HERALD of North-Western State Medical University named after I.I. Mechnikov
Journal: Рeer-review medical academic journal
History: publishes from 2009
The target audience of a peer-reviewed journal "HERALD of North-Western State Medical University named after I.I. Mechnikov" is faculty members of medical universities and institutions of additional professional education, for research staff, as well as for practitioners of various specializations.
The "HERALD of North-Western State Medical University named after I.I. Mechnikov" publishes original articles written by experts of different fields of clinical and preventive medicine, public health, biomedical and pharmaceutical sciences, scientific lectures, scientific reviews and discussions, as well as highlights various issues concerning the advanced training of practitioners.
The Editorial board cooperates with the faculty members of the leading research institutes and medical schools of Russia.
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Vol 16, No 1 (2024)
Reviews
Necessity and possible promising directions for creating artificial choledoch duct (literature review)
Abstract
This review is devoted to the prospect of creating an artificial choledoch duct in case of its intraoperative injuries. Currently, there is no consensus on the optimal tactics of reconstructive surgical interventions, determining indications for the formation of biliodigestive anastomoses and transhepatic drainage of the biliary tract. The quality patients’ life after reconstruction in low mortality rate in this type of surgery decreases due to recurrent cholangitis, which in the future leads to liver abscesses and cirrhosis. The first attempts of prosthetics of the common bile duct were associated with the first use of stents in surgical practice. The second stage in the study of the reconstruction of the common bile duct were attempts to use stents and patches from transplants of subcutaneous veins, urethra, vagina of the rectus abdominis, and small intestine. The third stage in the development of this direction is using stents made with fibers of biodegradable polymer compounds.
There several advantages of using biodegradable stents. Firstly, they are completely metabolized in the body and perform a skeleton function. Secondly, it is possible to use multilayer structures by means of cellular technologies that ensure the conformitythis of the model with the structures of the common bile duct. A stent from biodegradable material can be used with radiopaque dye and medications, for example, antibiotics to prevent cholangitis, or drugs supressing enhanced formation of fibrous tissue to prevent strictures.
5-11
Radiological methods for diagnosing temporomandibular joint diseases
Abstract
The article provides a literature review of modern views on the application of radiological methods diagnosing temporomandibular joint diseases. This problem is one of the most current in dentistry. Correct choice of the method of radiological diagnosis of temporomandibular joint diseases is the key to their successful treatment. Computed tomography and magnetic resonance imaging make it possible to assess the severity of the pathological process in more detail than other radiological examination methods, systematize the results obtained and, based on them, distinguish the stages of disease development. However, the most complete assessment of the anatomical and functional state of the temporomandibular joint, including visualization of bone and soft tissue structures, is possible with the comprehensive application of radiological diagnostics methods.
13-24
Original research
Concentration of some macronutrients of tooth enamel in patients living in areas with different concentrations of fluoride in drinking water
Abstract
BACKGROUND: This article examines the effect of fluoride concentration in drinking water on the concentration of certain macronutrients of tooth enamel in patients living in areas with different levels of fluoride.
AIM: To determine the relationship between the concentration of fluoride in drinking water and the content of macronutrients in tooth enamel.
MATERIALS AND METHODS: Information was collected on the concentration of fluoride in drinking water in various areas. Then a sample of patients living in these areas was collected and the content of trace elements in the enamel of their teeth was analyzed.
RESULTS: The data obtained demonstrate the presence of a significant correlation between the concentration of fluoride in drinking water and the content of certain macronutrients in the enamel of patients’ teeth. A high concentration of fluoride in drinking water was associated with an increased content of certain trace elements, while a low concentration of fluoride was associated with their low levels.
CONCLUSIONS: These results highlight the importance of fluoride content in drinking water for dental health. They also provide additional data for the development of recommendations on the optimal level of fluoride in drinking water, which can help in maintaining dental health of the population in various areas. Further research in this area may help refine these results and advance our understanding of the relationship between fluoride and macronutrients in tooth enamel.
25-30
Electrophysiological properties of the atrial myocardium and cardiac conduction system in patients with atrial fibrillation and different comorbidity
Abstract
BACKGROUND: Atrial fibrillation is a rhythm disorder that has a complex and not yet fully understood etiology and pathogenesis. Catheter ablation is the most effective method for rhythm control in atrial fibrillation patients. The effectiveness of catheter ablation differs in patients with various concomitant pathologies of the cardiovascular system.
AIM: To study electrophysiological properties of atrial myocardium and cardiac conduction system during catheter ablation for atrial fibrillation in patients with different cardiovascular comorbidities.
MATERIALS AND METHODS: Intraprocedural data obtained during primary catheter ablations in 151 selected patients with atrial fibrillation were retrospectively analyzed. The patients were divided into 3 groups based on the presence or absence of cardiovascular comorbid pathology: group 1 — patients with idiopathic atrial fibrillation, group 2 — patients with a combination of atrial fibrillation and isolated essential arterial hypertension, group 3 — patients with a combination of atrial fibrillation and ischemic heart disease.
RESULTS: The ventricular rate in the patients with atrial fibrillation was significantly higher than the heart rate in the patients with sinus rhythm (102.6 ± 20.8 beats/min and 64.9 ± 11.9 beats/min, respectively; p < 0.001). The rhythm frequency differed significantly in Group 1, Group 2 and Group 3 in sinus rhythm (61.2 ± 10.9 beats/min, 60.1 ± 8.8 beats/min and 57.2 ± 10.3 beats/min, respectively; р < 0.001), and in atrial fibrillation (107 ± 15.8 beats/min, 89.9 ± 14.3 beats/min and 102 ± 12.5 beats/min, respectively; р < 0.001). In the patients of all groups both in sinus rhythm and in atrial fibrillation, the heart rate increased after pulmonary vein isolation compared with the rate before ablation (p < 0.001). In all groups, after isolation of the pulmonary veins, a statistically significant decrease in the frequency of atrial fibrillatory activity was noted compared to the baseline: by 72 imp/min (р < 0.001) in group 1, by 49 imp/min (р < 0.001) in group 2, and by 49 imp/min (р = 0.003) in patients of group 3. The frequency of fibrillatory activity after pulmonary vein isolation was comparable in the study groups (р = 0.45), both before and after surgery. In the patients without coronary artery disease, there was a significant decrease in the amplitude of atrial electrograms after ablation compared to preoperative values (р = 0.042 in group 1; p < 0.001 in group 2). The effective refractory period of the atrial myocardium did not differ between the groups (235 ± 30.3 ms, 220.6 ± 25.6 ms and 231.2 ± 39.4 ms, respectively; р = 0.359).
CONCLUSIONS: In the patients with atrial fibrillation, the presence of concomitant pathology of the cardiovascular system affects the electrophysiological properties of the myocardium and conduction system of the heart and their changes after pulmonary vein isolation. Additional research is needed to develop a personalized approach to the treatment of atrial fibrillation in patients with concomitant pathology of the cardiovascular system.
31-40
Electrocardiographic signs of cardiovascular system dysfunction in the context of various courses of COVID-19 in young and middle-aged individuals
Abstract
BACKGROUD: Intensive monitoring of patients with the coronavirus disease should include functional monitoring of the cardiovascular system. Physiologic methods can detect dysfunction of the cardiovascular system, however, it is not always possible to identify initial or hidden dysfunction. Therefore, clinical data should be complemented with results from instrumental methods, particularly electrocardiography.
AIM: To identify preclinical electrocardiography signs of cardiovascular system dysfunction in the context of various courses of coronavirus disease in young and middle-aged individuals.
MATERIALS AND METHODS: A retrospective analysis of 337 medical records of young and middle-aged individuals (40.0 ± 13.3 years old) was conducted. The analysis of the medical records included electrocardiograms in 12 leads with the assessment of standard parameters, results of laboratory and instrumental tests. In order to identify the main factors predicting an unfavorable course of the coronavirus disease, a factor analysis was conducted using electrocardiography parameters. Logistic regression analysis was used to develop a statistical model for predicting the likelihood of a severe course and fatal outcome of COVID-19, followed by assessing the diagnostic value of the prognostic model using the ROC curve and determining the area under the curve.
RESULTS: The main factors predicting an unfavorable course of the new coronavirus disease in young and middle-aged individuals based on electrocardiography data include the α angle factor, the ventricular repolarization factor and the heart rate factor. In addition, as electrocardiography predictors, the elongation of the P wave and PQ interval, the amplitude of the R wave in lead one, the decrease in the T wave amplitude in the precordial leads, and the amplitude of the R wave in leads two and three can be considered. Based on the identified electrocardiography predictors, a mathematical model for predicting a severe course and fatal outcome of the new coronavirus disease was developed.
CONCLUSIONS: Thus, electrocardiography is an indicative method that can be influenced by infectious process which is performed for all individuals upon admission to the hospital, allowing this examination to be considered the most accessible for detecting preclinical signs of an unfavorable course of COVID-19.
41-50
Assessment of the endothelial glycocalyx state in patients with axial spondyloarthritis associated with Crohn’s disease
Abstract
BACKGROUND: Epithelial barrier dysfunction, including their permeability increment, is supposed to be a pathogenetic link in the development of various immunoinflammatory diseases, including Crohn’s disease and axial spondyloarthritits. Endothelial permeability regulation is provided by both intercellular contacts and endothelial glycocalyx.
AIM: To study the microcirculatory state by measuring the endothelial glycocalyx thickness in patients with axial spondyloarthritits associated with Crohn’s disease. To identify an association between the endothelial glycocalyx thinning and the epithelial permeability severity in patients with Crohn’s disease, axial spondyloarthritits and their combination.
MATERIALS AND METHODS: 12 patients with axial spondyloarthritits associated with Crohn’s disease (group A), 22 patients with idiopathic axial spondyloarthritits (group B), 24 patients with Crohn’s disease (group C) and 16 healthy individuals (group D) were examined. The endothelial glycocalyx thickness was assessed in the sublingual region using dark-field microscopy. Fecal calprotectin and fecal zonulin was studied.
RESULTS: A statistically significant increase in the perfused boundary region high flow was found (p = 0.001), as well as the MicroVascular Health Score (p = 0.004) in group A compared with the control. In Group A, a positive correlation between perfused boundary region high flow and scores Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index 10 (p < 0.05) was found; perfused boundary region 5–9 mµ correlated positively with the fecal calprotectin (p = 0.007). Perfused boundary region high flow measurement provides 77.1% accuracy for correct classification of axial spondyloarthritits associated with Crohn’s disease and idiopathic axial spondyloarthritits (p = 0.010). In group C, a positive correlation between fecal zonulin and perfused boundary region 5–9 mµ, 10–19 mµ, 5–25 mµ (p < 0.05) was also found.
CONCLUSIONS: The findings suggest that the patients with axial spondyloarthritits associated with Crohn’s disease have endothelial glycocalyx impairment; the detection of these abnormalities may be useful in assessing the disease integral activity and in the differential diagnosis of axial spondyloarthritits associated with Crohn’s disease and idiopathic axial spondyloarthritits. Further studies of microcirculation will allow better understanding of spondyloarthritis and inflammatory bowel diseases pathogenesis and improve the management of patients with these diseases.
51-62
Comorbid pathology in patients with hyperuricemia in the Khabarovsk region
Abstract
BACKGROUND: Uric acid can affect many metabolic processes in the human body. In recent decades, great importance has been given to increased levels of uric acid — hyperuricemia. Hyperuricemia has been proven to be an independent risk factor for the development of cardiovascular, renal and metabolic diseases, and not just their marker, as had previously ben considered.
AIM: To determine the incidence of hyperuricemia at the primary outpatient stage, as well as to assess the prevalence of comorbid pathology among patients with hyperuricemia in the Khabarovsk Territory.
MATERIALS AND METHODS: We analyzed 5261 medical records of the patients who applied for an initial outpatient appointment at the Clinical Diagnostic Center and the Viveya Consultative and Diagnostic Center in Khabarovsk from November 2022 to November 2023. From the total number of medical records 2428 patients had elevated level of uric acid in the blood.
RESULTS: Arterial hypertension (60.5%) was the most common pathology; obesity – the second (27.35%); diabetes mellitus type 2 was less common in the patients with hyperuricemia (17.75%), and nephrolithiasis was the least common pathology (7.91%).
CONCLUSIONS: A high prevalence of hyperuricemia among the population of the Khabarovsk Territory was revealed. Elevated levels of uric acid affect the development of comorbid pathology in the patients, in particular cardiovascular pathology. The results obtained during the study indicate a high prevalence of comorbid diseases in hyperuricemia with arterial hypertension being the most frequent.
63-70
Surgical tactics for Crohn’s disease complicated by intestinal bleeding
Abstract
BACKGROUND: The course of Crohn’s disease often leads to complications requiring surgical treatment. One of the most serious complications of Crohn’s disease is intestinal bleeding.
AIM: To determine the most optimal timing and extent of surgical treatment in patients with Crohn’s disease complicated by intestinal bleeding when conservative therapy is ineffective.
MATERIALS AND METHODS: The article presents the experience of treating patients with Crohn’s disease complicated by intestinal bleeding at the Center for Gastroenterology and Oncopreventology of the Elizabeth Hospital (Russia) and the Republican Scientific Center of Coloproctology (Uzbekistan).
RESULTS: Despite the possibilities of conservative treatment, in 33% of cases the therapy was ineffective and required urgent surgical intervention. The degree of intervention was selected individually based on multivariate analysis.
CONCLUSIONS: Intestinal bleeding is a life-threatening complication of Crohn’s disease, causing the need for surgical intervention in almost a third of cases. Crohn’s disease is characterized by various damage to the gastrointestinal tract, which require multiple options for resective surgery on the small and large intestines, as well as an individual approach to the degree of intervention. The use of modern methods of complex conservative therapy for Crohn’s disease can reduce the risk of complications and reduce the amount of surgical intervention.
71-77
The effectiveness of calcium hydroxylapatite-based Implant in eliminating increased sensitivity of teeth
Abstract
BACKGROUND: Dental hypersensitivity affects up to 57% of the world’s population. In Russia, high demand for treating hyperesthesia was found among patients aged 30–59 years. Despite the large number of studies conducted, understanding of the etiology and proposed treatment methods to eliminate increased sensitivity of teeth, there is still no effective drug to treat this pathology. Current methods do not ensure long-term elimination of hypersensitivity, which substantiates the need to develop new treatment methods.
AIM: To determine the effectiveness of the Radiesse implant (Merz North America, USA) in patients with dental hyperesthesia.
MATERIALS AND METHODS: Eighty-six patients aged 35–44 years — men and women with dental hyperesthesia — were examined. The condition of periodontal tissues of teeth with hypersensitivity was assessed by clinical examination methods, and an objective assessment of dental hypersensitivity (tactile impact — TV) was carried out using an electromagnetic device Yeaple Probe (XininX Research Inc., USA).
RESULTS: Dental hypersensitivity after a single injection of the Radiesse implant steadily decreases compared to its initial values.
CONCLUSIONS: Dental hypersensitivity after a single injection of the Radiesse implant steadily decreases compared to its initial values (p < 0.05). Effective reduction of dental hypersensitivity when using Radiesse (Merz North America, USA) lasts for more than 6 months in contrast to the effect of standard treatments.
79-86
Case report
Pheochromocytoma in combination with severe aortic insufficiency: clinical case
Abstract
Pheochromocytoma is a rare neuroendocrine tumor of the adrenal medulla with widespread cardiac complications. Dilation of the heart chambers can cause valve defects. At the same time, severe cardiac comorbid conditions that complicate the choice of treatment tactics for patients are not sufficiently described in the literature. A clinical case of pheochromocytoma in combination with severe aortic insufficiency in a man admitted to the endocrinology department is presented. In conditions of aortic insufficiency, the risk of surgical intervention is extremely high. After a thorough analysis of clinical and laboratory-instrumental data, the patient was recommended to have a right-sided laparoscopic adrenalectomy.
87-93
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор). Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 71733 от 08.12.2017.