Vol 100, No 2 (2019)

Aim. To determine magnesium deficiency in patients with paroxysmal atrial fibrillation using a comprehensive clinical and laboratory approach.

Methods. The prospective cohort study included 35 patients of the cardiology department of the Medical association «Novaya bolnitsa». The main group consisted of 22 patients with frequently recurrent paroxysmal atrial fibrillation, the control group - 13 patients without cardiac arrhythmias. The clinical status, Holter-monitoring of the electrocardiogram, the results of the clinical test for magnesium deficiency, laboratory parameters of calcium, magnesium in blood plasma and formed elements, magnesium in whole blood, free fatty acids and plasma osmolarity were evaluated.

Results. The clinical score of magnesium deficiency was significantly higher in patients from the main group compared to the control [16.5 (11÷21) vs 13 (8÷15), p <0.001]. In the main group, there was a decrease of magnesium in the whole blood [0.55 (0.5÷0.59) vs 0.61 (0.58÷0.54), p=0.002] and inside the blood cells [0.68 (0.53÷1.29) vs 1.38 (1.29÷1.44), p <0.001]. In patients with atrial fibrillation there is a shift of the ratio of calcium to magnesium in blood plasma [2.5 (2.5÷3) vs 2.9 (2.8÷3.15), p=0.029] and intracellularly [4.85 (2.62÷9.3) vs 1.7 (1.4÷1.95), p=0.002]. The redistribution of calcium and magnesium is influenced not only by the initial concentration of cations, but also by free fatty acids. The best redistribution was obtained when the concentration of free fatty acids was 900 µmol/l, magnesium 1 mmol/l, and calcium 3 mmol/l, which is consistent with the optimal value of cations in the blood plasma.

Conclusion. Patients with paroxysmal atrial fibrillation had a significantly lower magnesium content in whole blood and inside the blood cells; magnesium concentration in the cells and in whole blood closely correlated with the results of the clinical test for evaluating magnesium deficiency; intracellular magnesium content can be influenced by the complexing interaction with free fatty acids.

Aim. To study the relationship of the perception of illness and coping strategies in patients with ischemic heart disease before coronary artery bypass grafting with purpose in life orientation.

Methods. The study included 108 males aged 45 to 73 years with a diagnosis of ischemic heart disease. Clinical and psychological diagnostics included the study of the patient's perception of illness using the Personal Questionnaire of the Bekhterev Institute, the coping strategies were assessed with the Ways of Coping scale developed by Lazarus and Folkman. To study the purpose in life orientation (formation of goals in life, the level of self-realization of a person, meaningfulness and saturation of life in the past and present, plans for the future), the «Purpose-in-Life Test» by D.A. Leont'ev was used.

Results. The study showed the predominance of adaptive variants of the perception of illness and moderate use of both productive and unproductive coping strategies in the studied group, as well as the preservation of aims and guidelines for the future in the situation of preparing for coronary bypass surgery. A positive relationship was found between the indicators of general meaningfulness of life, dedication, satisfaction with the process of activity and achievement of results with the indicators of adaptive variants of the perception of illness and productive coping behavior. Low levels of overall meaningfulness of life, inability to set goals and achieve them, as well as lack of satisfaction from past events, are associated with high rates of maladaptive variants of the perception of illness and the choice of unproductive coping strategies.

Conclusion. A high level of purpose in life orientation in patients with ischemic heart disease can lead to the formation of adaptive variants of the perception of illness variants and productive coping strategies, whereas a low level of purpose in life orientation probably leads to the risks of the formation of maladaptive perception of illness variants and coping strategies.

Aim. To study the role of oxidative protein modification of bone tissue proteins in the formation of destruction of temporal bone structures in chronic otitis media.

Methods. The study included 139 patients aged 16-75 years with a verified diagnosis of chronic otitis media, who are candidates for surgical treatment. Depending on the method of surgical treatment, patients are divided into four groups (by nosology and complications and reoperations): patients with tubotympanic otitis media and epitympanic antral otitis, without complications and with local or intracranial complications, after reconstructive sanitizing ear surgery. The state of the processes of oxidative modification of proteins was evaluated in the bone tissue of the middle ear cavities, obtained intraoperatively, by the content of carbonyl products with the use of spectrophotometry. The data were processed by descriptive statistics and were presented in the form of a median and a range between quartiles with an estimate of the reliability of the intergroup differences by the Mann-Whitney U-criterion.

Results. A comparison of the indicators characterizing the oxidative modification of bone tissue proteins of the temporal bone in patients with complicated and recurrent forms of chronic otitis media demonstrates a greater degree of free radical destruction of proteins, primarily markers of early stages of protein damage and an increase of aldehyde products, both at the basal level and in response to induction in a complicated course of the disease.

Conclusion. The obtained data allow drawing a conclusion about a high level of oxidative stress in bone tissue in destructive forms of chronic otitis media accompanied by relapses and complications, and about the perspectives of antioxidant pre-operative use taking into account the features of oxidative stress in bone tissue in patients with chronic otitis media.

Aim. To evaluate the expression levels of Ki-67 and cyclin D1 and β-catenin in the subtypes of triple negative breast cancer.

Methods. The study was conducted on the surgical material from 60 patients of clinical stage 2A (T1N1M0 or T2N0M0) who were treated at the Rostov Research Institute of Oncology from 2012 to 2015. For immunohistochemistry, antibodies to estrogen and progesterone receptors, cytokeratins 5/6, Ki-67, cyclin D1, β-catenin, HER2/neu and EGFR proteins were used.

Results. Triple negative breast cancer with the signs of basal epithelium was found to have a significantly higher expression level of Ki-67 compared to non-basal-like one. In some part of triple negative breast cancer samples overexpression of cyclin D1 was observed. The high level of cyclin D1 in the basal-like subtype was less common than in the subtypes without the signs of basal epithelium, but its average value was significantly higher. In triple negative cancer with cyclin D1 overexpression, the loss of β-catenin on the cell membrane and its abnormal accumulation in the cytoplasm was significantly more frequent. β-catenin translocation into the cell nucleus was observed only in basal-like triple negative cancer, and 2 times more often in case of cyclin D1 overexpression.

Conclusion. In triple negative breast cancer tumors with overexpression of cyclin D1 and abnormal expression of β-catenin are observed in some cases; these biomarkers can be considered as potential therapeutic targets for this group of tumors.

Aim. To study the dynamics of indicators of microcirculation during a single episode of hypothermia of moderate degree in rats, both immediately after cessation of cooling, and in different periods of posthypothermia.

Methods. The study was performed on 25 Wistar rats. The animals were subjected to a single immersion cooling in water at a temperature of 5 °C until reaching a rectal temperature of 27-30 °C. Analysis of the microvasculature was carried out immediately upon reaching a moderate degree of hypothermia, 2, 5, 10 and 14 days after the cooling. The microcirculation parameters were estimated using a laser analyzer of capillary circulation LAKK-02 (SMO «Lazma», Russia) at a wavelength of 0.63 μm. The main parameters of microcirculation were recorded, and the amplitude-frequency spectrum of blood flow oscillations was analyzed.

Results. Immediately after reaching a moderate degree of hypothermia, vasospasm was recorded, which was confirmed by a decrease in the rate of perfusion and wave amplitudes of all frequency ranges. 2 days after stopping the cooling perfusion index returned to baseline, a decrease in amplitude of endothelial, vasomotor and respiratory waves was observed with an increase in pulse waves. On day 5, perfusion increased by 5 times was observed along with decreased amplitudes of the waves of all ranges. By day 10, the level of blood flow returned to its original values, and the wave amplitudes of all frequency ranges remained at the same low level. By day 14, a progressive decrease of the factors of bloodflow modulation was associated by the decrease of perfusion.

Conclusion. Single cooling to a moderate degree of hypothermia leads to a progressive decrease of tissue perfusion and deep inhibition of active and passive factors of bloodflow modulation.

The main role in spontaneous abortion in 2nd and 3d trimesters is assigned to cervical insufficiency. According to a number of researchers, bed rest, elevated lower limbs, restriction of physical activity, tocolysis, antibacterial therapy do not affect the prolongation of pregnancy and are ineffective for preventing premature spontaneous labor. Correction of cervical insufficiency can be carried out by a vaginal form of progesterone, cerclage, pessary. The use of vaginal progesterone is justified in women with recurrent miscarriage, a history of premature birth, and shortening of the cervix to less than 25 mm. Indications for surgical correction are limited to patients with habitual loss of pregnancy due to cervical weakness or a history of premature birth. In the absence of significant obstetric history, cerclage has no advantages over the use of progesterone. The optimal time for cerclage is up to 20 weeks of pregnancy. Unlike progesterone cerclage has complications, the frequency and severity of which are attributable to the timing and indications for correction. Transabdominal cerclage is performed only when there is a technical impossibility of vaginal access due to the absence of a vaginal part of the cervix or after unsuccessful attempts of vaginal cerclages. Most often, the use of a pessary is associated with the diagnosis of a short cervix in terms of more than 24 weeks of gestation in the absence of an aggravated history. The combined use of gestagens, pessary and cerclage does not increase the efficiency of carrying a singleton pregnancy. Methods for the prevention of preterm delivery in multiple pregnancy, such as the introduction of a specialized outpatient service, bed rest, antibacterial therapy, progesterone, preventive cerclage or the insertion of a pessary do not change the incidence and mortality of newborns.

Over recent decades due to improved visualization (ultrasound, computer tomography and magnetic resonance imaging) prevalence of adrenal incidentaloma has increased. The term «adrenal incidentaloma» is generic and includes a group of tumors of various morphology and over 1 cm in diameter accidentally discovered during radiologic investigation. The found tumor can be hormonally inactive or actively releasing different hormones, malignant or benign, and originating from different adrenal zones or having non-specific organ origin. Based on the frequency of revealing and clinical significance the most noteworthy is functionally autonomous cortisol synthesis. It means changes of hypothalamic pituitary adrenal axis without classic clinically prominent signs of cortisol excess such as proximal myopathy, stretch marks, body fat redistribution and other metabolic changes related to cortisol. Currently a large number of recommendations on the management and tactics of treatment of adrenal incidentaloma can be found in the literature. Based on the analysis of these guidelines the conclusions were made about the diagnostic errors and incorrect approaches to the choice of treatment of such patients. Recently a lot of studies have been directed to the early detection of carbohydrate and lipid metabolism disorders, relation with obesity and type 2 diabetes mellitus, arterial hypertension and osteoporosis for preserved quality of life of such patients. Influence of hypercorticism is considered to worsen the course of these conditions but at the moment no effect of adrenalectomy on mortality and life duration was confirmed.

The values of the global longitudinal systolic deformation of the left ventricle have sufficiently high diagnostic informativeness, preceding the reduction of the left ventricular ejection fraction, local contractility and increase of troponins. Its indicators reflect the early deformation disorders not only in coronary heart disease, but can serve as a sensitive parameter of the formation of systolic dysfunction in diseases of any origin. The study of the global deformation of the left ventricle with the preservation of traditional echocardiographic parameters within the norm (ejection fraction, local contractility, wall thickness, valve status, diastolic function, etc.) allows identifying a risk group for the subsequent targeted search for signs of coronary atherosclerosis. The sensitivity and specificity of longitudinal deformation by speckle-tracking echocardiography in the verification of myocarditis and cardiomyopathies are higher than those of magnetic resonance imaging. The prognostic value of the levels of deformation in the short and long term in relation to rehospitalization and death due to the progression of heart failure is proved. Dynamic observation of the global longitudinal deformation allows revealing the side cardiotoxic effects of drugs in patients with cancer and rheumatic diseases. Numerous studies show that the values of global longitudinal deformation in healthy individuals vary from -18 to -25% depending on the calculation program used, distinguishing this parameter from a number of other ultrasonic parameters. Illustrative color marking of numerical values of segmental systolic deformation of the left ventricle in the form of a «bull's eye» is much less reproducible than the value of the officially recommended global deformation. The differences in global and segmental longitudinal strain thresholds due to ultrasound scanner software and the lack of standardized clinical observations and statistical generalizations should stimulate further research in this area.

Alcoholism and drug addiction are concomitant or indirect causes of death in almost all subclasses of diseases, as well as frequent causes of violent death. In the field of detection, treatment, prevention and support of the studied group of patients, there is a huge number of problems, such as anosognosia, possible limitation of patients' rights, socially restrictive nature of addiction care, etc. As a result, patients taking psychoactive substances, have significantly reduced motivation to appeal to narcologists. There are many systemic organizational problems in the work of the addiction service, which significantly hamper the routing of patients, which differs from the routing of patients of somatic profile. In relation to this, scientific research aimed at optimizing drug addiction service is of particular relevance. In addition, each subject of the Russian Federation has a number of features (territorial, economic, i.e.), and this indicates the need to study certain types of specialized assistance, taking into account the characteristics of each specific region. There are several levels of patient routing, each of which includes certain tasks, components, and indicates the expected result. The routing of addictive patients has its own peculiarities, related both to temporary isolation of patients and to further long-term rehabilitation. As a result, the model of highly specialized care for patients using psychoactive substances does not allow involving the greatest possible number of people in need in each stage of therapy and does not contribute to solving the main public health problems. Despite the obvious availability of this type of assistance, for most potential customers it remains unattractive.

The type and etiology of stroke in young patients are known to differ from those in elderly patients, that influences the diagnosis and treatment. Dissection of cerebral arteries holds the top position in the structure of the causes of ischemic stroke in children and young people below 45 years. Currently no clear guideline on the proper treatment of this pathology exists. The article presents the case of acute ischemic stroke in a young patient (the stroke was caused by the occlusion due to dissection of the internal carotid artery) successfully treated with radiosurgical method - stenting of the cervical part of the artery with the transition to petrous segment of the left carotid artery using combined proximal and distal protection of cerebral vessels. The control of patient's state and results of angiography and ultrasound demonstrate the favourable immediate and medium-term prognosis for the patient.

Aim. To demonstrate the possibility of successful transplantation of pancreaticoduodenal complex with isolated splenic artery supply and to assess the quality of its perfusion.

Methods. 6 patients who underwent pancreas transplantation with isolated splenic artery blood supply were examined. The recipients were 3 men and 3 women, the median age was 36.5 [31; 42] years. To evaluate the state, quality of transplant perfusion and their function, the laboratory data, doppler ultrasound, measurement of blood flow volume (CT-perfusion) and treatment outcomes were assessed.

Results. Based on the results of investigations, adequate pancreatic graft blood supply through the splenic artery alone was detected. Pancreatic transplant function in all patients was satisfactory, blood glucose levels remained within normal values. Hospital mortality was 0%.

Conclusion. Successful transplantation of pancreaticoduodenal complex with isolated splenic artery supply is technically possible due to the presence of intraorganic arterial collaterals.

Aim. To evaluate the efficiency of laparoscopic devascularization of the esophagus and stomach with endoscopic ligation of varicose esophageal veins in the prevention of esophageal-gastric bleeding among patients with decompensated liver cirrhosis.

Methods. The results of treatment of 73 patients with decompensated liver cirrhosis and high risk of bleeding were analyzed. To prevent recurrent bleeding from esophageal and gastric veins, all patients underwent endoscopic ligation at the first step of treatment. In case of inefficiency of ligation and recurrence of varicose veins of esophagus, laparoscopic devascularization of esophagus and stomach was performed. The efficiency of laparoscopic devascularization with intraoperative endoscopic ligation of varicose esophageal veins and ligation as an independent method of treatment for the prevention of upper gastrointestinal bleeding was estimated by comparison of the frequency of recurrence of esophageal and gastric bleeding and recurrence of esophageal varices according to upper endoscopy in comparison groups.

Results. In 6 months, 1 and 2 years after laparoscopic devascularization of the esophagus and stomach in combination with endoscopic ligation, the risk of bleeding is less compared to endoscopic ligation as an isolated treatment method (p=0.05; p=0.052; p=0.06). Laparoscopic devascularization with ligation reduces the risk of recurrence of esophageal varices during the first year after surgery by 20% (χ2=2.61; p=0.106), in 2 years by 23% (χ2=1.75; p=0.091) compared to endoscopic ligation only.

Conclusion. Patients with liver cirrhosis with decompensated hepatic failure satisfactorily postpone endovideosurgical interventions; laparoscopic gastric devascularization with the intersection of the main inflows to the esophageal varicose veins is an effective method to prevent esophageal-gastric hemorrhage among patients with decompensated liver cirrhosis after ineffective endoscopic ligation.

Aim. To determine the diagnostic possibilities of using liver shear wave elastography in pregnant women with hepatitis B and C viral infection.

Methods. The study included 87 women with hepatitis B and C viral infections admitted to the Center of Clinical Medicine №1 and Educational and Therapeutic Clinic of Azerbaijan Medical University (basis of the department of obstetrics and gynecology 2 of Azerbaijan Medical University) in 2016 to 2017 aged 18-45 (average age 31.4±7.1 years), and 50 uninfected women with physiological pregnancy matched by the age (average age 30.6±6.8 years). Infected women were divided into two groups: 70 pregnant women (group 1) and 17 women (group 2), who were non-pregnant at the time of the study (average age 29.8±7.2 and 30.9±6.7 years, respectively). Women with physiological course of pregnancy were included into group 3 (average age 30.6±6.8 years). Groups of pregnant patients were matched by age, gestation age and parity (p ˃0.05). All patients underwent clinical and biochemical analyses and shear wave elastography of the liver. The obtained data were processed using the methods of variation statistics with calculation of mean and standard error (M±m), Mann-Whitney U-test, Spearman's rank correlation coefficient.

Results. In 52.9±6% of the examined pregnant women with viral hepatitis, hepatitis B was identified, in 47.1±6% - hepatitis C. According to the results of shear wave elastography, the average density of the liver in these patients was 7.2±1.0 kPa. An increase in liver density in pregnant women with viral hepatitis was not accompanied by changes in the size of the liver (only 1 patient had hepatomegaly). In 71.4±5.4% of the patients, F1 degree was revealed, in 20.0±4.8% - F2, in 5.7±2.8% - F3, in 2.9±2.0% - F4. İn comparison with infected patients without pregnancy, pregnant women with viral hepatitis B and C had more severe degree of fibrosis [F1 was significantly less frequent (p ˂0.05), and F2 was significantly more frequent (p ˂0.05)], and also had F4 degree, which was not observed in non-pregnant. In infected pregnant women, there was a positive correlation between liver echogenicity and density of its tissues (p=0.495; p <0.001).

Conclusion. In pregnant women with hepatitis B and C viral infection, the use of shear wave elastography allows detecting various degrees of liver fibrosis by a non-invasive method in the early stages, even in the absence of marked clinical and laboratory changes.

The article is dedicated to Professor L.L. Fofanof’s scientific activity. He headed the faculty therapeutic clinic of Kazan Imperial University in 1915-1920. Being a student L.L. Fofanov was interested in pathological anatomy and physiology. His dissertation «To physiology of n. depressoris» was dedicated to studying the vasomotor center. During his visit in Germany he worked a lot. In Charite together with Professor His he studied gout and its treatment with Radium emanation. In Halle clinic under Professor Schmidt’s supervision he studied assimilation of starch in normal and pathological digestion. L.L. Fofanov also made a contribution to tuberculosis treatment: with professor V.F. Orlovskiy he studied treatment of tuberculosis with simulated pneumothorax. In his research professor L.L. Fofanov paid great attention to the issues of pathogenesis and pathogenetic substantiation of the clinical manifestation and treatment. During the World War I and Civil War he fought against typhus epidemies: he saw patients, gave lectures, studied the features of myocardial involvement. He died in 1920 from typhus.

4–6 февраля в Университете прикладных наук Западной Норвегии (Берген, Норвегия) прошёл Международный семинар по научно-
обоснованным исследованиям в рамках программы действий CA17117 COST — Европейского сотрудничества в науке и технологиях: «Навстречу Международному сообществу по научно-обоснованным исследованиям в области клинических и биомедицинских исследований» [Towards an International Network for Evidence-based Research in Clinical Health Research — EVBRES COST Action Workshop in Bergen (EVBRES: EVidence-Based RESearch)].

Вопрос обзора. Мы рассмотрели рандомизированные испытания (в которых участники имеют равные шансы быть определёнными в любую группу лечения), исследующие влияние увеличения потребления омега-3 жиров, полученных из рыбы и растений, на заболевания сердца и сосудов (называемые сердечно-сосудистыми заболеваниями, которые включают инфаркты миокарда и инсульт), на степень ожирения и на содержание жиров в крови [липиды, в том числе холестерин, триглицериды, липопротеины высокой плотности (ЛПВП - «хороший» холестерин) и липопротеины низкой плотности (ЛПНП - «плохой» холестерин)].