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Vol 14, No 4 (2022)

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Reviews

Polymorphism of folate metabolism genes in breast cancer patients

Timofeeva A.A., Minina V.I., Astafeva E.A.

Abstract

Breast cancer is a widespread oncological disorder, which is considered one of the leading causes of mortality among women. DNA repair processes a well as it’s methylation involving genes of folate cycle play a crucial role in cancerogenesis. The aim of the study is to generalize the current data about association between polymorphic variants of folate cycle genes MTHFR С677Т (rs1801133), MTR A2756G (rs1805087), MTRR А66G (rs1801394) with risk of breast cancer development. The search of scientific papers has been conducted using PubMed and elibrary.ru sources. Original and randomized surveys published from 2008 till 2022 have been included in this review.

The study has accumulated sufficient data on MTHFR С677Т polymorphic variant in breast cancer patients, having significant influence on disease development. However, the data about MTR A2756G and MTRR A66G variants is quite limited. According to the findigs of many scientific papers, there is no link between polymorphic variants of these genes and breast cancerogenesis manifestation. Such factors like ethniсity and sufficient consumption of folates with nutrition can have significant impact on results and conclusions of studies about role of folate cycle genes in breast cancer patients.

Further investigation of MTHFR С677Т (rs1801133), MTR A2756G (rs1805087) and MTRR А66G (rs1801394) genetic polymorphic variants with consideration of gene-environment and gene-gene interactions could explain the presence of individual differences of breast cancer risk.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(4):5-16
pages 5-16 views

Endothelial dysfunction in axial spondyloarthritis associated with inflammatory bowel disease

Marchenko V.N., Shchukina O.B., Davydov D.A., Bogacheva A.I., Banko V.V., Makarenko A.R.

Abstract

Spondyloarthritis is a group of musculoskeletal inflammatory diseases, including axial and peripheral forms. The current classification of these diseases emphasizes the diagnostic importance of the well-known association between spondyloarthritis and inflammatory bowel diseases (Crohn’s disease and ulcerative colitis). According to many large clinical studies, both spondyloarthritis and inflammatory bowel diseases demonstrate increased cardiovascular risk, but the underlying mechanisms are not entirely clear. One of the possible ways to involve the cardiovascular system in these diseases is supposed to be the formation of endothelial vascular dysfunction developing in many inflammatory and non-inflammatory conditions. At the same time, endothelial dysfunction needs to be analyzed multidimensionally due to its participation in regulation of many processes, such as the providing of vascular tone, cell migration, angiogenesis, and hemostasis.

This review examines the latest data on endothelial dysfunction in axial spondyloarthritis and inflammatory bowel diseases, and separately analyzes the studies of this phenomenon in patients with inflammatory bowel diseases-associated axial spondyloarthritis. Special attention is paid to modern laboratory and instrumental methods for assessing endothelial function and their potential diagnostic significance in clinical practice.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(4):17-32
pages 17-32 views

Original research

Comparative analysis of the effectiveness of neoadjuvant systemic therapy and primary surgical treatment of patients with BRCA - associated triple-negative T1 breast cancer

Enaldieva D.A., Donskikh R.V., Krivorotko P.V., Imyanitov E.N., Zhiltsova E.K., Sokolenko A.P., Tabagua T.T., Amirov N.S., Pesotsky R.S., Shaikhelislamova L.F., Emelyanov A.S., Mortada V.V., Gigolaeva L.P., Yerechshenko S.S., Komyakhov A.V., Nikolaev K.S., Zernov K.Y., Bondarchuk Y.I., Paltuev R.M., Bessonov A.A., Artemyeva A.S., Semiglazov V.V., Semiglazova T.Y., Semiglazov V.F., Belyaev A.M.

Abstract

BACKGROUND: BRCA-associated triple-negative breast cancer does not only have a better overall survival rate, but also a longer recurrence-free period in compatison to patients with sporadic breast cancer. BRCA-associated triple-negative breast cancer shows high sensitivity to chemotherapeutic agents, but the benefit of systemic neoadjuvant therapy for patients with tumor size ≤T1 in triple-negative breast cancer is unclear.

AIM: The aim of the study is to determine the recurrence rate in the patients with BRCA-associated triple-negative breast cancer and to determine the recurrence rate for the group of patients with tumor size ≤T1, depending on the initial treatment.

MATERIALS AND METHODS: The study includes the data of 129 patients diagnosed with BRCA-associated triple-negative breast cancer treated in the period from 2010 to 2022 at the Department of Breast Tumors of the N.N. Petrov National Medical Research Center of Oncology. All the patients have been divided into two groups depending on the initial treatment. Group I included 93 (72.1%) patients whose treatment was started with systemic neoadjuvant therapy, group II, whose initial treatment involved surgery, included 36 (27.9%) patients.

RESULTS: In group I, the number of recurrences was 22 (23.6%), and in group II — 6 (16.6%). Depending on the pathomorphological response to systemic neoadjuvant therapy, the patients of group I have been separated: in the group of patients with a complete pathomorphological response, the number of relapses was 6 (13.3%), and in the group of patients with a partial pathomorphological response — 16 (33.3%). A comparative analysis of 2 groups with tumor size ≤T1 has shown that in group I the number of patients with tumor size ≤T1 was 11 (11.8%) cases, and in group II — 16 (44.4%). Subgroup comparative analysis in group I, taking into account tumor size ≤T1, has shown that recurrence has not been observed when a complete pathomorphological response was achieved in 8 (17.7%) patients, and in the group with partial pathomorphological response in 3 (6.25%) patients with tumor size ≤T1. A relapse has been observed in 1 (2%) case. With clinical tumor size ≤T1 (n = 16), there was no recurrence in group II.

CONCLUSIONS: Patients diagnosed with BRCA-associated triple-negative breast cancer remain at a high risk of recurrence at a later stage of the disease, but this does not apply to patients with a tumor size ≤T1 since the difference in relapse-free survival [AP1] between patients, whose treatment was started with neoadjuvant systemic therapy and patients, whose initial treatment involved surgery % with a clinical tumor size ≤T1, is not confirmed.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(4):33-42
pages 33-42 views

The effectivnes of Radiesse in dental practice for prevention and non-surgical treatment of gum recession

Shalak O.V., Satygo E.A., Deev R.V., Presnyakov E.V.

Abstract

BACKGROUND: According to clinical and statistical observations, there is the high prevalence of gingival recession in children and adults. Currently, the methods of treating gingival recession are considered as corrective surgical measures. However, all modern corrective techniques are traumatic and force the patient to refuse surgical treatment in the presence of a shallow recession with a depth of no more than 2 mm. The depth of gingival recession in the absence of treatment progresses, which causes clinicians to search for alternative minimally invasive therapy for such patients.

AIM: The aim of our study is to determine the effectiveness of prevention and non-surgical treatment of gum recession using a Radiesse filler (Merz North America, USА).

MATERIAL AND METHODS: 36 patients (men and women) of the young age between 18–44 with thin and intermediate biotype of gums and bones and patients with initial signs of gum recession (not more than 2 mm) have been examined. The state of periodontal tissues and changes in them have been assessed by clinical examination methods; laser Doppler flowmetry and a morphological analysis of tissues have been performed.

RESULTS: Two injections of a Radiess filler have been found to improve the condition of the patients with gum recession compared with the initial values.

CONCLUSIONS: Gingival recession after two injections of a Radiesse filler steadily decreases compared to its initial values. In the absence of treatment, a statistically significant (p < 0.05) increase in the depth of gingival recession has been noted after 12 months from the start of observation. When using a Radiesse dermal filler to support the keratinized zone of the gums, a decrease in microcirculation in the injection zone is observed in the first month, however, after 6 and 12 months, its value significantly increases compared to the initial value and the data of the control group.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(4):43-52
pages 43-52 views

Anemia of inflammation is a predictor of the progression of postoperative infection in obstetrics

Korobkov N.A., Bakulina N.V., Lodyagina N.S.

Abstract

BACKGROUND: There is an insufficient number of studies studying the association of postpartum infectious and inflammatory complications with anemia of inflammation, which undoubtedly contributes to the risk of postpartum infection and the severity of its course.

AIM: To assess the prevalence of anemia of inflammation in pregnant women, to determine its prognostic value as an independent predictor of the progression of endometritis after caesarean section.

MATERIALS AND METHODS: A retrospective study of case histories and data from primary medical records of 648 puerperas delivered by caesarean section has been carried out. 406 of the patients have been diagnosed with endometritis after caesarean section and 242 — with a physiological course of the postoperative period. Anemia during pregnancy has been diagnosed with a decrease in hemoglobin <110 g/l (in the first trimester) and <105 g/l (in the second and third trimesters). Primary iron deficiency was determined by the level of serum ferritin. Anemia of inflammation has been diagnosed after exclusion of iron deficiency in the presence of documented signs of an inflammatory process (chronic diseases) and in accordance with the international hematological criteria: normochromic normocytic anemia, normo-/hyperferritinemia (serum ferritin >30 μg/l), hypotransferrinemia (transferrin <2 g/l) and the level of C-reactive protein in the blood (> 6 mg/l).

RESULTS: Anemia of inflammation can be attributed to the most significant predictors of the development of endometritis. The odds ratio for this factor was 4.12 (95% confidence interval 1.28–6.19; p < 0.001). The study has also shown that significant factors in the development of endometritis after caesarean section are obesity (odds ratio 3.45; 95% confidence interval 1.14–5.11; p = 0.005), asymptomatic bacteriuria (odds ratio 3.68; 95% confidence interval 1.31–4.94; p < 0.001), carbohydrate metabolism disorders (odds ratio 2.84; 95% confidence interval 1.54–3.52; p = 0.012) and arterial hypertension (odds ratio 2.14; 95% confidence interval 1.12–4.04; p = 0.032).

CONCLUSIONS: The prevalence of anemia of inflammation in pregnancy is 2.1%. Anemia of inflammation complicates the course of pregnancy 5.5 times more often in puerperas with endometritis after caesarean section (27.4 vs. 4.9%; χ2 = 52.1; p < 0.001), which makes it possible to classify it as a significant predictor of the development of postoperative infectious and inflammatory complications.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(4):53-61
pages 53-61 views

Minimally invasive technologies for treatment of gallstone disease complicated by mechanical jaundice in patients of elderly and senior age

Zarkua N.E., Krivov A.P., Akimov V.P., Lysenkov S.Y.

Abstract

BACKGROUND: In recent years, there has been a significant increase in the number of patients of older age groups with cholelithiasis and its complications. Trans-light endoscopic and hybrid technologies for the treatment of cholelithiasis complicated by mechanical jaundice in such patients can reduce the proportion of traditional operations, the frequency of complications and mortality.

AIM: To develop an algorithm for the treatment of cholelithiasis complicated by mechanical jaundice in elderly and senile patients based on the use of modern minimally invasive and hybrid technologies.

MATERIALS AND METHODS: The analysis of the treatment of 116 elderly and senile patients with cholelithiasis complicated by mechanical jaundice from 2016 to 2021 has been carried out.

RESULTS: After a comprehensive examination of patients, the following pathology has been diagnosed: choledocholithiasis (cholecystectomy in the anamnesis) — in 7.8%; сholedocholithiasis (cholecystectomy in the anamnesis) + stricture of the distal choledochus — in 9.5%; сholecystocholedocholithiasis — in 82.7%, including choledocholithiasis without major duodenal papilla stricture in 7.3%, Mirizzi syndrome (including major duodenal papilla stenosis — in 3.1%) — in 5.2%, choledocholithiasis + stricture of the distal choledochus in 79.2% and choledocholithiasis + stricture of the distal choledochus + parafaterial diverticulum in 8.3% of the patients. The severity of the comorbidity index according to the Kaplan – Feinstein scale in 2.6% of patients corresponded to a mild degree, in 70.7% — to a moderate degree, in 26.7% — to a severe degree. Trans-luminous endoscopic and hybrid technologies have been used to eliminate the stricture of the distal part of the bile duct and sanitation of the bile ducts. Traditional operations by endovideosurgical and mini-access as well as laparotomy have been performed in 5.2%, 13.8% and 2.6% of the patients, respectively. The mortality rate was 3.5%. Complications associated with endoscopic interventions have developed in 5 (4.3%) patients, including — retrograde cholangiopancreatography-induced pancreatitis — in 2, bleeding from the incision of the duodenal papilla — in 3 patients.

CONCLUSIONS: Trans-light endoscopic and hybrid technologies for the treatment of cholelithiasis complicated by mechanical jaundice in patients with severe comorbidity index can reduce the proportion of traditional operations, the frequency of complications and mortality.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(4):63-70
pages 63-70 views

Long term effects of de-escalation antimicrobial strategy in the burn unit

Medvedev D.S., Bakulina N.V.

Abstract

BACKGROUND: De-escalation strategy of antimicrobial therapy demonstrates favorable short-term results: it lowers the mortality and reduces the cost of treatment. The long-term results of applying this strategy in the burn unit had not been studied previously.

AIM: To compare the long-term results of the de-escalation approach to antimicrobial therapy on the microbial spectrum, resistance of the hospital microflora and consumption of antimicrobials in the burn unit.

MATERIALS AND METHODS: The study comprises the data from the burn unit of the Severstal hospital for 2006, 2012 and 2021: statistical data on mortality and the average duration of hospital stay; microbiological data on spectrum and resistance of bacteria to antimicrobials.

RESULTS: The use of the de-escalation strategy of antimicrobial therapy in the burn unit of the Healthcare Institution “Severstal” for 10 years has reduced mortality, length of stay, consumption of antimicrobials. De-escalation strategy has not significantly affect the spectrum of nosocomial microflora but has lowered the resistance of gram-positive microorganisms to antibiotics. There was a decrease in the drug resistance index for the main pathogens of infectious complications as a result of implementing the de-escalation strategy.

CONCLUSIONS: The implementation a de-escalation strategy of antimicrobial therapy requires conducting periodic microbiological monitoring for early correction of starting antimicrobial regimens.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(4):71-81
pages 71-81 views

Moscow experience of using etanercept biosimilar in patients with immune-inflammatory rheumatic diseases

Zagrebneva A.I., Simonova E.N., Mezenova Т.V., Burmistrova N.B., Gavrikova Y.A., Dolgov V.V., Morozova E.O., Kodzeva Z.M., Sapogina K.S., Fomina A.A.

Abstract

The growing demand for biological disease-modifying antirheumatic drugs (bDMARDs) and their high cost put a heavy burden on the healthcare budget, thereby limiting the availability of treatment for patients. The introduction of bDMARDs’ biosimilars into clinical practice has made it possible to expand the availability of therapy for a larger number of patients. Our analysis of the use of the biosimilar etanercept Erelzi® in 103 patients with rheumatoid arthritis showed that the drug is highly effective in the treatment of rheumatoid arthritis. It can be used both in bionaive patients with the ineffectiveness of basic therapy, and in the case of medical switching from other biologics (including tumor necrosis factor alpha inhibitors (iTNF)) and targeted synthetic basic anti-inflammatory drugs (tsDMARDs), as well as when non-medical switching is necessary. The biosimilar of etanercept Erelzi® has optimal cost of treatment course and the lowest cost-effectiveness value, which means that its use will not affect the budget and will make highly effective therapy available to more patients.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(4):83-92
pages 83-92 views

Case report

Disseminated seronegative echinococcosis: difficulties of diagnosis and treatment

Mazurov V.I., Gaidukova I.Z., Nochvay E.E., Petrova M.S., Inamova O.V., Mazurenko S.O., Petrova Y.A., Bychkova A.S., Vorobyev S.L.

Abstract

Disseminated seronegative echinococcosis, occurring with damage to soft tissues, bones and joints, is a rare variant of the course of helminthiasis, often associated with diagnostic difficulties, a high probability of complications and difficult treatment.

This article presents a case of disseminated seronegative echinococcosis, clinically and laboratory simulating a severe form of Weber–Christian panniculitis complicated by sepsis. The advantages and disadvantages of serological and morphological studies in the verification of disseminated echinococcosis are discussed, as well as the feasibility of using repeated histological studies in cases of echinococcosis under the masks of rheumatic diseases.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(4):93-100
pages 93-100 views

A case of successful treatment of a neuroendocrine tumor of the small intestine complicated by partial intestinal obstruction

Kurkov A.A., Sigua B.V., Lataria E.L., Gurzhiy D.V., Kvarku V.E., Belyaeva A.V., Vinnichuk S.A., Abdulov A.R., Zemlianoi V.P.

Abstract

The incidence of neoplasms of the small intestine does not exceed 3% in the structure of all tumors of the gastrointestinal tract. Among them, the frequency of neuroendocrine tumors is about 30%. Due to the absence of pathognomonic symptoms, such tumors are usually detected at the stage of surgical complications such as intestinal obstruction or intestinal necrosis. In such a situation, the oncological process is already either locally widespread or generalized. Therefore, timely diagnosis of tumors should be based not only on the complaints and anamnesis, allowing to suspect the development of complications, but also on the use of modern imaging methods.

A clinical case demonstrating the difficulties of timely diagnosis of a neuroendocrine tumor of the small intestine is presented.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2022;14(4):101-107
pages 101-107 views


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