Vol 11, No 3 (2019)


MiRNAs as promising biomarkers in cancer

Tarmaev A.A., Beylerli O.A.


By 2004 according to the resuts of the international genome sequencing, about 20,000 protein-coding genes had been analyzed which correspond to more than 2% of the total genomic sequence. The vast majority of gene transcripts are actually characterized as non-coding RNA (ncRNA) and are a cluster of RNA that do not encode functional proteins. They can be small, approximately 20 nucleotides in length, known as microRNAs (miRNAs), or transcripts longer than 200 nucleotides, defined as long non-coding RNAs (lncRNAs). miRNAs are short ncRNAs that are involved in the post-transcriptional regulation of gene expression. Discovered over 15 years ago, these molecules have been recognized as one of the main regulatory molecules in the human genome. They play an important role in all biological processes being important modulators of the eukaryotic genes expression. Focusing on transcripts that encode proteins, miRNAs influence the cellular transcript, thereby helping to determine the outcome of the cell. Aberrant miRNA expression was observed in cancer patients. Tissue concentrations of specific miRNAs have been shown to be associated with tumor invasiveness, metastatic potential, and other clinical characteristics for many types of cancer. Compared to traditional biomarkers like proteins, miRNA has several advantages that will allow them to be considered as new potential biomarkers in cancer. This review looks at biogenesis, functions, technologies used to detect miRNA, and the association of miRNA with human cancer, in particular, colorectal cancer.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):5-12
pages 5-12 views

Original research

The prolonged sub-tenon block for long vitreoretinal surgery

Marova N.H., Vasilyev Y.I., Vasilyeva G.N., Grib P.A., Dautova Z.A., Karelov A.E., Klyushnikova E.V., Kononov A.V.


The purpose of this study was to compare efficiency and safety of the prolonged Sub-Tenon block in comparison with IV 100 mg tramadol for long vitreoretinal surgery ander general anesthesia. 74 patients were undergoing microinvasive vitrectomy. For the prolonged Sub-Tenon block 1% solution of lidocaine at the speed of 2 ml/hour was used. The value of block of oculovisceral reflexes, HR and MAP, the need for muscle relaxants, time of awakening and time of removal of a laryngeal mask, postoperative pain and analgesia requirements, and postoperative nausea and vomiting were recorded. In prolonged Sub-Tenon block group there was more effective blocking of oculocardiac and oculovasomotor reflexes, a smaller average dose of muscle relaxants, shorter awakening time and removal of a laryngeal mask, and also lower pain syndrome in the first 24 hours after surgery. Postoperative nausea and vomiting also was in Sub-Tenon block group considerably less frequent than in tramadol group. Use of the prolonged Sub-Tenon block with the general anesthesia is an effective and safe technique for vitreoretinal surgery.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):13-22
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Neural network prediction of difficult tracheal intubation risk by using the patient’s face image

Aidaraliev A.A., Volkovich O.V., Mirkin E.L., Nezhinsky S.S.


Background. The prognosis of the difficult tracheal intubation remains an essential problem. The effectiveness of using predictors does not allow to foreseen such situation accurately.

The purpose of the study was to develop a predictive system and evaluate its effectiveness in difficult tracheal intubation based on facial image analysis combined with the most significant predictors of difficult intubation.

Materials and methods. A database based on the registration of difficult intubation predictors was developed. It was based on the patient’s face images with marked reference points. It allowed to estimate the information signs associated with the difficult tracheal intubation. The degree of intubation severity was determined directly during the intubation process according to the proposed original scale of severity.

Results. The classifier was synthesized by using the self-organization neural network method. The trained neural network was the basis of the classifier model implemented as a computer application. The sensitivity of the difficult tracheal intubation prognosis was 90.90%, specificity was 97.02%, the prognostic value of the positive result was 58.82%, the negative one was 99.56%.

Conclusions. The proposed decision support system allows patients to be stratified into groups according to the degree of difficult tracheal intubation risk. In addition, the self-learning process of the system continues as the new data become available. This allows to improve its efficiency continuously.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):23-32
pages 23-32 views

Metabolic disorder and outcomes of reconstructive interventions in patients with peripheral arterial disease

Glushkov N.I., Ivanov M.A., Puzdryak P.D., Samko K.V., Isakova A.A., Artemova A.S.


The purpose of this study was to assess the effect of metabolic disorders on the effects of revascularization in patients with obliterating atherosclerosis.

Materials and methods. The reconstruction was performed in 253 patients with femoral-tibial arterial segment lesion (98 — open operations, 116 — endovascular interventions and 39 patients were treated with hybrid technique).

Results. Endovascular revascularization techniques are justified in case of disorders of carbohydrate metabolism. Conventional operations remain the method of choice in the case of those variants of atherosclerotic lesions, where minimally invasive techniques are impossible.

Conclusions. Metabolic disorders in patients with peripheral atherosclerosis on the background of severe comorbid pathology may be the basis for choosing hybrid methods of revascularization.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):33-40
pages 33-40 views

Improvement of diagnostic and surgical treatment of colon cancer complicated with perifocal inflammation in patients of the elderly and senile age

Glushkov N.I., Kabanov M.Y., Gorshenin T.L., Sementsov K.V., Belikova M.Y., Sizov Y.A., Dulaeva S.K.


The article analyzes the treatment of patients in older age groups with colon cancer complicated by perifocal inflammation. It is shown that the treatment modality for this category of patients depends largely on the severity of paracancrosis inflammation. A large number of postoperative complications and a high level of postoperative mortality accompany traditional operations performed for colon cancer complications. The introduction of laparoscopic technology allows improving the treatment results in patients of elderly and senile age.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):41-48
pages 41-48 views

Clinico-biochemical and morphological mapping in chronic liver diseases in patients of the senior age group

Stolov S.V., Yamshchikova T.Y., Garan T.A., Kochergina T.A., Schwazman Z.D., Makarova O.V., Ugleva E.M.


Diagnosis of chronic liver diseases in elderly patients has its own features due to polymorbidity, multiple organ failure, being subtle the course of the disease.

The purpose of the study was to identify correlations of inflammation biochemical parameters and hepatocellular failure with histology in chronic hepatitis (CH) and liver cirrhosis (LC) in elderly patients.

Materials and methods. The study included medical records of patients with chronic liver disease (CLD) who died in the Clinical Hospital for War Veterans of Saint Petersburg between 2009 and 2015 (with the average age of 81 year). The diagnosis of chronic hepatitis (45 cases) and chronic cirrhosis (54 cases) was confirmed by postmortem examination. Morphological changes in the liver were described according to Knodell creteria. The degree of inflammatory activity in the liver was evaluated in points (0.1 to 3.0) depending on the level of AST, ALT, γ-globulin, alkaline phosphatase, γ-GTP, bilirubin. For similar scoring severity hepatocellular insufficiency (0.1–3.0) considered total protein, albumin, prothrombin index, fibrinogen. For cirrhotic patients the Child-Pugh criteria were also used.

Results. Chronic liver disease (CLD) — hepatitis and cirrhosis of the elderly is detected in 1,5% of cases. In most cases, CLD develop secondary to diseases of the cardiovascular system, and are accompanied by subtle symptoms, which limits their life-time diagnosis. The integral evaluation of the process activity degree according to biochemical indices was significantly higher in the group of chronic hepatitis than in the group of liver cirrhosis. Correlations of the inflammation bichemical parameters (AST and / or ALT, γ-globulin, alkaline phosphatase, γ-GTP) having a degree of Knodell Histological Activity Group chronic hepatitis and cirrhosis have not been established. The study established correlation of histological activity with total bilirubin levels in both groups of CLD. Integral assessment of hepatocellular deficiency by biochemical indicators of liver cirrhosis group was higher than in the group of chronic hepatitis.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):49-56
pages 49-56 views

A temporary bypass used in end-to-end anastomosis of major vessels without stopping blood flow in the segment under repair

Trunin E.M., Smirnov A.A., Nazarova M.A., Begishev O.B., Tatarkin V.V., Shulga V.P., Ovsepyan A.L., Stepanova V.A., Sizov P.A.


The authors developed an original set of tools and a method of carrying out end-to-end anastomosis on major vessels, without stopping blood circulation in the vascular segment being repaired. The proposed set of tools includes 10 tubes (temporary vascular grafts) made of medical silicone with external diameters from 8 to 26 mm. The length of each tube is not less than 10 cm, and the wall thickness is 1.2 mm. A spiral notch with a step of 1.2 mm is made on the outer surface of the tubes, to a depth of 1 mm. The set of tools also includes a set of metal hollow half — cylinders with a through hole made in the middle, designed to extract the temporary shunt of the appropriate diameter. Before the formation of a vascular anastomosis, a silicone tube is selected, the outer diameter of which corresponds to the inner diameter of the damaged vessel. It is necessary to cut off a length of the tube, so that 2–3 cm of it could be introduced into the lumen of the proximal and distal segments of the damaged vessel. A stay-suture is laid in the center of the temporary bypass, on a site of its wall between two neighboring spiral notches. The ends of the temporary bypass, pre-filled with saline solution, are introduced into the distal and proximal ends of the divided vessel and are firmly fixed in the lumen of the vessel with two elastic bands. After placing the temporary bypass in the lumen of the damaged vessel, the blood flow is restored. Using the intraluminar temporary shunt as a scaffold, the edges of the vessel are approximated and stitched to its entire circumference, tying the first and last stitches of this seam. The last additional suture is placed in the area of the stay-suture overlying the wall of the temporary vascular shunt and is not tightened. A half-cylinder is placed above the untightened vascular suture and a stay-suture is placed at its opening. After that, tightly pressing the metal hollow half-cylinder to the vascular wall, and applying traction to the ends of the stay-suture the mechanical destruction of the silicone tube along the line of the spiral incision ensues. As a result, the tube is transformed into a double silicone rod, which is pulled through a through hole in the metal half-cylinder floor. After the extraction of the tube, the anastomosis is completed by tying a knot on the provisional suture. To simulate the proposed method, 10 operations were performed using a closed experimental circuit that completely simulates the real situation of restoring a damaged major vessel. The time of the operation, the technical features of the intervention, as well as the volume of “blood loss”, which was estimated by reducing the volume of blood circulating in the experimental circuit, were evaluated. Experimental testing with the use of a model simulating the situation of restoring a damaged major vessel, demonstrated the effectiveness of the developed method of applying a vascular end-to-end anastomosis with the use of a destructible temporary bypass; the average time of the operation was 10 minutes, and the volume of blood loss did not exceed 5 ml. The proposed set of tools and method can be effectively used in case of major vessels injury. The technique completely excludes the need for interrupting blood flow through the sutured vessel; it allows to reduce the volume of blood loss in vascular trauma, minimizes the time of ischemia in the area of blood supply to the damaged artery or venous stagnation of the drained segment (when suturing a vein), as well as to facilitate the imposition of a vascular suture to surgeons who do not have sufficient qualification in vascular surgery.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):57-64
pages 57-64 views

Acute traumatic spinal cord injury in Saint Petersburg: causes, clinical characteristics, risk factors

Lobzin S.V., Mirzaeva L.M., Dulaev A.K., Sarana A.M.


This article presents the results of a retrospective clinical and epidemiological analysis of acute traumatic spinal cord injury (causes, level and severity), a study of comorbid pathology and risk factors in Saint Petersburg for the period from January 1, 2012 to December 31, 2016. The obtained data are compared with similar domestic and foreign studies.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):65-72
pages 65-72 views

The new diagnostic test for dystonia

Belenky V.V., Leontiev O.V., Klicenko O.A., Gelman V.Y., Koroleva E.M., Golovkin V.I.


Dystonia is the debilitating movement disorder of central nervous system, often inherited, appearing as involuntary movements that occur due to deficiency or excess of neurotransmitters. The penetrance of dystonia is 30%, which means, that inherited dystonia is manifested only in 30% of mutating gene carriers, while the rest suffer from latent forms, so called “forms frustes” of this disorder. Until now only few mutations responsible for dystonia, had been unveiled, but we expect to exist up to 100 such mutations. Unless we uncover all mutations responsible for dystonia, we require reliable test for diagnosing latent forms of dystonia; and this necessity explains the importance of present study. The purpose of this research was to elaborate discrimination of dystonia on the basis of biogenic amines exchange peculiarities. The study presents the observational case — control study. The control group was randomly composed of those patients, who were checked for neuroglial tumors. We checked catecholamines and serotonin metabolites in plasma and urine of 12 dystonia patients main group by means of chromatography method and compared the results obtained from these two groups by means of the decision tree method, discriminant analysis, and factor analysis. We revealed increased serotonin turnover in dystonia, and on the base of those increased metabolites in plasma, such as 5-hydroxytryptophane and 5-hydroxiindolacetic acid, by means of advanced statistical methods we eleborated sensitive and specific test for diagnosis of dystonia. We recommend introducing into clinical practice of diagnostic tests for dystonia on the base of analysis of diagnosing level in plasma of 5-hydroxytryptophane and 5-hydroxiindolacetic acid by means of discriminant analysis and classification tree method due to high sensitivity and high specifity of those methods.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):73-78
pages 73-78 views

Features of the structural and functional condition of the myocardium in patients with chronic kidney disease and chronic heart failure

Frolov D.S., Salukhov V.V., Shustov S.B., Lokshina T.R., Izilyaeva E.A., Ekimov V.V.


Relevance. The results of the structural and functional condition of the heart in patients with chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction and chronic kidney disease stage 3 were analyzed.

Purpose. To study clinical and laboratory parameters, as well as the structural and functional condition of the myocardium in patients with chronic kidney disease stage 3 and chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction.

Materials and methods. A total of 41 patients with chronic stage 3 kidney disease and chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction were examined. Structural and functional changes in the myocardium were estimated by means of echocardiography and tissue Doppler imaging.

Results and conclusion. In patients with chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction, the presence of chronic kidney disease stage 3b in comparison with stage 3a is characterized by a more significant interatrial conduction abnormality, AV-node and bundle of the His, and also more significant violation of systolic function, not only the left, but also right ventricles. In the patients with chronic heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction and the presence of chronic kidney disease stage 3a, diastolic dysfunction of the left ventricle of the I type prevails significantly more often. In the patients with chronic kidney disease of 3b stage diastolic dysfunction of the left ventricle type II is more common.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):79-84
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Prevalence of risk factors of cardiovascular complications in elderly women with left breast cancer

Vologdina I.V., Poroshina E.G., Zhabina R.M., Stanzhevsky A.A.


The purpose to study the risk factors for elderly women with left breast cancer at the stage of chemotherapy and radiotherapy in the context of daily clinical practice for early detection of possible cardiovascular complications and optimization of therapy.

Material and methods. 69 women with HER2 neu negative left breast cancer without severe cardiovascular disease were examined. The first group included 39 elderly patients (67.7 ± 3.8 years). The second group consisted of 34 middle-aged patients (49.8 ± 5.7 years). In addition to the risk assessment according to the Score scale, additional factors including psychosocial factors were studied. The examination was carried out before the start of treatment, after the end of the course of doxorubicin in a cumulative dose of up to 360 mg/m2 and after the completion of radiation therapy 3D conformal radiation therapy SOD 39 Gr.

Results. In elderly patients, risk factors such as obesity, increased cholesterol, and hypertension were significantly more common. In both study groups, low physical activity was revealed associated with both cancer itself and the treatment. All examined patients had moderate reactive anxiety on the Spielberger-Hanin scale. Elderly patients showed high level of personal anxiety; the number of points scored — 49.3 ± 3.6. According to the Score scale, a moderate risk was detected in 18 (58.1%) and a high risk in 13(41.9%) elderly patients. After doxorubicin treatment asymptomatic systolic dysfunction was detected in 8 (20.5%) patients (decrease in EF<50%), 21 (75%) diastolic dysfunction with relaxation slowdown (E/A<1). In 9 (23.1%) of the women without reducing the EF fibrotic changes in the myocardium of the left ventricle was revealed. In 8 (20.5%) women a thickening of the pericardial layer was revealed.

Conclusion. The findings suggest the need for a personalized approach and assessment of risk factors in patients of different age groups with left breast cancer at the stage of preparation and conduct of chemoradiotherapy. This highlights the need for enhanced history collection and consideration of not only key but also additional risk factors. The results of the study can be used in the work of practical health care institutions for the planning, development, implementation and control of chemoradiography safety in terms of preventing cardiovascular complications.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):85-92
pages 85-92 views

Case report

Multistage treatment of a patient with spontaneous rupture of the esophagus in a multidisciplinary hospital setting

Demko A.E., Sinenchenko G.I., Kulagin V.I., Ivanov V.I., Babich A.I.


The article presents a clinical case of 2-stage treatment of an elderly patient with spontaneous rupture of the esophagus. Exclusion the esophagus in the first stage of treatment with the use of minimally invasive technologies (endoscopy, laparoscopy, drainage of the pleural cavity) allowed to minimize surgical trauma and create conditions for the recovery of the patient, relief of mediastinitis, sepsis and restore the natural passage of food through the digestive tube during the second stage of treatment. The presented clinical case demonstrates the feasibility of the multistage approach using minimally invasive technology in the treatment of eldery patients with spontaneous rupture of the esophagus and severe sepsis.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2019;11(3):93-95
pages 93-95 views

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