Open Access Open Access  Restricted Access Access granted  Restricted Access Subscription Access

Vol 102, No 5 (2021)

Cover Page

Full Issue

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Theoretical and clinical medicine

Features of venous blood circulation and valve function in the lower extremities according to duplex scanning data and morphofunctional studies

Ignatyev I.M., Evseeva V.V., Ahunova S.Y., Gradusov E.G.


Aim. To study the mechanisms of venous return and the functioning features of lower extremity venous valves in horizontal and vertical positions.

Methods. The study, conducted from April 2019 to December 2020, included 100 people. The study participants were divided into 2 groups. The first group was represented by 44 patients (88 limbs) with varicose veins, whose venous system was examined by duplex ultrasound scanning during inpatient rehabilitation. The second (control) group consisted of 56 healthy individuals (92 limbs) without visible signs of venous pathology who underwent an outpatient examination of the venous system. The average age of the patients in the two groups was 49.2±2.4 and 51.1±1 years, respectively; women predominated in both groups. The qualitative and quantitative parameters of venous blood flow were studied in the study. Venous valvular insufficiency was assessed by using reflux duration and the Psatakis index. A morphometric study was conducted on 140 limbs of 48 human corpses, from which venous fragments were taken for biomechanical studies of the valves. The clinical characteristics of patients are presented by descriptive statistics, quantitative parameters are reported as the mean value (M) and standard deviation (SD). The differences were tested for significance by using the Student's t-test.

Results. In the study, we introduced the concept of the valve index, the aspect ratio of the ellipse, the shape of which has a venous valve in cross-section. Duplex ultrasound scanning, as well as a morphofunctional examination of the valves, made it possible to establish that the valve index is significantly higher in the presence of signs of varicose veins, which indicates dilation and incipient varicose vein, which leads to valvular insufficiency. The elasticity index defined by us, as the indicator of change in the venous lumen size, measured by the ratio of its diameters, also significantly (p=0.034) differed in the studied groups: the elasticity index in the group of healthy people was 1.37±0.11, in the group of patients with varicose veins — 1.56±0.17. The studied factors allowed us to develop a test that has an important prognostic value for the early diagnosis of varicose veins as well as the implementation of preventive health measures.

Conclusion. The features of venous blood circulation and valve function studied in the study not only have prognostic value for the early diagnosis of varicose veins but are also of practical interest for developing methods of surgical correction of venous valvular insufficiency.

Kazan medical journal. 2021;102(5):597-605
pages 597-605 views

The structure and features of the course of chronic kidney disease in patients with coronary heart disease and comorbid diseases

Sigitova O.N., Bogdanova A.R., Kim T.Y.


Aim. To investigate the prevalence, structure, and features of the course of chronic kidney disease (CKD) in patients with coronary heart disease (CHD) associated with comorbid diseases.

Methods. The observation group consisted of 257 patients of the Interregional Clinical Diagnostic Center (Kazan) with coronary heart disease (2014–2018): 183 males and 74 females, aged from 38 to 95 years (mean age 61.8±0.6). Observation program: clinical examination; serum creatinine and lipid profiles, the albumin/creatinine ratio in a single portion of urine, morning urine osmolality, glomerular filtration rate estimated by the CKD-EPI; renal scintigraphy, ultrasonography of the kidneys, renal Doppler ultrasound and angiography. Chronic kidney disease was diagnosed if one of the criteria was met: the glomerular filtration rate <60 ml/min/1.73 m2 or the ratio of albumin to creatinine in urine (ACR) >30 mg/g. Statistical analysis was performed by using the methods of variational statistics: determination of the arithmetic mean (M), standard error of the mean (m) and difference significance according to the Student's test (t).

Results. Examination of patients revealed the following comorbid diseases and syndromes: hypertension (90.7%), hyper- and dyslipidemia (96.5%), overweight/obesity (74.3%), diabetes mellitus (17.9%), chronic heart failure stages I–IIa according to Strazhesko–Vasilenko classification (100%). 164 (63.8%) patients were first time diagnosed with chronic kidney disease: hypertensive nephropathy — in 66.4%, ischemic renal disease — in 21.9%, diabetic nephropathy — in 2.4%, a combination of diabetic and hypertensive nephropathy — in 9.3%. 51.2% of patients had stage 2 of chronic kidney disease, 42.1% — stage 3, 6.7% — stage 4 or 5. A feature of chronic kidney disease is its latent course (absence of complaints and clinical manifestations) and, as a consequence, unidentified diagnosis at the prehospital stage, which is generally characteristic of secondary nephropathies in cardiovascular diseases and these comorbid conditions.

Conclusion. Chronic kidney disease was first diagnosed in 63.8% of patients with coronary heart disease with 1 to 5 comorbid diseases; a feature of chronic kidney disease is its secondary nature, the course of the disease is hidden by underlying and/or comorbid disease and, as a result, its late diagnosis.

Kazan medical journal. 2021;102(5):606-613
pages 606-613 views

Comparative efficacy of enalapril and valsartan in heart failure with mid-range ejection fraction

Glebova T.A., Galin P.Y.


Aim. To compare the effectiveness of the angiotensin-converting enzyme inhibitor enalapril and the angiotensin II receptor antagonist valsartan in patients with heart failure with mid-range ejection fraction (HFmrEF) from the standpoint of the effect on the clinical picture, echocardiographic parameters and the level of the N-terminal fragment of the prohormone brain-type sodium (NT-proBNP).

Methods. 110 patients with heart failure with mid-range ejection fraction were included in the study based on the City Clinical Hospital named after N.I. Pirogov of Orenburg between 2018 and 2020. All patients were divided into two randomized groups. Patients of the first group (n=55) were prescribed enalapril, the second group (n=55) — valsartan. Each patient was followed up for 1 year. The six-minute walk test, NT-pro-brain natriuretic peptide level, echocardiography parameters were assessed in dynamics. Statistical analysis was performed by using Statistica 10.0 software, Shapiro–Wilk, Mann–Whitney, Wilcoxon tests.

Results. During the year of observation in both groups, there was a significant decrease in the functional class of chronic heart failure (p <0.005) without a statistical difference between the groups (p=0.251). The distance during the six-minute walk test increased from 350 (310–400) m to 490 (420–530) m (p <0.001) in the first group, from 360 (330–400) m to 510 (450–520) m (p <0.001) in the second group, also without significant differences (p=0.361). The NT-pro-brain natriuretic peptide level decreased from 491 (410–610) pg/ml to 286 (187–350) pg/ml (p <0.001) in the first group, and from 446 (376–534) pg/ml to 210 (143–343) pg/ml (p <0.001) in the second, with a more significant change in the second group (p=0.020). The dynamics of echocardiography parameters were comparable in the groups (p >0.05), while ejection fraction normalized in 89.1% of patients received enalapril and 92.7% of patients received valsartan.

Conclusion. The efficacy of enalapril and valsartan in heart failure with mid-range ejection fraction is comparable in its effect on the clinical picture and echocardiography parameters with a more pronounced decrease in NT-pro-brain natriuretic peptide when taking valsartan during a year of follow up.

Kazan medical journal. 2021;102(5):614-620
pages 614-620 views

Blood group genotyping in multi-transfused patients

Mineeva N.V., Krobinets I.I., Gavrovskaya S.V., Bodrova N.N., Sisoeva E.A., Chechetkin A.V., Bessmeltsev S.S.


Aim. To assess the possibility of using blood group genotyping in recipients who received transfusions for 3 months.

Methods. The study included blood samples from 95 patients who received 3 or more erythrocyte transfusions within 3 months. The patients had the following diagnoses: multiple myeloma (n=7), beta thalassemia (n=4), non-Hodgkin's lymphomas (n=11), chronic myeloid leukemia (n=16), primary myelofibrosis (n=9), myelodysplastic syndrome (n=22), acute leukemia (n=21), aplastic anemia (n=5). Red blood cells phenotyping was performed in Diaclon Rh Subgroups+K Gel Cards. The Rh and Kell genotyping was performed by using RBC SSP-PCR kits — FluoGene vERYfy (Inno-train Diagnostics, Germany). The standard RHD/RHCE alleles, as well as polymorphisms associated with KEL1/KEL2 [T698C (Met198Thr)] of the KEL gene were genotyped.

Results. The concordance rate between serological and molecular genetic typing of RhCE and Kell blood groups for donors was 100%, while the patient´s results were discordant in 45.3% of cases. Discrepancies in antigens of the Rh system were registered in 41 patients: one antigen of the Rh system — in 30 patients, two — in 9 patients. Ten patients who had been previously phenotyped as RhCc were genotyped as RHCE*CC. 2 patients who had been previously phenotyped as Rhee were genotyped as RHCE*EE. In 2 patients, antigens D and C were not detected in the phenotype but were identified in the genotype. Discrepancies in antigen K were recorded in 2 patients, and the antigen was absent in the phenotype but was present in the genotype. The genotyping results were confirmed by serological typing at subsequent hospitalizations.

Сonclusion. Blood group genotyping is a useful adjunct to traditional methods when serological typing is limited.

Kazan medical journal. 2021;102(5):621-625
pages 621-625 views

Clinical and immunological features of opisthorchiasis

Sabitov A.U., Soldatov D.A., Khamanova Y.B.


Aim. To assess the clinical and immunological features in patients with chronic opisthorchiasis, depending on the duration of the infection.

Methods. The first group consisted of 19 patients with the duration of the infection up to 1 year, the second group consisted of 21 patients with the duration of the infection between 1 and 5 years, the third group was formed of 23 patients with the duration of the disease more than 5 years, the control group — 20 healthy individuals. Immunological research was carried out at the Clinical Diagnostic Center. Statistical processing was performed using Microsoft Excel 2010 and Statistica 6.0 software. The statistical significance of differences was determined by using the Mann–Whitney test (U-test) at the level of significance of p <0.05. The correlations were assessed by calculating Spearman's rank correlation coefficients.Results Clinical features of chronic opisthorchiasis were revealed in the disease duration groups of up to 1 year, from 1 year to 5 years, more than 5 years: the subclinical course was most common in the group of up to 1 year; cholangiohepatitis prevailed in the group of between 1 to 5 years, allergic skin syndrome, cholangiocholecystitis and pancreatitis dominated in the group of more than 5 years. The immune response in chronic opisthorchiasis was characterized by: up to 1 year — lymphocytosis, increased levels of immunoglobulins M (IgM) and circulating immune complexes (CIC), a decrease in the number of T-lymphocytes (CD3+), as well as an increase in bactericidal activity of leukocytes (BAL); between 1 and 5 years — monocytosis, increased levels of immunoglobulins M, immunoglobulins G and circulating immune complexes, a decrease in T-cytotoxic lymphocytes (CD8+) and nitro blue tetrazolium (NBT test), as well as an increase in NK cells and phagocytic activity of monocytes, more than 5 years — eosinophilia.

Conclusion. Common features of rearrangement of the immune system in opisthorchiasis: inflammatory changes in the hemogram, activation of humoral immunity with parallel suppression of the cellular component of the immune system, and increased phagocytosis.

Kazan medical journal. 2021;102(5):626-635
pages 626-635 views

Salivary growth factors in patients with chronic periodontitis

Bazarnyi V.V., Polushina L.G., Sementsova E.A., Maksimova A.Y., Svetlakova E.N., Mandra Y.V.


Aim. To determine the clinical value of the growth factors concentration in the oral fluid in patients with mild chronic periodontitis.

Methods. A prospective study including 30 patients with chronic periodontitis and 20 healthy volunteers was conducted. The diagnosis was made based on standard clinical and radiological criteria. Nerve growth factor β (NGF-β), hepatocyte growth factor (HGF), epidermal growth factor (EGF), vascular endothelial growth factor A (VEGF-A), platelet-derived growth factor BB (PDGF-BB) were determined in oral fluid samples by using multiparametric fluorescence analysis with magnetic microspheres (xMAP technology, Luminex 200, USA). Statistical analysis was performed using nonparametric measures: median (Me) and interquartile range (Q1, Q3). Receiver operating characteristic (ROC) analysis was used to determine the clinical value of the parameters.

Results. The chronic periodontitis was accompanied by an increase in the level of nerve growth factor-β by 2.2 times, epidermal growth factor by 3 times, vascular endothelial growth factor A by 1.9 times (p <0.05) compared with the control. The platelet-derived growth factor BB concentration did not change. Using the ROC analysis, diagnostic sensitivity and diagnostic specificity of the studied parameters were determined: 89.1 and 91.1% for nerve growth factor β, 92.3 and 96.1% for epidermal growth factor, 87.1 and 95.3% for vascular endothelial growth factor A, respectively.

Conclusion. Salivary growth factors (nerve growth factor β, epidermal growth factor, vascular endothelial growth factor A) can be considered as potential biomarkers of mild chronic periodontitis.

Kazan medical journal. 2021;102(5):636-641
pages 636-641 views

Experimental medicine

Effects of tranexamic acid and exogenous fibrin monomer on the liver injury area and systemic circulation in pharmacological suppression of platelet function in an experiment

Vdovin V.M., Momot A.P., Shakhmatov I.I., Bobrov I.P., Orekhov D.A., Terjaev V.V., Chernus' V.E., Kuznetsova D.V.


Aim. To identify and compare the morphological, hemostatic and hemostasiological consequences of intravenous administration of tranexamic acid and fibrin monomer in controlled liver injury against drug-induced thrombocytopathy.

Methods. The morphological features of fibrin formation in the area of liver injury after spontaneous bleeding arrest combined with the indicators of blood loss in the animals treated with intravenous placebo, tranexamic acid or fibrin monomer was studied in 69 male rabbits. The effects of these drugs were assessed against thrombocytopathy associated with the combined use of acetylsalicylic acid and clopidogrel. Platelet number and function (adnosine diphosphate-induced aggregation), the data of thromboelastometry and calibrated automated thrombogram, fibrinogen concentration and D-dimer level were considered in the blood test. The feature distribution in the samples was assessed using the Shapiro–Wilk test. Depending on the distribution, Student's t-test, Mann–Whitney U test or Wilcoxon signed-rank test were used to test for a significant difference between the features. Differences in mortality rate were established by using Fisher's exact test. The differences were considered statistically significant at p <0.05.

Results. A model of thrombocytopathy which showed decreased platelet aggregation function (by 4.5 times), increased blood loss (by 40%), and high mortality (53.9%) was reproduced. Only a small accumulation of thrombotic material was noted on the injured surface of such animals. The use of tranexamic acid led to decreased post-traumatic bleeding (2.5 times) and animal mortality (20%). The latter was provided on the wound surface by increasing the thickness of both thrombotic deposits and fibrin strands. When fibrin monomer was used, the phenomenon of an overcompensated decrease in blood loss (by 6.7 times) accompanied by zero mortality was noted despite a pronounced decrease in platelet aggregation. The maximum increase in the thickness of thrombotic material and fibrin strands was morphologically determined in the injury area compared with other animal groups.

Conclusion. Morphological features of traumatic hemostatic effect at the injured area when using tranexamic acid and fibrin monomer have a number of differences despite the similarity of the achieved results in minimizing blood loss.

Kazan medical journal. 2021;102(5):642-653
pages 642-653 views

Study of metabolic disorders in rats under exposure to hypobaric hypoxia and development of ­correction approaches by simultaneous action on different elements of pathogenesis

Semina I.I., Baychurina A.Z., Shilovskaya E.V., Tikhonova N.E., Nikitin D.O., Begichev E.V., Ovchinnikova A.G.


Aim. To study the indicators of metabolic changes in the blood and brain structures of rats after exposure to hypobaric hypoxia and to determine possible pharmacological approaches to correction these changes.

Methods. Hypobaric hypoxia in rats was simulated for 30 minutes in a pressure chamber, simulating an ascent to 8500 m. 3 and 24 hours after hypoxia, the activity of alanine aminotransferase, aspartic aminotransferases, alkaline phosphatase, creatine phosphokinase, lactate dehydrogenase, the content of glucose, total protein, triglycerides, cholesterol, β-lipoproteins, iron and uric acid were determined in the blood serum. The level of malondialdehyde in the hippocampus and frontal cortex was examined. The studies of the effect of 2-chloroethoxy-aryl-dimethyl-aminophenylphosphorylacetohydrazide (CAPAH) (1 mg/kg) and Рiracetam (100 mg/kg) after intraperitoneal injection 40 minutes before hypoxia and 1 hour after removing the rats from the pressure chamber were carried out. Statistical analysis was carried out using the GraphPad Prism software version 8.0.1, and the Student's t-test was used to test statistical significance.

Results. After 3 hours of hypobaric hypoxia, rats showed hyperenzymemia and dyslipidemia, the activity of almost all studied enzymes in the blood serum of rats was increased, the content of triglycerides was decreased, and the concentration of cholesterol was increased, the content of malondialdehyde in the hippocampus and frontal cortex was increased. In 24 hours after hypoxia, an increased level of creatine phosphokinase in the blood serum and malondialdehyde in the brain structures were noted. The use of 2-chloroethoxy-aryl-dimethyl-aminophenylphosphorylacetohydrazide prevented the development of hyperenzymemia, dyslipidemia and corrected the increased level of creatine phosphokinase after 24 hours; in both modes of administration, it reduced the serum level of malondialdehyde. Piracetam showed little effect only when administered prophylactically, preventing an increase in serum alkaline phosphatase activity and cholesterol levels.

Сonclusion. The revealed efficacy of 2-chloroethoxy-aryl-dimethyl-aminophenylphosphorylacetohydrazide and its previously studied complex mechanism of action suggest that 2-chloroethoxy-aryl-dimethyl-aminophenylphosphorylacetohydrazide is a potential drug for the prevention of hypoxic disorders and acceleration of adaptation to high-altitude hypoxia.

Kazan medical journal. 2021;102(5):654-662
pages 654-662 views

Effect of diet-induced hypercholesterolemia on metabolic processes in the heart, liver, and pancreas in rats

Mikashinovich Z.I., Romashenko A.V., Semenets I.A.


Aim. To analyze the biochemical changes in the cells of the heart muscle, liver and pancreas, as well as to establish their pathogenetic significance in diet-induced experimental hypercholesterolemia.

Methods. The study was conducted on 65 outbred male rats. During the experiment, the animals were divided into groups: the first (control, n=30) — animals that were kept on a general vivarium diet; the second (experimental, n=35) — animals with diet-induced hypercholesterolemia for three months by keeping on a special diet. At the end of the experiment, the concentrations of pyruvic acid, lactate, reduced glutathione, the activity of glutathione reductase, and glutathione peroxidase were determined in the tissues by using biochemical methods. The Student's t-test was used for the experimental data of the samples after normality testing.

Results. The analysis of energy metabolism indicators in animals with hypercholesterolemia relative to the control group revealed a lower level of pyruvic acid in the heart muscle (0.29±0.03 mmol/mg protein; p ≤0.05) and liver (0.25±0.02 mmol/mg protein; p >0.001). A significantly higher lactate level was recorded in all tissues, most pronounced in the liver (6.73±0.6 mmol/mg protein; p ≤0.001). The results obtained indicate the predominance of the anaerobic glycolysis in the tissues and the accumulation of incomplete-oxidation products. The study of the key glutathione-linked enzymes in animals with hypercholesterolemia relative to the control showed a lower activity of glutathione reductase in the pancreas — 0.52±0.05 mmol/mg protein/min (p ≤0.001), as well as its higher activity in the liver — 0.297±0.03 mmol/mg protein/min (p ≤0.001) and heart — 13.58±1.4 mmol/mg protein/min (p >0.001). The activity of glutathione peroxidase and reduced glutathione in all organs remained practically unchanged, or the differences were insignificant. This trend indicates a violation of the antioxidant defense system and oxidative stress.

Conclusion. Changes in the metabolic link of adaptive-compensatory responses in the cells of the heart muscle, liver, and, most pronounced in the pancreas, indicate the role of the pancreas as a “target organ” in the pathogenesis of diet-induced hypercholesterolemia.

Kazan medical journal. 2021;102(5):663-668
pages 663-668 views

Activation of reparative liver regeneration following the combined transplantation of multipotent mesenchymal stromal cells and hepatic stellate cells

Maklakova I.Y., Grebnev D.Y., Osipenko A.V.


Aim. To study the effect of combined transplantation of multipotent mesenchymal stromal and hepatic stellate cells on the reparative liver regeneration.

Methods. Laboratory mice were given intravenous administration of multipotent mesenchymal stromal and hepatic stellate cells after partial hepatectomy. The mice were divided into four groups: control, experimental 1 (injection of multipotent mesenchymal stromal cells), experimental 2 (co-transplantation of multipotent mesenchymal stromal cells and hepatic stellate cells), the comparison group. Comparison of the experimental groups with the control group and the comparison group was carried out. Each group consisted of 14 animals. The control and experimental groups underwent partial hepatectomy. The experimental mice were injected with the cells into the lateral tail vein 1 hour after the operation. Multipotent mesenchymal stromal cells were administered at a dose of 4 million cells/kg (120 thousand cells/mouse), hepatic stellate cells — in the amount of 9 million cells/kg (270 thousand cells/mouse), suspended in 0.2 ml 0.9% NaCl solution. The control group animals were injected with 0.2 ml 0.9% NaCl solution into the lateral tail vein. The comparison group consisted of mice without partial hepatectomy, injected with 0.2 ml 0.9% NaCl solution. To assess reparative regeneration of the liver, morphometric parameters of the liver, blood biochemical parameters on the 3rd and 7th days after partial hepatectomy were studied. The severity of apoptosis was assessed by the immunohistochemical method, the activity of deoxyribonucleic acid (DNA) repair enzymes of the poly (ADP-ribose) polymerases was determined by flow cytometry. The number of micronucleated hepatocytes was also determined. The hepatocyte growth factor (HGF) content was measured by using an enzyme-linked immunosorbent assay in serum. The significance of differences in the compared samples was determined by using the Student's t-test. Statistical data processing was performed by using the SPSS Statistics software version 17.0.

Results. It was found that the combined transplantation of multipotent mesenchymal stromal and stellate liver cells causes restoration of the activity of alanine aminotransferase (a decrease of 30.3%, p=0.016), aspartate aminotransferase (a decrease of 27.7%, p=0.021), alkaline phosphatase (a decrease of 21.1%, p=0.036), an increase in the protein synthetic function of the liver (increase in albumin level by 36.6%, p=0.009), an increase in hepatocyte growth factor level by 74.3%. These changes were accompanied by the restoration of liver morphometric parameters: there was an increase in the mitotic activity of hepatocytes by 28.7% (p=0.008), the nuclear area of hepatocytes by 26.7% (p=0.006), the number of binucleated hepatocytes by 26.1% (p=0.004), which led to the restoration of liver mass. There was a decrease in the level of apoptosis by 28.8% (p=0.006) and a decrease in the number of micronucleated hepatocytes by 22.7% (p=0.001) compared with the control group, which may be related to an increase in the activity of Poly (ADP-ribose) polymerase repair enzymes detected in the study. The deviations were presented as a difference relative to the indicators of the control group (operated animals that were injected with 0.9% NaCl solution).

Conclusion. Combined transplantation of multipotent mesenchymal stromal and hepatic stellate cells activates reparative liver regeneration after partial hepatectomy.Keywords: multipotent mesenchymal stromal cells, MSC, hepatic stellate cells, HSC, liver regeneration, partial hepatectomy.

Kazan medical journal. 2021;102(5):669-677
pages 669-677 views

Morphometrical observation on the left atrium in human adults

Gaponov A.A., Noskova M.E., Iakimov A.A.


Aim. To determine the left atrial dimensions, their ratios and relationships that characterize anatomy for left atrium structure in the normal human adult using the model of the atrial end-diastolic phase.

Methods. We studied 54 heart specimens of subjects aged 35–88 years who died from non-cardiac causes. The atrial end-diastolic phase was modeled by filling a specimen fixed in 1% formalin with liquid silicone. After silicone hardened, we performed morphometric measurements by a caliper. The data were processed by using a cluster, correlation and variance analysis. For pairwise comparison, we used the Mann–Whitney U-test or a ­two-sided t-test.

Results. The article presents mean, standard deviation, median, 25th percentile and 75th percentile and coefficients of variation for the length, width and sagittal size of the left atrium, as well as the values of the distances between the pulmonary vein orifices, which characterize the dimensions of the left atrium posterior wall. Based on the left atrial size differences and their ratios, the specimens were divided into three clusters. The first (n1=23) and second clusters (n2=10) were represented by hearts with a cubic atrium; the second group differed from the first in the larger size of the left atrium. The third cluster (n3=21) included the hearts in which the largest left atrium size was the width, so the shape of the atria resembled a parallelepiped. The typical number of the pulmonary vein ostia we found in 91% of the specimens. The posterior wall of the left atrium, with a common number and topography of the ostia, were rectangle or an unequal trapezium in shape. We analyzed correlations between the sizes of the heart, left atrium and its posterior wall. We concretized the conceptual apparatus concerning the nomenclature and terminology of the left atrium anatomical structures.

Conclusion. Based on the size ratio, two shape variations of the left atrium body can be identified: cubic or parallelepiped; cubic atria can be divided into large and small; the co-directional dimensions of the left atrial body and its posterior wall showed the strongest correlations.

Kazan medical journal. 2021;102(5):678-686
pages 678-686 views

Anatomical characteristics of myocardial loops in the adults

Dmitrieva E.G., Iakimov A.A.


Aim. To establish structural features and adjacent anatomy of myocardial loops in the adult and elderly human hearts.

Methods. We studied 100 hearts obtained from adult and elderly people who died from non-cardiac causes. We dissected subepicardial blood vessels and their intramural segments on 60 formalin-fixed hearts. The rate of the cone artery directly originating in the aorta (third coronary artery) was recorded. The number of myocardial loops, their localization and length were determined. We made histological sections from 40 heart specimens from areas of the coronary groove containing myocardial loops. The shortest distances from the coronary sinus and myocardium of the left atrium to the artery, the thickness of the loops, the cross-sectional area of the artery and perivascular space and the ratio of these parameters were measured. The statistical significance of differences was assessed by using the Mann–Whitney U-test. The relationship between the two qualitative features was identified using the Pearsons χ2 test. The Spearman’s rank correlation coefficient (R) was used for the correlation analysis.

Results. Macroscopically, myocardial loops were found in 12 (20%) hearts out of 60. More often, they were determined on specimens where the cone artery directly originating in the aorta. Histological examination revealed myocardial loops in 10 (25%) hearts out of 40. They were located above the arteries accompanying the coronary sinus. Their length varied from 8.5 to 44.53 mm (Me=16.68 mm), thickness from 0.16 to 0.58 mm (Me=0.31 mm). Two types of myocardial loops (arterial and arteriovenous), differing in thickness (p=0.045), were distinguished.

Conclusion. The myocardial loops are predominantly located on the diaphragmatic surface of the heart in the left half of the coronary groove over the arteries accompanying the coronary sinus, while the artery can pass in the myocardial loop separately from the veins or in the “sleeve” of the coronary sinus; the presence of myocardial loops is associated with the independent aortic origin of the cone artery.

Kazan medical journal. 2021;102(5):687-693
pages 687-693 views


Methodological aspects of creation of patient-derived tumor xenografts

Goncharova A.S., Shevchenko A.N., Dashkova I.R., Anisimov A.E.


High rates of cancer incidence and mortality from malignant neoplasms remains an urgent health problem. The development of the most effective therapeutic algorithms is required to improve the survival of cancer patients. An important condition for the discovery of new anticancer drugs and their translation into clinical practice involves the ability to model tumor growth, reproduce the characteristics of human disease, and evaluate measurable effects of pharmacological substances in laboratory facilities. Xenograft models established by direct implantation of fresh tumor tissue samples from individual patients into immunodeficient mice are considered suitable for both preclinical trials and for solving fundamental problems in oncology. The review highlights the significance of patient-­derived xenograft models as a platform with high predictive value and the prerequisites that make them the preferred tool for research in cancer biology. The most important methodological aspects in the creation of these models are considered. Methods for obtaining and preparing biological tumor samples for xenotransplantation are discussed. The significance of the immune status, as well as the phenotypic and genetic characteristics of recipient animals, is described. The article presents the limitations of animal models associated with their immunodeficiency status and ways to overcome them. The principles for choosing xenotransplantation sites (heterotopic and orthotopic) and their advantages and disadvantages are discussed. In conclusion, we emphasize the need to continue the work on optimizing PDX (Patient-Derived Xenograft) models to overcome their limitations and to obtain the most reliable and valuable research results in oncology.

Kazan medical journal. 2021;102(5):694-702
pages 694-702 views

Lung lesions caused by COVID-19 in comparison with bacterial pneumonia and influenza pneumonia: pathomorphological features

Gainetdinov R.R., Kurochkin S.V.


This review aimed to summarize the literature data regarding the pathomorphology of lung lesions in COVID-19 and compare it with lung lesions in bacterial pneumonia and pneumonia caused by influenza virus. The analysis of scientific literature containing studies of domestic and foreign authors of different years related to morphology and anatomical pathology of lung injury was carried out. Special attention was paid to the data devoted to COVID-19 obtained between 2019 and 2021. Based on the study, the main aspects of lung lesions were identified and grouped into blocks depending on the etiology of the process. The review collects and summarizes information on etiology, pathogenesis and stages of disease development, outcomes and morphological picture during the autopsy of patients with bacterial pneumonia, influenza pneumonia and COVID-19 pneumonia. The common features and differences in the course, outcomes and typical morphological findings, most characteristics for each of the diseases were presented in the table. There is a great similarity of morphological findings in influenza pneumonia and COVID-19 pneumonia despite the background of the difference in their epidemiology. Most Russian and foreign authors agree that a key factor in the pathogenesis of the development of COVID-19 is the presence of a specific receptor-mediated pathway of penetration into the cells of the respiratory epithelium. According to most authors, the main morphological difference that determines the severity and unfavorable outcome of COVID-19 is angiopathy and microthrombosis of the pulmonary capillary bed, which aggravate the typical picture of viral pneumonia.

Kazan medical journal. 2021;102(5):703-715
pages 703-715 views

Features of tumor heterogeneity in regional metastasis of breast cancer

Konyshev K.K., Sazonov S.V.


The review looked at the issues of tumor heterogeneity in breast cancer. Tumor heterogeneity is classified according to the main feature demonstrating regional differences within a tumor (for example, heterogeneity of clinical manifestations, histological heterogeneity, heterogeneity of protein expression, etc.) and by tumor regions (differences between primary tumors and metastases, differences between cell clones within a single tumor node, etc.). Temporal heterogeneity is also distinguished, which manifests itself in the clonal evolution of tumor cells. The review covers the heterogeneity in the expression of four biomarkers from the “gold standard” for immunohistochemical staining of breast cancer: estrogen receptors, progesterone receptors, Her2/neu and Ki67 in primary tumor tissue and regional metastases. According to various studies, discordance in estrogen receptor status of primary tumor cells and metastases was observed with a frequency of 4 to 62%, progesterone receptors — from 12 to 54%, Her2/neu — from 0 to 24%, Ki67 — from 4 to 39%. The results of studies of changes in the expression levels of individual markers in breast cancer metastases, as well as the heterogeneity of surrogate subtypes of tumor tissue in metastasis, are briefly described. Possible reasons for heterogeneity in the expression of key prognostic and predictive markers by primary tumor and metastatic cells, such as artificial factors at the preanalytic and analytic stages of the study, polyclonality of the primary tumor before metastasis, clonal evolution of tumor cells during metastasis, selection of tumor clones under the therapy are highlighted.

Kazan medical journal. 2021;102(5):716-725
pages 716-725 views

Social hygiene and healthcare management

The results of the state population policy in the field of rehabilitation, medical and social expertise, social insurance, labor and employment of work-injured people

Sevastianov M.A., Bozhkov I.A., Vladimirova O.N., Didelev A.V., Goryainova M.V.


Aim. To study the indicators of industrial injuries and occupational morbidity in the Russian Federation and the effectiveness of measures for the professional rehabilitation of injured workers in the context of the implementation of state programs aimed at enhancing the labor force and employment.

Methods. The analysis of statistical indicators on the number of workers, insured and injured at work from 2007 to 2018 and the results of measures for victim rehabilitation between 2014 and 2019, using data from Rosstat, reporting form No. 7 — social security and open data of the social insurance fund. Descriptive statistics were used in the analysis.

Results. The level of employment of disabled people planned by the Government of the Russian Federation by 2020 at the level of 40% in relation to people who are injured at work has not been achieved. At the same time, about 80% of the injured person had mild and moderate dysfunctions, about 50% were of working age. Against this background, employment at the level of 0.2 to 6.6% per year indicates the insufficient effectiveness of vocational rehabilitation. In most EU countries, where the return to work rate for work-injured people exceeds 90%, the employer and the insurer jointly participate in the professional rehabilitation of the injured, applying and financing all the necessary organizational and rehabilitation measures. In the Russian Federation, measures for occupational adaptation, maintenance of employment and the creation of special jobs are not subject to reimbursement from insurance funds, only educational events are financed. An employer who has caused harm to the health of work-injured is not economically interested in restoring his professional status. The authors encouraged to amend the regulations of the Russian Federation to ensure financing of the entire range of measures for vocational rehabilitation and the economic interest of employers in restoring the occupational status of work-injured people.

Conclusion. Despite the favorable decreasing trend of industrial injuries and occupational morbidity at the enterprises of the Russian Federation over the past 12 years, the number of industrial injuries with permanent disability remains high, and the effectiveness of their vocational rehabilitation is low, which requires an expansion of the list of measures for vocational rehabilitation financed from the social insurance fund and ensuring the economic interest of employers in restoring the professional status of work-injured people.

Kazan medical journal. 2021;102(5):726-735
pages 726-735 views

Ethnicity as a model for the development of cardiovascular diseases and their risk factors in epidemiological studies

Mulerova T.A., Ogarkov M.Y., Tsygankova D.P., Kazachek Y.V., Polikutina O.M., Barbarash O.L.


Aim. To assess the indigenous small population of the Shor people in terms of the ethnic-specific development of cardiovascular diseases and their risk factors during the epidemiological studies in the Mountain Shoria.

Methods. The study was carried included the indigenous and non-indigenous population of the Mountain Shoria during two different time periods: the first period (1998–2002) — 1215 people (550 indigenous Shors and 665 non-indigenous people) and the second period (2013–2017) — 1409 people (901 and 508, respectively). The prevalence of cardiovascular risk factors, arterial hypertension (AH) and ischemic heart disease (CHD) was studied. In the second period of the study, the genotype frequencies of the genes ACE (I/D, r 4340), AGT (c.803T>C, rs699), AGTR1 (A1166C, rs5186), ADRB1 (c.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c.677C>T, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) and their associations with arterial hypertension were identified. There was data on organ damage obtained among patients with high blood pressure (left ventricular myocardial hypertrophia, carotid arteries intima-media complex thickening, albumin level).

Results. The first period of the studies showed that the Shors differed from the incoming population in an extremely low prevalence of lipid metabolism disorders, obesity, and an almost complete absence of diabetes mellitus. At the same time, there was a high prevalence of tobacco smoking and alcohol consumption. The second period of the studies demonstrated significant differences between different ethnic cohorts according to the “genetic passport” towards a more favorable profile among the indigenous people. However, the Shor people with arterial hypertension had a more severe course of hypertensive disease, defined as frequent organ damage. In addition, the “profile” of a patient with coronary heart disease differed depending on the place of residence, in urban or rural. Epidemiological studies contribute to the acquisition of new knowledge about different ethnic groups, their lifestyles and agricultural practices, regions of residence, and the features of candidate gene polymorphism. This provides valuable material for individualizing the prevention and treatment of diseases.

Conclusion. Ethnicity makes adjustments to the patient's profile; understanding the ethnic specificity allows developing targeted preventive measures, thereby preserving the people’s health.

Kazan medical journal. 2021;102(5):736-746
pages 736-746 views

Clinical observations

Prolonged QT interval on electrocardiogram and fainting — is there always a relationship?

Mishanina Y.S., Oslopov V.N., Oslopova Y.V., Teregulov Y.E., Khazova E.V.


Using a clinical example, the article draws the attention of doctors to the problem of the prolonged QT interval (“long QT”) and the related problem of fainting (syncope). Syncope is a component of long QT syndrome, and syncope is a precursor of sudden cardiac death. However, syncope in a patient with long QT syndrome may have pathogenesis that is completely unrelated to abnormalities of cardiac ion channels. In other words, such a patient may have a second disease as a syntropy relates to prolonged QT interval, to an extent mimicking long QT syndrome. The presented medical history of a 33-year-old patient S. shows the complexity of differential diagnosis of the causes of syncope. The crucial part in the diagnosis, in addition to the clinical picture, was the so-called “tilt test”, little-known to general medical practice, as well as the laboriousness of making a final diagnosis of the long QT Syndrome type 2, which required a molecular genetic study — whole-exome sequencing. Patient S. had vasovagal syncope that not associated with long QT syndrome, but she has a risk of sudden cardiac death, and the article identifies therapeutic and other measures to reduce this risk.

Kazan medical journal. 2021;102(5):747-750
pages 747-750 views

Clinical experiences

Complicated destructive appendicitis: finding the optimal treatment method

Malkov I.S., Mamedov T.A., Shakirov M.I., Filippov V.A.


Aim. To analyze the current practice for the surgical treatment of destructive acute appendicitis complicated by typhlitis and periappendicular abscess.

Methods. This study analyzed the treatment outcomes in 84 patients with acute destructive appendicitis aged 18 to 79 years who were treated in the Department of Surgery No. 2 of the City Clinical Hospital No. 7 of Kazan between 2016 and 2021 years. According to the method for completion of surgical intervention, patients were divided into 2 groups, similar in age, duration of the disease and morphological changes in the appendix. In the comparison group, 54 patients had the surgical intervention completed by gauze-glove drainage of the appendix bed. In 30 patients of the main group, the appendix stump and the adjacent intestinal wall was covered with a Tachocomb plate. Then the VAC system with the Vivano device and supplies from “Hartmann Group” (Germany) was connected. The statistical significance of the differences between the indicators was assessed by using the Student's t-test.

Results. The analysis of the surgical techniques used showed that in the main group, postoperative wound complications decreased by 3 times (23.3% of patients, p=0.04), intra-abdominal fluid collections decreased by 2 times (6.7% of patients, p=0.02), the hospital lengths of stay decreased by 1.8 times (p=0.02) compared with the comparison group.

Conclusion. The use of ligature appendectomy in combination with plastic closure of the appendix stump with a TachoComb and the technology of local vacuum-assisted laparostomy in patients with destructive appendicitis complicated by periappendicular abscess contributes to a 3-fold reduction in wound postoperative complications and reduces the hospital lengths of stay in this group of patients by 1.8 times.

Kazan medical journal. 2021;102(5):751-756
pages 751-756 views

Regional lymph nodes and hematogenous metastasis of cancer

Tsyplakov D.E.


Aim. Morphological study of the microvasculature of regional lymph nodes in relation to the cancer of the lymph nodes as possible additional or alternative metastasis pathways.

Methods. The lymph nodes of 150 cancer patients (1263 nodes in total), regional to cancer of various localization, were studied. Histological sections staining with hematoxylin and eosin by Van-Gieson’s method, pyronine by Brachet’s method, toluidine blue and picro-Mallory were prepared. An immunohistochemical study was performed using monoclonal antibodies to pan-cytokeratins, CD31, type IV collagen, CD3, CD20, and CD68. The area of metastases to the lymph nodes was determined by using a morphometric grid and used to identify the four study groups. In addition, the immunomorphological reactions of the lymph nodes were taken into account in each group.

Results. It was identified that the microvasculature of the lymph nodes can be involved in the metastatic process along with the lymphatic pathways. At the same time, there is a decrease in vascular wall function and violation of the rheological properties of blood, accompanied by the deposition of intra- and extravascular fibrin. Hematogenous metastasis is largely influenced by the state of lymph node sinuses, in which blood is found, and in some observations — by the expression of CD31 (a marker of blood endothelium). Hematogenous dissemination of cancer often begins after the appearance of lymph node metastases. The greater the anatomical extent of lymph node metastases, the more often tumor cells are present in the blood vessels. In addition, an isolated lesion of the microvasculature with the presence of tumor cells in the extranodal vessels without metastases in the lymph node itself was revealed. It was observed that the invasion of tumor cells into the microvasculature depended on the immunomorphological reactions of the lymph nodes.

Conclusion. The microvasculature of regional lymph nodes can be both an additional and an alternative lymphogenous metastasis pathway of cancer; at the same time, vascular invasion is accompanied by microcirculation disorders and depends on the volume of metastases and the immunomorphological reactions of the lymph nodes.

Kazan medical journal. 2021;102(5):757-764
pages 757-764 views

Indicators of lipid peroxidation and the activity of antioxidant system enzymes as predictors of the development of metabolic disorders in primary obesity

Nikishova T.V., Kurnikova I.A.


Aim. To assess the effectiveness of indicators of lipid peroxidation and the activity of antioxidant system enzymes in the early diagnosis of metabolic disorders.

Methods. The study included 269 women of fertile age with primary obesity. The control group consisted of 35 women. The clinical examination included identification of the type of obesity, whole-body fat percentage, the level of glycemia and the index of insulin resistance, biochemical markers of lipids, hormones (leptin and insulin), malondialdehyde and enzyme activity (peroxidase and catalase). The statistical significance of the differences was determined by using the inversion test. Spearman's rank correlation coefficient was used to assess the degree of relationship between quantitative characteristics, and scatter diagrams were used to compare two variables (Statistica software version 10.0).

Results. A statistically significant increase in basal and stimulated immunoreactive insulin was found in obese patients compared with the controls (p <0.01). Stimulated immunoreactive insulin levels, insulin resistance score (HOMA-IR) and the level of leptin in the group of patients with android obesity was higher than in the group with gynoid obesity (p <0.01). The relationship between the concentration of serum malondialdehyde and whole-body fat percentage was found to be more significant (r=0.412; p <0.001) than the relationship with the type of obesity (r=0.257; p <0.01). Positive correlations were found between serum malondialdehyde and insulin (r=0.35; p <0.001) and leptin (r=0.32; p <0.001) levels. The relationship between the concentration of serum malondialdehyde and the activity of enzyme systems was also noted. The activity of lipid peroxidation was higher in the group of patients with android obesity (malondialdehyde >3.3 μmol/L) compared with the group of patients with gynoid obesity. In the same group, a higher activity of enzyme systems was noted.

Conclusion. An increase in the concentration of serum malondialdehyde and the activity of enzyme systems should be considered as indicators of a high risk of developing metabolic syndrome.

Kazan medical journal. 2021;102(5):765-772
pages 765-772 views

Diagnostic capabilities of the biochemical composition of amniotic fluid in assessing fetal conditions

Fatkullina I.B., Lazareva A.Y., Fatkullina Y.N., Faizullina L.A., Stecenko N.A., Galeeva S.A.


Aim. To analyze the nature of changes in the biochemical parameters of amniotic fluid during fetal hypoxia.

Methods. The study was carried out in the maternity ward of the Republican Clinical Hospital named after Kuvatov (Ufa) between January 2016 and September 2018. The main group — 72 women in labor with symptoms of fetal distress, the control group — 70 women in labor without it. The biochemical composition of the amniotic fluid was measured using an analyzer. Statistical analysis was performed by using the Statistica 10.0 software. Comparison of qualitative characteristics was carried out by using Fisher's exact test when comparing quantitative data, the Mann–Whitney test. The statistical significance of the differences was set at p <0.05.

Results. It was found that in fetal distress, there is a decrease in such biochemical indicators of the composition of amniotic fluid as the level of triglycerides (0.2±0.1 and 0.3±0.1 mmol/L, p=0.0036) and cholesterol (0.1±0.16 and 0.3±0.2 mmol/L, p=0.0275), gamma-glutamyl transpeptidase activity (34.5±11 and 48.7±6.8 U/L, p=0.0261), while the level the lactate (in the main group 3.5±1.2 and 3.1±0.9 mmol/L in the control group, p=0.0035), glucose (1.2±0.6 and 0.6±0.3 mmol/L, p=0.0002) and nitrogenous substances such as urea (4.5±1.1 and 3.0±1.3 mmol/L, p=0.0018) increases.

Conclusion. The biochemical composition of amniotic fluid reflects the state of the fetus at birth, and therefore the study of the amniotic fluid is a relevant and accessible method.

Kazan medical journal. 2021;102(5):773-777
pages 773-777 views

Deriving electrophysiological phenotypes of paroxysmal atrial fibrillation based on the characteristics of heart rate variability

Markov N.S., Ushenin K.S., Bozhko Y.G., Arkhipov M.V., Solovyova O.E.


Aim. To analyze heart rate variability of patients with paroxysmal atrial fibrillation and identify electrophysio­logical phenotypes of the disease by using methods of exploratory analysis of twenty-four-hour electrocardiographic (Holter) recordings.

Methods. 64 electrocardiogram recordings of patients with paroxysmal atrial fibrillation were selected from the open Long-Term Atrial Fibrillation Database (repository — PhysioNet). 52 indices of heart rhythm variability were calculated for each recording, including new heart rate fragmentation and asymmetry indices proposed in the last 5 years. Data analysis was carried out with machine learning methods: dimensionality reduction with principal component analysis, hierarchical clustering and outlier detection. Feature correlation was checked by the Pearson criterion, the selected patient’s subgroups were confirmed by using Mann–Whitney and Student's tests.

Results. For the vast majority of patients with paroxysmal atrial fibrillation, heart rate variability can be described by five parameters. Each of these parameters captures a distinct approach in heart rate variability classification: dispersion characteristics of interbeat intervals, frequency characteristics of interbeat intervals, measurements of heart rate fragmentation, indices based on heart rate asymmetry, mean and median of interbeat intervals. Two large phenotypes of the disease were derived based on these parameters: the first phenotype is a vagotonic profile with a significant increase of linear parasympathetic indices and paroxysmal atrial fibrillation lasting longer than 4.5 hours; the second phenotype — with increased sympathetic indices, low parasympathetic indices and paroxysms lasting up to 4.5 hours.

Conclusion. Our findings indicate the potential of nonlinear analysis in the study of heart rate variability and demonstrate the feasibility of further integration of nonlinear indices for arrhythmia phenotyping.

Kazan medical journal. 2021;102(5):778-787
pages 778-787 views

History of medicine

90 years of the Ural State Medical University: development of scientific activity

Kovtun O.P., Ufimtseva M.A., Fedorova E.V., Vakhlova I.V.


Since the foundation of the Ural State Medical University (USMU), the importance of scientific activity in the training of specialists with higher medical education has been determined. A contribution to the history of medical science in the Urals since the 30s of the twentieth century was made by those who began work at the Sverdlovsk State Medical Institute, whose discoveries made it possible to find new methods of diagnosis and treatment, to identify the causes of any disease. For 90 years, the results of the activities of representatives of the established scientific directions and schools of Ural State Medical University have been used in the educational process and healthcare. The article describes the promotion of scientific activity of Ural State Medical University and its productivity over the previous decade. We analyzed reports on research activities for 2010–2020, materials based on the results of monitoring the effectiveness of Ural State Medical University, scientometric databases “Russian Science Citation Index” (RSCI), Web of Science, Scopus. Along with the development of traditional medical research areas and schools, the university researches in the areas of scientific medical platforms, cooperates with leading scientific, educational and medical organizations. The development of personalized medicine, digital medicine, reconstructive medicine, as well as the use of cellular technologies, and the fight against infectious diseases are highlighted among the topical areas. Over the current decade, the number of publications indexed in international abstract databases has increased 4 times in Scopus, 2 times in Web of Science, and 2.6 times in RSCI. The total number of citations of articles over five years (2016–2020) in Scopus was 990, Web of Science — 766. The number of articles included in the list of the Higher Attestation Commission under the Ministry of education and science of the Russian Federation, for a number of years on average — 456. There is the dynamic development of the scientific activity of Ural State Medical University with a focus on cooperation with leading research teams of other organizations, the implementation of research on a state assignment, accompanied by a significant increase in publication activity.

Kazan medical journal. 2021;102(5):788-794
pages 788-794 views


60 years to Andrey Yurevich Anisimov


23 августа исполнилось 60 лет доктору медицинских наук, профессору, Андрею Юрьевичу Анисимову. Андрей Юрьевич — один из ведущих специалистов в Республике Татарстан в области организации и управления хирургической помощью, неотложной хирургии и хирургии экстремальных состояний. Вся его трудовая деятельность связана с этим разделом медицины, сначала в качестве хирурга, затем — в качестве организатора здравоохранения и, наконец, — в качестве преподавателя высшей медицинской школы.

Kazan medical journal. 2021;102(5):795-797
pages 795-797 views

Cochrane Review Summaries

Eslicarbazepine acetate add-on therapy for drug-resistant focal epilepsy


Эсликарбазепина ацетат — это противоэпилептическое лекарство, которое может быть добавлено (так называемое «дополнительное» лечение) к лечению людей, которые принимают другие противоэпилептические лекарства, но у них продолжаются приступы (так называемая лекарственно-устойчивая эпилепсия). В этом обзоре рассматривалось, насколько хорошо действует эсликарбазепина ацетат при использовании в качестве дополнительного лечения, а также некоторые из потенциальных побочных эффектов этого лекарства.

Kazan medical journal. 2021;102(5):798
pages 798 views

Pharmacological treatment of hypertension in people without prior cerebrovascular disease for the prevention of cognitive impairment and dementia


Обсервационные исследования, в которых наблюдали участников в течение многих лет, показали, что высокое кровяное давление связано с последующим развитием деменции или новыми проблемами с памятью и мышлением (когнитивные нарушения). Важно установить, может ли лечение высокого кровяного давления снизить риск развития деменции и проблем с памятью и мышлением. Уже есть отчётливые доказательства в пользу лечения высокого кровяного давления после инсульта. Доказательства в отношении лечения высокого кровяного давления при отсутствии инсульта были неубедительными на момент написания протокола этого обзора.

Kazan medical journal. 2021;102(5):798-799
pages 798-799 views

­Interventions for promoting physical activity in ­people with neuromuscular disease


Мы изучили доказательства о способах повышения физической активности у людей с нервно-мышечными заболеваниями. Мы включили только те исследования, в которых физическую активность оценивали как исход. Для ответа на этот вопрос мы собрали и проанализировали все соответствующие исследования.

Kazan medical journal. 2021;102(5):799-800
pages 799-800 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies