Vol 104, No 5 (2023)

5–18% of pregnancies end in premature birth, defined as birth before 37 weeks of gestation. Every year, 15,000,000 babies are born prematurely worldwide, of which more than 1,000,000 die due to complications associated with prematurity. Their contribution to neonatal and infant mortality is significant (70 and 36%, respectively). Premature birth is a syndrome characterized by many etiological factors, such as intra- and extrauterine infections, decreased excretion and decreased reception of progesterone, uterine overdistension, cervical factor, stress and a number of other, sometimes unknown, reasons. Over the past decade, some progress has been made in predicting and preventing spontaneous preterm birth. The main method for predicting and diagnosing the threat of premature birth is transvaginal ultrasound cervicometry in the second trimester of pregnancy (14–24 weeks). The length of the sonographically measured cervix is the most accurate prognostic criterion for assessing the risk of preterm birth, especially in pregnant women at risk (history of preterm birth). Vaginal administration of micronized progesterone reduces the risk of preterm birth in women with a short cervix. Diagnosis is based on taking into account clinical symptoms, cervical length and biochemical tests that determine placental proteins. Hospitalization in a perinatal center or level III institutions, which include intensive care units and the second stage of nursing newborns, serves as the basis for the effective organization of medical care for premature birth. When indications for surgical delivery are indicated, preference should be given to a cesarean section with the extraction of a low-weight fetus in the entire amniotic sac. The article also reflects the contribution of the staff of the Department of Obstetrics and Gynecology named after prof. V.S. Gruzdev of Kazan State Medical University in solving the problem of premature birth.

Background. The peritumoral zone contributes to the progression of gliomas due to its altered metabolism. Superoxide dismutase is one of the main antioxidant defense enzymes; it may be related to gliomagenesis, since the activation of free radical oxidation provokes tumor transformation of cells.

Aim. Analysis of superoxide dismutase activity in different areas of the tumor depending on the status of gliomas’ molecular genetic markers.

Material and methods. The surgical material of 20 patients with gliomas of various degrees of anaplasia was analyzed. The brain tissue of people who died as a result of trauma (6 people) served as a control. The status of tumor markers was assessed immunohistochemically. Superoxide dismutase activity and free radical activity were determined in tumor and brain tissue homogenates using Fe-induced biochemiluminescence. For statistical analysis, the computer program StatPlus 6 with the Analyst Soft Inc package was used. Data analysis was carried out using nonparametric methods of statistical processing of the material using nonparametric criteria (Mann–Whitney U test, Kolmogorov–Smirnov test, Spearman's rank correlation coefficient).

Results. With active tumor growth (Grade IV), free radical activity and superoxide dismutase activity in the peritumoral zone were higher than in intact tissue. Superoxide dismutase activity in the peritumoral zone showed significant correlations: positive with the cell proliferation marker Ki-67 (rs=0.858) and negative with mutations in the isocitrate dehydrogenase (IDH) gene (rs=–0.514) and methylation of the O-6-methylguanine-DNA-methyltransferase promoter (rs=–0.766). The activity of the peritumoral zone enzyme differed depending on the molecular genetic profile of gliomas. Bioinformatic analysis of interactions between superoxide dismutase and molecular genetic markers of gliomas using the STRING, BioGrid, Signor, and SignaLink databases revealed the presence of mediated interactions with IDH1 with a clustering coefficient of 0.945. This level of clustering indicates the biological relationship of IDH1 with the main enzymes of the antioxidant system, superoxide dismutase and catalase.

Conclusion. Significant correlations of superoxide dismutase activity in the peritumoral zone with the status of a tumor markers’ number and significant differences in enzyme activity in groups depending on the molecular genetic profile suggest the importance of assessing superoxide dismutase activity as a factor in the gliomas’ progression.

Background. The positive effect of interval hypoxic therapy in the treatment of many diseases has become the basis for its use in rehabilitation after a new coronavirus infection to normalize disorders of the hemostatic system.

Aim. To identify the peculiarities of the interval hypoxic therapy effect on the hemostatic system of patients who have suffered a new coronavirus infection.

Material and methods. The work was carried out from April 2020 to May 2022. 220 men aged 45–59 years (average age 48.8±2.4 years) were examined. The main group included 90 people who had a moderate coronavirus infection a month ago; the control group (n=70) was represented by relatively healthy people; the comparison group (n=60) suffered coronavirus infection and underwent standard rehabilitation without hypoxic therapy. The content of platelets, D-dimer, international normalized ratio, prothrombin time, activated partial thromboplastin time, antithrombin III activity, interleukin-6 level, and C-reactive protein content in the blood serum was determined. To assess statistically significant differences, a parametric method applying paired and unpaired Student's t-test was used. Differences were considered statistically significant at p <0.05.

Results. In patients of the main group, a violation of the hemostatic system, indicating increased thrombogenicity of the blood against the background of persistent inflammatory activity, was revealed. After interval hypoxic therapy, the platelet count increased to 215.53±23.57×109/l (p=0.035), activated partial thromboplastin time to 26.74±1.84 s (p=0.035), international normalized ratio to 0.89±0.06 (p=0.005), antithrombin III activity in the blood up to 81.81±4.33% (p=0.007); the level of fibrinogen decreased to 3.86±1.09 g/l (p=0.035) and the content of D-dimer in the blood to 255.58±17.36 ng/ml (p=0.035). There was a decrease in the level of interleukin-6 to 6.03±0.65 pg/ml (p=0.035) and C-reactive blood protein to 1.03±0.15 mg/l (p=0.035).

Conclusion. Interval hypoxic therapy had a normalizing effect on the hemostatic system of patients who suffered a new coronavirus infection, as a result of suppressing the inflammatory process in the body.

Background. The presence of frailty negatively affects the prognosis of patients with chronic heart failure, increasing the frequency of hospitalizations, limiting treatment options, and also increasing the mortality of patients.

Aim. To develop a model for predicting mortality in patients with decompensated chronic heart failure, including frailty syndrome.

Material and methods. 107 patients aged 45–95 years with decompensated chronic heart failure were studied. Four age groups were formed: the first — 29 patients aged 45–59 years old (average age 53.9±4.5 years), the second — 31 elderly patients (60–74 years old, average 68.3±5.0 years), the third — 40 senile people (75–90 years, average age 81.5±4.1 years), the fourth — 7 long-lived patients (>90 years, average 92±1.4 years). A comprehensive geriatric assessment was performed using the program “Optimization of care in geriatrics depending on the degree of frailty”. A multivariate logistic regression analysis was performed to select mortality predictors.

Results. The prognostic model included 6 independent variables: age — 1.05 [0.96; 1.17] (p=0.28), male gender — 0.25 [0.03; 1.65] (p=0.17), frailty of severe or terminal degree — 5.56 [1.08; 37.14] (p=0.05), IV functional class according to the classification of New York Heart Association — 3.41 [0.60; 27.35] (p=0.19), ejection fraction 50% or more — 0.29 [0.03; 2.28] (p=0.26), ejection fraction 40–49% — 0.40 [0.05; 2.60] (p=0.36). The sensitivity of the model was 62%, specificity 82%, prognostic effectiveness 88%.

Conclusion. Severe or terminal asthenia is the strongest predictor of mortality, increasing the risk of an unfavorable outcome by 5.56 times.

Background. Maladaptive changes on the part of various organs and systems, in particular on the part of the hemostasis system, are manifested in extreme forms of physical inactivity, one of which is immobilization stress. If the organism is also subjected to psycho-emotional effects at the same time, then the combined effect of stressors is accompanied by an increase in maladaptive disorders.

Aim. To establish the influence of emotional-immobilization stress on the hemostasis system, as well as the possibility of correcting changes by taking a course of eleutherococcus.

Material and methods. The experiment was conducted on male rats, which were divided into four groups: the first group (n=14) — control, the second group (n=14) — animals treated with eleutherococcus for 30 days, the third group (n=14) — rats, subjected to a single 3-hour “water-immersion dipping”, the fourth group (n=14) — animals that took eleutherococcus for 30 days before the “water-immersion dipping”. The state of the hemostasis system was assessed in all experimental groups. Statistical processing of the results was performed using the Statistica 10.0 package (Statsoft, USA). Significance of differences was assessed using the nonparametric Mann–Whitney test and Student's t-test.

Results. A single immobilization effect was accompanied by hypercoagulable changes, which characterized by shortening of the silicone (p=0.001) and kaolin (p=0.002) time. Completion of the 30-day adaptogen intake followed by emotional immobilization stress was accompanied by an increase in silicone (p=0.001), kaolin (p=0.021), prothrombin (p=0.021) and thrombin (p=0.006) time, which indicated hypocoagulation changes.

Conclusion. The immobilization effect is characterized by hypercoagulability against the background of a decrease in the anticoagulant and fibrinolytic activity of the blood plasma; the course intake of eleutherococcus prior to immobilization is accompanied by hypocoagulant changes and an increase in the anticoagulant activity of the blood plasma.

Determination of the viability of the anastomosed ends of the intestine is the most important stage in operations on the gastrointestinal tract, since their insufficient blood supply leads to formidable complications in the form of necrosis of the intestinal wall, failure of the anastomotic sutures and peritonitis. Visual methods for determining viability by peristalsis, pulsation of marginal vessels, color of the serous cover are very subjective and depend both on the experience of the surgeon and on the conditions in which operations are performed. The development of colorectal surgery is continuously associated with the study and development of methods for intraoperative determination of the viability of the anastomosed ends of the intestine. This review is devoted to various instrumental methods for determining the level of vascularization of the colon walls. The review presents data from both experimental and clinical studies, which reflect the advantages and disadvantages of these methods, allowing us to conclude that they can be used in practice. Among the most well-known methods for assessing the microcirculation of the intestinal wall during surgery, from experimental to applied, most authors single out laser Doppler fluorometry as the most modern and informative method. However, there is no consensus on its feasibility and effectiveness. Other methods for assessing microcirculation are inappropriate due to the complexity of their implementation or inefficiency. Despite this circumstance, among all the methods, perfusion fluorometry and laser fluorescein angiography compare favorably, especially the latter, since it allows to more accurately determine the state of the intestine and is rather undemanding in execution. A less accurate, but more accessible method is Doppler ultrasound, since it does not require large financial resources.

The article presents the results of systematic studies on the search for new biologically active molecules with antidepressant activity in the series of thietane-containing heterocyclic compounds and 3-substituted thietane dioxides. The used strategy for the search for antidepressant substances, based on in vivo pharmacological screening in combination with in silico methods of mathematical modeling and toxico-pharmacokinetic evaluation, is described. Studies of the biological activity of thietane-containing reaction products of azoles with thiiranes have been carried out in the series of thietanylimidazoles, titanixanthines, thietanyltriazoles, thietanyltriazolones, and 3-substituted thietane-1,1-dioxides (more than 300 compounds have been studied). The main results of the preclinical evaluation of promising drug candidates with antidepressant activity, 3-methoxythiethane-1,1-dioxide and 3-ethoxythiethane-1,1-dioxide, are presented. Both 3-substituted thietane-1,1-dioxides are characterized by low toxicity when administered intraperitoneally to mice (class IV “low toxicity”), the absence of toxic risks (mutagenic, carcinogenic, reproductive toxicity, local irritant action), high pharmaceutical potential (compliance with the rule of five Lipinsky), a wide range of action and pronounced antidepressant activity, not inferior to the reference drug amitriptyline (10 mg/kg), confirmed in highly valid in vivo models of depressive-like states (chronic mild stress and resident intruder). In tests of neuropharmacological interaction, it was found that the proposed mechanism of action of 3-substituted thietane-1,1-dioxides is associated with stimulation of 5-HT1A receptors, blockade of 5-HT2A/2C receptors and/or α2-adrenergic receptors. The need for further research is substantiated in order to create domestic “first in class” antidepressants on their basis.

Background. In modern medicine, artificial intelligence algorithms are being actively introduced, for testing and training of which a large amount of labeled datasets is required. Software for labeling (annotation) of digital diagnostic images is a necessary element when creating datasets.

Aim. To review the capabilities and comparative analysis of the functionality of the most common available software for annotating digital diagnostic images.

Material and methods. Five free and one commercial software product for annotation of digital diagnostic images participated in the comparative analysis. When testing the marking process on medical images for several target types of pathology, the usability of the graphical user interface and functionality was evaluated. The functionality of the software products has been tested by radiologists with over 5 years of experience. In addition, a review of semi-automatic segmentation methods implemented in the studied software products was carried out. As initial medical images, datasets of computed tomography studies obtained from open sources, were used.

Results. Comparison of software functionality for annotation of digital diagnostic images was made: supported formats; loading, presenting and saving original images and annotation data; the possibility of visualization of medical images; annotation tools. The algorithms underlying semi-automatic segmentation methods were studied and systematized. The requirements for the basic functionality of software for labeling digital diagnostic images have been formulated. The results obtained create a systematic basis for developing recommendations for radiologists on the choice and use of digital diagnostic image marking tools.

Conclusion. The most complete functionality in the field of segmentation of digital diagnostic images among the considered free software has 3D Slicer; in the case of annotation for detection tasks, it is convenient to use the Supervisely, CVAT platforms; for automatic segmentation of some types of pathology and organs, 3D Slicer extensions and ready-made models in Medseg can be used.

Common variable immunodeficiency is a group of heterogeneous diseases that are primary immunodeficiencies with a predominant lack of antibody synthesis. The most common manifestation is chronic infectious pathology of the respiratory tract, less often — of the gastrointestinal tract, as well as septic arthritis. Non-infectious manifestations include autoimmune diseases, non-infectious diarrhea, cancer, benign lymphoid hyperplasia. In one patient, a combination of several syndromes is possible. Unlike most other primary immunodeficiencies that debut in early childhood, this pathology often manifests in the third or fourth decade of life, and sometimes later in apparently healthy people. Although the routine laboratory method for determining the concentration of the main classes of immunoglobulins makes it quite easy to identify patients with common variable immunodeficiency, often the diagnosis is made many years after the onset of the first clinical symptoms, when serious complications have already developed. The disease is characterized by a gradual onset, chronic progressive course and ineffectiveness of standard therapy. The main method of treatment is lifelong replacement therapy with intravenous immunoglobulins. The article considers a clinical case when an elderly patient with seronegative rheumatoid arthritis with a juvenile onset was diagnosed many years later. The results of immunological studies, including immunophenotyping of peripheral blood and bone marrow lymphocytes, are presented. Issues of differential diagnosis with secondary hypogammaglobulinemia and lymphoproliferative diseases are highlighted. It has been stated that until now, doctors of various specialties are not sufficiently familiar with the problem of primary immunodeficiencies, especially when it comes to adults, and non-infectious manifestations dominate in the clinical picture.

The article highlights the scientific and practical contribution of the Physico-Medical Society to the formation and development of oncology and achievements in providing medical care to patients in the Saratov province at the end of the 19th century. The work was done on the basis of the minutes of the meetings and the proceedings of the society in 1876–1900 and annual reports of the provincial zemstvo and city hospitals, indicating not only an increase in the number of patients with neoplasms, but also an improvement in clinical diagnostic methods, an expansion of indications for surgical treatment and rehabilitation measures after surgical interventions. The most interesting clinical cases and rare localizations of neoplasms are presented, brief speeches of members of the society when discussing reports, are given, that may be of not only historical and medical, but also of great clinical interest to modern practitioners. Published materials show that the diagnosis and surgical treatment of neoplasms in patients at the end of the 19th century were carried out at a high professional level.

The article describes the medical, scientific, organizational, as well as political activities of the outstanding doctor of the Tatar and Bashkir ASSR Mstislav Aleksandrovich (Mukhametkhan Sakhipgareevich) Kulaev. His name went down in history because of the signing of the “Agreement of the Central Soviet Power with the Bashkir Government on Soviet Autonomous Bashkiria” on March 20, 1919 in Moscow. The relevance of this study is due to the fact that February 7, 2023 marked the 150th anniversary of the birth of M.A. Kulaev, and in 2019 the Republic of Bashkortostan celebrated the 100th anniversary of its formation. The article publishes for the first time previously unknown facts concerning “Essays on the diagnosis of pulmonary tuberculosis,” the author of which is M.A. Kulaev, who collected material during his work with tuberculosis patients. In addition, the authors were able to personally meet with the heirs of the famous Kazan doctor and draw many new, unknown facts from the biography of this outstanding healthcare figure in the Tatar and Bashkir Autonomous Soviet Socialist Republics.

11 октября 2023 г. исполняется 70 лет со дня рождения и 44 года профессиональной деятельности заслуженного деятеля науки Республики Татарстан (РТ), лауреата государственной премии в области науки и техники РТ, отличника здравоохранения РФ, доктора медицинских наук, профессора, заведующего кафедрой хирургии, декана хирургического факультета Казанской государственной медицинской академии (КГМА) Игоря Сергеевича Малкова.

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Gabaldón Figueira JC, Wagah MG, Adipo LB, Wanjiku C, Maia MF. Topical repellents for malaria prevention. Cochrane Database of Systematic Reviews. 2023. Issue 8. Art. No.: CD015422. DOI: 10.1002/14651858.CD015422.pub2.