Vol 97, No 1 (2016)

Theoretical and clinical medicine
24-hour arterial stiffness monitoring in comorbid patients with cardiovascular pathology
Panchenkova L.A., Khamidova K.A., Shelkovnikova M.O., Yurkova T.E., Rassudova N.V., Ustinova M.R., Kazantseva E.E., Bychkova E.V., Martynov A.I.

Aim. To evaluate 24-hour dynamics of the arterial stiffness main indicators in patients with arterial hypertension associated with metabolic syndrome, coronary heart disease and type 2 diabetes mellitus.

Methods. The study included 54 patients with hypertension, who formed main groups: the first group - 17 patients with hypertension amid the metabolic syndrome, the second - 21 patients with metabolic syndrome and coronary heart disease, the third group - 16 patients with hypertension and type 2 diabetes mellitus. All patients underwent the vascular stiffness parameters study using a multifunctional complex for the 24-hour monitoring and office measurements of blood pressure and vessels condition. At the same time blood pressure, cardiac function and vascular stiffness indicators were examined: PWVao - pulse wave velocity in the aorta (m/s); PWTT - the pulse wave transit time (m/s); Aix - augmentation index (%); Asi - the arterial stiffness index. (mmHg).

Results. When comparing the 24-hour arterial stiffness dynamics indicators, changes were found in all main patients groups compared to the healthy group. Thus, a statistically significant increase in the pulse wave velocity in the aorta (PWVao) in all groups of patients compared with the control group, a decrease in the index of the pulse wave transit time (PWTT) in all main groups of patients and a significant increase in arterial stiffness index (Asi) were found. When assessing the results of arterial stiffness monitoring at night time significantly larger values of the pulse wave velocity in the aorta were observed in patients with the metabolic syndrome and combination of metabolic syndrome and coronary heart disease. The obtained data are indicative of improvement in vascular stiffness indicators at night time in healthy individuals group, as well as maintaining a high degree of the vascular wall stiffness both in the night and in the daytime in a group of examined patients, especially in groups with the metabolic syndrome, and a combination of metabolic syndrome and coronary heart disease.

Conclusion. 24-hour monitoring of vascular stiffness indicators in comorbid patients have revealed variability of the main indicators during the day; such arterial stiffness indicators as the pulse wave transit time, pulse wave velocity in the aorta, the arterial stiffness index, augmentation index can be used to assess early signs of the major arteries remodeling.

Kazan medical journal. 2016;97(1):5-12
Comorbid cardiovascular system disorders in patients with cryoglobulinaemia
Petrov A.V., Zayaeva A.A.
Aim. To study a possible association between cryoglobulinemia and cardiovascular and peripheral vascular disease in patients with symptomatic cryoglobulinemic vasculitis and rheumatoid arthritis patients with elevated cryoglobulins. Methods. Analysis of the coexistent cardiovascular system diseases prevalence, heart and carotid arteries echocardiography data of 32 patients with cryoglobulinemic vasculitis, and 129 patients with rheumatoid arthritis depending on the fact of high cryoglobulins titers in the blood plasma compared to 32 healthy volunteers in the control group was conducted. Cryoglobulins isolation from the blood was performed using the A.E. Kalovidoris method in N.A. Konstantinova modification. Results. In patients with cryoglobulinemic vasculitis and rheumatoid arthritis with asymptomatic cryoglobulinemia a high frequency of hypertension prevalence (46.8 and 34.4%, respectively), ischemic heart disease (15.6 and 7.9%), congestive heart failure (9.4 and 10.5%), chronic venous insufficiency (53.1 and 23.7%) and postthrombophlebetic syndrome (28.1 and 18.4%) was observed. When analyzing ultrasound data in patients with cryoglobulinemic vasculitis and rheumatoid arthritis it has been found that the cryoglobulinemia is accompanied by left ventricular myocardial geometry violation (in 81.3 and 65.7% respectively versus 12.5% of patients in the control group), myocardial diastolic dysfunction (71 9 and 65.7% versus 15.6%), an increase in the proportion of patients with the «intima-media» complex thickening (78.1 and 36.8% versus 31.2%) and atherosclerotic plaques (34.4 and 13, 2% versus 6.2%) in the carotid arteries. Conclusion. Cryoglobulinemia can be considered as adjuvant risk factor for cardiovascular disease in patients with rheumatism.
Kazan medical journal. 2016;97(1):12-16
Gender differences of response to various options of drug therapy in patients with chronic heart failure after suffered myocardial infarction
Dadashova G.M.

Aim. To evaluate gender features of treatment in patients with chronic heart failure who suffered myocardial infarction, determine the effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers II, as well as antidepressants in the clinico-functional and psycho-emotional status, morphological and functional parameters of the heart in the treatment of men and women with this pathology.

Methods. The study included 205 men and 185 women with chronic heart failure after suffering a myocardial infarction. Patients were randomized into three groups. Patients of the first group (80 men and 70 women) received background treatment (cardiac glycosides, diuretics, aldosterone antagonists, prolonged nitrates if necessary, acetylsalicylic acid, atorvastatin and perindopril 5-10 mg/day. The patients of the second group (80 men and 70 women) received valsartan 80-160 mg/day in addition to the above-noted background treatment. In the therapeutic regimen of the third group of patients (45 men and 45 women) sertraline in a dose of 50 mg/day was included in addition to background treatment. All the patients underwent usual methods of general clinical examination, the 6-minute walk test, clinical status evaluation, the anxiety syndrome severity assessment using a Hamilton scale, echocardiography. The patients dynamic monitoring was carried out for 6 months.

Results. The study results showed that provided therapy has comparable clinical effect in both men and women in all three groups. Statistically significant improvement in clinical condition indicators was reported and as a result, exercise tolerance increased. At the same time the quality of life improvement was more pronounced (p <0.001) in patients of the third group, amid the perindopril and sertraline use. According to the results of our study in patients of all three groups provided therapy has a comparable positive effect on echocardiography indicators, including those which characterize left ventricular hypertrophy.

Conclusion. Amid the provided treatment in all three groups positive dynamics of clinical status indicators and intracardiac dynamics was reported; in addition to that the dynamics of both clinical status and linear and volumetric heart parameters was more pronounced amid the treatment with perindopril in combination with sertraline.

Kazan medical journal. 2016;97(1):17-25
Ways to prevent complications in endoscopic transpapillary interventions
Sayfutdinov I.M., Slavin L.E.

Aim. To assess the effectiveness of preventive measures in endoscopic interventions on the major duodenal papilla.

Methods. 1028 transpapillary interventions related to benign and malignant diseases were performed on 575 patients from 2007 to 2015. The analysis of complications rate and structure in different time intervals, taking into account the changing of patients management tactics and the use of different preventive technologies, was performed.

Results. During 2007-2015, 30 cases of post-manipulational complications were registered (2.9% of patients) with a mortality rate of 0.09%. In the period from 2007 to 2008 post-manipulational complications rate was 8.5%. The main causes of complications were surgery long duration (up to 2 hours) and the lack of endoscopist experience. During this period, there was only one death, which was caused by acute cardiovascular insufficiency. From 2009 to 2011, the complications number decreased to 3.4% due to the careful patients selection for elective surgery, including the endosonography in diagnostic algorithm, octreotide, and hyoscine butylbromide use, the expansion of indications for the bile ducts stenting, exclusion the main pancreatic duct contrast, nasobiliary drainage in obstructive jaundice and suppurative cholangitis. In the period from 2012 to 2015, in the presence of a high risk of post-manipulational pancreatitis, every fifth intervention was completed by the main pancreatic duct stent placement with reducing of manipulations duration to 25-35 minutes, and increasing the surgery phases number. During this period, post-manipulational complications rate was 1.2%.

Conclusion. Analysis of post-manipulational complications allowed to identify the most important measures to enhance the transpapillary interventions safety, thereby reducing the number of complications from 8.5% in the period of 2007-2008, to 1.2% in the period of 2014-2015.

Kazan medical journal. 2016;97(1):26-31
Treatment compliance in patients with gastrointestinal diseases: role of certain factors
Goryacheva E.E., Alekseeva O.P., Kasimova L.N.

Aim. To study the influence of socio-psychological factors, factors associated with the disease, the patient, and psychopathological disorders on the treatment compliance.

Methods. Structured interviews were conducted with 151 patients (57 patients with irritable bowel syndrome, 57 - gastroesophageal reflux disease, 37 - peptic gastric ulcer and duodenal ulcer). Compliance was assessed using Morisky-Green validated test. Patients were divided into three groups: the first group - compliant patients, the second - risk group, the third group - non-compliant patients.

Results.Negative effect on compliance had the following socio-psychological factors: employment, lack of higher education, age from 40 to 49 years, non-constructive model of parent-child relationships, conflict relationships in their own family. Overprotective parenting was mentioned more often in the third group than in the first (20.7 and 42.3%, p

Conclusion. The influence of certain socio-psychological factors, factors associated with the disease, the patient and the psychopathological disorders presence on the treatment of patients with gastrointestinal diseases was identified, and therefore comprehensive gastroenterologist and psychiatrist monitoring with the subsequent treatment of psychopathological syndromes is necessary.

Kazan medical journal. 2016;97(1):31-37
Minilaparotomy cholecystectomy in elderly and senile patients
Omorov R.A., Toktosunov A.S., Avasov B.A.

Aim. To evaluate the efficacy of minilaparotomy access and programmed treatment of cholecystectomy complications in elderly and senile patients.

Methods. 160 patients (113 women and 47 men), who underwent surgery in the period from 2010 to 2012 in the departments of surgery at the Municipal clinical hospital №1 (Bishkek), were followed-up. Patients mean age was 68.4±3.5 years. Cholecystectomy and biliodigestive anastomoses were performed using mini-access in all patients. In addition to clinical and laboratory diagnostic methods, ultrasound examination with gallbladder projection detection on the anterior abdominal wall to select surgical approach was used.

Results. The surgery results of 160 elderly and senile patients with acute cholecystitis who underwent minilaparotomy cholecystectomy are presented. In 12 (7.5%) patients after cholecystectomy, choledochotomy (or choledochoduodenostomy) was performed to remove stones from the common bile duct; external drainage of the common bile duct by Ker or A.V. Vishnevskiy was performed on 10 of them, and in 2 cases choledochoduodenoanastomosis by Yurash-Vinogradov was imposed. Complications were registered in 9 (5.6%) patients. 1 patient died as a result of pulmonary embolism developed on the 5th day after the surgery. Conversion rate was 5% (8 patients). Treatment of complications was performed by developed and implemented in the clinic algorithm (regional lymphostimulation, breathing exercises, infrared laser irradiation). The average hospital stay of patients without complications was 7.8±0.87 bed-days, and patients with complications - 9.4±0.14 bed-days.

Conclusion. Our observations showed the possibility to perform surgery for acute cholecystitis in elderly and senile patients by the minilaparotomy access in case of taking into account patients general condition, following the surgical technique and the active management of the postoperative period.

Kazan medical journal. 2016;97(1):37-41
Modern possibilities of homeostatic reserves indication in bronchitis in children
Pikuza O.I., Vahitov H.M., Generalova E.V.

Aim. To study the homeostatic reserves indicators in children with bronchitis by assessment of colonization resistance indicators and oxidative stress processes in the oral cavity.

Methods. Clinical and instrumental examination of 115 children aged 5 to 14 years admitted to hospital with different variants of bronchitis was performed. The patients (main group) were divided into two subgroups according to the diagnosis: the first subgroup included 70 children with recurrent bronchitis, the second subgroup consisted of 45 children with acute bronchitis. The control group included 33 apparently healthy children of the same age. The examination complex included, in addition to conventional clinical and laboratory methods, special methods of examination - the oral cavity colonization resistance indicators identification (buccal epithelial cells colonization index and saliva anti-adhesive activity). In addition, oxidative stress indicators on oral neutrophils model - spontaneous and induced luminol-dependent chemiluminescence, were measured.

Results. It was found that colonization index and saliva anti-adhesive activity was significantly lower in children of the main group than in control group. The lowest rates were characterstic for the first subgroup of patients. In children with acute bronchitis higher values of the induced and the spontaneous luminol-dependent chemiluminescence were registered as compared to control, whereas in recurrent bronchitis, by contrast, they were lower than in control (p

Conclusion. Patients with recurrent bronchitis extremely «vulnerable» in relation to recurrent bacterial infections (diseases) in connection with the mucosal protection system severe defects; they need to undergo aimed preventive and rehabilitation measures, the effectiveness control of which can be performed using the proposed non-invasive methods.

Kazan medical journal. 2016;97(1):41-47
The modern non-injecting mesotherapy use in treatment of patients with inflammatory periodontium lesions
Pashaev A.C., Dzhafarli I.E.

Aim. To perform clinical reasoning and evaluation of non-injection mesotherapy use in complex treatment stages in patients with periodontitis.

Methods. The current study included treatment results of 46 patients with generalized periodontitis who received out-patient treatment at a clinical site of the therapeutic dentistry department of Azerbaijan Medical University. The mean age of patients was 25±3.1 years (from 17 to 49 years).

Results. The use of «TEAQRIP» applications on treatment stages in addition to conventional measures, as well as mesotherapy sessions (2 times a week) contributed to the sooner and stable clinical effect by the end of 2-week treatment course. Procedures («TEAQRIP» application + mesotherapy) were continued for the next 2 weeks (2 times a week). All patients noted subjective improvement in their general condition amid the accelerated remitting of the inflammation developed in periodontal tissues. At the end of treatment, there were no complaints of bleeding, discomfort, itching in 14 (87.5%) patients. Hyperemia, cyanosis and edema disappeared or decreased in all patients, tooth mobility decreased in 6 patients (37.5%). Acquired data showed that all patients well tolerated mesotherapy sessions.

Conclusion. The clinical effect is associated with regenerative processes acceleration, enhanced (by mesotherapy sessions) action of used traditional drugs and «TEAQRIP» applications; combined ultrasound and photon irradiation of periodontal tissue contributed to a deeper effect of the used remedies.

Kazan medical journal. 2016;97(1):47-51
Electron microscopic analysis of regional lymph nodes in the process of cancer development
Tsyplakov D.E., Bazhanov A.B.

Aim. To study regional lymph nodes ultrastructure at different cancer stages, determine the reactive changes dynamics and identify the factors contributing to the inadequate local immune response and spread of tumor.

Methods. The regional lymph nodes obtained from 149 cancer patients during surgery for cancer of various localization were studied. Lymph nodes obtained from 32 apparently healthy individuals who died of accidental causes were used as a control. One part of lymph node, cut in two parts along the major axis, was used for the histological sections preparation, the second - for electron microscopy. A comparative study of the following groups of preparations was conducted: (1) lymph nodes of the control group; (2) lymph nodes without metastases in stage I cancer; (3) lymph nodes without metastases in stage II cancer; (4) the affected lymph nodes in the II and III stages with various volume metastasis.

Results. Ultrastructural changes in the regional lymph nodes in the process of cancer development have a certain dynamics: amid increasing microcirculation disorders and sclerotic processes, redistribution of immune cells and the immune reactions shift to B-cell humoral immunity occurs, resulting in the later stages to inactivation of T-cell-mediated immune reactions and macrophage-monocyte system, while maintaining plasmacytic reaction with high antibody-producing ability of the cells.

Conclusion. Factors, contributing to inadequate local immune response are: (a) a progressive decrease in the number of activated (immune) lymphocytes - main cytotoxic anticancer elements, in cancer development; (b) high amount of antibody-producing plasma cells, which can block T-cell cytotoxic effect by humoral antibodies, at all stages of cancer development; (c) decrease of the number of migrated (free) macrophages of monocytic origin and the fixed macrophages - sinuses reticular cells, phagocytic activity decrease; (d) the sclerotic processes and microcirculatory disorders that impede tumor cells and cytotoxic lymphocytes contact.

Kazan medical journal. 2016;97(1):51-59
The role of doppler ultrasound and multislice spiral computed tomography angiography in the common form of stomach cancer diagnosis
Pulatova I.Z., Isamukhamedova M.A.

Aim. To evaluate the results of Doppler ultrasound and multislice computed tomography angiography in patients with gastric cancer and the sensitivity of these diagnostic methods for the detection of the abdomen great vessels lesions.

Methods. The study included 32 patients aged 37 to 82 years who had histologically confirmed gastric adenocarcinoma diagnosis. The control group consisted of 30 apparently healthy people of the same age. Transabdominal ultrasonography of the abdominal cavity organs and stomach in gray-scale mode (B-mode before and after the stomach filling with degassed liquid), Doppler ultrasound of the abdomen and the stomach wall vessels, multislice spiral computed tomography angiography were performed in all patients at the preoperative stage. The analysis of the study results and their comparison with intraoperative data were conducted.

Results. In patients with gastric cancer a statistically significant increase in peak systolic velocity in the celiac trunk, superior mesenteric artery, left gastric artery and resistive index decrease in these blood vessels (p <0.05) with the presence of atypical vascularization in the affected stomach walls were registered. The data obtained during the multislice spiral computed tomography angiography were analyzed. The sensitivity of Doppler ultrasound in the preoperative detection of abdominal cavity great vessels affection in patients with gastric cancer was 77.8%, multislice spiral computed tomography angiography - 88.9%, the combination of these two methods - 96.3%.

Conclusion. The analysis of used diagnostic methods of examination of patients with stomach cancer showed that Doppler ultrasound should be included in the patients examination standard to assess the abdominal cavity great vessels condition, what is important in deciding on the possibility of operative intervention; the sensitivity of the combination of dopplerography and multislice spiral computed tomography angiography in the diagnosis of great vessels affection is 96.3%.

Kazan medical journal. 2016;97(1):59-65
Comparative characteristics of bronchial obstruction formation trigger mechanisms in children with bronchial asthma and recurrent obstructive bronchitis
Gaparkhoeva Z.M., Bashkina O.A., Seliverstova E.N.

Aim. To study the comparative characteristics of the causative significant factors involved in the bronchial obstruction development in children with bronchial asthma and recurrent obstructive bronchitis.

Methods. A cross-sectional (transversal) study of 50 children with bronchial asthma, 38 children with recurrent obstructive bronchitis was conducted. The differences and similarities of etiopathogenetic factors of the bronchial obstruction occurrence were revealed. According to medical history, in all patients regardless of the severity and duration of the disease at the time of examination, the impact of the factors, acting as triggers of bronchial asthma, according to patients, such as infectious agents, infectious allergens and aeroallergens, nighttime, climatic conditions deterioration, physical and/or emotional stress, was registered.

Results. The main triggers that influence the bronchial obstruction occurrence in children with asthma were infectious factors impact, allergens and aeroallergens, and in patients with recurrent obstructive bronchitis more important in the bronchial obstruction development were infectious agents and weather conditions worsening (high humidity, fog, rain). However, unlike the other factors involved in the bronchial obstruction development in asthma, nighttime, allergens and aeroallergens did not have significant impact on the bronchial obstruction occurrence in children with recurrent obstructive bronchitis. In both groups, physical stress (jogging, gymnastics) and emotional stress (loud laugh, crying) contributed to the bronchial obstruction syndrome development with the corresponding clinical picture, but in the second group of children with recurrent obstructive bronchitis duration of cough lasted 2 times less (1-1,5 h) than in children with bronchial asthma (over 3 hours).

Conclusion. Conducted comparative characteristics showed that there is a clear link with the trigger mechanisms of bronchial obstruction occurrence in bronchial asthma and recurrent obstructive bronchitis, and triggers, regardless of the severity and duration of disease, have the same effect on the recurrent obstructive bronchitis outcome.

Kazan medical journal. 2016;97(1):66-69
Experimental medicine
Dependence of clot contraction (retraction) on the molecular and cellular blood composition
Peshkova A.D., Lozhkin A.P., Fathullina L.S., Malyasev D.V., Bredikhin R.A., Litvinov R.I.

Aim. To study the effect of the blood components on clot contraction dynamics in vitro.

Methods. The original method based on the optical detection of changes in the blood clot volume over time was used. Whole blood, as well as reconstructed samples using washed platelets, erythrocytes, purified fibrinogen, platelet-poor and platelet-rich plasma were studied.

Results. Blood clot contraction has a non-linear kinetics, reflecting the complexity of the underlying mechanisms. Platelets increase the blood clot contraction, while the red blood cells have an inhibitory effect. Blocking the fibrin and platelets interaction using the RGDS peptide, an integrin αIIbβ3 antagonist, reduces the extent and rate of clot contraction. The exogenous Ca2+ is not required for contraction, but its addition stabilizes clots by inhibiting the erythrocytes. Thrombin has a dose-dependent effect and increases the rate and extent of contraction. In blood samples of patients taking warfarin, blood clot contraction was delayed.

Conclusion. The blood clot contraction is a process which depends on many factors, including the blood cell composition, amount of fibrinogen, the endogenous thrombin activity and platelets interaction with fibrin; understanding the mechanisms of the blood clot contraction could form the basis for the development of novel approaches to the hemostatic disorders treatment.

Kazan medical journal. 2016;97(1):70-77
Electron microscopy study of antibacterial effect of selimakcid against salmonella and escherichia
Murtazina G.K., Salnikova M.M.
Aim. To assess Selimakcid effect on the submicroscopic organization of Salmonella and enteropathogenic Escherichia. Methods. Salmonella enteritidis and enteropathogenic Escherichia coli isolates were used in a study. Their morphological and functional characteristics after Selimakcid exposure were studied using methods of negative staining and ultrathin sections. Selimakcid was taken at 10, 15 and 25 mg/ml concentration in a physiological isotonic sodium chloride solution. Results. Incubation of Salmonella and Escherichia cultures with Selimakcid has no effect on the cells size compared to the control. Ultrastructural picture of Selimakcid post antibiotic effect on the Salmonella enteritidis cells demonstrated the outer membrane vesicles increase and cell wall changes, which can be attributed to the adaptation. In the Escherichia coli culture after incubation in medium containing Selimakcid at 25 mg/ml concentration, the presence of both damaged (with flake-like cytoplasm and plasma membrane ruptures) and lysed (release their content into the environment) cells was observed. Conclusion. The effect of Selimakcid on Salmonella enteritidis cells is characterized by the outer membrane vesicles increase and cell wall changes; in the Escherichia coli culture after Selimakcid exposure the presence of damaged and lysed cells was observed.
Kazan medical journal. 2016;97(1):77-83
Prevention of compartment syndrome after abdominal surgeries
Salakhov E.K., Salakhov K.K.
The article presents the basic concepts and definitions of compartment syndrome, some mechanisms of its development, methods of treatment and prevention. Abdominal compartment syndrome is diagnosed in 20% of patients with therapeutic and 30% of patients with surgical pathology. Mortality in its development amid the treatment reaches 42-68%, and without treatment - 100%. The high risk of abdominal compartment syndrome development is characteristic for patients with generalized peritonitis. The trigger mechanism of syndrome development becomes increased intra-abdominal pressure, which leads to the multiple organ failure development. Currently, there are different approaches to the abdominal compartment syndrome prevention. There is no doubt that it is better to prevent this syndrome than cure, as well as any other pathological condition. It is necessary to bear in mind the probability of its formation and routinely measure intra-abdominal pressure in high-risk patients. Treatment tactics choice and timely detection of intra-abdominal hypertension are crucial in prevention of the abdominal compartment syndrome development in patients with abdominal surgical pathology. In general, it is recommended to perform preventive measures in respect of abdominal compartment syndrome in two directions. As the first one, the decision on the type of wound suturing is considered. Tissue perfusion optimization is considered as another preventive direction. Currently, there is no single approach in the abdominal compartment syndrome prevention in patients with generalized peritonitis, and further studies in this area are highly relevant. Since this pathology leads to impairment of almost all vital body functions and is associated with extremely high mortality, its early diagnosis by the intra-abdominal pressure monitoring, which allows to perform timely actions that prevent an adverse outcome, is of particular importance.
Kazan medical journal. 2016;97(1):84-89
Serotonergic mechanisms of regulation of the systemic circulation vessels lumen
Sveshnikov D.S., Kuchuk A.V., Smirnov V.M., Cherepanova G.V.
Review is devoted to the assessment of the serotonergic mechanisms role in the hemodynamics regulation. The special attention is given to the role of various serotonin receptors involved in the gastrointestinal tract motility regulation, in particular located in the digestive system vessel walls. It is known that serotonin has a dual effect on the vessel lumen, due to the heterogeneity of serotonin receptors, which are part of the vascular wall, and different sensitivity of serotonin receptors. Mechanisms at various levels, from central to local, are able to participate in the serotonergic regulation of the vascular lumen, as well as in motility control. According to our data, in the regulation of the upper gastrointestinal tract motor activity participate 5-HT1B- and 5-HT3-receptors located in the stomach and intestines autonomic ganglia, 5-HT2B-receptors localized on stomach plexus neurons and on small and large intestine smooth muscles; 5-HT4-receptors located on stomach wall smooth muscles and intraorgan intestinal plexus neurons. According to the literature, vascular wall 5-HT2B- and 5-HT7-receptors provide vasodilation, whereas the 5-HT1B/1D-, 5-HT2A- and 5-HT2B-receptors - vasoconstriction. Significance of plasma free serotonin level for hemodynamic, serotonergic mechanisms for the different types vessels diameter changing, the interaction of serotonin receptors with sympathetic nervous system and their possible role in the vascular tone regulation are described, particularly the role of presynaptic 5-HT1B/1D-receptors, which prevent the catecholamines release by vegetative nerves endings, is established. Different points of view on the serotoninergic regulation issue, existing contradictions, as well as areas for further fundamental and practical research are presented.
Kazan medical journal. 2016;97(1):89-94
Modern surgical approaches in treatment of simple solitary, multilocular, multiple cysts and polycystic kidney disease in children
Akramov N.R., Baybikov R.S.
In a review of current literature, the evolution of technology of endovideosurgical treatment approaches of simple solitary, multilocular, multiple cysts and polycystic kidney disease in children is presented. The article describes different puncture, «open», retroperitoneoscopic and laparoscopic types of surgical interventions used in this disease, their negative and positive aspects. Over the past two decades, endoscopic surgery for cystic kidney disease minimize surgical trauma so that they became comparable to puncture techniques, and surpass them in the intervention radicality. Herewith cosmetic effect is not inferior to that when using puncture techniques. When comparing videoscopic with «open» operations, the advantage of the first in a traumatic effect on the child’s body, and cosmetic results also were noted, while the surgical treatment radicality of compared techniques was identical. Presented statistical data obtained from the international literature analysis (more than 500 cases of endovideosurgical treatment of cystic kidney disease in 22 hospitals) demonstrate the short duration of surgery, short-term hospitalization and a high proportion of treatment success up to 90-100%. The comparative analysis of surgical procedures performed in the renal cysts endoscopic fenestration performance by retroperitoneal access is conducted. All presented in the literature review surgery methods are original and can be used in the treatment of children with cystic kidney disease, however, each operation has its own complexities of the technical performance. In this connection, the search for the best method of surgical treatment that can become the «gold standard» treatment for children with cystic kidney disease continues. In conclusion, it is noted that endovideosurgical methods of treatment of solitary, multilocular, multiple cysts and polycystic kidney disease in children have excellent prospects for the widespread implementation in pediatric urology and andrology.
Kazan medical journal. 2016;97(1):95-101
Modern concepts of celiac disease
Kopishinskaya S.V.
Celiac disease is widespread autoimmune disease, which develops in genetically predisposed individuals in case of gluten intake and manifests as enteropathy and extraintestinal signs or without symptoms. Celiac disease is recognized as one of the most common genetic diseases in the world with about 1% prevalence. The review organizes literature data concerning epidemiology, pathogenesis, clinical presentation, diagnosis and treatment of celiac disease. The historical and geographical features of the celiac disease prevalence associated with the wheat consumption and human migration are described. The disease pathogenesis caused by both genetic factors, in particular the human leukocyte antigens (HLA) type, and the environmental influence, the gluten intake. The classification uniting a number of gluten-related diseases, which differ in the development mechanism and clinical manifestations, is described. Celiac disease can clinically manifest by classic and atypical symptoms or occur in a latent form. It usually manifests in early childhood after the introduction of the cereals into diet with symptoms of chronic diarrhea, delayed growth and development. Celiac disease develops throughout life and increases morbidity and mortality if left untreated. Diagnosis is based on the presence of antibodies to tissue transglutaminase, gliadin and deamidated peptides and biopsy results. An algorithm for the interpretation of the diagnostic findings in the celiac disease diagnosis is presented. Significance of gluten-free diet and new drugs in the celiac disease treatment is highlighted. Different ways to reduce the gluten toxicity for celiac patients are described, such as gliadin hydrolysis modification, gluten intake decrease, immune response activity inhibition.
Kazan medical journal. 2016;97(1):101-107
Social hygiene and healthcare management
Modern ethical, legal and institutional framework of biomedical cell technologies development in the People’s Republic of China
Kuz’menko G.N., Lobazova O.F., Evreeva O.A.
New Chinese medicine democracy almost did not affect the traditional bases of the medical code, a certain pragmatism in relation to the moral component was preserved in it. Interest in the individual’s health was originally inscribed in the worldview code of the Chinese nation, which understands the best way of a living being existence as a harmony of the natural elements, energy states in it. General pantheistic basis, hidden or explicit anthropological naturalism of religious and philosophical views, which are traditional for China, Confucianism, Taoism and Buddhism form had a corresponding impact on medical ethics. Millennium beginning was expressed in the focusing of the government attention on the ethical and legal support of biotechnologies, in particular biomedical cell technologies. Government set targets to accelerate the implementation of the governmental scientific and technological specific projects in innovation areas. As a result of special solutions development by the China’s Communist Party, government emphasized the formation of developed system of «high technology zones», including biotechnoparks. Strict regulatory requirements for production, storage and use of stem cells different types, which have been adopted by the government of the People’s Republic of China in recent years, objectively allow China to sell products and services in the field of cell technology not only domestically but also abroad. If the business component of those services types, which are currently formed in the Chinese industry of biomedical cell technologies, are considered, three models can be distinguished: the first model is related to stem cells collection and storage; the second model includes stem cells production and research; the third business model - enterprises directly engaged with stem cell transplantation.
Kazan medical journal. 2016;97(1):108-113
Epidemiological features and risk factors of non-scpecific low back pain in petrochemical enterprise workers
Amirova T.K., Gubanov R.A., Akhmetov I.I., Egorova E.S., Khismatova Z.F., Fatkhutdinova L.M.

Aim. To study the prevalence and incidence of new cases, and the role of risk factors such as PARK2 gene polymorphism and mechanical loads in non-specific low back pain development in workers of a large petrochemical enterprise.

Methods. On a cross-sectional study by continuous sampling method (all factory workers - 580 people, the participation rate 87.6%) the prevalence of problems with the musculoskeletal system, including low-back pain was studied. Russian version of the Nordic questionnaire and the analysis of medical records were used. 228 people without any musculoskeletal system problems (the participation rate 82.4%) were selected for the 6-month prospective study. PARK2 gene rs926849 A/G polymorphism has been identified in 177 workers; epithelial cells of the oral cavity served as material for genetic analysis. The severity of the work process was evaluated in all workplaces. Multivariate statistical analysis was conducted by logistic regression method.

Results. The prevalence of low back pain reached 38.7%; the incidence of new cases at 6 months was 13.3%. In case of genotype AA of PARK2 gene rs926849 polymorphism (compared with protective genotypes AG and GG) the low back pain was more common (OR=1.68, p=0.047). Another risk factor was age (OR=1.06, p=0.005). The presence of the «work severity» variable in the model increased the level of statistical significance of the «genotype» variable from p=0.055 to p=0.047, i.e. the association with the risk of low back pain increased.

Conclusion. Hereditary predisposition and age play a significant role in the development of non-specific low back pain among workers; mechanical loads may increase the effect of a genetic predisposition, but do not have an independent etiologic importance.

Kazan medical journal. 2016;97(1):114-119
Ethnic variability of bladder cancer in the Republic of Kazakhstan
Nurgaliyev N.S.

Aim. To study the bladder cancer incidence in ethnic groups of the Republic of Kazakhstan.

Methods. The study, covering the period from 2004 to 2013, included patients with newly diagnosed and registered cases of bladder cancer. Statistical methods of cancer incidence descriptive epidemiology were used. Besides, age-specific, crude and standardized indices of bladder cancer incidence were calculated.

Results.In total in 10 years 4887 patients with bladder cancer were registered in Kazakhstan. Crude incidence rate of bladder cancer among the Kazakh ethnic group was the highest in Akmola (2.2) and Kostanay (2.2) regions, as well as in Almaty (2.1 per 100 thousand population). The lowest incidence rate among indigenous ethnic groups was registered in South Kazakhstan region - 0.8 per 100 thousand population. The highest average annual incidence of bladder cancer among Russians was registered in Almaty - 11.4 per 100 thousand population. The same high figures were registered in West Kazakhstan (11.0), North Kazakhstan (10.5), Kyzylorda (10.5) and Aktobe (10.0 per 100 thousand population) regions. The lowest incidence was observed among persons of Russian nationality in the Atyrau region (4.0 per 100 thousand population). In general, the incidence among the Kazakh ethnic group was 1.59±0.41 per 100 thousand, that was significantly less than among Russians - 8.25±1.88 per 100 thousand population (p

Conclusion. There is considerable ethnic variability in bladder cancer incidence in Kazakhstan: the incidence among Russians 5 times higher than among Kazakhs.

Kazan medical journal. 2016;97(1):120-124
Medico-demographic situation in prisons of Volga federal district in the period of the penal system reforming
Tulenkov A.M., Dyuzheva E.V., Romanov K.A.

Aim. To assess tendency in medico-demographic indicators of persons held in prisons of Volga Federal District in the period of the penal system modern reforming (2006-2014).

Methods. Assessment of the studied contingent quantitative and qualitative medico-demographic indicators dynamics, the most relevant for the prisons for the 2006-2014. Forecasting of studied indicators for the period up to 2017 was conducted. Intensive and extensive indicators calculation and their dynamic comparison were performed.

Results. Changes of demographic indicators for the 2006-2014 period involve the total number of prisoners reduction, the proportion of women increase and the proportion of teenagers decrease, reduction the punishment serving duration, migration processes intensification. The studied contingent, which was held in the prisons of the Volga Federal District, in the vast majority (91.0%) was presented by male persons. The mean age of convicted is 30.9 years. The mean term of punishment in prisons is 7.6 years. During the 2006-2014, the constant tendency of the studied contingent mortality increase due to the continuing increase in the number of patients with socially significant diseases amid decrease of the total number of persons held in prisons was registered. In 2014, the mortality rate was 7.1‰, which is 36.5% higher than in 2006 (5.2‰). The leading causes of death were infectious and parasitic diseases (37.1%). Studied medico-demographic indicators changes had significant regional features.

Conclusion. Revealed significant changes in the medico-demographic indicators of studied contingent, definitely affecting the penalty system medical service activity, dictate the necessity of considering them when adopting the strategy of medical care organization in prisons.

Kazan medical journal. 2016;97(1):124-130
Analysis of surgical care delivery to gynecological patients
Mazitova M.I., Kibardina N.A., Kniazeva N.A., Zaripova G.M., Khayrullina E.A., Abdullaeva G.S.

Aim. To analyze surgical care delivery to patients with urgent gynecological diseases in Kazan hospitals for the period of 2010-2014.

Methods. The data on incidence, its structure, performed interventions, types of surgical approaches, obtained from eight Kazan hospitals, serving the urban population over the last 5 years (2010-2014) were analyzed.

Results. During this period, 86 165 women were treated in gynecological departments, 13 863 (16%) of them were provided with surgical care. During the analyzed period, the number of gynecological patients increased by 7000: from 12 374 to 19 548 people. Abdominal surgical interventions prevailed. When analyzing the surgical approaches types ratio in elective abdominal interventions, the prevalence of abdominal laparoscopic approach was revealed. The increase in the use of endoscopy at urgent conditions from 73% in 2010 to 83.7% in 2014 was observed. The downward trend of the laparoscopic approach use during elective surgery, observed in recent years, to some extent may be due to reprofiling of departments and hospitals. The tendency to increase the ectopic pregnancy frequency - from 48.1 to 55.2%, ovarian apoplexy - from 20.8 to 31.7% in 2010 and 2014 respectively, was revealed. The laparoscopy use increase by almost 20% both in ectopic pregnancy and in ovarian apoplexy was observed.

Conclusion. Adequate provision of city gynecological departments with endoscopic equipment, the possibility of its round-the-clock use, increase in the number of gynecologists mastered laparoscopic technology allow to increase the proportion of mini-invasive methods of surgical treatment.

Kazan medical journal. 2016;97(1):130-134
To the 40th anniversary of Pharmaceutical Faculty of Kazan State Medical University
P2-receptors as promising target for future drugs
Ziganshin A.U.
Now it is recognized that extracellular adenosine triphosphate (ATP), along with certain other purine and pyrimidine compounds is capable to regulate many intracellular processes by affecting specific receptors - P2-receptors. These receptors are widely distributed in the organs and tissues of humans and animals. It has been shown that P2-receptors are involved in the vascular tone maintenance, nerve transmission modulation, hemostasis regulation and functions of many internal organs. P2-receptors wide variety and broad representation makes them very attractive as potential targets for new drugs with the original mechanism of action. About 20 years ago in the Kazan State Medical University laboratory was created and research group on studying the fundamental and applied aspects of the P2-receptors was formed. Professor A.U. Ziganshin, a disciple and colleague of professor G. Burnstock, leads this group. In this article, an overview of research carried out by the author or under his supervision over the past two decades to study the physiological and pathophysiological role of P2-receptors in humans and animals, as well as the evaluation of these receptors as potential targets for action of new drugs, is given. In particular, it describes the work to identify new and effective P2-receptors antagonists, the role and characteristics of ecto-ATPase activity in different tissues are described, an overview of studies to assess the unique hypersensitivity of P2-receptors at low temperatures is given. Also studies on assessing the presence and functional role of P2-receptors in the pregnant human uterus, inflamed fallopian tubes, various blood vessels are presented in summary form. Obviously, due to the growing interest of many pharmaceutical companies to this area, in the near future we can expect new drugs, which are P2-receptors agonists or antagonists and are effective in treatment of various human diseases.
Kazan medical journal. 2016;97(1):135-141
Intermacromolecular interactions with Eudragit® copolymers as a new principle of the microparticulate oral drug delivery systems development
Moustafine R.I.
The main trends of combining the chemically complementary types of (meth)acrylic copolymers of pharmaceutical-grade - Eudragit® in oral microparticulate systems with modified release (spheres, granules, capsules, etc.) - and the technological methods used in their manufacture, including various types of coating (single-layer, multi-layered, combined) are considered. It is noted that the processes that control the drugs release are based on pH-dependent intermacromolecular interaction of reactive groups between a pair of opposite charged Eudragit® copolymers both inside of spherical micro-matrix and inside the multilayer and combined coatings, allowing regulating both the degree and time of active pharmaceutical ingredients (API) release from pharmaceutical form. Using this principle allows to develop time-sensitive and pH-sensitive systems with a targeted API delivery to predetermined parts of the gastrointestinal tract, preferably to the colon, which is not only the optimal zone for absorption of many API, but also often requires treatment of inflammatory diseases of different origin. Analysis of these processes is of key importance to a better understanding of the mechanisms underlying the API transport from considered systems types, methods of their correction, modification of macromolecular parameters (such as the copolymer units charge density, the stoichiometry of the produced composition, the hydrophilic and hydrophobic fragments ratio in the polycomplexes structure affecting the swelling and resulting permeability of the system), as well as perspectives of (meth)acrylate polycomplexes use as a new class of carriers in the design of modern self-regulating, depending on the gastrointestinal tract physiological fluids pH, microparticulate oral API delivery systems.
Kazan medical journal. 2016;97(1):142-147
Development of new potential drugs with psychotropic activity among phosphorylacetohydrazides and other phosphorylated carboxylic acids derivatives - priority area of Kazan school of psychopharmacologists
Semina I.I., Baychurina A.Z.
In the present review professors A.I. Razumov and I.V. Zaikonnikova ideas development on the prospects of potential drugs investigation in the class of phosphorylated carboxylic acids are described. The first representative of these compounds, approved for clinical use, became a difenilphosphorylacetic acid hydrazide - the drug phosenazid (diphenizid, phosphabenzide, gidiphen) with a tranquilizing, anti-alcohol, antidepressant and antiepileptic properties. Continuing research, we studied the new series of phosphorylacetohydrazides and found that the 4-dimethylaminophenyl, 2’-chloroethoxyphosphorylacetic acid hydrazide (CAPAH) improves memory and learning in normal and pathological conditions, shows neuroprotective properties, corrects behavioral disorders in double-transgenic mice with the Alzheimer’s disease, has antidepressant properties. Hydrazide of 4-dimethylaminophenyl,2’-chloroethoxyphosphorylacetohydrazide acid has an original mechanism of action, which is its ability to enhance glutamatergic transmission through NMDA-receptors strychnine-insensitive glycine sites; enhances the interaction with the main mediator in the cholinergic synapses through neurokinin NK-1 receptors similar to substance P neuropeptide; has membranolipotropic effect by changing the phosphatidylcholine membrane bilayer organization, what may contribute to the positive effect on the receptors function. Using computer-aided prognosis, design and synthesis of phosphorylacetohydrazides new series and other derivatives of phosphorylated carboxylic acids was made, their nootropic, antidepressant and tranquilizing properties, some aspects of the mechanism of action were investigated, the main pharmacophores were identified and directions in the most promising compounds development were determined. The review also presents the research results analysis on the development of phosphorylacetohydrazides targeted delivery methods using calixarenes and polymer nanoparticles based on interpolyelectrolyte complexes. It is concluded that the development of new phosphorylacetohydrazides and other derivatives of phosphorylated carboxylic acids as potential drugs opens new possibilities of this unique class of compounds.
Kazan medical journal. 2016;97(1):148-155
Clinical observations
Two clinical cases of nonspecific aortoarteritis
Borodina I.E., Khrustaleva N.B., Shardina L.A.
Non-specific aortoarteritis is a chronic inflammatory disease of the aorta and its main branches with the stenosis or occlusion development of the affected blood vessels and secondary ischemia of organs and tissues. The main clinical symptoms most often are pulselessness or low-tension pulse on one of hands, the asymmetry of brachial artery systolic blood pressure, intermittent claudication, weakness, weight loss. Non-specific aortoarteritis is an uncommon condition for general practitioners, and the disease manifestations are often interpreted as symptoms of another pathology. It causes large number of diagnostic and tactical mistakes in management of these patients. The relative rarity of nonspecific aortoarteritis becomes one of the factors determining the complexity and time lag of its diagnosis, inadequate treatment, what leads to early disability and high risk of life-threatening complications development. The article considers two clinical cases of non-specific aortoarteritis. In one of them abdominal pain syndrome is on the foreground, in the other - cephalalgia. Often clinicians consider given symptoms in young people as a manifestation of dyspepsia (in the first patient) and one of the vasoneurosis symptoms (in the second one). The difficulty in diagnosis is that there is no specific laboratory and instrumental symptoms which are pathognomonic for nonspecific aortoarteritis as in other vasculitis.
Kazan medical journal. 2016;97(1):156-158
Experience of Fournier’s gangrene clinical diagnostics
Prokhorov A.V.
The article represents clinical cases review of rare and serious disease - Fournier’s gangrene. 3 patients with Fournier’s gangrene aged 53±13 years were followed up in Moscow City Clinical Urological Hospital №47 and City Clinical Hospital №57 in the period from 2005 to 2015. All patients with Fournier’s gangrene were admitted to the hospital with a different referral diagnoses: «acute epididymo-orchitis», «testicular abscess», «scrotal phlegmon». Standard clinical and laboratory tests, abdominal cavity and urogenital system plain radiography and ultrasound examination were performed. For genital organs ultrasound examination a high-resolution linear transducer (6-16 MHz) was used. Ultrasonography in the admission room allowed to exclude acute scrotal diseases in all patients, Fournier’s gangrene was diagnosed in 2 patients, and suspected in 1 patient. In all patients with Fournier’s gangrene ultrasound examination revealed marked thickening of testicular coats (more than 15 mm), the accumulation of a small amount of fluid between the testicular coats and in the tunica vaginalis cavity, testicular coats intense hypervascularization; normal blood flow and the unchanged structure of the testes and epididymis. Scrotal emphysema was detected by ultrasound examination in all patients, by the plain radiography and physical examination - in 2 patients. In all cases, ultrasound helped to clarify the cause of Fournier’s gangrene: to reveal anorectal abscesses, acute prostatovesiculitis and exclude acute epididymo-orchitis, scrotal phlegmon and testicular injury. As an illustration Fournier’s gangrene observation, which occurred as an anorectal abscess complication is presented. Ultrasonography allows to confirm the Fournier’s gangrene presumptive diagnosis (to reveal soft tissue of the penis and scrotum emphysema), make differential diagnosis of Fournier’s gangrene with other external genitalia and perianal area acute diseases, determine treatment strategy.
Kazan medical journal. 2016;97(1):159-162
History of medicine
Medical detachments activities during the 2nd battle of Geok Tepe
Blokhina N.N.
The article presents the organization of the preparation to the 2nd Battle of Geok Tepe (also known as Akhal-Teke military expedition). The Russian Red Cross active assistance is described in the context of the forthcoming expedition. Medical tactics in the surgical treatment of wounded soldiers on the part of military surgeons is reviewed based on the memoirs of the 2nd Battle of Geok Tepe surgeons N.A. Vel’yaminov and A. Keldysh. The article describes the activity of Russian Red Cross Society authorized I.P. Balashev and S. Shakhovskiy. Thus, chief authorized I.P. Balashev traveled through the battle area, which was occupied by Russian troops at that time, and having studied the local conditions, as well as having learnt the nature of the upcoming activities had made the general provisions on the Red Cross aid organization. The military-medical care organizational structure was developed quite reasonably. Nine defenses were all along the military road from Chikishlyar to Bami, that is over 320 versts. Intermediate hospitals for the sick were arranged in each of them. The article describes the activity of Sisters of Charity, who worked in military hospitals for the wounded weal during the 2nd Battle of Geok Tepe. In February 1881 the 2nd Battle of Geok Tepe campaign was completed. Russian troops and medical services got significant experience during the 2nd Battle of Geok Tepe in 1879-1881.
Kazan medical journal. 2016;97(1):163-167
Professor Andrey Nikolaevich Mayanskiy
Kazan medical journal. 2016;97(1):168

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