Vol 97, No 5 (2016)

Theoretical and clinical medicine
Indicators of bone metabolism in patients of psychiatric clinic on the background of dimephosphone intake
Il’ina R.Y., Pasynkova O.O., Mukhamedzhanova L.R., Ziganshina L.E.
Abstract

Aim. To study the indicators of bone metabolism in patients of psychiatric clinics on the background of dimephosphone oral intake.

Methods. Research was conducted at the Republican Clinical Psychiatric Hospital named after V.M. Bekhterev (Kazan). 64 patients (36 men and 28 women) aged 45 to 68 years (mean age 56.8±6.9 years) with various forms of mental disorders taking psychotropic drugs for the period of 3 years and over were examined. Resorption markers were determined - D-pyridinoline in urine, serum tartrate-resistant acid phosphatase, alkaline phosphatase, and the content of total and ionized serum calcium. All patients were divided into two groups: those who received dimephosphone in the combined systemic therapy and those who did not. The average duration of the dimephosphone administration was 22±4.2 days, the patients undergone on average 2.6±1.44 courses of treatment during 6 months.

Results. The activity of tartrate-resistant acid phosphatase in psychiatric patients was higher compared with those of the control group. The maximum value was registered in patients who were not taking dimephosphone. The alkaline phosphatase activity was the highest in mentally healthy patients of the control group. In psychiatric patients treated with dimephosphone, alkaline phosphatase activity was 20% lower compared with the control group. The minimum values of alkaline phosphatase were registered in patients with mental disorders not taking dimephosphone. When studying the concentration of total and ionized serum calcium there were no significant differences between patients of comparison group and psychiatric patients.

Conclusion. Shift in processes of bone remodeling toward its resorption indicates a high risk of pathological fractures in psychiatric patients and the need for osteoporosis prevention; identified changes in biochemical markers of osteoporosis on the background of dimephosphone intake allow to recommend it for the treatment of diagnosed osteoporosis in a psychiatric hospital settings.

Kazan medical journal. 2016;97(5):669-673
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Efficacy of medication for therapeutic angiogenesis in combined treatment of patients with diabetes mellitus and critical limb ischemia
Kalinin R.E., Suchkov I.A., Pshennikov A.S., Mzhavanadze N.D., Krylov A.A., Plaksa I.L., Deev R.V.
Abstract
The combination of peripheral atherosclerosis and diabetes mellitus is a severe pathology, characterized by a high rate, mortality and social significance. The results of limb salvage and distant survival in this pathology in a remote period are unsatisfactory in spite of all existing treatment methods. Clinical trials in previous years have shown efficacy and safety of the medication, which is a plasmid construct with the gene encoding vascular endothelial growth factor - kambiogenplasmid, in patients with disease stage IIa-III according to the A.V. Pokrovsky and Fontaine classification, who were not indicated for surgical treatment. The article presents the clinical cases of successful use of this drug for therapeutic angiogenesis in patients with critical limb ischemia and severe type 2 diabetes mellitus. The inclusion of therapeutic angiogenesis in the conservative treatment algorithms is promising for the treatment of this group of patients. There is a need for further research on the efficacy and safety of the medication in patients with peripheral atherosclerosis and diabetes mellitus in a remote period.
Kazan medical journal. 2016;97(5):674-680
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Features of the clinical course of chronic obstructive pulmonary disease and quality of life in patients with coexisting metabolic syndrome
Kozhevnikova S.A., Budnevskiy A.V.
Abstract

Aim. To study the clinical course of chronic obstructive pulmonary disease in patients with metabolic syndrome and analyze the degree of influence of the metabolic syndrome components on chronic obstructive pulmonary disease and patients’ quality of life.

Methods. 100 patients with chronic obstructive pulmonary disease were examined: 30 patients without metabolic syndrome (the first group) and 70 patients with metabolic syndrome (the second group). Anthropometric measurements (weight, height, body mass index, waist circumference), laboratory tests (levels of triglycerides, cholesterol, low- and high-density lipoproteins, fasting blood glucose, the oral glucose tolerance test), physical examination, quality of life assessment were performed.

Results.Patients of the second group had statistically significant differences in the studied parameters in comparison with the first group. The number of exacerbations, calls to ambulance service, hospital admissions were 1.4; 1.3 and 1.5 times higher, respectively. Dyspnea intensity, cough and sputum score were 1.6; 1.7 and 1.6 times higher respectively as compared with the first group (p

Conclusion. Metabolic syndrome is associated with a more severe course of chronic obstructive pulmonary disease, which results in a higher frequency of exacerbations, hospital admissions, more severe clinical manifestations, greater influence of dyspnea on the physical activity limitation of patients, more severe airflow obstruction, low exercise tolerance with worse performance of everyday activities, emotional perception of the disease, worse psychosocial adaptation of patients.

Kazan medical journal. 2016;97(5):681-686
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Prevalence of cardiovascular disease risk factors among shipping professionals
Agaeva K.F., Gadzhizade S.A.
Abstract

Aim. To perform comparative assessment of the prevalence of cardiovascular disease risk factors among the main groups of shipping professionals (captains, their assistants, mechanicians, machinists, electrical officers, and sailors).

Methods. Monitoring was conducted by the continuous coverage of males under the age of 40 years, recognized as apparently healthy based on the planned complex preventive examinations in the system of the Azerbaijan State Caspian Shipping Company.

Results.The proportion of overweight people (body mass index >25.0 kg/m2) was the highest in the group of captains and their assistants (50.0±6.7%) and the lowest in the group of electrical officers (38.2±5.9%). In the group of captains and their assistants an average weight is significantly higher than that in the group of mechanicians, electrical officers and sailors (p

Conclusion. Among apparently healthy shipping professionals younger than 40 years in the system of the Azerbaijan State Caspian Shipping Company cardiovascular disease risk factors (overweight and obesity, abdominal obesity, hypercholesterolemia, dyslipidemia ≥32,1%, smoking) are common; the total cardiovascular risk among shipping professionals depends on the type of professional activity (higher among machinists, captains and their assistants, less among the sailors).

Kazan medical journal. 2016;97(5):687-690
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Endothelial dysfunction in patients with hypertension and peripheral artery disease
Denisenko M.N., Genkel V.V., Shaposhnik I.I.
Abstract

Aim. To assess endothelial function in patients with hypertension and peripheral artery disease.

Methods. The study included 100 patients with an established diagnosis of essential hypertension. Ultrasonic duplex scanning of brachiocephalic arteries and lower limb arteries was performed. The functional state of the endothelium was evaluated using postocclusive reactive hyperemia test by D.S. Celermajer.

Results. Atherosclerotic plaques in the carotid arteries were found in 71% of patients, in the lower limb arteries - in 60%. The combined affection of both vascular beds was diagnosed in 51% of patients. Endothelial dysfunction was found in 64% of patients. In patients with carotid arterial system atherosclerosis, brachial artery dilation response was 6.1%, while in those with intact carotid arteries - 4.7% (p=0.041). The value of the brachial artery dilation response in patients with atherosclerotic lesions of lower extremities arteries was 5.9%. In the subgroup of patients with intact lower limbs arteries, the increase in brachial artery diameter was 9.60% an average (p=0.04). Among 51 people with affection of both vascular systems the brachial artery diameter increase was 5.4%, while in comparison, in the subgroup consisting of 49 patients without combined carotid and lower limb arteries lesions, - 9.9% (p=0.003). According to the results of the correlation analysis, the relation between endothelial dysfunction and the maximum percentage of stenosis of the carotid arteries and lower limb arteries at the level of tibial segment was revealed.

Conclusion. In patients with hypertension and peripheral artery disease, decrease in dilation response in endothelium-dependent vasodilation test was registered regardless of the localization of atherosclerotic lesions; endothelial dysfunction in essential hypertension was associated with the highest percentage of stenosis of the carotid arteries and lower limb arteries at the level of tibial segment.

Kazan medical journal. 2016;97(5):691-695
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Complications after periacetabular osteotomy
Gakhramanov A.G.
Abstract

Aim. To study the frequency and structure of complications after periacetabular osteotomy in patients with hip dysplasia.

Methods. Complications that arose after the Ganz periacetabular osteotomy, based on observation of 71 patients (83 operated joints): 58 women and 13 men, were analyzed. The average follow-up duration was 8 years, the mean age - 23 years (range 13 to 44 years). Complications after surgery were divided into two groups: minor and major. Functional state of the hip joint was evaluated by the Harris Hip Score (HHS) before and after surgery.

Results. In 5 patients dysesthesia of external femoral nerve, in 1 - of sciatic nerve, was revealed, ossification grade 1-2 (according to Brucker) was found in 5 patients, grade 3-4 - in 2, ischial bone pseudarthrosis was determined in 2 patients, the ilium fracture - in 3, superficial abscess - in 2, screw penetration into the joint - in 2, femoral head subluxation - in 1, symptomatic screws - in 5 patients. In 71 adult patients (83 joints) with hip dysplasia and arthrosis after Ganz osteotomy, in 17 (20.4%) cases minor complications, in 11 (13.25%) - major complications were registered. In 66 patients out of 71 the joint preservation was achieved.

Conclusion. Ganz osteotomy performed according to indications is effective and allows joint preservation in the majority of cases, however, the surgical complexity and the relatively high rate of complications require sufficient qualification and experience of the physician.

Kazan medical journal. 2016;97(5):696-700
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Changes in functional activity of the retina after vitrectomy in patients with diabetic retinopathy
Shahbazova N.A.
Abstract

Aim. To evaluate the functional state of the retina according to multifocal electroretinography and visual acuity in patients with proliferative diabetic retinopathy before and after vitrectomy.

Methods. 18 patients (19 eyes) were examined. Mean age was 57±15 years. All of patients were diagnosed with proliferative diabetic retinopathy complicated by vitreomacular traction syndrome. All the patients underwent vitrectomy. Visual acuity was measured and multifocal electroretinography was performed in all patients before and after surgery.

Results. During the optical coherence tomography, retinal profile deformation was revealed. Central retinal thickness was 347±106 microns. The average density of bioelectrical response of the macular area in patients with proliferative diabetic retinopathy complicated by vitreomacular traction, was sharply reduced and amounted to 44.987 nV/deg, in parafoveal area - 14.20 nV/deg. 1 month after vitrectomy averaged density of macular region bioelectrical response slightly increased and amounted to 51.52 nV/deg, in parafoveal area - 18.94 nV/deg. Visual acuity in patients before surgery was in average 0.09 (0.699 LogMAR). 1 month after pars plana vitrectomy visual acuity rose to an average of 0.32 (0.749 LogMAR).

Conclusion. In proliferative diabetic retinopathy, retinal thickness is increased, which is accompanied by multifocal electroretinography amplitudes depression; the correlation between morphological parameters of foveal avascular zone and its bioelectric activity was revealed.

Kazan medical journal. 2016;97(5):700-704
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Effectiveness of sub-tenon’s administration of an angiogenesis inhibitor in treatment of wet age-related macular degeneration
Gaybaryan R.V., Epikhin A.N., Bondarenko Y.F.
Abstract

Aim. To study the clinical results of the administration of an angiogenesis inhibitor into sub-Tenon’s space on the viscous carrier.

Methods. The study was conducted in two stages. At the first stage, analysis of examination and treatment of 32 patients (34 eyes) with the wet age-related macular degeneration was conducted. Patients were injected the angiogenesis inhibitor (bevacizumab 12.5 mg) on the viscous carrier (1.0 ml of 2% hydroxypropylmethylcellulose solution) into the posterior sub-Tenon’s space. At the second stage, a retrospective analysis of the treatment results of 30 patients (30 eyes) with the wet age-related macular degeneration, who received the standard monotherapy in the form of 3 monthly intravitreal injection of angiogenesis inhibitor (0.5 mg ranibizumab), and then according to indications, was conducted. The best-corrected visual acuity and optical coherence tomography data over the period of 12 months were evaluated.

Results. When comparing the effectiveness of treatment, the mean best-corrected visual acuity significantly improved in both groups after treatment, and its final values were not significantly different. Also central retinal thickness, length, height and volume of lesions significantly decreased as a result of the treatment, and final values were not significantly different between the groups. The duration of the achieved clinical effect in sub-Tenon’s administration was 2-2.5 months, in intravitreal administration - 1-1.5 months.

Conclusion. Administration of angiogenesis inhibitors into the posterior sub-Tenon’s space in wet age-related macular degeneration has an equivalent effectiveness to intravitreal introduction and at the same time provides more prolonged effect of medications.

Kazan medical journal. 2016;97(5):705-709
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Clinical evaluation of mechanism of precipitate labor
Zhelezova M.E., Malceva L.I., Zefirova T.P.
Abstract

Aim. To study the clinical course of pregnancy, labor and features of the structural changes in the cervix in women with precipitate labor.

Methods. We observed 186 women who delivered vaginally at 37-41 weeks of gestation. Main (I) group consisted of 146 women with precipitate labor. The comparison group (II) consisted of 40 women with a standard duration of delivery. Morphological and immunohistochemical study of cervical tissue, determining the expression level of collagen genes COL1A2 and SOL3A1 in the cervix and blood of women of studied groups were performed. Material sampling was carried out in the early postpartum period.

Results. In absolute majority of cases precipitate labor is not accompanied by intense patrimonial activity. Multiple complications develop during delivery, post-natal and early neonatal periods in 60% of patients with the precipitate labor. Pregnancy in women with a complicated course of precipitate labor occurs amid the infectious disease with predominant localization in the lower genital tract. The results of histological study of cervical tissue show numerous inflammatory changes. The expression levels of collagen genes in women with precipitate labor multifold exceed those in women with physiological duration of delivery.

Conclusion. Pathologic outcomes of precipitate labor are caused not by the character of patrimonial activity, but by adverse infectious background; accelerated cervical remodeling plays a key role in the genesis of precipitate labor; high rate of collagen metabolism in these women constitutes the epigenetic realization of the genetic determinants, formed under the influence of a number of exogenous and endogenous factors.

Kazan medical journal. 2016;97(5):709-716
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Features of chronic hepatitis C course in pregnant women
Filipovich O.M., Kuznetzov N.I.
Abstract

Aim. To study features of the course of chronic hepatitis C virus infection in pregnant women and its effect on pregnancy.

Methods. The study included 111 pregnant women: 67 with chronic hepatitis C and 44 healthy women. The mean age was 28 years. The number of pregnancies among examined women ranged from 1 to 8. All pregnant women had no concomitant therapeutic pathology and various addictions (alcohol, nicotine, drugs). The viral load in pregnant women with chronic hepatitis C ranged from 3.18×102 to 2.4×107 IU/mL.

Results. Alanine aminotransferase and bilirubin levels in the group of chronic hepatitis C and in healthy pregnant women did not exceed the normal range and were not statistically different from each other. In repeated pregnancies viral load of hepatitis C virus was lower, compared with the first pregnancy: median [25%; 75%] = 5.202 [4.079; 6.364] and 6.658 [5.708; 7.380], respectively (p106 IU/mL). At the same time threatened miscarriage, intrauterine hypoxia and preeclampsia were registered more often.

Conclusion. In the first pregnancy the viral load is higher than in repeated pregnancies; pregnancy in women with chronic hepatitis C without concomitant diseases does not cause activation of the inflammatory process in the liver; in pregnant women with chronic hepatitis C, especially at higher viral loads, medical history remarkable for obstetric diseases are more likely detected.

Kazan medical journal. 2016;97(5):716-720
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Pathogenetic features of generalized periodontitis course in patients with chronic disorder of cerebral circulation
Usmanova S.R., Hadzhimetov A.A.
Abstract

Aim. To reveal disorders of basic defense systems of the oral cavity in chronic generalized periodontitis of moderate severity in patients with chronic cerebral ischemia.

Methods. 52 patients with chronic generalized periodontitis of moderate severity were observed: 24 people without concomitant diseases and 28 patients with chronic generalized periodontitis in association with cerebral vessels atherosclerosis. The comparison group (control) consisted of 12 persons without somatic diseases at the age of 35-40 years with an intact periodontium. Levels of homocysteine and autoantibodies against heat shock proteins (HSP-70) in blood plasma and oral fluid were determined by enzyme immunoassay method.

Results. In chronic generalized periodontitis of moderate severity, high levels of antibodies to HSP-70 in saliva, 1.6 times exceeding the normal values, were revealed. These changes are more pronounced in patients with chronic generalized periodontitis and cerebral vessels atherosclerosis. Similar changes were observed in blood values in patients with chronic generalized periodontitis, in whom levels of antibodies to HSP-70 were 1.3 times higher than the «normal» value, and 1.9 times higher in combination of periodontitis with chronic cerebral ischemia. In patients with chronic generalized periodontitis of moderate severity combined with atherosclerotic vascular disease, in contrast to patients with only chronic generalized periodontitis, there was a more significant increase in homocysteine levels in the blood and saliva.

Conclusion. The findings confirm the importance of determining homocysteine levels in the blood in chronic generalized periodontitis, particularly when it is combined with atherosclerotic vascular disease.

Kazan medical journal. 2016;97(5):720-723
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Need for parodontitis treatment in adult population and compliance with it
Biktimerova O.O.
Abstract

Aim. Investigate the need of the population for treatment of inflammatory parodontal diseases and the degree of motivation and compliance with treatment and following the dentist’s recommendations.

Methods. 427 patients aged 18 to 85 were evaluated by means of the index of assessment of periodontal tissues’ state (CPITN, 1980) and the questionnaire. Patients were divided into two groups: the first group included 143 people diagnosed with parodontitis who had previously received parodontal treatment, and the second group consisted of 284 patients who were not previously aware of their periodontal status. All obtained numerical values were subjected to statistical analysis.

Results. Symptoms of periodontal inflammation were identified in 84.5% of cases, in most cases moderate severity of periodontitis was diagnosed. Severity of inflammation of the periodontal tissues is similar in males and females, besides there is no significant difference in inflammation signs observed in patients older than 45 years. Despite the fact that the patients of the first group knew about their disease, their degree of motivation in oral hygiene does not differ from that of patients from the second group who have periodontitis of almost the same severity, but did not know about the disease or did not go to a dentist complaining of periodontium pathology. Despite the 100% motivation in oral hygiene of patients previously diagnosed with periodontitis only 50% of them take regular treatment and preventive measures and demonstrate compliance with treatment and prevention.

Conclusion. Obtained data demonstrate the significant need for periodontal treatment along with poor compliance with prescribed treatment.

Kazan medical journal. 2016;97(5):723-726
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Prevention of osteoporosis with the use of the product of specialized medical nutrition
Beniova S.N., Kiku P.F., Gel’tser B.I., Bobyleva M.V., Korableva E.V., Starodumov I.G., Kolesnikov A.B., Moreva V.G., Shekunova I.O.
Abstract

Aim. To study the efficacy of shellfish dry extract with «Calcium-reparative» filler as a product of specialized medical nutrition to optimize bone metabolism.

Methods. Total of 44 female patients aged from 49 to 71 years, mean age of 54.5±3.8 years, with a combination of several osteoporosis risk factors were involved. 72.7% of all patients complained of pain of varying severity in major joints, in the thoracic and lumbar spine. The patients were randomly divided into two groups - study group (29 patients) and control group (15 patients). Within 30 days, the participants of the study group received «Calcium-reparative» - a product created on the basis of natural biologically active compounds isolated from Far Eastern marine shellfish and purified Altai Shilajit. The efficacy of the product was assessed by means of standard questionnaires for the assessment of quality of life, 10-point visual analogue scale, biochemical laboratory tests. Measurement of serum osteocalcin was performed by ELISA, and immunochemical method - N-terminal propeptide of procollagen type I (the biomarker of bone tissue metabolism).

Results. Adverse and allergic reactions to the product were not registered. Among those receiving the product 37.9% noted improvement of well-being and reduction of pain intensity from 6.9±0.45 to 4.28±0.74 points. In those receiving «Calcium-reparative» the level of synthesis of osteocalcin in the study group did not statistically significantly change and appeared to be 18.6±3.8 ng/ml. The increase in the concentration of procollagen type I from 20.9±3.0 ng/ml prior to administration of the therapeutic product to 37.6±5.8 ng/ml (t=0.006, p ≤0.001) after its administration was observed.

Conclusion. Product of medical nutrition «Calcium-reparative» has the ability to stimulate the cells of bone tissue to synthesize bone matrix protein collagen type I.

Kazan medical journal. 2016;97(5):727-731
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Reviews
Influence of obesity on the course, treatment and prognosis of chronic obstructive pulmonary disease
Kozhevnikova S.A., Budnevskiy A.V., Malysh E.J., Ovsyannikov E.S.
Abstract
Obesity is associated with many chronic diseases, including the cardiovascular system diseases, diabetes mellitus, and currently more and more attention is focused on the role of overweight and obesity in lung diseases. Chronic obstructive pulmonary disease is one of the diseases characterized by high incidence, disability, ranking third among the leading causes of death worldwide. Association between obesity and chronic obstructive pulmonary disease is increasingly recognized, but to date remains largely unexplored. On the one hand, the obesity is associated with reduced lung function, increasing prevalence of certain lung diseases. On the other hand, obesity has a protective effect in case of severe course of chronic obstructive pulmonary disease. The nature of nutrient intake and diet is also associated with lung function, which is reflected in the character of the course and progression of chronic obstructive pulmonary disease. Thus, the establishment and in-depth study of the causal relationships between obesity, nature of nutrition and lung function with a view to the further development of strategies for the prevention and treatment of chronic obstructive pulmonary disease in patients who are overweight or obese is relevant. Studying prognostic role of obesity in patients with chronic obstructive pulmonary disease is promising.
Kazan medical journal. 2016;97(5):732-735
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Diagnosis of solitary pulmonary nodules and patients follow-up strategy
Porhanov V.A., Shulzhenko L.V., Polyakov I.S., Bolotova E.V., Smolin A.A.
Abstract
Solitary pulmonary nodule is the common clinical problem. Following the detection of solitary nodules practitioner first face the question of the probability of malignancy and the future strategy and tactics of the patient management. The report highlights the issues of differential diagnosis of solitary nodules and modern standards of management of these patients, including issues of their follow-up care. The importance of a multidisciplinary approach to this problem is emphasized. Strategy for the management of patients with solitary nodules include: (1) the computed tomography performance, its comparing with previous data; (2) an assessment of the margin, size, calcification type, solitary nodule type (solid, subsolid); (3) the risk of malignancy assessment. Further actions can be performed according to algorithms: nodule ≤8 mm; nodule >8 mm. According to screening tests for the early detection of lung cancer in smokers at high risk for development of malignant tumors, solitary nodules are found in 50% of cases. When choosing a strategy it is necessary to inform the patient about all the positives and negatives of follow-up care by means of computed tomography. Its main goal is to secure patient with benign nodules against unwanted invasive procedures, especially if there is no need for treatment. This advantage is put on one side of the scale, and on the second - the risk of delayed diagnosis of cancer, and excessive exposure to radiation. In light of the above all the patients with solitary nodules of undefined etiology should be referred to a specialized pulmonary center for multidisciplinary experts evaluating - pulmonologists, thoracic surgeons, pathologists and radiology specialists, which allows to develop the most optimal strategy for these patients.
Kazan medical journal. 2016;97(5):736-743
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Heat shock proteins - participants in osteoarthrosis pathogenesis
Kabalyk M.A., Gel’tser B.I., Osipov A.L., Fadeev M.F.
Abstract
Osteoarthrosis is a disease that affects all tissues of synovial joints, resulting in chronic pain and often a need for replacement. The high prevalence and the lack of reliable conservative approaches impose significant economic sanctions on most economies in the world. Currently the mechanisms of osteoarthrosis progression have been well studied. At the same time, the known pathogenetic concepts do not allow to define reliable targets of conservative treatment. There is a clear need for searching alternative concepts, which will help to expand the understanding of the pathogenesis and identify ways to address therapeutic issues. Heat shock proteins (chaperones) are involved in intra- and extracellular signaling in the pathogenesis of many diseases. The aim of this review is to analyze the current state of the problem of studying the role of heat shock proteins in the pathogenesis of osteoarthrosis. The review considers the fundamental aspects of the activation and functioning of chaperones, experience of studying chondrocyte heat shock proteins is described, issues of programmed cell death mechanisms are mentioned, scheme of shaperone activity in osteoarthrosis is illustrated. The role of heat shock proteins from the perspectives of reparation and alteration carried out in the articular cartilage is described, the prospects for further clarification of their role in the pathogenesis of osteoarthrosis are identified. The role of two key molecules - protein with molecular weight of 70 kD and a small molecule with molecular weight of 27 kD, is emphasized. Heat shock proteins are of fundamental and applicative interest from the perspective of their participation in the key ways of osteoarthrosis pathogenesis and phenomena (oxidative, microcrystalline, hydrodynamical, stress, aging, etc.). Further study of heat shock proteins will allow to significantly expand the knowledge of osteoarthrosis and to identify ways of targeted therapy.
Kazan medical journal. 2016;97(5):744-749
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Methods of surgical treatment of bilateral paralytic laryngeal stenosis
Alimetov A.C.
Abstract
Median stenosis of the larynx, occurring due to paresis or paralysis of the vocal cords, is the most severe pathology in terms of disablement, the treatment complexity and further rehabilitation. Amid the high surgical activity on the organs surrounding larynx, an increase in patients with this pathology is observed. The main surgical approaches in the treatment of bilateral paralytic laryngeal stenosis are described. Two main variants of surgical interventions are emphasized: static - aimed at mechanical expansion of airway lumen, dynamic (functional) - aimed at vocal cord mobility restoration. In considering options aimed at the mechanical expansion of the laryngeal lumen, surgical technique is conventionally used. Most of the authors used removal of the anatomical structures of the larynx to expand its lumen - the vocal cords, arytenoid cartilage, or both at the same time. However, when using these methods, there are possibility of cicatricial changes in violation of the mucosal integrity with recurrent stenosis, eruption of ligatures with the return of the vocal cords in the original position in lateral fixation. In a number of surgical approaches the high invasiveness, technical complexity of execution, as well as the violation of the protective function of the larynx were registered. Among the dynamic methods neuroplasty with an attempt to restore the laryngeal muscles innervation by suturing intersected part of the nerve «end-to-end» and «end-to-side»; myoplasty, when to restore the vocal cords mobility surrounding muscles of the neck were used; neuromuscular plastic, when reinnervation was performed using nerve-muscle flap, were described. The methods are functional, but they have their own disadvantages. The necessity of further search for effective methods of treatment was shown.
Kazan medical journal. 2016;97(5):749-754
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Hygiene and healthcare management
Justification of the model for improvement of activities for hypertension early diagnosis and prevention
Reshetnikov V.A., Kozlov V.V., Royuk V.V., Sokolov N.O.
Abstract

Aim. To develop medical and organizational measures to optimize the early diagnosis and prevention of hypertension complications.

Methods. A study of the hypertension incidence in population of Krasnogorsk city based on the analysis of report forms was performed. A questionnaire survey of 400 office workers of working age for the presence of high blood pressure was conducted.

Results. It was found that, despite the downward trend in the prevalence and incidence of hypertension in population served by Krasnogorsk City Hospital №1, as well as the decrease in the relative frequency of hospital admissions of patients with hypertension in 2011-2015, mortality due to hypertension-related causes does not decrease. The results of the survey and blood pressure measurement in 400 office workers of working age have shown that only 30.8% of respondents regularly monitor the blood pressure, and women 3.5 times more often than men. In 14.5% of examined persons, who claimed that they have no high blood pressure, unstable blood pressure, in 19.1% - high blood pressure is detected.

Conclusion. As an important measure for the early detection and correction of hypertension, the organization of units for measuring blood pressure at workplaces in organizations and institutions should be considered. Heads of organizations and institutions, in agreement and cooperation with the healthcare authorities, are recommended to organize units for measuring blood pressure at the personnel workplace and purchase devices for measuring blood pressure. Local healthcare authorities should organize trainings of the institutions personnel on self-measured blood pressure monitoring by means of collective actions involving volunteer health professionals in health centers, and in organizations and institutions, if possible.

Kazan medical journal. 2016;97(5):755-763
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Elaboration and implementation of the program for prevention of acute disorders of cerebral circulation as exemplified in Rybnaya Sloboda district of the Rebublic of Tatarstan
Kitaeva E.A., Kitaev M.R., Salyakhova L.Y., Vafin A.Y.
Abstract

Aim. Improvement of activities aimed at reduction of morbidity of stroke and recurrent stroke, mortality and disability rates for stroke of the population of the Republic of Tatarstan, by means of implementation of primary and secondary prevention program.

Methods. Activities that would reduce mortality rate and improve the quality of life of the population of Rybnaya Sloboda region for 2013-2015 were developed. Differentiated approach to stroke prevention for different groups of patients based on individual assessment of stroke risk was suggested. At Rybnaya Sloboda Central District Hospital the project of Stroke education Center was developed and implemented. It provides an opportunity for personified prevention of first-ever and recurrent stroke, massive preventive measures for the whole population aimed at maintaining awareness of present risk factors and methods of their reduction. Statistic analysis of mortality and morbidity rates for acute disorders of cerebral circulation for the population for the Republic of Tatarstan, Chistopolskiy, Tetushi and Rybnaya Sloboda districts for the period from 2013 to 2015 was performed.

Results. In the Republic of Tatarstan, mortality rate in 2015 decreased by 1.6%, compared to the level of 2014, and the mortality rate of working age population reduced by 3.1%. During the last 10 years mortality rate of the population of the Republic of Tatarstan decreased by 13%. In Rybnaya Sloboda district, it was possible to reduce total mortality by 11% in 2015. In the last three years in the Republic of Tatarstan mortality from circulatory system diseases is decreasing, including mortality from stroke which reduced by 1.25 times (or by 25%). In Rybnaya Sloboda district mortality from circulatory system diseases decreased by 2.48 times, from myocardial infarction by 1.83 times, from stroke by 2.29 times. Mortality of working-age population from stroke was not registered in 2015.

Conclusion. The implemented program has demonstrated its efficacy: due to undertaken activities in 2015 it was possible to reduce total mortality in Rybnaya Sloboda district, mortality of working-age population including that from stroke.

Kazan medical journal. 2016;97(5):764-770
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Health risk assessment for adolescents depending on environmental factors and lifestyle
Efimova N.V., Myl’nikova I.V.
Abstract

Aim. To assess the risk of developing non-carcinogenic health disorders in adolescents depending on environmental factors and lifestyle.

Methods. Calculation of daily doses in inhalation exposure of substances was performed according to the monitoring data of The Federal Service for Hydrometeorology and Environmental Monitoring of Russia (ambient air of Angarsk) in 2003-2014 and the results of the control of impurity levels (formaldehyde, carbon monoxide, nitrogen dioxide, suspended solids) in ambient air, as well as in the air of study rooms and living accommodations, conducted in the laboratory of physical and chemical methods of investigation. The study of the impact of lifestyle factors was performed according to the results social hygienic survey of adolescents. Health problems in adolescents were identified as a result of the medical examination conducted with the participation of the pediatrician, ophthalmologist, otolaryngologist, neurologist, orthopedist, endocrinologist.

Results. It has been established that the risk of non-carcinogenic effects for adolescents of industrial city and suburban villages was caused by the presence of formaldehyde and suspended solids, mainly in indoor air. For adolescents living in areas with low exposure, the health risks were associated with the concentration of suspended solids in ambient air and indoor air. The adverse impact of lifestyle factors was observed only in urban adolescents. High relative risk of scoliosis, valgus feet, and flat feet was found for adolescents with insufficient physical activity, myopia - for those with long-term working at a computer.

Conclusion. The results are indicative of the specificity of the effects of combined factors (ambient air pollution and lifestyle) on the developing body; adolescents living in the city have higher relative risk of diseases of the upper respiratory tract, musculoskeletal system, visual organs, and autonomic dysfunction syndrome.

Kazan medical journal. 2016;97(5):771-777
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Retracted: Experience of cooperation in the creation of hematopoietic stem cells donors registry
Murzabekova M.A., Neredko J.S., Marchenko Y.M.
Abstract

This article has been retracted.


Aim. To evaluate the experience of participating in the creation of a national registry of hematopoietic stem cells donors.

Methods. Potential hematopoietic stem cells donor filled out a questionnaire, after the examination, he was assigned an individual donor code (bar code). The results of typing and questionnaires are placed on the registry of potential hematopoietic stem cells donors. Maintenance of HLA-typed potential hematopoietic stem cells donors registry and the selection of compatible «donor-recipient» pairs in RMSPC «Rosplazma» were performed using a specialized program «Prometheus» (Steiner Ltd., Czech Republic).

Results. 484 donors, who were indigenous peoples of Stavropol and Stavropol Krai, as well as representatives of the North Caucasus small nations of different nationalities, were included into the registry for the period from 08.20.2013 to 20.06.2014. Age ranged from 19 to 42 years. As of 31.10.2015, 31 491 potential hematopoietic stem cells donors (54% - female, 46% - male) were included into the registry, 28 509 donors were typed: 24 310 for HLA - A, B, C, and DRB1 loci; 2305 for HLA - A, B, C, DRB1, and DQB1 loci; 1894 for HLA - A, B, and DRB1 loci. The registry has the highest number of A-B-DRB1 typed donors among Russian registries. New HLA-alleles in the Russian populations were revealed in 57 cases for 28 509 typing (1:500).

Conclusion. There is a clear need to enhance cooperation of RMSPC «Rosplazma» with all regions of Russia and create unified national registry of hematopoietic stem cells donors with its inclusion in international databases.

Kazan medical journal. 2016;97(5):777-780
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Comparative assessment of morbidity of the population above working age in the Russian Federation and Novosibirsk region
Pogodina V.A., Babenko A.I., Babenko E.A., Gusel’nikova N.A.
Abstract

Aim. To conduct a comparative analysis of the overall morbidity of the population above working age (55 years for women and 60 years for men) in the Russian Federation and Novosibirsk region according to the data of patient attendance in 2009-2014.

Methods. The method of computing the mean value with amplitude of fluctuations by years, the analytical method were used. The data of official statistical compilations: Federal State Statistics Service (Rosstat), «Healthcare in Russia» and «Russian Statistical Yearbook» were analyzed.

Results. The difference in increase in the morbidity rate between the Russian Federation (42.4‰), and the Novosibirsk region (85.8‰) was 43.4‰, with difference of 36.0‰ in the value fluctuation amplitude by years. The main differences in the prevalence of diseases in the Russian Federation are characterized by higher rates of musculoskeletal system and connective tissue disorders, diseases of the skin and subcutaneous tissue, urogenital disorders, diseases of the ear and mastoid process (an increase by 23.2; 19.5; 18.9 and 12.8%, respectively), and in the Novosibirsk region - diseases of the blood and blood-forming organs, endocrine disorders, neoplasms, certain infectious diseases, injury and poisoning, digestive system diseases (by 33.3; 28.1; 16.8; 14.9; 13.5 and 11.1%, respectively).

Conclusion. Morbidity of the population above working age is higher in the Novosibirsk region; the differences in the indices of morbidity structure between the Russian Federation and the Novosibirsk region were identified.

Kazan medical journal. 2016;97(5):780-783
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Assessment of the body’s nonspecific defense in workers exposed to noxious factors of chemical and petrochemical industry
Sabitova R.I., Kravets E.D., Galiullina E.F., Shakirov D.F., Kamilov F.K., Buliakov R.T., Samsonov V.M., Enikeev D.A.
Abstract

Aim. To study the processes of free-radical oxidation, antioxidant defense, energy metabolism, electrolyte metabolism, and cytokine system reflecting the state of the non-specific defense of the body in workers exposed to complex of toxic substances under the conditions of manufacturing, substantiating the importance of indicators of preclinical diagnosis of disease development risk.

Methods. The study included 90 workers of JSC «Experimental Plant Neftekhim», 95 workers of JSC «Kaustic» and 101 workers of JSC «Ufa plant of elastomeric materials, products and structures». Materials for the study were blood, mixed saliva, gingival fluid and urine. The laboratory studies were performed to evaluate the free radical oxidation processes, antioxidant defense, energy metabolism, electrolyte metabolism, and cytokine system. Taking into account the features of industrial factors, particularly their effects on the workers bodies, routes of toxic compounds entry by inhalation, oral cavity and skin of the hands, three professional groups were formed (A, B, C). Group A included employees having constant contact with chlororganic compounds. The group B included persons who have constant contact with the higher and lower aromatic hydrocarbons. A group C consisted of employees who have constant contact with a mixture of chemicals: rubber compound containing carcinogens - benzo(a)pyrene, NDMA, nitrosodiethylamine; white carbon black, rubber dust, talc, amine compounds, sulfur dioxide, carbon monoxide. The control group consisted of employees of administrative and managerial staff.

Results. The study revealed that one of the major pathogenetic mechanisms of action of chemical and petrochemical industry hazards is activation of free radical oxidation.

Conclusion. Among the mechanisms of the influence of chemical contaminants of working environment a leading role play intensification of free radical oxidation processes, failure and/or inhibition of the antioxidant defense components.

Kazan medical journal. 2016;97(5):784-792
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Clinical observations
Stress myocardial injury after arthroscopic surgery
Gadzhieva L.R.
Abstract
Any surgery can cause the body’s stress response, which is initiated by tissue damage, with the participation of neuroendocrine factors leading to the development of tachycardia, hypertension, increased myocardial oxygen demand, stimulating the activation of free radical oxidation processes, metabolic disorders, and myocardial energy supply. Currently there are reasons to believe that the stress reaction can both aggravate injuries caused by surgical intervention and complicate the postoperative process, reducing the overall efficiency of therapeutic measures. A clinical case of stress myocardial injury with the development of left ventricular heart failure and pulmonary edema in young men in the early postoperative period after arthroscopic resection of the medial meniscus of the right knee joint is presented. The advantage of echocardiography in the diagnosis of left ventricular systolic dysfunction, accompanied by an increase in the cavity, a significant deterioration in the global and regional myocardial contractility, as well as the development of acute valvular insufficiency is described.
Kazan medical journal. 2016;97(5):793-796
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Difficulties in diagnosis of addisonian crisis in primary adrenal insufficiency
Oslopov V.N., Oslopova J.V., Makarov M.A., Khasanov E.N.
Abstract
The observation of a rare case of Addisonian crisis, which developed in 28-year old patient with asymptomatic hypocorticoidism in a stressful situation and was fatal, is described. In patient with left-sided interrupted tubal pregnancy after recovery from anesthesia after a successful laparoscopic tubectomy, shock blood pressure lowering happened, an acute left ventricular heart failure occurred. Addisonian crisis developed under stress conditions (pregnancy, rupture of the fallopian tube, culdocentesis, anesthesia, performed surgery) amid the previously undiagnosed primary adrenal insufficiency due to congenital hypoplasia of the adrenal cortex. During the autopsy there was found hypoplasia of fasciculate and reticular zones of adrenal cortex, which formed only about 40%, while normally form 85% of the adrenal cortex. Under stress (in the presence of normal adrenal glands) fasciculate zone must significantly increase in size (and account for more than 75%), while in patient who was under the severe stress they accounted for only 10-20% of the adrenal cortex. Adrenal insufficiency was not recognized. The patient has no hyperpigmentation and hyperkalemia, which confirms the conclusion of primary adrenal insufficiency. Therapeutic measures were reduced to the administration of low-dose prednisone, sympathomimetic drugs and liquid. Due to the possible existence of forms of the adrenal insufficiency with mild manifestations, there should be an awareness in terms of possible hypocorticoidism in case of development of hemodynamic instability in response to stress, despite intensive infusion therapy and administration of adrenergic drugs. In such cases, it is necessary to administer, perhaps ex juvantibus, high doses of glucocorticoids, which at the correct diagnosis match «as the key to the lock», and at the same time are safe for use. In the treatment of shock of various etiologies, there is a need for wider use of glucocorticoid therapy using high doses of hormones.
Kazan medical journal. 2016;97(5):797-800
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Clinical experiences
Self-expanding nitinol stent in combined treatment of bleeding from esophageal varices
Loginov A.V., Mamkeev E.K., Anisimov A.Y.
Abstract

Aim. To assess the capabilities of endoscopic hemostasis using self-expanding nitinol stents as an alternative to balloon tamponade using Sengstaken-Blakemore probe-obturator in the combined treatment program of patients with acute bleeding from esophageal varices.

Methods. In 15 of the 266 patients with portal hypertension of various origins and with high risk of rebleeding (or at the height of the latter) endoscopic hemostasis with Danis self-expanding nitinol stents was performed instead of the traditional balloon tamponade using Sengstaken-Blakemore probe-obturator.

Results. In all 15 cases, the Danis stent was inserted under intravenous general anesthesia with preservation of spontaneous breathing, using direct laryngoscopy. 5 of the 15 inserted by the manufacturer’s instructions stents (33.3%) migrated into the stomach: 1 did not deploy at all, 4 were in the expanded form. 10 (66.7%) stents were successfully inserted in a standard position in the esophagus without any complications. This was confirmed endoscopically immediately after the delivery device removal. In 2 of 4 patients who was inserted Danis stent at the height of esophageal bleeding, a reliable hemostasis was achieved. In none of the 15 cases, we did not observe any complications associated with the presence of the stent in the esophagus or its removal procedure. 4 of 15 patients (26.7%) died, despite the achieved endoscopic hemostasis, against the background of progressive multiple organ failure.

Conclusion. Endoscopic hemostasis in a combined treatment program of patients with bleeding from esophageal varices using Danis self-expanding nitinol stents can be considered as a reasonable alternative to balloon tamponade using Sengstaken-Blakemore probe-obturator.

Kazan medical journal. 2016;97(5):801-805
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Studying the microbial landscape of peritoneal exudate in acute diffuse purulent peritonitis
Kemerov S.V., Dorzhieva T.S., Stepin D.A., Kemerova Z.S.
Abstract

Aim. To study current trends in changing microbial landscape of peritoneal exudate for improving treatment outcomes, as well as the generalization of the methods of predicting fatal outcomes of postoperative peritonitis, its etiological and pathogenetic treatment.

Methods. A bacteriological study of peritoneal exudate in 60 patients with purulent peritonitis at toxic and terminal phases, who were treated in the department of purulent surgery, and their comparison with the results obtained 10 years ago were performed. Laboratory testing was performed, APACHE II (Acute Physiology And Chronic Health Evaluation - scale for the evaluation of various acute and chronic diseases), Mannheim peritoneal index, albumin-globulin ratio, leukocyte index of intoxication were calculated.

Results.During the 10-year period change in the microbial landscape of peritoneal exudate in patients with postoperative peritonitis was registered, with a statistically significant decrease in representation of Enterobacter, Staphylococcus, Escherichia coli, Pseudomonas aeruginosa bacteria, and increase in representation of Streptococci, Enterococci and anaerobic gram-negative cocci, Citrobacter, Klebsiella. Study results of microflora sensitivity to antibiotics showed that the vast majority (over 90%) of peritoneal infection pathogens has full or partial resistance to all antibiotics; antimicrobial effect increased in case of combined treatment using two or three drugs with a synergistic effect. With a decrease in the albumin-globulin ratio by 0.1 from 1.5 the mortality rate increased by 5-10%, and in patients with multiple organ failure was doubled (p

Conclusion. Prediction of postoperative peritonitis, complications and outcomes allows their timely prevention and treatment; basic conditions of preventing peritonitis are primary qualitative debridement of the abdominal cavity, the right choice of surgical volume, starting adequate antibiotic therapy, qualified perioperative anesthetic management and a complex of adequate pathogenetic treatment.

Kazan medical journal. 2016;97(5):806-811
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Jubilees
65 years to Professor Nikolay Sergeevich Strelkov
 
Abstract
Kazan medical journal. 2016;97(5):812-813
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Obituary
Acadimician Eduard Nazipovich Sitdykov
 
Abstract
Kazan medical journal. 2016;97(5):814-815
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Professor Almaz Askhatovich Akhunzyanov
 
Abstract
Kazan medical journal. 2016;97(5):815-816
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