Vol 105, No 6 (2024)

BACKGROUND: In patients who successfully survived the 1st year after myocardial infarction, the risk of death remains elevated.

AIM: To determine laboratory and instrumental parameters of myocardial remodeling associated with a lethal outcome in the long-term follow-up period in patients 1 year after myocardial infarction.

MATERIAL AND METHODS: The study included 184 patients 12 months after myocardial infarction: the first group — living patients at the 5-year follow-up point (n=160), the second group — deceased patients at the 5-year follow-up point (n=24). A comparative analysis of inflammation and myocardial dysfunction biomarkers, as well as echocardiographic parameters reflecting the types of left ventricular remodeling, linear dimensions of the cavities and wall thickness of the heart, chamber volumes, and ventricular systolic function was retrospectively performed. After assessing the distribution of quantitative data, the Student's t-test or Mann–Whitney U-test and the χ² criterion for categorical data were used. The model was built on the basis of logistic regression. The ROC curve, the Hosmer–Lemeshow test, and the bootstrap method were used to assess the model itself and its reliability.

RESULTS: Patients in the second group were older (p=0.007), and more often had myocardial infarction with ST-segment elevation during hospitalization (p <0.001). Twelve months after myocardial infarction, a multidirectional pattern of changes in the level of N-terminal brain natriuretic propeptide was revealed: a decrease was registered in the first group, while an increase was registered in the second group. In the dynamics of the second group, the index of end-diastolic volume (p=0.014) and the size of left ventricular asynergy were higher (p=0.043), and the ejection fraction was lower (p=0.015) than in the first group. The model for predicting 4-year mortality in patients who survived myocardial infarction during the 1st year included such parameters as the index of the left ventricular end-diastolic volume, the content of the N-terminal fragment of the natriuretic peptide and the presence of concentric hypertrophy of the left ventricle.

CONCLUSION: In patients who survived 1 year after myocardial infarction, the long-term risk of death is associated with a set of parameters reflecting left ventricular remodeling and the development of heart failure.

BACKGROUND: It is known that chronic heart failure contributes to the development of multiple organ pathology, including skeletal muscle pathology.

AIM: To determine the strength and electrical activity of the inspiratory muscles in patients with chronic heart failure with preserved left ventricular ejection fraction.

MATERIAL AND METHODS: The study involved 80 patients of both sexes aged 45 to 74 years, who were divided into three groups: the first group consisted of 24 patients with stage IIA chronic heart failure, the second group consisted of 20 patients with stage I chronic heart failure, and the third group (control group) consisted of 36 patients without chronic heart failure. All patients underwent serum N-terminal fragment of natriuretic brain propeptide determination, 6-minute walk test, measurement of inspiratory muscle strength, and surface electromyography of the inspiratory muscles using three exercise tests. The statistical significance of differences between the groups was assessed using the Mann–Whitney test and Pearson χ².

RESULTS: It was found that when dividing the groups by gender, the maximum inspiratory pressure in women of the first group was lower than in women of the control group by 31.5% (p=0.006). In patients of the first group, a smaller increase in the amplitude of the diaphragm electromyogram was recorded in the 1st test — with maintaining an inspiratory effort of 30% power for 15 s by 27.9% (p=0.010), 26.1% (p=0.025) and 40.7% (p=0.033) at the 5th, 10th and 15th seconds, respectively, in the 2nd test — with maintaining an inspiratory effort of 50% power for 5 s, by 32.6% (p=0.041) at the 5th second, in the 3rd test — with maintaining an inspiratory effort of 70% power for 5 s, by 42.8% (p=0.009) at the 5th second compared to the control group. At the same time, a more pronounced decrease in the electromyogram frequency was noted in the 1st sample — by 24.2% (p=0.048), 24.7% (p=0.030) compared to the control group, which serves as a sign of fatigue. On the accessory inspiratory muscles, the amplitude increase was higher in patients of the first group compared to the control group, which indicates activation of additional motor units: on the external intercostal muscles in the 1st sample — by 31.7% (p=0.032), 37.9% (p=0.044), in the 2nd sample — by 28.9% (p=0.048), 43.1% (p=0.036); on the sternocleidomastoid muscle in the 1st sample — by 66.1% (p=0.033), 49.4% (p=0.043), in the 2nd sample — by 128.6% (p=0.032).

CONCLUSION: In patients with chronic heart failure stage IIA, surface electromyography using stress tests revealed diaphragm fatigue and increased activity of accessory inspiratory muscles.

BACKGROUND: Spleen status is associated with survival in carcinomas. One of the mechanisms may be related to the effects of immunosuppressive hematopoietic cells originating from the spleen.

AIM: To study the composition and quantity of hematopoietic cells with stem cell traits in the spleen and their association with hematogenous metastasis in patients with different nosological forms of carcinomas.

MATERIAL AND METHODS: The study included 40 patients with stomach cancer, cardioesophageal junction cancer, cancer of pancreas, splenic flexure of the colon, sigmoid colon, kidney, ovary and uterus. The subgroup with hematogenous metastases (15 patients) included 7 cases of stomach cancer, 1 case of cardioesophageal junction cancer, 4 cases of colon cancer, 1 case of pancreatic cancer, 1 case of kidney cancer, and 1 case of ovarian cancer. The subgroup without hematogenous metastases (13 patients) included 6 cases of stomach cancer, 4 cases of cardioesophageal junction cancer, 1 case of colon cancer, 1 case of pancreatic cancer, and 1 case of uterine cancer. Formalin-fixed and paraffin-embedded spleen tissue sections served as the study material. The method of multiplex tyramide signal amplification — modified immunohistochemistry of tissue sections was applied, using antibodies to CD45, CD34, CD133, TIE2, VEGFR1, CD90, CD11b. The studied parameters were described as median (Me) and interquartile range (Q₁–Q₃). Differences in parameters were assessed using the Mann–Whitney criterion. ROC analysis was used to assess the prognostic value of the parameters. Differences were considered significant at a significance level of p <0.05.

RESULTS: The study of spleen tissue with simultaneous determination of several markers on each cell allowed us to identify 20 phenotypes related to representatives of the continuum of hematopoietic stem cells and the continuum of stem cells with hematopoietic/angiogenic potentials, characterized by pronounced phenotypic diversity. In the general group, including all the studied nosological forms, the number of stem cells with the CD45^–CD34⁺CD133^–TIE2^–VEGFR1^– phenotype found in the lymphoid follicles of the spleen was lower in cases with hematogenous metastases: 43.313 (0.00–85.393) and 110.034 (83.050–197.915) (p=0.03), respectively. In the group of gastric cancer patients with hematogenous metastases, a lower number of stem cells with the CD45^–CD34⁺CD133^–TIE2^–VEGFR1^– phenotype [31.092 (0.000–37.987)] compared to the group without hematogenous metastases [119.962 (103.486–258.533)] (p=0.001), a higher number of stem progenitor cells with the CD45⁺CD34^–CD133⁺TIE2^–VEGFR1^– phenotype determined in the lymphoid follicle [7901.164 (5705.314–8563.807) versus 4670.894 (3328.607–6473.649)] (p=0.035), as well as a higher number of cells with phenotype CD45⁺CD34^–CD133⁺TIE2⁺VEGFR1⁺, identified in the red pulp of the spleen [131.396 (35.701–167.521) versus 21.524 (6.123–30.117)] (p=0.02), were found.

CONCLUSION: The number of spleen cells with the phenotypes CD45^–CD34⁺CD133^–TIE2^–VEGFR1^–, CD45⁺CD34^–CD133⁺TIE2^–VEGFR1^– and CD45⁺CD34^–CD133⁺TIE2⁺VEGFR1⁺ is associated with hematogenous metastasis.

BACKGROUND: Lymphopenia in patients with coronavirus infection COVID-19 is associated with the risk of developing severe forms and unfavorable outcome. One of the reasons for the development of lymphopenia is apoptosis.

AIM: Evaluation of the severity of peripheral blood lymphocytes' apoptosis in patients with moderate and severe COVID-19.

MATERIAL AND METHODS: A total of 42 patients with COVID-19 aged 37 to 90 years were examined. They were hospitalized at the Republican Clinical Infectious Diseases Hospital named after Professor A.F. Agafonov, Kazan, from October 24, 2021 to March 1, 2022. In 13 patients, the lung lesion volume ranged from 10 to 25% (CT-1), in 20 — from 25 to 50% (CT-2), in 9 — from 50 to 75% (CT-3). Ribonucleic acid of the SARS-CoV-2 virus was isolated from the nasopharynx in 35 (83%) patients. COVID-19 was moderate in 14 patients, and severe in 28 patients. The control group consisted of 10 conditionally healthy people of the same age. Lymphocyte apoptosis was assessed by quantifying hypodiploid cells by changing the intensity of their staining with propidium iodide using flow cytometry. To determine the reliability of differences in indicators between the compared groups, the Mann–Whitney U-test was used, and when comparing percentages, the χ² criterion was used. The reliability of differences was established at p <0.05.

RESULTS: It was found that patients with COVID-19 had significantly higher lymphocyte apoptosis activity compared to the control group. The median of the studied indicator in patients with COVID-19 was 39.3%, while in the control group it was 15.1% (p <0.001). The severity of lymphocyte apoptosis correlated with the severity of the disease: the highest rates were recorded in patients with severe COVID-19 (p=0.02). Moreover, lymphocyte apoptosis >55% was associated with the risk of death (p=0.03). A moderate correlation was established between lymphocyte apoptosis rates and blood ferritin levels (Spearman coefficient p=0.39, p <0.05).

CONCLUSION: Coronavirus infection COVID-19 was accompanied by an increase in the activity of peripheral blood lymphocyte apoptosis; the highest apoptosis rates were recorded in patients with severe COVID-19.

BACKGROUND: Intravital analysis of parotid gland morphometric parameters in the context of various skull shapes is promi­sing, since it allows systematizing the available information on the parotid gland anatomy.

AIM: To identify the features of the parotid gland anatomical parameters in men with different skull shapes according to computed tomography and magnetic resonance imaging.

MATERIAL AND METHODS: We conducted a retrospective study based on the examination of computer and magnetic resonance tomograms of the heads of 92 men. Depending on the skull shape, the study material was divided into groups: dolichocranes (n=30), mesocranes (n=32), brachycranes (n=30); chamecranes (n=19), orthocranes (n=47), hypsicranes (n=26); taipenocranes (n=33), metriocranes (n=30), acrocranes (n=29). Depending on the face shape, three groups were distinguished: euryenes (n=29), mesenes (n=33), leptens (n=40). A morphometric study of the parotid gland was performed with measurement of the sizes in three planes, as well as the volume of the organ using the technique of measuring internal organs’ volume during ultrasound examination. Statistical analysis was performed using nonparametric methods, such as the Kruskal–Wallis test, Mann–Whitney U test with Bonferroni correction, and Spearman.

RESULTS: In men, the sagittal size of the parotid gland significantly increased from brachycranes (4.22 cm on the right, 3.99 cm on the left) to dolichocranes [4.77 cm on the right (p=0.0001), 4.57 cm on the left (p=0.0001)]. A decrease in the frontal size of the gland was revealed from brachycranes ([3.43 cm on the right, 3.47 cm on the left) to dolichocranes [2.49 cm on the right (p=0.0001), 2.47 cm on the left (p=0.0001)]. With regard to the shapes of the facial skull, a significant difference in the vertical size of the gland was found [in euryenes 6.12 cm on the right, 6.18 cm on the left; in leptenes 6.98 cm on the right (p <0.0001), 6.95 cm on the left (p <0.0001)]. The frontal size value decreased significantly from euryens (3.42 cm on the right, 3.53 cm on the left) to leptenes [2.51 cm on the right (p <0.0001), 2.58 cm on the left (p <0.0001)].

CONCLUSION: In men with different forms of the cerebral skull, determined by the transverse-longitudinal index, the sagittal size of the parotid gland varies significantly; in men, depending on the shape of both the cerebral and facial skull, the frontal size of the gland changes.

BACKGROUND: One of the promising types of radiation therapy for colon malignant neoplasms is electron irradiation.

AIM: Morphological assessment of apoptosis and proliferation of animals’ colon epithelium after local fractional irradiation with electrons in a total focal dose of 25 Gy.

MATERIAL AND METHODS: Wistar rats were used, which were divided into two groups: the first — control (n=10); the second — experimental (n=20). Animals of the experimental group were subjected to local fractional irradiation with electrons in a total focal dose of 25 Gy (in fractions of 5 Gy on the 1st, 3rd, 5th, 7th, 9th day of irradiation). Fragments of the colon were examined by light microscopy, immunohistochemical reactions were carried out with antibodies to Ki-67 and Cas3. The wall thickness and the diameter of the serous-mucous membrane were measured and calculated in micrometers. Morphological changes were evaluated in points. The results were assessed using the Kolmogorov–Smirnov test, Student's t-test, Mann–Whitney U-test and Fisher's test.

RESULTS: Macroscopic examination of the colon of rats in the experimental group revealed hyperemia of the mucous membrane without significant destructive changes. Microscopic examination revealed minor damage to the mucous membrane of the colon compared to the control group, a reduction in goblet cells (63.17±1.87% versus 21.64±1.37%, p=0.009) was noted. The number of caspase-3-positive epithelial cells increased (28.7±8.2% versus 14.5±3.9%, p=0.027). The proliferative index (Ki-67) in the intestinal crypts of the colon after local electron irradiation with a total focal dose of 25 Gy was reduced compared to the control group (11.14±6.23% versus 19.45±5.12%, p=0.013).

CONCLUSION: With local fractional electron irradiation of rats in a total focal dose of 25 Gy, weak degenerative and dystrophic changes in the epithelium, reduction of goblet cells with preservation of regenerative potential occur in the colon.

Improvement of the human habitat has led to an increase in average life expectancy. Long life goes hand in hand with old age, which reduces the quality of human life and it is an acute social problem. Thus, the search for approaches that can improve the quality of life, the ability to live it without age-related diseases is an extremely urgent task. Aging of the body begins with the aging of cells, in which the activation of the aging process occurs through the induction of specific signaling pathways, which irreversibly divides the life of any cell into “before and after”. Aging cells are able to influence their microenvironment, secreting more inflammatory signaling molecules and inducing pathological changes in neighboring cells. The accumulation and long-term preservation of aged cells lead to deterioration of the condition of tissues and organs, and ultimately to a decrease in the quality of life and an increased risk of death. Among the most promising approaches to the correction of aging and age-related diseases are pharmacological, gene and cell therapy. Increasing the expression of aging suppressor genes, using certain populations of native and genetically modified cells, as well as senolytic drugs can help delay aging and associated diseases for a more distant future. This review examines currently studied approaches and achievements in the field of anti-aging therapy, in particular gene therapy using adeno-associated vectors and approaches based on cell therapy.

The paper discusses the concept of acute kidney disease, a relatively new concept in clinical medicine, the introduction of which is due to the presence of kidney diseases that do not meet strict criteria for acute kidney injury or chronic kidney disease. The article presents the criteria and severity stratification of acute kidney disease proposed by the Kidney Disease: Improving Global Outcomes Foundation, interpretation of the criteria and severity stratification by the Scientific Society of Nephrologists of Russia, associations of nephrologists and anesthesiologists-resuscitators of Russia, the National Society of Specialists in Hemapheresis and Extracorporeal Hemocorrection in accordance with the classification system of the Acute Dialysis Quality Initiative group. The role of acute kidney disease in the modern renal continuum is outlined. The article reviews the results of studies of acute kidney disease in patients with septic shock, patients who underwent total joint replacement, myocardial infarction with ST segment elevation and having acute kidney injury, patients with ischemic stroke, after coronary angiography, after acute surgery for type A aortic dissection, which demonstrate the prevalence of acute kidney disease and its outcomes. Despite the fact that acute kidney disease has a high prevalence among patients with various pathologies, worsens the prognosis and increases the risk of death or complications, its significance in modern medicine remains extremely underestimated. The article identifies the most common and studied biochemical markers that can potentially increase the proportion of patients at risk of adverse outcomes when used in clinical practice.

BACKGROUND: The importance of studying the growth and development processes of the child population is due to the significance of the pre-clinical approach aimed at primary disease prevention.

AIM: To provide the constituent entities of the Russian Federation with standards for the physical development of children and adolescents aged 7–17 years.

MATERIAL AND METHODS: An analytical study was conducted, big data from the database “Physical Development of Children, Adolescents, and Youth of the Russian Federation in 2000–2021” were analyzed, containing 395,956 observations of physical development (length and body weight indicators) of children, adolescents, and young people living in 49 constituent entities of the Russian Federation. Priority was given to research in the constituent entities for which regional standards had never been developed or for which they were developed 15–20 years or more ago. As a result, at least 2 constituent entities were analyzed in each federal district. Big data processing using machine learning was carried out on the basis of the PostgreSQL database. A web application was created that implemented the functions of tabular display of data, construction of histograms with the ability to select parameters and subsequent data publication on the map of the Russian Federation.

RESULTS: In Russia at the beginning of the 21st century, the characteristics of physical development of students living in diffe­rent constituent entities of the Russian Federation were established, which allowed us to talk about the presence of “regional scenarios” that must be taken into account when developing standards. At the age of 15, the range of average values of growth indicators for boys in the constituent entities ranged from 161.70±0.20 cm in the Kursk Region to 174.55±0.40 cm in the Krasnodar Territory (the difference was 12.85 cm, p=0.001), for girls — from 154.60±0.50 cm in the Republic of Tyva to 165.69±0.55 cm in St. Petersburg (the difference was 11.09 cm, p=0.001). The range of body weight of 15-year-old boys in the regions was from 50.17±0.70 kg in the Kursk region to 66.00±0.80 kg in the Khabarovsk region (difference 15.83 kg, p=0.001), girls — from 46.90±0.60 kg in the Chelyabinsk region to 58.40±0.70 kg in the Khabarovsk region (difference 8.50 kg, p=0.001).

CONCLUSION: 40 regional standards for the physical development of the child population have been developed in a standar­dized manner, which allows taking into account regional characteristics and makes it possible to use them in practical healthcare in the constituent entities of the Russian Federation.

Weakening of the chewing act, typical for modern humans due to consumption of soft food, causes a deficit of chewing load and has a negative effect on the dental system. To combat hypodynamia of the masticatory apparatus with the aim of preventing destructive processes in its structures, a gnathotraining system was developed, including electrical stimulation of the masticatory muscles themselves in physiological parameters, which develops the effect of “imaginary chewing”, and gnathotraining using chewing gum. In addition, functional training of the masticatory apparatus using chewing exercises was proposed. Considering that chewing gum practically does not compensate for the deficit of chewing load observed in modern society, the staff of the Kazan State Medical University and the Kazan National Research Technological University developed the “Denta Fit” dental trainer and a dental training system. It has been established that dental and jaw training stimulates secretion of saliva, its mineralizing potential, functional resistance of tooth enamel, allows achieving a good level of oral hygiene, reduces the rate of increase in the intensity of dental caries, as well as the severity of muscular-articular disorders of the temporomandibular joints, enhances neuromuscular activity of the masticatory muscles and regional blood flow. In children with permanent bite, dental and jaw training maintains the hydrogen index (pH) of oral fluid at a neutral level and provides, in combination with a toothbrush, optimal hygienic dental care, contributes to the formation of a correct dental occlusion. Thus, the effects of increased neuromuscular activity of the masticatory muscles, as well as regional vascular tone, arising during dental and jaw training, indirectly indicate that the dental and jaw system receives adequate mechanical loads necessary for the normal functioning of all its links. The results of the conducted studies indicate the effectiveness and feasibility of using dental training to improve dental status, which serves as a new approach to the prevention and treatment of dental diseases.

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Whing J, Nandhra S, Nesbitt C, Stansby G. Interventions for great saphenous vein incompetence. Cochrane Database of Systematic Reviews. 2021. Issue 8. Art. No.: CD005624. doi: 10.1002/14651858.CD005624.pub4