Kazan medical journal

Medical peer-review journal for physicians and researchers.

Editor-in-Chief: Ayrat U. Ziganshin, MD, PhD, Professor.

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Published bimonthly since 1901, distributed by subscription.

About: the Kazan Medical Journal is a peer-reviewed journal for clinicians and medical scientists, practicing physicians, researchers, teachers and students of medical schools, interns, residents and PhD students interested in perspective trends in international medicine.

Missions of the Journal are to spread the achievements of Russian and international biomedical sciences, to present up-to-date clinical recommendations, to provide a platform for a scientific discussion, experience sharing and publication of original researches in clinical and fundamental medicine.


 

 

 

 

 

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Vol 103, No 3 (2022)

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Theoretical and clinical medicine

Phenotypes of lymphocytes in exudate in atopic dermatitis
Kibalina I.V., Tsybikov N.N., Fefelova E.V.
Abstract

Aim. To determine subpopulations of lymphocytes in exudate in atopic dermatitis.

Material and methods. The study included 80 patients with atopic dermatitis according to predetermined inclusion and exclusion criteria, who were under dispensary supervision at the Regional Dermatovenerologic Dispensary (Chita) from 2018 to 2021. Two groups (adolescents and adults) and two subgroups (patients with limited and widespread lesions) were formed. Skin exudate sampling was carried out during the period of exacerbation of the disease. The control group consisted of 30 practically healthy volunteers undergoing a medical examination at the same dispensary, having primary health records and meeting the inclusion criteria for the study. Lymphocyte phenotypes were determined in skin exudate by flow cytofluorometry. Statistical analysis was performed using Microsoft Excel, IBM SPSS Statistics version 25.0, and the Shapiro–Wilk test, Mann–Whitney and Wilcoxon U-test, Kruskal–Wallis nonparametric analysis of variance were used. The data were presented by median and interquartile intervals — Me (25%; 75%). The critical indicator of the significance level of the differences was p <0.05.

Results. In the exudate of practically healthy volunteers, obtained by the “skin window” method, no subpopulations of lymphocytes were detected. In the skin exudate of adolescents with limited lesions, the content of lymphocytes was 149.00 (129.75; 157.75) cells/μl, T-lymphocytes (CD3+CD19–) — 109.5 (96.25; 113.75) cells/μl, among them 48.95% active, T-helpers — 42.5 (39.25; 57.50) cells/μl, natural killers (CD3+CD16+CD56+) — 38.50 (36.25; 41.00) cells/μl, however, with the widespread process, the level of lymphocytes increased by 11% (p1=0.002), T-helpers — by 45%, natural killers — by 27%, T-lymphocytes up to 125.00 (110.5;135.75) cells/μl (p1=0.00001). These indicators in adults and the level of cytotoxic T-lymphocytes (CD3+CD8+) in adolescents and adults had no significant differences. The number of T-NK-killers (CD3+CD16+CD56+) in adolescents was higher with a widespread process — 23.00 (11.75; 29.75) cells/μl (p1=0.0001), in adults with a limited process — 18.00 (10.25; 20.75) cells/μl (p2=0.0001). The number of NKCD8+ (CD3–CD16+CD56+CD8+) in adolescents with limited dermatosis was 22.50 (18.25; 26.00) cells/μl, with widespread dermatosis — 1.6 times more (p1=0.0001), in adults with a limited process — 29.50 (25.25; 33.75) cells/μl, with widespread — 27% less (p1=0.0001).

Conclusion. In the skin exudate in atopic dermatitis, cytotoxic T-lymphocytes, T-NK-killers, natural killers, CD8-positive NK-killers are detected.

Kazan medical journal. 2022;103(3):357-363
pages 357-363 views
Metabolic therapy and its impact on lung respiratory function in patients with severe COVID-19
Yakovlev A.Y., Pevnev A.A., Dudorova M.V., Ilyin Y.V., Belous M.S.
Abstract

Background. Metabolic disorders, often detected in patients with severe COVID-19 infection, indicate the severity of the infection process and play an important role in the pathogenesis of the disease. Changes in muscle metabolism lead to weakness and reduced mobility of the diaphragm, which exacerbates the progression of respiratory failure.

Aim. To evaluate the effect of a meglumine sodium succinate 1.5% solution on the dynamics of metabolic blood parameters and respiratory function of the lungs in patients with COVID-19.

Material and methods. The observational prospective study included 105 patients with severe COVID-19 treated in the intensive care unit. As an infusion therapy, patients in the control group (n=54) received Ringer's solution, in the main group (n=51) — 1.5% solution of meglumine sodium succinate. Infusion therapy was carried out for 11 days. All patients underwent standard laboratory tests. Diaphragm mobility was assessed using an ultrasound scanner. Intergroup comparisons were performed using the Mann–Whitney test, and intragroup dynamics were assessed using the Kruskal–Wallis test.

Results. Upon admission to the intensive care unit, in 36.2% of patients, the development of respiratory failure was accompanied by a decrease in the excursion of the right dome of the diaphragm to less than 1.7 cm, in 92.4% of patients — the development of hyperglycemia and hyperlactatemia. By the 11th day of ongoing treatment, hyperglycemia persisted in 16.7% of patients in the control group and 3.9% of patients in the main group, hyperlactatemia — in 53.7 and 9.8% of patients, respectively. Maintenance and then gradual restoration of diaphragm excursion in patients of the main group, a decrease in hypercapnia and a gradual increase in the pO2/FiO2 index were registered. Therapy with a solution of meglumine sodium succinate significantly reduced the duration of hospital treatment after transfer from the intensive care unit (p=0.007).

Conclusion. The inclusion of a 1.5% solution of meglumine sodium succinate in the therapy of patients with severe COVID-19 can reduce the duration of metabolic disorders, which has a positive effect on the degree of respiratory dysfunction, diaphragmatic excursion depression and the treatment duration after transfer from the intensive care unit.

Kazan medical journal. 2022;103(3):364-372
pages 364-372 views
Comparative analysis of the treatment results of patients with breast cancer using various ­reconstruction methods
Kaganov O.I., Orlov N.A., Tkachev M.V.
Abstract

Background. Breast cancer in many cases becomes the main cause of deterioration in the quality of life of patients due to the presence of severe postoperative asymmetry.Аim. To compare immediate and long-term results, quality of life indicators and cost-effectiveness in the treatment of patients diagnosed with breast cancer using an endoprosthesis and lipofilling reconstruction.

Material and methods. A prospective study of the treatment results of 72 patients diagnosed with breast cancer was carried out. Patients in the control group (n=40) underwent subcutaneous mastectomy with endoprosthesis plastics. Patients of the main group (n=32) underwent subcutaneous mastectomy with primary reconstruction by lipofilling. The calculation of indicators characterizing the efficiency of the use of hospital beds of a medical institution was carried out, the number of cases and days of temporary disability was calculated, an analysis of economic costs was made based on the tariff for a completed case of treatment of the disease. All statistical analyzes were performed using the Statistica 10.0 software. The study established a significance test of p <0.05.

Results. In the compared groups, the immediate results of surgical treatment did not differ statistically significantly (p=0.973), while the quality of life in patients after subcutaneous mastectomy with plastic lipofilling was significantly higher on the social functioning scale (0.004) than after reconstruction with the use of an endoprosthesis. When using the method of reconstruction with the use of lipofilling, it was possible to statistically significantly reduce the length of stay of patients in the hospital.

Conclusion. The use of lipofilling as a new method of reconstruction in patients diagnosed with breast cancer allows maintaining significantly high quality of life indicators on the scale of social functioning in comparison with the group of patients who underwent reconstruction with an endoprosthesis, and also makes it possible to significantly reduce the economic costs of treating patients.

Kazan medical journal. 2022;103(3):373-379
pages 373-379 views
Microstructural features of the thyroid gland in far eastern region goiter endemic zone inhabitants
Ageenko K.I.
Abstract

Background. At present, the use of informative integration criteria for assessing the ecological well-being of the population’s health is relevant. Monitoring of the morphofunctional parameters of the thyroid gland and its functional indices in inhabitants of different regions makes it possible to control the degree of tension of adaptive reserves in response to environmental influences.

Aim. Establishment of the features of the morphofunctional status of the thyroid parenchyma in inhabitants of the territory endemic for goiter in the Far East region.

Material and methods. 168 sectional thyroid glands without morphological signs of tissue pathology were used. Approaches were applied taking into account the age periodization of a person, depending on the mass of the gland and colloid-epithelial relations of the thyroid tissue (I epithelial, II epithelial, colloid types of glands). The qualitative and quantitative characteristics of thyroid gland macro- and microanatomy were studied.

Results. Based on cluster analysis, three morphological groups (types) of thyroid glands were identified: colloidal (61.9%), I epithelial (33.3%), II epithelial (4.7%). In the discriminant analysis, structural components that determine the assignment of the gland to a specific type (hormonal colloid and interfollicular epithelium) were established. In normal-weight glands, variants of the histostructure of colloidal and epithelial type I were equally found. For hypertrophied glands, the morphology of the colloidal type was characteristic (86.67%), the I epithelial type was slightly expressed (13.33%) and the II epithelial type was practically not found. It is determined that in the age aspect the colloidal type is the leading one.

Conclusion. Two factors — morphological stability and functional activity, have been established, which can be considered as informative markers of compensatory-adaptive reactions and the level of activity of the thyroid tissue of far eastern region goiter endemic zone inhabitants.

Kazan medical journal. 2022;103(3):380-389
pages 380-389 views
Analysis of the antibacterial drugs use and evaluation of the caesarean section outcomes in the ­regional perinatal center in two time periods with a 10-year interval
Tashtanbekova C.C., Evstratov A.A., Aleksandrova E.G., Chuenkova E.A., Ziganshina L.E.
Abstract

Background. Infectious inflammatory complications that occur in women after caesarean section may affect the length of hospital stay. Timely drug therapy plays a major role in preventing the development of complications in the postoperative period.

Aim. To conduct a comparative pharmacoepidemiological analysis of antibiotics use and evaluate the surgery outcomes (on the part of the puerperal and the newborn) in women delivered by caesarean section.

Material and methods. A retrospective analysis of 1025 birth histories of women after planned and emergency caesarean section with a detailed assessment of the antibiotics use in two time periods with a 10-year interval: in 2007–2009 (first period, n=523) and in 2016–2017 (second period, n=502) was carried out. The operation outcomes, the length of hospital stay, the duration of antibiotics use were studied. The significance of differences in relative indicators was assessed by Pearson (χ2).

Results. The frequency of prescribing antibiotics in monotherapy for planned and emergency cesarean section in both time periods did not differ (p=0.858; p=0.726). There were more cases of using two antibiotics at the same time in the first period, both for planned (88 cases, 35.5%) and for emergency surgery (93 cases, 34%; p=0.001). Combinations of three antibiotics were used more frequently in the first period than in the second. The increase in body temperature after surgery (>37.5 °C) was statistically indistinguishable in two periods. The duration of hospital stay with primary antibiotic therapy in the first period was 6 bed-days, with primary antibiotic prophylaxis in the second period — 4 bed-days. Exacerbation of urinary tract infections during emergency and planned caesarean section was diagnosed 4 and 5 times more often in the first period than in the second. Outcome on the part of the newborn — an Apgar score of less than 7 points was more common with emergency intervention in the second period (10%) than in the first (3.5%; p=0.003).

Conclusion. In the first studied time period (2007–2009), with combined antibiotic therapy after caesarean section, a longer stay of women in the hospital, a higher frequency of urinary tract exacerbations in puerperas, and a better assessment of the condition of newborns according to the Apgar score were registered, compared with these indicators in the second time period (in 2016–2017), when antibiotic prophylaxis was predominantly used.

Kazan medical journal. 2022;103(3):390-401
pages 390-401 views
Evaluation of the natural medical-table hydrocarbonate mineral water application effectiveness in rehabilitation therapy of patients with urolithiasis
Radchenko O.R., Knni Y.A., Arkhipov E.V.
Abstract

Background. Urolithiasis can be considered as a socially significant disease not only because it affects mostly people of working age, but also because it often turns into a chronic form, leading to an increase in the level of disability. This dictates the need to search for effective methods of treatment and prevention of disease recurrence, among which an important role is given to the use of non-pharmacological treatment methods — balneological therapeutic factors.

Aim. Evaluation of the effectiveness of the natural low-mineralized mineral water “Tarkhanskaya-3” use in the rehabilitation therapy of urolithiasis in working-age patients.

Material and methods. The study program involved 33 patients with urolithiasis. The patients of the main group (22 people), who did not have concomitant somatic acute or chronic pathology, took mineral water for 28 days 6 times a day, at home under the supervision of a polyclinic doctor and a nurse , at the rate of 4 ml/kg, degassed, heated to 22–26 °C. The control group (11 people) did not receive mineral water as a non-pharmacological therapy. The history of the disease, changes in the general analysis of urine and well-being (quality of life according to the Wisconsin questionnaire) were studied. The significance of differences was considered according to the generally accepted values of the Student's criterion and χ2.

Results. Comparative assessment of complaints and quality of life showed an improvement in the condition of patients who took mineral water: discomfort during urination disappeared, the number of patients with a positive costovertebral angle tenderness decreased, while no changes were recorded in the control group. In patients of the main group, a tendency towards a decrease in the level of uric acid from 326 to 256 μmol/L (t=0.96; p >0.05) was revealed. Reliable data were obtained on the effect of mineral water intake on inorganic urinary sediment — a decrease in the level of crystalluria (oxalaturia) in 70% of cases (χ2=3.9, p=0.048). Spontaneous discharge of salt crystals was registered in 2/3 of patients, an increase in daily urine output — in all patients who took mineral water. The assessment of the quality of life of the main group patients showed a significant improvement in the state of health according to the scale “impact on health” (t=2.13; p <0.05). Evaluation of clinical and laboratory parameters did not reveal a significant effect on the electrolyte metabolism and concentration function of the kidneys.

Conclusion. The intake of “Tarkhanskaya-3” mineral water for the purpose of secondary prevention in the rehabilitation therapy of urolithiasis has a positive effect on the course of the disease.

Kazan medical journal. 2022;103(3):402-408
pages 402-408 views
Comparison of the diagnostic capabilities of fecal and serum markers in determining the severity of an ulcerative colitis attack
Bolotova E.V., Yumukyan K.A., Dudnikova A.V.
Abstract

Background. The clinical manifestations of ulcerative colitis are heterogeneous and may change over time. The main problem at present is the search for non-invasive diagnostic markers to assess the activity and severity of an attack in patients with ulcerative colitis.

Aim. Comparative evaluation of the diagnostic significance of serum and fecal biomarkers depending on the severity of an attack of ulcerative colitis.

Material and methods. 178 patients with ulcerative colitis were divided into 4 groups depending on the presence and severity of the attack, the control group included 40 patients with irritable bowel syndrome. The cytokine profile (interleukins-1, -2, -4, -6, -10, -17, tumor necrosis factor α) and the concentration of fecal markers (lactoferrin, calprotectin, neopterin) were determined, the clinical activity index (CAI) and scores according to Mayo scale were assessed. Dispersion, correlation and ROC analysis were used. The indicators are presented as M (SD) for parametric distribution and as Me (25–75) for non-parametric distribution. Differences were considered statistically significant at p <0.05.

Results. Patients with ulcerative colitis showed a statistically significant correlation of Mayo scores with the CAI index (r=0.815, p=0.001), interleukin-6 (r=0.598, p=0.001), interleukin-17 (r=0.587, p=0.005 ), tumor necrosis factor α (r=0.701, p=0.001), fecal calprotectin (r=0.881, p=0.001), lactoferrin (r=0.799, p=0.001), neopterin (r=0.791, p=0.001). Statistically significant correlations between CAI and interleukin-6 (r=0.525, p=0.001), interleukin-17 (r=0.587, p=0.005), tumor necrosis factor α (r=0.624, p=0.001), fecal calprotectin (r=0.831, p=0.001), lactoferrin (r=0.672, p=0.005), neopterin (r=0.765, p=0.002) were found. Cut-off points for serum markers in predicting endoscopically active disease were as follows: interleukin-6 — 9.6 pg/ml, interleukin-17 — 6.6 pg/ml, tumor necrosis factor α — 7.6 pg/ml; cut-off points for fecal markers: calprotectin, 78.6 µg/g; lactoferrin — 765 μg/g; neopterin — 79.5 μg/g.

Conclusion. A higher diagnostic significance of the use of fecal biomarkers compared to serum biomarkers, as well as the advantages of fecal calprotectin in terms of sensitivity and specificity among all the indicators we studied were revealed.

Kazan medical journal. 2022;103(3):409-417
pages 409-417 views

Experimental medicine

Effect of chronic stress on the relative level of dopamine receptor gene expression
Valeeva E.V., Semina I.I., Galeeva A.G., Mukhametshina A.D., Mukhametshina R.D., Kravtsova O.A.
Abstract

Background. The regulation of the central dopaminergic system under the influence of chronic stress is disturbed, however, the dynamics of changes in the dopamine receptors expression in the periphery remains poorly understood.

Aim. Evaluation of the different models of chronic stress influence on changes in the relative level of dopamine receptor gene expression in peripheral blood cells of rats during immobilization and intense physical activity.

Material and methods. For 270 days on 88 Wistar rats, the study on the effect of different models of chronic stress on the change in the relative level of Drd1–5 genes expression was performed in four groups: the first control group; the second group was subjected to intensive physical activity in the “Forced swimming with a load” test (7-minute swimming with a load of 8% of body weight 2 times a week); the third group experienced daily 90-minute immobilization for 14 days; the fourth group had combined exposure of physical activity and immobilization. The relative level of dopamine receptor gene expression was determined by real-time polymerase chain reaction after 90, 180, and 270 days of the experiment in peripheral blood cells of the tail vein. The calculation of the relative level of gene expression was carried out based on the Livak method (2–ΔΔCt); the assessment of the difference significance — using a two-sample t-test for independent samples.

Results. The analysis of the relative level of genes encoding D1-type dopamine receptors expression showed that a decrease in the Drd1 gene expression level after 90 days of the experiment was detected only in male rats from immobilization stress and control groups [RQ 0.35 (p=0.003) and 0.21 (p=0.002), respectively], while in males from other groups and females, the activity of this gene did not change significantly throughout the course of the experiment. The relative expression level of Drd5 gene changed only in female rats. In females subjected to intense physical activity, the level of this gene expression increased almost 4 times (RQ 3.82, p=0.005) 90 days after the start of the experiment, and in females of the control group, the transcriptional activity of the gene decreased 4 times after 180 days of the experiment (RQ 0.25, p=0.015). When assessing changes in the activity of genes encoding D2-type receptors for the Drd3 and Drd4 genes, a significant increase in the relative expression level was revealed in all experimental groups, both in males and females, on the 180th day of exposure to stress factors. At the same time, activation of both genes was occurred after 90 days in the control group only in females and persisted up to another 90 days, after which it returned to the initial level. Expression of the Drd2 gene wasn't detected in rat blood cells.

Conclusion. The relative level of expression of D1- and D2-like receptor genes in rat peripheral blood cells depends on the type of chronic stress and has pronounced sexual dimorphism.

Kazan medical journal. 2022;103(3):418-426
pages 418-426 views
Effect of 3d-metal gluconates on leukocyte parameters of endogenous intoxication
Knyazeva O.A., Kireeva E.A., Konkina I.G., Urazaeva S.I., Gazdalieva L.M., Murinov Y.I.
Abstract

Background. The development of endogenous intoxication in the treatment of oncological pathology with cytostatic drugs complicates targeted therapy, so the search for correctors of these conditions is an actual task. Previously, we have shown in vivo the corrective effect of 3d-metal gluconates on the humoral link of immunity with the administration of the widely used cytostatic cyclophosphamide. It is of interest to evaluate the effect of 3d-metal gluconates on changes in leukocyte parameters of endogenous intoxication affected by cyclophosphamide.

Aim. Evaluation of the effect of 3d-metal gluconates (Mn, Fe, Co, Cu, Zn) on the degree of endogenous intoxication in mice against the background of the cytostatic effect of cyclophosphamide.

Material and methods. The experiment was carried out on white laboratory male mice weighing 25–28 g, divided into 9 groups [1 — intact animals, 2 — administration of cyclophosphamide without treatment, 3 — administration of cyclophosphamide and a comparison drug with an immunostimulating effect, 4 — administration of cyclophosphamide and the comparison drug calcium gluconate, groups 5–9 — administration of cyclophosphamide and gluconates of 3d-metals (MnGl, FeGl, CoGl , CuGl and ZnGl, respectively)], 12 individuals each, kept in the vivarium conditions on a standard diet. Endogenous intoxication was induced by a single injection of cyclophosphamide. 3d-metal gluconates (Mn, Fe, Co, Cu, Zn) and comparison drugs (glucosaminylmuramyl dipeptide in the form of Likopid, and calcium gluconate) were used to correct changes in the immune system. The administration of the drugs was started 24 hours after the administration of the cytostatic and then daily orally during 21 days. Blood sampling was performed on the 22nd day. The assessment of the degree of endogenous intoxication was carried out by determining the leukocyte indices: stress activity index, leukocyte intoxication index, nuclear index of the degree of endotoxicosis, and leukocyte shift index. Statistical processing of the results was performed using the Statistica 10.0 program. To calculate the significance of differences between groups, the nonparametric Mann–Whitney test was used. Changes were considered significant at p <0.05.

Results. After the administration of cyclophosphamide in animals, a significant change in the leukocyte formula, which indicates an acute intoxication of the body, was observed: there was a decrease in the content of monocytes (3 times), segmented neutrophils (1.5 times), an increase in stab neutrophils (2 times), lymphocytes (1.1 times). The intake of 3d-metal gluconates led to the correction of leukocyte indices, the degree of which statistically significantly exceeded the degree of correction by the comparison drugs Licopid and Calcium gluconate (p <0.05), and for Zn (II) gluconate it was from 45 to 84%, for Mn (II) gluconate — from 44 to 100%.

Conclusion. Gluconates of 3d-metals reduce the degree of endogenous intoxication caused by cyclophosphamide, increase the reactivity of phagocytes and the regeneration rate of the leukocyte link. In terms of efficiency, 3d-metal gluconates can be arranged in the following order (according to metals): Mn ˃Zn ˃Cu ˃Co ˃Fe.

Kazan medical journal. 2022;103(3):427-433
pages 427-433 views
Morphometric characteristics and histotopography of the left atrium walls
Gaponov A.A., Iakimov A.A.
Abstract

Background. Knowledge of the anatomical features of the left atrium walls will minimize complications during the “Cox-Maze” surgery.

Aim. To clarify common features and local anatomical specificities of the anterosuperior, lateral and inferior walls of the left atrial body of the heart of an adult.

Material and methods. From 60 preparations of the hearts of men and women aged 35–89 years who died from non-cardiac causes, 61 histotopograms and 180 anatomical sections of the left atrium walls were made. A stereoscopic microscope (×4.7–15 magnification), a histological microscope (×40 magnification), and an image recognition program were used. Nonparametric dispersion, correlation, one-way regression analysis were applied. The significance of differences was assessed by the Mann–Whitney U-test. The results were presented as medians.

Results. Anatomical markers of the anterosuperior wall were a compact group of transverse myocardial fibers (anterior interatrial Bachmann bundle) and a thinned section of the lower third of the medial half of the wall. A feature of the lateral wall was a group of oblique myocardial fibers (left lateral ridge). The inferior wall was characterized by well-developed subepicardial tissue. Anteroposterior wall in the medial area (5130 µm) and lateral wall (5243 µm) were thin. The epicardium with subepicardial tissue in the medial part of the inferior wall was thicker (4750 µm) than in the lateral (2651 µm) and anterosuperior (2535 µm) walls. The myocardium of the anteroposterior wall (2714 µm) was thicker than the myocardium of both the lateral (2213 µm) and inferior wall in its central (1947 µm) and lateral (1913 µm) sections. The median thickness of the endocardium of different walls varied from 335 to 426 µm. The wall thickness in the upper third mostly depended primarily on the myocardium thickness, and in the inferior third on the epicardium and subepicardial tissue thickness.

Conclusion. For the walls of the left atrium, their thickening towards the coronary sulcus was common due to the subepicardial adipose tissue. The peculiarities were the differences of the left atrium walls in thickness and their unique pattern of myocardial anatomy.

Kazan medical journal. 2022;103(3):434-444
pages 434-444 views
Monitoring of the state of intramural intestinal vessels in acute mesenteric ischemia with optical coherence angiography
Ryabkov M.G., Sirotkina M.A., Baleev M.S., Sizov M.A., Gelikonov G.V., Moiseev A.A., Gladkova N.D., Kiseleva E.B.
Abstract

Background. Objective data on the state of intramural microvessels are needed to select an effective therapy for the intestine reversibly damaged by mesenteric occlusion.

Aim. To monitor the condition of the small intestine blood vessels in acute mesenteric ischemia using the method of optical coherence angiography.

Material and methods. The study was carried out on male rats weighing 215–315 g (n=17) on a model of acute mesenteric ischemia. Monitoring of the microvascular bed was performed using the optical coherence angiography before ischemia modeling and 60, 120, and 180 minutes after the onset of ischemia. The data were evaluated by calculating the total length (L, mm) and area (S, mm2) of vessels on angiograms, as well as the S/L ratio, an index of vessel diameter that provides information about the diameter of vessels regardless of their length, what means it is sensitive to their dilation/spasm. The significance of differences in quantitative characteristics was assessed using the Mann–Whitney and Kruskal–Wallis criteria.

Results. In the devascularized sector, the state of the vascular wall changed in different directions for 180 minutes, as evidenced by statistically significant changes in the parameters L, S and their ratio. During the first hour of ischemia, the median S/L ratio decreased by 9.2%. By the 120th minute of ischemia development, the S/L ratio recovered and did not differ statistically from the initial values (p=0.339). After 180 minutes, there was a trend towards an increase in the diameter of the remaining perfused vessels — the median S/L on angiograms in the devascularized sector exceeded the initial level by 12.9% (p=0.045).

Conclusion. Areas of the small intestine, localized at the border of spread of ischemia, according to the optical coherence angiography, are characterized by multidirectional changes in the total length and area of the intramural vessels; during the first hour of ischemia, functional changes predominate, probably due to an increase in the tonus of the vascular wall; after 180 minutes of observation, signs of irreversible dilatation of microvessels are recorded.

Kazan medical journal. 2022;103(3):445-454
pages 445-454 views

Reviews

The role of mitochondrial DNA in the pathogenesis of cardiovascular diseases
Kireeva V.V., Lepekhova S.A., Inozemcev P.O., Usoltsev Y.K., Trofimova E.A.
Abstract

Diseases of the cardiovascular system keeps the lead among the main causes of invalidity, disability and mortality of the population. There is a steady increase in cardiovascular diseases, that is why the identification of new markers, that would allow calculating the risks of complications and associated pathological conditions, is one of the most important tasks of modern fundamental and applied medicine. The paper presents current information on the relationship between the qualitative and quantitative characteristics of mitochondrial DNA with the risk of organ failure. The reasons for the body's immune response to the mitochondrial DNA presence outside the cell are considered. The question of mitochondrial DNAs role in the pathogenesis of cardiovascular pathology and inflammatory processes is highlighted. Contradictory information about the change in the amount of freely circulating mitochondrial DNA during the development of organ failure was revealed. However, all authors agree that the number of mitochondrial DNA copies indicates disorders associated with the provision of vital functions of cells, organs and tissues. The study shows that the level of freely circulating mitochondrial DNA in blood plasma, which is currently used to predict the development of complications and mortality in a number of different diseases, is a promising nonspecific marker of cytolytic processes. A comprehensive study of cytological, biochemical and molecular biological indicators at various (especially at early) stages of organ failure development, as well as during the cardiovascular diseases establishment, will provide new important information about the cellular mechanisms of disease pathogenesis and will form the basis for the development of early diagnostic markers and new therapeutic schemes.

Kazan medical journal. 2022;103(3):455-466
pages 455-466 views
Determination of the endotoxin aggression etiology as a prospect for improving the effectiveness of the treatment-and-prophylactic process
Rascheskov A.A., Markelova M.M., Anikhovskaya I.A., Beloglazov V.A., Gordienko A.I., Meshkov M.V., Rascheskov A.Y., Tumanova E.L., Yakovlev M.Y.
Abstract

A third of a century ago, an assumption about the ability of intestinal microflora and stress to induce systemic inflammation, contrary to the fundamental postulates of general pathology, was made. Verification of this very bold assumption for that period of time, required the creation of a new methodological basis for studying the role of intestinal endotoxin (lipopolysaccharide) in human biology, which was successfully carried out by Russian scientists. The use of therapeutic agents to normalize the integral indicators of systemic endotoxinemia in the treatment regimen of a wide variety of diseases, including enterosorbents, choleretics, LPS filters, immune drugs, and other medications and procedures, has significantly increased the effectiveness of the treatment. The validity of the endotoxin theory of human physiology and pathology was also confirmed by the Nobel achievements of foreign colleagues (nomination — 2008, prize — 2011). They discovered the receptors of innate immunity, which made it possible to qualify LPS as an “exohormone of adaptation”, since TLR4 is the central receptor for regulating the activity level of the immune and other adaptive systems of the body. One of the reasons for the increase in the LPS concentration in the general bloodstream (what leads to the induction of systemic inflammation) may be the overgrowth of certain gram-negative bacteria that are part of the intestinal microbiota. Verification of these bacteria was first carried out by Ruaasian scientists and it is presented in this review. Determinating of the etiology of endotoxin aggression is a basic element in creating a new direction in nutrition and pharmaceuticals. The search for selective inhibition methods of excessive bacterial growth and the creation of medicines, food supplements and/or an individual diets based on them in the future is an important scientific task, the solution of which can significantly increase the effectiveness of treatment-and-prophylactic process and optimize material costs in the healthcare system.

Kazan medical journal. 2022;103(3):467-475
pages 467-475 views
Early diagnostics and screening for ovarian cancer
Savinova A.R., Gataullin I.G.
Abstract

Ovarian cancer is the sixth most common cancer in women. The overall 5-year survival rate for ovarian cancer is approximately 40% due to the fact that most cases are diagnosed at late stages. Detection of ovarian cancer at the earliest possible stages is a public health priority. The article provides a review of existing scientific data regarding the early detection and screening of ovarian cancer, based on an analysis of publications in international electronic databases. Screening strategies are most effective for detecting diseases in their early stages, but at the moment there is no standard instrumental method that could be recommended as a screening examination for detecting ovarian cancer at an early stage. In this regard, most researchers have switched to the field of biomarkers and their combinations. Currently, more than 200 tumor markers, which are produced with varying intensity in ovarian cancer, have been proposed, but only two of them, CA-125 and HE4, have been tested in clinical experience. The article highlights the role of new tumor markers, multimarker panels, longitudinal algorithms in the early diagnosis of ovarian cancer. Most of the studies on the early diagnosis of ovarian cancer is aimed at searching for new biomarkers or developing multimodal algorithms that include both tumor markers, free deoxyribonucleic acid, and ultrasound of the pelvic organs. However, there are still no convincing data on mortality reduction based on randomized controlled trials, which stops doctors from including one or another strategy for the early diagnosis of ovarian cancer in national protocols and/or recommendations as a screening examination.

Kazan medical journal. 2022;103(3):476-483
pages 476-483 views
Oxaloacetate: signaling molecule, molecular mechanisms of interaction, prospects for clinical application
Kolotyeva N.A., Gilmiyarova F.N., Gusyakova O.A., Sharafutdinova I.A.
Abstract

Small molecules make up a majority of cellular molecules, their intracellular concentrations vary over a wide range, and they are involved in a multifarious molecular transformations. However, there is not enough information about how small molecules regulate protein functions through intermolecular binding, which creates an urgent need for fundamental research and the study of the metabolites’ role. Our attention was focused on small molecules located at the intersection point of metabolic pathways of proteins, fats, carbohydrates, the structural and functional potential of which provides numerous biomolecular processes. The intermediates availability can regulate energy and intermediate metabolism, cellular redox potential, and production of adenosine triphosphate, determining the direction of metabolism that is priority for the cell at this point in time. Of particular interest in the study of metabolite-protein interactions are those studies that can reveal new enzyme-substrate relationships and cases of metabolite-induced remodeling of protein complexes. The review is devoted to the study of the role of the small molecule oxaloacetate and malate, as well as malate dehydrogenase involved in their transformations, the activity of which can be used as a diagnostic marker in oncological and neurodegenerative diseases. Oxaloacetate has protective and promitochondrial effects, it serves as a neuroprotector, prevents inflammation and neurodegeneration. The penetration of oxaloacetate through the blood-brain barrier into the central nervous system was established, which became a prerequisite for conducting preclinical trials of drugs containing it in models of Alzheimer's disease and ischemic stroke.

Kazan medical journal. 2022;103(3):484-491
pages 484-491 views
Clinical-social and psychological-pedagogical approaches in the prevention and treatment of obesity and metabolic syndrome in children
Dudareva V.A., Shikaleva A.A., Maksimov M.L., Dyadikova I.G., Shulaev A.V.
Abstract

Childhood obesity is an acute problem in the European Region, including countries participating in the World Health Organization's European Childhood Obesity Surveillance Initiative. According to their data, the proportion of overweight children reaches 43%. Overweight and obesity, as well as related diseases, are largely preventable. For this reason, the prevention of childhood obesity should be given top priority. Adolescence obesity has reached epidemic proportions worldwide, with the prevalence of complicated obesity increasing at least fourfold over the past 35 years. Most obese adolescents also have excess body fat mass in adulthood, which increases the risk of obesity-related complications, such as type 2 diabetes and cardiovascular disease, and negatively affects social and psychological health. In modern conditions the prevention of the overweight and obesity formation among schoolchildren is not systemic: no attention is paid to the identification of possible risk factors, no unified approaches exist among specialists of various levels to the methodology for preventing the overweight and obesity formation, rational hygienic measures for preventing obesity are not always implemented, the causes of late diagnostics of overweight and obesity among schoolchildren by pediatricians are not fully analyzed, the motivation of children and parents to change their lifestyle in order to fight overweight are not sufficiently studied. The systemic implementation of such preventive measures could help to reduce the number of overweight schoolchildren and improve the health of the child population.

Kazan medical journal. 2022;103(3):492-503
pages 492-503 views

Clinical observations

A rare clinical case of Lemierre’s syndrome
Khaertynov K.S., Anokhin V.A., Nikolaeva I.V., Khamidullina Z.L., Idrisova I.R.
Abstract

Lemierre's syndrome is a clinical variant of sepsis characterized by a combination of an infectious process in the oropharynx with thrombosis of the internal jugular vein and metastatic septic foci. Currently, Lemierre's syndrome is a rare pathology, almost a “forgotten disease”. The article describes a case of Lemierre's syndrome, in which the course of acute tonsillopharyngitis in a 20-year-old female patient was complicated by thrombosis of the left internal jugular vein and metastasis of septic foci in the lungs. The process was accompanied by a systemic inflammatory reaction and thrombocytopenia. The microorganism from the blood was not isolated. In crops from the oropharynx, Klebsiella pneumonia was found. The treatment included antibiotic therapy with ceftriaxone and azithromycin, the administration of glucose-salt solutions, the use of anticoagulants, and local antiseptic treatment of the oral cavity. Body temperature returned to normal on the 3rd day of hospitalization, inflammatory changes were jugulated after 9 days. The patient was discharged home on the 12th day of hospitalization in a satisfactory condition. Lemierre's syndrome is still a life-threatening condition, no matter how or by what it was caused. For this reason, early diagnosis and antibiotic therapy are critical to a favorable outcome of the syndrome.

Kazan medical journal. 2022;103(3):504-508
pages 504-508 views
Clinical case of coronary artery aneurysm
Zakirova E.B., Tsybulkin N.A., Gaynutdinova L.I., Tukhvatullina G.V., Khairullin A.Z., Kurochkin S.V.
Abstract

An aneurysm of a coronary artery is considered to be its expansion by 1.5 times or more over a short distance. The relevance of this pathology is determined by the severity of complications, mainly thrombotic. According to autopsies, it is detected in approximately 1.5% of all autopsies. In the majority of cases, coronary artery aneurysms are asymptomatic, but they also can cause symptoms similar to acute coronary syndrome. A rupture of the aneurysm is a rare but potentially dangerous complication of coronary artery aneurysm. The tactics of managing patients is determined by the severity of symptoms, aneurysm localization, the dynamics of the aneurysm, the presence of myocardial infarction in the area of the altered artery blood supply, the risk of surgical intervention, the distribution and degree of atherosclerotic changes in the coronary vessels, and the possibilities of drug therapy. Reliable diagnostic methods are coronary angiography and multidetector computed tomography. The paper describes a clinical case with patient G., aged 50, who was admitted to the emergency cardiology department with a typical picture of acute coronary syndrome, with stable hemodynamics and without echocardiographic signs of ischemia or infarction. An in-depth study of the coronary system was carried out in order to determine the prospects and the need for planned percutaneous coronary intervention. Computed tomography was performed for this purpose and revealed not only high degrees of stenosis in several coronary arteries, but also structural changes in the coronary system in the form of an aneurysm of the proximal segment of the anterior interventricular branch. The results obtained with computed tomography determined the need for coronary angiography. Its data made it possible to clarify the number, location and severity of stenotic changes in the coronary arteries, as well as to determine other localizations of aneurysms of the coronary system. The summary data of the two studies made it possible to establish that the patient had both stenosing atherosclerosis of the coronary arteries and multiple aneurysms of some arteries at the same time. It was deemed appropriate to continue conservative treatment aimed at preventing recurrence of acute coronary syndrome and thrombosis of coronary artery aneurysm, treatment of hypertension and secondary prevention of atherosclerosis. This clinical case demonstrates that the combined pathology of the coronary arteries can have clinical manifestations in the form of a single episode of acute coronary syndrome.

Kazan medical journal. 2022;103(3):509-515
pages 509-515 views

Clinical experiences

Experience in using a minimally invasive method for removing salivary gland duct calculus under sonography control
Ivanov O.A., Sharafislamov I.F., Voronina E.M., Ksembaev S.S., Khamzin I.I.
Abstract

Background. Removal of calculi in salivary stone disease is one of the urgent problems of maxillofacial surgery and surgical dentistry due to the complexity of the manipulation, the trauma of the technique and the frequent development of complications.

Aim. Improvement of the treatment results of patients with salivary stone disease by using our developed method of minimally invasive removal of calculi located in any part of the excretory duct of the submandibular and/or parotid salivary glands, under constant ultrasound visualization of the intervention.

Material and methods. The study included patients diagnosed with salivary stone disease (10 people: 9 male and 1 female aged 18–50 years, mean age 44.2±1.25 years). The methodology was as follows. An ultrasonic sensor was brought in from the side of the skin, and the location of the calculus in the gland duct was determined. Next, a needle with a diameter of 0.3 cm with a mandrin was inserted percutaneously through a puncture into the duct of the salivary gland to the distal surface of the calculus, and it was advanced with the help of a needle as far as possible towards the mouth of the excretory duct. Then the needle was removed, leaving a mandrel in the duct, with which the calculus was fixed in a new position. After bougienage of the excretory duct, Dormia’s basket was introduced into it, and the calculus was captured and removed. The manipulations were performed under constant ultrasound imaging.

Results. The use of the technique developed by us for minimally invasive removal of a calculus with a diameter of up to 5 mm, located in any part of the excretory duct of the submandibular and/or parotid salivary glands, under constant ultrasound visualization of the intervention course, made it possible to achieve a positive result in all 10 patients included in clinical observations.

Conclusion. The minimally invasive technique for removing calculi from the excretory ducts of the salivary glands under constant ultrasound imaging developed by us makes it possible to facilitate manipulation, its visibility and accuracy, as well as atraumaticity and prevention of complications.

Kazan medical journal. 2022;103(3):516-521
pages 516-521 views

Cochrane Review Summaries

Interventions for the management of transient tachypnoea of the newborn
Abstract

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Bruschettini M, Hassan K-O, Romantsik O, Banzi R, Calevo MG, Moresco L. Interventions for the management of transient tachypnoea of the newborn — an overview of systematic reviews. Cochrane Database of Syste­matic Reviews. 2022. Issue 2. Art. No.: CD013563. DOI: 10.1002/14651858.CD013563.pub2.

Kazan medical journal. 2022;103(3):522-523
pages 522-523 views

Through the pages of the “Kazan Medical Journal”

Reprint of the article by I.V. Domracheva, published in the Kazan Medical Journal 100 years ago
Abstract

This publication is a reprint of an article by Prof. I.V. Domrachev “To the replacement of extensive skull defects”, published in the Kazan Medical Journal in 1922. Reprinting is carried out in preparation for the celebration of the 150th anniversary of the first issue of the Kazan Doctors' Society Diaries, the assignee of which is the Kazan Medical Journal. Original publication: Domrachev IV. To the replacement of extensive skull defects. Kazan Medical Journal. 1922;18(3):61–68. DOI: 10.17816/kazmj79147.

Kazan medical journal. 2022;103(3):524-532
pages 524-532 views

Letters to the Editor

Letter to the editor from V.N. Oslopov and Yu.S. Mishanina
Oslopov V.N., Mishanina Y.S.
Abstract

This letter was written by V.N. Oslopov and Yu.S. Mishanina regarding the reprinted in the Kazan Medical Journal article by S.S. Zimnitsky “What is our method of functional diagnosis of the kidneys and what does it allow?”, published in 1922.

Kazan medical journal. 2022;103(3):533-536
pages 533-536 views


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