Vol 97, No 1 (2016)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.