Vol 10, No 4 (2018)

Original researches
Blood serum metabolomic assessment — a perspective diagnostic method for non-alcoholic fatty liver disease in men
Abatsieva M.P., Bakulin I.G., Sitkin S.I., Vakhitov T.Y., Demyanova E.V.

Abstract

Diagnosis of liver disease in particular non-alcoholic fatty liver disease (NAFLD) is largely determined by methods that are informative, safe, non-invasive, highly sensitive and can be used in all patients without exception. One of these methods is gas chromatography-mass spectrometry (GC-MS). Our study presents the results of serum metabolome assessment by the GC-MS method in male patients for the diagnosis of NAFLD at the stage of non-alcoholic steatohepatitis. In serum samples obtained from 25 patients, 319 compounds were identified, among them 109 were annotated. In patients with NAFLD, there was a significant increase in indole carboxylic and fatty acids, hypoxanthine, hydroxycarboxylic and phenylcarboxylic acids. The results of the study showed that low-molecular metabolites in particular reduced levels of 4-hydroxybutyric acid and 360 compounds suggests possible influence of metabolites on the pathogenesis of NAFLD, and an elevated level of sugar alcohol suggests a possible damaging effect on liver cells. For the detected compounds 4-hydroxybutyric acid, compound-360 and sugar alcohol, high specificity and sensitivity values, high confidence intervals and AUC values were shown, which indicates the possibility of using mass spectrometry analysis of plasma metabolome at high levels of steatohepatitis with high degree of reliability and probability.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):5-14
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The connection between the clinical picture of myocardial infarction associated with cardiorenal syndrome with NOS3 gene polymorphism and systemic inflammatory response
Siverina А.V., Skorodumova E.A., Kostenko V.A., Pivovarova L.P., Ariskina O.B., Malyshev M.E., Skorodumova E.G., Rysev A.V., Fedorov A.N.

Abstract

Background. At present close attention is paid to the study of genetic mutations and markers of systemic inflammatory response (SIR) in patients with cardiorenal syndrome.

Aim. To evaluate the effect of NOS3 gene t786c polymorphism and SVR on the clinical course of hospital and long-term periods in patients with myocardial infarction (MI) and acute kidney injury (AKI).

Materials and methods. 108 patients treated for MI were examined. All patients were divided into 2 groups: the first — 56 patients with IM and AKI, the second — 52 patients with IM but without AKI.

Results. In patients with MI and AKI, heterozygote and homozygote by allele С with NOS3 gene polymorphism Т786С, as well as leukocytosis and elevated C-reactive protein (CRP) in the blood were significantly more frequently detected. In the hospital period there was a large percentage of relapses of acute coronary syndrome (ACS), which led to high mortality. In the long-term period recurrent ACS and stent thromboses were also significantly more frequent, as well as high mortality rate.

The conclusion. Patients with IM and AKI revealed high frequency of allele C inheritance with polymorphism t786c gene NOS3, which in combination with the induction of SVR, being manifested by leukocytosis and increase in the content of CRP in the blood, was associated with the severity of the clinical picture, both in hospital and in the long-term periods.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):15-22
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Improving the efficiency of orthodontic treatment of dentofacial anomalies using information systems
Malahova N.E., Silin A.V., Shmatko A.D., Padun B.S.

Abstract

The review of the general literature devoted to the prediction of the results of dental anomaly orthodontic treatment was carried out. An effective tool for reliable stage and result planning of orthodontic treatment is the creation of a software system contributing to individual approach as well as taking into account many factors that influence the etiopathogenesis of dental anomalies. On the background of studying the dynamics of changes in chronic gingivitis during orthodontic treatment, a protocol was developed for constructing a mathematical model for creating software which can be used for implementing personalized treatment approach.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):23-30
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Efficacy and renal safety of Meloxicam in patients with degenerative disk disease: Results of the “Moment” scientific programm
Bichurina D.M., Gaydukova I.Z., Rebrov A.P.

Abstract

Purpose of the study was to evaluate the short-term efficacy and renal safety of meloxicam in patients with low back pain due to degenerative disk disease.

Materials and methods. The study included 34 patients with low back pain who were receiving Meloxicam (in the form of rectal suppositories) in a dose of 15 mg per day for the period or 6 days and 20 healthy individuals who did not receive NSAIDs last year. We assessed the efficacy of the drug and renal safety (markers of kidney damage) over time.

Results. The mean GFR in patients with degenerative disk disease was 68.5 (57.0; 83.0) ml/min/1.73 m2, in healthy individuals, the mean GFR was 88.4 (72.5; 99.5) ml/min/1.73 m2 (p = 0.0021); the urine albumin/creatinine ratio in patients with degenerative disk disease of the spine was 35.9 (20.9; 45.0) mg/g, in control group — 18.9 (17.3; 25.0) mg/g (p = 0.0005); in patients high degree of microglobulinuria was established (94.0 (68.9, 137.1) mg/g) compared with the healthy individuals (12.5 (10.9; 13.2) mg/g), p = 0.0000. After the course of treatment, the patients revealed a reduction in the pain syndrome (p < 0.01). Moreover, there was no deterioration in renal function and an increase in markers of kidney damage (p ≥ 0.05).

Conclusions. Meloxicam is an effective drug for reducing the intensity of the low back pain in patients with degenerative disk disease. Its administration is relatively safe in terms of development of nephrotoxicity in a short term perspective.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):31-36
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Effect of thiazolidinediones on dislipidemia in patients with metabolic syndrome depending on the gene PPAR-gamma rs1801282 polymorphism
Eremenko T.V., Kotova S.M., Vorokhobina N.V., Matsievskiy N.A., Matezius I.Y.

Abstract

Background. To evaluate the effect of thiazolidinediones on lipid spectrum of blood in patients with metabolic syndrome depending on gene polymorphism rs1801282.

Materials and methods. The study included 109 patients with newly diagnosed metabolic syndrome. All subjects in the study underwent general clinical, laboratory methods, presence of polymorphism rs1801282 of the PPAR-gamma gene was also determined. All patients were recommended to keep a diet, increase physical activity and receiving pioglitazone 30 mg per day for the period of 3 months.

Results.During therapy with pioglitazone it was noted that the degree of reduction of triglycerides was more pronounced in patients with IGT carrying rs1801282 -1.2 (-1.7; -1.1) versus -0.2 (-0.4; 0.0) in patients with wild genotype (p < 0.001) as well as in patients with type 2 diabetes, carries of polymorphic allele -1.3 (-1.6; -1.2) versus -0.2 (-0.3; 0.0) in patients with wild genotype (p < 0.001).

Conclusion. As a result of administering pioglitazone, an improvement in the lipid spectrum of the examined patients was noted. The maximum degree of reduction of triglycerides was observed in patients carrying rs1801282 polymorphic allele compared with the wild genotype.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):37-42
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Diagnostic issues
The pecularities of odontogenic mediastinitis diagnostics conditioned by its development mechanism
Kozlov V.A., Egorova O.A.

Abstract

In the triad of symptom complexes developing in mediastinitis and forming the mediastinal syndrome two of them, painful and toxic, determine the background of the disease being constant and pronounced.

The third symptom complex, caused by compression of the neurovascular bundle, spreading purulent exudate, determines the nature and variety of symptoms that can imitate the independence of any nosological form: acute pancreatitis, gastric ulcer, myocardial infarction, etc., which have nothing to do with mediastinitis and complicating the diagnosis, leading to erroneous tactics and tragic outcome.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):43-48
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Healthcare system development
Multidisciplinary approach in geriatrics
Konson C., Frolova E.V., Kostyukovich O.M.

Abstract

The article considers the issues of modern systematic approach for solving complex rehabilitation and nursing care problems of geriatric patients. The multidisciplinary approach in the frame of case management has a positive impact on the process and the result of patient’ functional and mental status restoration due to coordinated work of different medical and non-medical specialists depending on the specific problems of a geriatric patient.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):49-54
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For the 25th anniversary of interventional surgery foundation in Leningrad region
Artyushin B.S., Ryzhkov V.K.

Abstract

The article analyzes the historical aspects of endovascular surgery development in Leningrad region, one of the largest North-Western regions. Particularities of introducing modern endovascular techniques in practical work of surgeons in the Head Medical organization of the Leningrad region are presented. The article presents the results of interaction between endovascular surgeons and other specialists in improving methods of treating patients not only with cardiovascular diseases but also with hastroenterologic, hynecologic, urologic and other pathologies. The article also considers scientific works of Angiography department in Leningrad Region Hospital in XX–XXI centuries and in the period of modernization in the Russian Health System as well as the perspectives of Leningrad endovascular surgery.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):55-64
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Case report
Fever-induced epileptic encephalopathy in children (FIRES)
Sсhugareva L.M., Poteshkina O.V., Kruchina M.K., Rusak M.A.

Abstract

Fever infection-related epilepticy syndrome, FIRES — rare severe epileptic encephalopathy infection or fever-induced refractory epileptic status developing in a previously healthy child. The etiology of FIRES remains unknown; post-inflammatory and autoimmune mechanisms are assumed. Recovery is possible, but the majority of children develop significant cognitive failure and refractory epilepsy.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):65-72
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Reviews
Von Willebrand factor
Chernova Y.V.

Abstract

Von Willebrand factor is a multimeric glycoprotein which appears to be one of the most important clotting factors providing an implementation of bleeding stop mechanism. This hemostatic protein represents a poly-functional molecule which performs its physiologic functions by taking an active part in initiation of platelets adhesion in the area of vessel endothelium damage. Moreover, von Willebrand factor bonds with collagen which is exposed when a vessel wall is damaged. Another important feature of von Willebrand factor is co-factor activity related to clotting factor VIII, manifesting in stabilization of the latter, providing its physiological clearance and its delivery to the vessel endothelium damage site. Genetically determined quantitative or qualitative von Willebrand factor deficiency leads to development of the most frequent hemostasis system disease — von Willebrand disease. The unique feature of von Willebrand factor is a waveform pattern of its functional activity. Von Willebrand factor may also appear as a ligand for large platelet integrin αIIbβ3 (GPIIb/IIIa). The role of von Willebrand factor in angiogenesis process is currently actively studied. It was shown that absence of von Willebrand factor promotes processes of angiogenesis which is manifested in significant increase of proliferation rate of endothelium cells in vitro.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):73-80
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The impact of adjuvant radiotherapy on the outcome of immediate breast reconstruction after mastectomy in breast cancer patients
Romanenkov N.S., Movchan K.N.

Abstract

Background. Data allowing to estimate the impact of postoperative radiotherapy on the possibility of prosthetic breast reconstruction with silicone implants or tissue expanders are mainly presented in single-level retrospective cohort studies.

Material and methods. We searched for scientific papers in English published from January 1, 2000 to September 30, 2018 in the PubMed/MEDLINE database. The study parameters included demographic data, the method of breast reconstruction, information about adjuvant radiotherapy parameters, the incidence of postoperative complications.

Results and discussion. Having studied the data about immediate prosthetic breast reconstruction with silicone implant or a tissue expander performed after mastectomy in 3,654 breast cancer patients. The complications after surgery were reported in 40% of all clinical observations. In 15% of cases, the specialists stopped the attempts to perform breast reconstruction. In general, the aesthetic results of immediate prosthetic breast reconstruction performed before postop radiotherapy are far from being perfect. Nevetheless, most patients are satisfied with them after the surgery.

Conclusion. Adjuvant radiotherapy has a negative impact on the results of immediate prosthetic breast reconstruction after mastectomy. Despite this, the need for radiotherapy should not be regarded as an absolute contraindication for the immediate breast reconstruction with silicone implants and tissue expanders.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2018;10(4):81-88
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