYP11B2 344 C>T, NOS3 786 T>C.

Results. The greatest influence on the severity of secondary risk factors was exerted by the following variants of a combination of gene polymorphisms: AGT 521 C>T and NOS3 786 T>C in the individuals with a heterozygous risk variant, both genes showed a significant increase in the duration of the corrected QT interval, heart rate, and a decrease in heart rate variability. AGT 521 C>T and CYP11B2 344 C>T — homozygous risk variant of the CYP11B2 344 C>T and the heterozygous risk variant AGT 521 C>T is associated with a longer duration of the corrected QT interval, and the heterozygous risk variant for both genes is associated with higher heart rate values. AGT 521 C>T and GNB3 825 C>T — combination of a homozygous risk variant of the gene GNB3 825 C>T and the heterozygous variant of the gene AGT 521 C>T is associated with the greatest effect on a heart rate.

Conclusions. The presence of a homozygous risk variant of the gene NOS3 786 T>C, a heterozygous risk variant of the gene GNB3 825 C>T is prognostically unfavorable for its effect on the severity of secondary risk factors for sudden cardiac death. The combination of the heterozygous variant AGT 521 C>T with a heterozygous variant of NOS3 786 T>C and a homozygous risk variant by the gene CYP11B2 344 C>T and the heterozygous risk variant AGT 521 C>T are also the most unfavorable in terms of its effect on secondary risk factors for sudden cardiac death. Secondary risk factors of sudden cardiac death are influenced by both individual polymorphisms of genes of arterial hypertension, and their various combinations.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):27-34
pages 27-34 views

Prognosis and effectiveness of antibacterial treatment of endometritis after cesarian section with isolating drug-resistent ESKAPE pathohens

Korobkov N.A., Bakulina N.V., Kakhiani E.I.


Purpose. The purpose of this study was to determine the frequency of isolation of drug-resistant ESKAPE pathogens isolation in endometritis after cesarean section; to assess the prognosis of the disease and the effectiveness of initial empirical antimicrobial therapy for isolating multiresistant pathogens.

Methods. A retrospective analysis of all the cases of endometritis after cesarean section in St. Petersburg was performed. The study period: September 2008 – September 2019.

Results. 68 (26.7%) out of 255 cases of endometritis after cesarean section were caused by pathogens of the rESKAPE group. In puerperas with endometritis caused by rESKAPE pathogens, the following are more often observed: clinical failures in prescribing initial empirical antimicrobial therapy compared with endometritis of another etiology (p = 0.0012); severe course of infectious process with the risk of its generalization and hysterectomy (p < 0.05).

Conclusions. Endometritis after abdominal delivery caused by rESKAPE pathogens is associated with an unfavorable prognosis of the disease and a high risk of ineffective antimicrobial therapy.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):35-40
pages 35-40 views

Comparative evaluation of clinical efficacy, safety, and economic expenses of two endoscopic techniques for treating prostatic hyperplasia in elderly patients

Peshekhonov K.S., Shpilenia E.S., Komyakov B.K., Burlaka O.O., Morozova N.V.


Introduction. Rapidly developing highly specialized medical care and the emergence of new medical technologies determine the trend in surgical, minimally invasive treatment of patients with lower urinary tract symptoms due to prostatic hyperplasia. Drug therapy in elderly patients with somatic diseases poses a problem of poor compliance due to pronounced side effects caused by a drug. In this group of patients, surgical treatment of prostate hyperplasia is the most preferred solution. A doctor’s task is to choose the optimal method of surgery which will not only provide a long-term clinical effect, but also will minimize the economic costs of both surgical intervention and the postoperative period. The emergence of various types of energies for enucleating the prostate gland in urological practice has become an attractive alternative to transurethral resection of the prostate (TURP). However, when choosing surgical endoscopic intervention, it is important to consider the economic factor, which is considered to be a crucial problem in the medical care in Russia. Modern treatment options can not only prevent serious complications, and additional surgical interventions, but also improve the quality of patients’ lives. However, the introduction of new technologies is impossible without taking into account data on their cost-effectiveness.

Purpose. To compare the results and evaluate cost-effectiveness of two types of BPH endoscopic surgical treatment (bTURP, HOLEP) in elderly patients (>60 years old).

Materials and methods. The study includes patients who underwent two different methods of endoscopic treatment of HPV (bTURP, HOLEP) from October 2017 to September 2018. The inclusion criteria were the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume >40 cm3, maximum urine flow <15 ml/sec. The exclusion criteria were the presence of cystostomy drainage, oncological process of the urinary system, active inflammatory process of the genitourinary system, previous surgical interventions on the organs of the urinary system, and symptoms of an overactive bladder. In each group of the patients the following indicators were evaluated the international system for the total assessment of prostate diseases (IPSS and QoL), the international index of erectile function, the dynamics of postoperative changes in prostate-specific antigen, the maximum urine flow, the residual volume, safety of the operation, intraoperative and postoperative economic expenses as well as socio-economic consequences. Cost-effectiveness analysis was carried out by calculating the indicators “cost-effectiveness”, “cost-utility”, net monetary benefit. 20-year prediction of the results was carried out by building the Markov chain model.

Results. 150 patients operated within a year were examined. HOLEP has showed its clinical efficacy before bTURP in terms of the duration of surgery, the volume of tissue removed, the time of postoperative catheterization and the length of hospital stay which was significantly lower in the HOLEP group. However, the economic expenses associated with HOLEP were also higher compared to the bTURP group.

Conclusions. Holmium laser enucleation is the preferred method for surgical treatment of prostatic hyperplasia in the prostate of more than 40 cm3, from the point of view of surgical safety, effectiveness, and also the length of the patient’s recovery period in elderly patients. Moreover, laser operations are considered to be economically reasonable in comorbid patients associated with a minimal risk of complications.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):41-54
pages 41-54 views

Features of anxiety, vegetative manifestations and adaptation of children of elementary school at different cognitive level of development

Lebedenko A.A., Levchin A.M., Ershova I.B., Glushko Y.V.


Purpose. To study the features of the nature and level of anxiety, vegetative manifestations and adaptation of primary school students with different cognitive development.

Material and methods. The research group consisted of 631 children from secondary schools in Rostov-on-Don and Lugansk. Depending on the cognitive development, the children were divided into 2 groups; the main group was made up of highly intelligent schoolchildren. The study evaluated the features of school anxiety manifestations (according to Beeman N. Phillips questionnaire), autonomic disorders and adaptive potential depending on the level of IQ.

Results. The data analysis showed that younger schoolchildren with high cognitive development showed higher school anxiety, which prevailed in the fourth grade, combined with the stress of adaptation mechanisms. Highly intelligent children are significantly more likely to have autonomic disorders.

Conclusion. The revealed features of adaptive mechanisms that are closely related to psycho-autonomic disorders in highly intellectual children require the development and implementation of preventive measures in educational institutions.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):55-62
pages 55-62 views

Features of the course of rheumatoid arthritis and osteoarthritis in patients with asymptomatic hyperuricemia

Mazurov V.I., Bashkinov R.A., Fonturenko A.Y., Gaydukova I.Z., Petrova M.S., Inamova O.V., Nagirnyak I.M.


Introduction. According to numerous studies, the prevalence of asymptomatic hyperuricemia has increased in most countries. Uric acid is an important biomarker of the cardiovascular system, and there are now quite a big number of sources indicating its role in the development of a some chronic metabolic conditions, cardiovascular disease and associated mortality. At present, there is no consensus on the need for urate-lowering therapy in patients with asymptomatic hyperuricemia. There is a limited number of studies examining the problem of asymptomatic hyperuricemia in patients with rheumatic diseases, the features of comorbidity in these conditions, the frequency and effectiveness of urate-lowering therapy.

Purpose. To study the peculiarities of the course of rheumatoid arthritis and osteoarthritis with associated asymptomatic hyperuricemia and compare them with the ones associated with arthragra.

Materials and methods. The analysis was performed on the basis of the data collected from the city register of the patients with arthragra and asymptomatic hyperuricemia in St. Petersburg. The data collected included the medical records of 1725 patients with arthragra, 433 patients with rheumatoid arthritis and hyperuricemia and 355 patients with osteoarthritis and hyperuricemia.

Results. The patients with rheumatoid arthritis and hyperuricemia were more likely to have increased erythrocyte sedimentation rate and C-reactive protein, the highest medium level of erythrocyte sedimentation rate; acute myocardial infarction, chronic heart failure, gallstone disease and non-alcoholic fatty liver disease were more frequently detected. The patients with osteoarthritis and hyperuricemia were more likely to have high total cholesterol, at its highest medium level; stable angina, arrhythmia, varicosity, obesity, prediabetes and type 2 diabetes mellitus were more likely to be detected. Kidney damage was detected more frequently in the patients with arthragra. In the group of rheumatoid arthritis and hyperuricemia urate-lowering therapy was started in 30.95% of the patients, in the group of osteoarthritis and hyperuricemia — in 36.06%.

Conclusions. In rheumatic diseases, hyperuricemia is a common associated condition. Their combination leads to increased risk and frequency of cardiovascular, metabolic and gastroenterological comorbidity. The prescription of urate-lowering therapy to the patients with rheumatic diseases and asymptomatic hyperuricemia with high cardiovascular risk led to the target uric acid levels in 34.58% of the patients with rheumatoid arthritis and 52.08% of the patients with osteoarthritis.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):63-72
pages 63-72 views

How CT reconstruction parameters effect measurement error of pulmonary nodules volume

Alderov Z.A., Rozengauz E.V., Nesterov D.


One of the the widely used way to follow up oncological disease is estimation of lesion size differences. Volumetry is one of the most accurate approaches of lesion size estimation. However, being highly sensitive, volumetric errors can reach 60%, which significantly limits the applicability of the method.

Purpose was to estimate the effect of reconstruction parameters on volumetry error.

Materials and methods. 32 patients with pulmonary metastases underwent a CT scanning with 326 foci detected. 326 pulmonary were segmented. Volumetry error was estimated for every lesion with each combination of slice thickness and reconstruction kernel. The effect was measured with linear regression analysis

Results. Systematic and stochastic errors are impacted by slice thickness, reconstruction kernel, lesion position and its diameter. FC07 kernel and larger slice thickness is associated with high systematic error. Both systematic and stochastic errors decrease with lesion enlargment. intrapulmonary lesions have the lowest error regardless the reconstruction parameters.

Lineal regression model was created to prognose error rate. Model standart error was 6.7%. There was corelation between model remnants deviation and slice thickness, reconstruction kernel, lesion position and its diameter.

Conclusion. The systematic error depends on the focal diameter, slice thickness and reconstruction kernel. It can be estimated using the proposed model with a 6% error. Stochastic error mainly depends on lesion size.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):73-77
pages 73-77 views

Case report

Cutaneous manifestations of ANCA-associated vasculitis and immunosuppressive therapy: cause-effect relationships (a case report)

Kitova M.A., Maksimov M.V., Marchenko V.N., Bruchkus E.A., Davydov D.A.


Granulomatosis with polyangiitis, formerly known as Wegener’s granulomatosis, is an autoimmune ANCA-associated systemic vasculitis characterized by extensive damage to multiple organs and systems. Besides a typical clinical triad of ENT, lungs, and kidneys injury, various types of skin lesions can be found in 10–50% of cases. A severe course of the disease and low survival of patients often requires using aggressive treatment in a form of combined immunosuppressive therapy. On the one hand, it generally improves the prognosis, and on the other is itself associated with numerous complications. One of them is a secondary infection. Skin is the second most common localization of infection after the respiratory system. Preceding skin lesions caused by vasculitis may increase the risk of infection. Thus, patients with ANCA-associated vasculitis should be carefully observed for cutaneous manifestation, both before and during the immunosuppressive therapy.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(3):79-84
pages 79-84 views

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