Сибирское Медицинское Обозрение. 2021. № 4 View full textКоличество просмотров : 400
Experimental justification for clinical application of bone growth stimulators in traumatology and orthopaedics (a review)
Konev VA, Labutin DV, Bozhkova SA. Experimental justification for clinical application of bone growth stimulators in traumatology and orthopaedics (a review). Siberian Medical Review.2021;(4):5-17. DOI 10.20333/25000136-2021-4-5-17
Analysis of scientifi c publications devoted to effi cacy assessment and experimental justifi cation of cell technology and growth factors application for osteogenesis stimulation in clinical practice of traumatologists-orthopaedists.Th e search was performed for papers published in PubMed and E-library digital databases within the period of 2010-2020. Th e search fi lter was set to explore randomised clinical trials. Th e key words were: “platelet growth factor OR vascular endothelial growth factor OR bone morphogenetic proteins OR autologous bone marrow stromal cells AND bone defect AND human”. Works dated 2010-2020 were selected for analysis of experimental studies using the following key word combinations: “mesenchymal stromal cells AND osteogenesis OR bone regeneration”, “growth factors AND mesenchymal stromal cells AND osteogenesis OR bone regeneration”. In addition, essential literatures describing properties of multipotent mesenchymal stromal cells (MSCs) were cited as well as issues in their osteogenic diff erentiation. Despite the great number of experimental works related to cell technology application for bone growth stimulation, a large variety of unresolved issues associated with optimal means to create such cells, their cultivation and combined application with morphogenetic proteins and growth factors remains. Clinical application of rhBMP-2, PDGF has demonstrated effi cacy in complex treatment of patients with bone defects. Therewith, growth factors may be effi caciously used in different combinations with MSCs. In a number of cases, application of implants enriched with growth factors may become an alternative for autogenic graft s. To the present day, there is crucial defi cit in the number of works presenting results of randomised controlled clinical trials devoted to stimulation of bone tissue repair. The controversial results of the publications analysed may be based on a low number of patients enrolled. With consideration for active development of reparative medicine as a whole, further investigation of possibilities in bone growth stimulation with local application of cell-engineering constructions is considered to be a promising trend for traumatology and orthopaedics.
Keywords: bone growth stimulation, platelet-derived growth factor, vascular endothelial growth factor, bone morphogenetic proteins, autologous bone marrow stromal cells, bone defect.
Alekseeva AY, Ziganshin АM. Historical development of estimated fetal weight calculation. Siberian Medical Review.2021;(4):18-25. DOI 10.20333/25000136-2021-4-18-25
Accurate calculation of the estimated fetal weight is necessary for the choice of a correct approach to management of labour. Th e existing methods are not universal and require complex application. Th is article presents a review of literatures published in PubMed and Google Scholar databases in 1955-2021 and devoted to historical aspects in development of the existing clinical and instrumental approaches to calculation of estimated fetal weight. The paper presents existing methods for calculation of estimated fetal weight at diff erent gestational ages as well as methods making it possible to predict fetal weight before gestation onset. Data on their informative value during the third trimester and alterations in their accuracy depending on the pregnant patient’s BMI are presented. The topic of application of magnet-resonance imaging for fetometry is considered with comparison of this approach to a more common method of ultrasonography
Keywords: estimated fetal weight, sonography, fetometry, anthropometry, magnet-resonance imaging, a method for calculation of estimated fetal weight
Lyapina IN, Zavyrylina PN, Nacheva LV. Intestinal microbiota – a new risk factor in cardiovascular diseases. Siberian Medical Review.2021;(4):26-33. DOI 10.20333/25000136-2021-4-26-33
The search for new mechanisms of development and progression of cardiovascular diseases (CVD) remains relevant. In recent times, signifi cant attention has been drawn to investigation of the role of intestinal microbiota as a risk factor in diff erent of metabolic disorders and CVD development. In pathological conditions, microbiota may act as an independent factor defi ning the adverse prognosis of the disease, exert infl uence on drug metabolism and facilitate production of pharmacologically active secondary metabolites capable of inducing side effects. This review presents data on the connection between intestinal dysbiosis and arterial hypertension and chronic heart failure and also discusses methods and new developments aimed at dysbiosis correction. Attention is focused on important aspects of personalised therapy for patients with consideration for the infl uence of human microbiome on individual variability of the reaction to medicinal products. In light of the high incidence and mortality of CVD, active studying of intestinal microbiota and the search for means of dysbiosis correction will make it possible to obtain additional tools for management of the risks of cardiovascular pathology development
Keywords: intestinal microbiota, cardiovascular diseases, arterial hypertension, chronic heart failure
Ostroumova OD, Klepikova MV, Litvinova SN. Drug-induced acute interstitial nephritis. Siberian Medical Review.2021;(4):34-50.. DOI 10.20333/25000136-2021-4-34-50
Among the causes of acute interstitial nephritis, drug-induced acute interstitial nephritis accounts for 50 to 78 % of all cases. Th e review summarizes the literature data on drugs that cause acute interstitial nephritis. Search in eLibrary databases.RU, PubMed®, MEDLINE, EMBASE, manuals and guidelines, materials of adverse drug reactions databases, instructions for the medical use of drugs. it was held until October 2020. Th e most probable mechanisms of its development are considered. Most attention is paid to non-steroidal anti-inflammatory drugs, anticoagulants, antibiotics, antitumor drugs (immune checkpoint inhibitors), which are widely used in clinical practice. Th e symptoms of drug-induced acute interstitial nephritis are variable and oft en non-specific; therefore, a kidney biopsy is required for an accurate diagnosis. The main direction of treatment of drug-induced acute interstitial nephritis is the cancellation of nephrotoxic drugs, if this condition is not feasible and/or the duration of acute interstitial nephritis is less than 3 weeks, the biopsy has minimal interstitial fibrosis and there are no serious contraindications, then the possibility of using it should be considered
Keywords: acute kidney injury, drug-induced acute kidney injury, acute interstitial nephritis, drug-induced acute interstitial nephritis, drugs, adverse drug reactions.
Bronchial asthma in practice of the allergist and the pulmonologist: a comparative analysis
Vafina AR, Vizel IYu, Vizel AA, Skorokhodkina OV, Luntsov AV, Salakhova IN. Bronchial asthma in practice of the allergist and the pulmonologist: a comparative analysis. Siberian Medical Review.2021;(4):51-59. DOI 10.20333/25000136-2021-4-51-59
Aim of study. To carry out a comparative analysis of a population of patients with bronchial asthma under observation of pulmonologists and allergists. Material and methods. A total of 377 cases of bronchial asthma were studied and analysed. Th e non-interventional, observational, comparative study was carried out in the setting of actual clinical practice. Th e patient underwent medical history collection, evaluation of adherence to treatment and of the level of bronchial asthma control, physical examination, spirometry, their laboratory data and earlier treatment taken into consideration. The evaluation results were analysed via the SPSS-18 soft ware program. Results. Th e patients observed by pulmonologists had uncontrolled BA more frequently with almost 2-fold predominance of patients with severe disease progression, FEV1 was below normal values with signifi cantly more frequent exacerbation and hospitalisation. Th e patients observed by allergists were more frequently male. Th ey were younger with signifi cantly more frequent controlled bronchial asthma or bronchial asthma with mild progression, 3-fold more frequent rhinitis, a lower number of exacerbation and hospitalisation over the past year, 2-fold less frequent FEV1 below the normal values and 2-fold less frequent application of short-acting bronchodilators. Th e patients observed by pulmonologists had severe uncontrolled progression of the disease with presence of extrapulmonary concomitant diseases. Th ere was no diff erence between the patients in relation to the frequency of baseline therapy via inhaled glucocorticosteroids and their combinations with long-acting bronchodilators. Conclusion. Bronchial asthma is a disease, the heterogeneity of manifestations of which leads to management of patients with the same nosological entity being performed by specialists in two fi elds, which is based on the diff erences in the clinical profi le determined in this study.
Keywords: bronchial asthma, allergist, pulmonologist
Prediction of osteoporosis severity in patients with rheumatoid arthritis via evaluation of the fetuin-A level
Akhverdyan YR, Papichev EV, Zavodovsky BV, Polyakova YV, Seewordova LE. Prediction of osteoporosis severity in patients with rheumatoid arthritis via evaluation of the fetuin-A level. Siberian Medical Review.2021;(4):60-65. DOI 10.20333/25000136-2021-4-60-65
Aim of study. To investigate the level of dependence of osteoporosis (OP) progression severity on the level of fetuin-A (FA) in order to predict the OP progression severity in RA patients. Material and methods. We have examined a total of 110 RA patients (mean age 54.2+11.97). Th e diagnosis was established based on ACR/EULAR criteria 2010. A total of 30 conventionally healthy subjects were enrolled serving as a control group. Evaluation of bone mineral density (BMD) was performed using DXA (Lunar DPX-NT GE densitometer). Th e FA level was determined through indirect enzyme-linked immunoassay (Human Fetuin-A ELISA test-system). Results. Mean serum FA in healthy subjects amounted to 653.55-972.19μg/ml. We formed 2 groups of RA patients: with blood serum FA levels <653.55μg/ml (23 patients) and with normal FA values: 653.55μg/ml or higher (87 patients). A lowered FA level was revealed in 20 (86.96 %) subjects in the group of OP patients and only in 3 (13.04 %) patients with RA without OP (р<0.001). Osteoporotic bone fractures were diagnosed in 12 (13.79 %) patients in the group with normal FA levels and were absent in 75 (86.21 %) patients (р<0.001). Apart from that, RA patients with lowered FA had reliably lower mean BMD in the area of femoral neck and vertebral column as well as lower BMD total value (р<0.001). In order to determine the diagnostic accuracy of laboratory tests, the characteristic curve (ROC curve) was applied. Th e area under the ROC-curve was 0.663 with the cut-off point matching the FA level of 660.3μg/ml. This value corresponds with 84.72 % specifi city and 47.37 % sensitivity. Conclusion. We have revealed reliable correlations between the serum FA level in RA patients, the frequency of OP development, osteoporotic bone fractures and BMD values (p<0.001). Laboratory evaluation of FA for OP progression severity prediction for RA patients has good quality with the specifi city of 84.72 % and the sensitivity of 47.37 %.
Keywords: rheumatoid arthritis, osteoporosis, low-impact fracture, fetuin-A, cytokine, hepatokine
Mudrov VA, Yakimova AV, Ziganshin AM. A technology for prediction of preterm discharge of amniotic fl uid. Siberian Medical Review.2021;(4):66-72.. DOI 10.20333/25000136-2021-4-66-72
Aim of study. To create a technology for prediction of preterm discharge of amniotic fluid based on universally accessible methods of laboratory and instrumental evaluation. Material and methods. A retrospective analysis of 200 birth cases dated 2018-2021 at the premises of obstetric facilities in Chita and Ufa cities featuring patients admitted to the inpatient unit shortly before term labour (1-2 days). In the course of the study, 2 groups were distinguished: Group 1 included 128 female patients with term discharge of amniotic fluid and Group 2 was constituted by 72 female patients with preterm discharge of amniotic fluid. The groups were comparable in age, anthropomorphic parameters and extragenital pathology. On admission, all women underwent general medical examination and ultrasonography. Statistical processing of the results was performed via the IBM SPSS Statistics Version 25.0 soft ware. Results. Th e technology for prediction of preterm discharge of amniotic fl uid was based on multilayer perceptron learning. Th e structure of the learning neural network included 5 input neurons: body mass index, fundal height, the total bilirubin level, activated partial thromboplastin time and the amniotic fl uid index. Th e percentage of incorrect predictions of the neural network totalled 28.5 %. Conclusion. A complex approach based on integration of universally accessible methods for laboratory and instrumental tests shortly before the labour based on a neural network makes it possible to predict possible preterm discharge of amniotic fluid with an accuracy of up to 75 %. Application of this technology in clinical practice will make it possible not only to perform timely preparation of the parturient canal but also to reduce the frequency of adverse obstetric and perinatal outcomes.
Keywords: technology, prognostics, preterm discharge of amniotic fl uid, labour abnormalities
Incidence in school students and the efficacy of regular medical checkup at different stages of study
Tepper EA, Taranushenko TE, Narkevich AN. Incidence in school students and the efficacy of regular medical checkup at different stages of study. Siberian Medical Review.2021;(4):73-79. DOI 10.20333/25000136-2021-4-73-79
Th e publication presents results of investigation of health of 437 school students at diff erent stages of school education (before entering school, aft er the 1st grade, at the moment of transition to subject-oriented learning and upon completion of school education) and depending on the school starting age. Dynamic detectability analysis of school students with consideration for the school starting age within a period of 10 years has shown an increase in the ratio of school students with diseases of the upper respiratory tract, skeletomuscular system and vision organs. Substantial growth of the listed pathologies was predominant at the 2nd and the 4th stages of observation and predominantly in school students who started their education at the age of 6 and 8. The data obtained have enhanced the importance of formation of healthy lifestyle habits and skills in the students and their parents within the framework of the National Priority Projects of Russia. Aim of study. To evaluate the state of health in school students who started their education at diff erent ages within a 10-years observation period based on dynamic analysis of depleted and general incidence, detection rate of the relevant pathology (ARVI) and health index. Material and methods. Within the framework of the study, dynamic evaluation of the state of health in 437 school students at diff erent stages of school education (before entering school, aft er the 1st grade, at the moment of transition to subject-oriented learning and upon completion of school education) based on medical history and medical documents, data obtained from clinical examination, statements of physicians in niche specialities based on medical checkup data. The results obtained are presented for groups of school students with consideration for the school starting age. Results. Results of the study with analysis of school students’ health state indices attest to a decrease in functional reserves and a more adverse trend in incidence indices (depleted, general and the number of diseases per one student in a year) during school education among children who started their education at the age of 6 and 8. Conclusion. The presented analysis of schools students’ state of health at diff erent stages of school education depending on the school starting age has made it possible to present generalised data on the incidence in school students over a 10-years period of dynamic observation, outline adverse trends in the state of health in children who started their school education at the age of 6 and 8 years and to note the necessity of a more careful attention to children at a lower chronological age in comparison to a more functionally prepared peers, while that increases the probability of maladaptation under the circumstances of school workload with consequent deterioration of the child’s health and high incidence during the whole period of studying.
Keywords: children, school students’ health, school starting age, incidence, school pathology, health index
Assessment of cytokine and humoral status children with primary Epstein-Barr viral infection, recurrent respiratory infections and adenoviral infection
Makhmutov RF. Assessment of cytokine and humoral status children with primary Epstein-Barr viral infection, recurrent respiratory infections and adenoviral infection. Siberian Medical Review.2021;(4):80-84. DOI 10.20333/25000136-2021-4-80-84
Aim of study. To assess the humoral and cytokine status in children with infectious mononucleosis (induced by Epstein-Barr virus), recurrent respiratory infections and adenoviral infection. Material and methods. Indices of humoral (IgА, IgМ and IgG immunoglobulins) and cytokine (IFN-α and IFN-γ interferons, IL-1β and IL-6 interleukins) immunity were evaluated in 93 children with infectious mononucleosis (induced by Epstein-Barr virus (EBV)), 167 children with recurrent respiratory infections of the upper respiratory tract (RRI) and 76 children with adenoviral infection (AI) aged 1 to 18 years as well as 90 children of the same age without diseases associated with lymphoproliferative syndrome and with no medical illnesses exacerbating at the moment of study. Results. A decrease in virus resistance of children with viral infections combined with the lymphoproliferative syndrome was manifested by a 1.5 to 2-fold decrease of IFN-α and IFN-γ. Signifi cantly elevated levels of IL-1β and IL-6 anti-infl ammatory interleukins in children with viral infections combined with the lymphoproliferative syndrome attested to severe progression of the pathological process, predominantly in infectious mononucleosis (induced by EpsteinBarr virus). Results of analysis of cytokines in peripheral blood during infectious diseases may be considered as additional laboratory criteria for diff erential diagnosis of diseases accompanied by the lymphoproliferative syndrome. Conclusion. While interferons suppress viral replication, investigation of the cytokine status of children with infectious mononucleosis (induced by EpsteinBarr virus), recurrent respiratory infections and adenoviral infection is especially relevant for practical healthcare.
Keywords: cytokines, immunoglobulins, infectious disease, lymphoproliferative syndrome, children
Drozdov ES, Baranov AI, Shkatov DA, Klokov SS. Selection of the optimal type of the stapler cassette for distal pancreas resection. Siberian Medical Review.2021;(4):85-91.. DOI 10.20333/25000136-2021-4-85-91
Aim of study. Investigation of risk factors in development of postoperative pancreatic fi stula (POPF) in patients aft er distal pancreatectomy (DP) involving application of a cutting stapler device (CS) as well as determination of the criteria for selection of the optimal cassette type for such devices making it possible to reduce the POPF development frequency. Material and methods. A two-centre retrospective/prospective controlled study was performed. A total of 46 patients (19 (41.3 %) male and 27 (58.7 %) female) were enrolled. All patients included in the study underwent DP surgery using CS for excision of the pancreas with closure of its stump. In all cases, measurement of the pancreas thickness in the resection area based on the data of preoperative computed tomography and calculation of the diff erence between the pancreatic parenchymal thickness in the resection area and the staple closure height (SCH). Th e patients were distributed between two groups: 1) without POPF of with biochemical leakage (BL); 2) with clinically relevant POPF (CR-POPF). Results. CR-POPF developed in 15 (32.6 %) cases (type-B POPF: 14 (93.3 %) cases, type-С: 1 (6.7 %) case). Statistically signifi cant diff erence in mean pancreatic parenchymal thickness in the resection area as well as mean SCH between the group without POPF or with BL and the group with CR-POPF (15.4±4.3mm versus 12.3±3.5mm, р=0.01 and 12.8±2.3mm versus 16.4±3.1mm, р<0.01, respectively). The frequency of CR-POPF development was reliably lower at the SCH varying from 8 to 14mm (9.5 %) as compared to cases with SCH below 8mm (55.6 %, p<0.01) and above 14mm (50.0 %, p<0.01). Conclusion. Upon analysis of risk factors in POPF development aft er DP, it has been established that a greater pancreatic parenchymal thickness in the resection area as well as SCH are statistically signifi cant risk factors for this complication. Th e optimal SCH making it possible to achieve the minimal frequency of POPF aft er pancreatic stump closure using a CS is within the range of 8-14mm
Keywords: pancreatic fi stula, distal resection, pancreatic stump, stapler
Pavlov AV, Timofeev VE, Ovchinnikova NV, Lazutina GS, Pronin NA, Bakharev IV. Microsurgical anatomy of arteries in anterior perforated substance of human brain. Siberian Medical Review.2021;(4):92-97. DOI 10.20333/25000136-2021-4-92-97
Aim of study. To specify the peculiarities in spatial arrangement of arterial branches in the area of anterior perforated substance. Material and methods. The work was carried out using brain material of 25 people of both genders from the archive of the Department of Anatomy at the FSBEI HE Ryazan State Medical University MOH RF. In order to verify the arteries before formaldehyde fixation of brain, their injection with gelatine solution was performed. The peculiarities in origin of central arteries from the internal carotid artery, middle cerebral artery, anterior cerebral artery as well as their calibres and quantity were examined. Results. The study has shown that the spatial arrangement of the perforating arteries in the anterior perforated substance depends on the particular site of origin. Th e origins of arterial branches fl owing through the anterior perforated substance are the internal carotid artery, anterior cerebral artery, middle cerebral artery and anterior choroidal artery. Perforating branches originating from the internal carotid artery were registered in both hemispheres in 98 % of the cases. Unilateral (left ) absence of branches originating from the C4 segment was only noted in one case. Th e largest quantity of arteries originated from M1 segment of the middle cerebral artery. Th erewith, the majority of the branches belonged to the lateral group exceeding the quantity of such branches in the medial group by 2.3 times on average. Th ereat, the quantity of branches in each group showed no valid difference in relation to the side of the body. Conclusion. Knowledge of the anatomy of the anterior perforated substance, the peculiarities in spatial arrangement of the branches of middle cerebral artery and the anterior choroidal artery is important and is of interest for clinicians from the perspective of diagnosis and timely treatment of cerebral tumours and aneurisms of its arterial ring
Keywords: brain, anterior perforated substance, cerebral arteries, perforating arteries, lenticulostriate arteries
Moskaleva PV, Shnayder NA, Petrova MM, Bezzabotnova OG, Nasyrova RF. Convulsive syndrome. Part 1. Siberian Medical Review.2021;(4):98-105.. DOI 10.20333/25000136-2021-4-98-105
Convulsive syndrome is an urgent, potentially life-threatening condition in neurological, paediatric and general practice. Over the past decade, reconsideration has been committed in relation to the defi nition of epilepsy, epileptic syndromes, including convulsive syndrome with simultaneous expansion of the arsenal of medicinal products for cessation of convulsive seizures in children and adults. In this connection, we have prepared this lecture comprising two parts: the first part considers the defi nition, pathogenesis, aetiology and diagnosis of the convulsive syndrome. Th e lecture is designed for neurologists, paediatricians, general practitioners, ambulance physicians and anaesthesiologists-reanimatologists. The system of continuing medical education (CME) considers convulsive syndrome within the framework of the programme for postgraduate training of physicians in these specialities
Keywords: convulsive syndrome, defi nition, terminology, pathogenesis, aetiology, diagnosis
Liver transplantation in hepatic cirrhosis: the experience of work of the Federal Siberian research clinical centre
Kuchkarov MF, Dunaevskaya SS, Kartashkov EV, Kosik AA. Liver transplantation in hepatic cirrhosis: the experience of work of the Federal Siberian research clinical centre. Siberian Medical Review.2021;(4):106-109. DOI 10.20333/25000136-2021-4-106-109
Prevalence and mortality in terminal stages of diff use liver diseases amount to 60 %. Foremost, liver transplantation is required by hepatic cirrhosis patients with life expectancy below one year or low quality of life conditioned by the disease. Over the past decade, it has become apparent that only orthotropic liver transplantation is a radical, eff ective and life-saving treatment for hepatic cirrhosis patients. Th is article reports our own results of operative treatment provided for 13 patients using orthotropic liver transplantation advised in relation to diff erent reasons. Th e patients underwent surgery at the surgical department of the Federal Siberian Research Clinical Centre under FMBA of Russia. Th e earliest outcomes observed during the postoperative period and the structure of complications have been analysed. A clinical case of successful orthotropic liver transplantation is presented. It is postulated that development of this fi eld leads to correction of indications to transplantation and the number of absolute contraindications decreases. Consequently, a possible increase in the number of patients advised to undergo transplantation is to be expected.
Keywords: transplantation, liver, liver diseases, hepatic cirrhosis, donor liver, cadaveric liver
Trophicity decline and fibroid nodule necrosis in pregnant patients. The problem of physician’s difficult choice
Tskhay VB, Kaplunov VA, Andreeva AA, Badmaeva SZh, Polstyanaya GN, Kuzmina SV, Dzhunagova ESh. Trophicity decline and fibroid nodule necrosis in pregnant patients. Th e problem of physician’s diffi cult choice. Siberian Medical Review.2021;(4):110-116. DOI 10.20333/25000136-2021-4-110-116
Th e prevalence of uterine fi brosis during pregnancy is considered to be relatively low and totals 3-12 %. However, uterine fibrosis may lead to severe complications during pregnancy such as miscarriage, intrauterine growth restriction, placenta praevia, trophicity decline and fibroid nodule necrosis. Myomectomy is rarely performed on pregnant patients due to the fear of miscarriage and the risk of uncontrolled bleeding necessitating hysterectomy. This article reports our own cases of removal of subserosal leiomyoma that had led to septic or aseptic necrosis. It is claimed that myomectomy performed on thoroughly selected patients prevents sepsis induced by septic of aseptic necrosis of the fibroid nodule and also prevents impairment of functions of adjacent organs
Keywords: uterine fibrosis, myomectomy, pregnancy, fibroid nodule necrosis, aseptic necrosis