Vol 105, No 6 (2024)

BACKGROUND: The risk of death remains high in patients who survive 1 year after myocardial infarction (MI).

AIM: To identify the laboratory and instrumental parameters of myocardial remodeling associated with long-term mortality in patients 1 year after MI.

MATERIAL AND METHODS: The study included 184 patients who survived 1 year after MI. Group 1 included living patients who were followed up for 5 years after MI (n = 160). group 2 comprised patients who had died by the 5-year mark (n = 24). Inflammation and myocardial dysfunction biomarkers and echocardiographic parameters reflecting types of left ventricular remodeling, linear dimensions of cardiac cavities, wall thickness, chamber volumes, and systolic ventricular function were retrospectively analyzed. After analyzing the distribution of numerical data, the Student’s t-test or Mann–Whitney U test and χ² test for categorical variables were applied. A logistic regression model was developed. This model was validated and assessed for reliability using the receiver operator characteristics curve, Hosmer–Lemeshow goodness-of-fit test, and bootstrap method.

RESULTS: Patients in group 2 were older (p = 0.007) and more likely to experience ST-segment elevation MI during hospitalization (p < 0.001). One year after the MI, a complex pattern of N-terminal brain natriuretic propeptide level changes was observed, with a decrease in group 1 and an increase in group 2. The end-diastolic volume index (p = 0.014) and left ventricular asynergy size were higher (p = 0.043) and the ejection fraction was lower (p = 0.015) in group 2 than in group 1. The model for predicting 4-year mortality in patients who survived MI during the first year includes parameters such as the left ventricular end-diastolic volume index, N-terminal pro-brain natriuretic peptide level, and presence of concentric left ventricular hypertrophy.

CONCLUSION: In patients who survive 1 year following MI, long-term mortality risk is associated with parameters reflecting left ventricular remodeling and heart failure development.

BACKGROUND: Chronic heart failure contributes to multiorgan dysfunction, including skeletal muscle impairment.

AIM: This study aimed to assess the strength and electrical activity of inspiratory muscles in patients with chronic heart failure with preserved left ventricular ejection fraction.

MATERIAL AND METHODS: Eighty patients of both sexes aged 45–74 years were included and divided into three groups: group 1 comprised 24 patients with chronic heart failure classified as NYHA functional class II, group 2 included 20 patients with NYHA class I chronic heart failure, and group 3 (control group) involved 36 patients without chronic heart failure. All participants underwent evaluation for serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, a 6-minute walk test, assessment of inspiratory muscle strength, and surface electromyography of inspiratory muscles during three loading tests. The significance of intergroup differences was assessed using the Mann–Whitney and Pearson χ² tests.

RESULTS: When stratified by sex, women in group 1 had 31.5% lower maximal inspiratory pressure than those in the control group (p = 0.006). The patients in group 1 demonstrated a smaller increase in diaphragm electromyography amplitude during the first test—sustained inspiratory effort at 30% intensity for 15 seconds—by 27.9% (p = 0.010), 26.1% (p = 0.025), and 40.7% (p = 0.033) at 5, 10, and 15 seconds, respectively. In the second test—sustained inspiratory effort at 50% intensity for 5 seconds—electromyography amplitude decreased by 32.6% (p = 0.041) at 5 seconds. In the third test—sustained inspiratory effort at 70% intensity for 5 seconds—the reduction was 42.8% (p = 0.009) at 5 seconds compared with the control group. Additionally, a more pronounced decrease in electromyography frequency was observed during the first test—by 24.2% (p = 0.048) and 24.7% (p = 0.030) compared with the control group—indicating fatigue. In the accessory inspiratory muscles, electromyography amplitude gain was higher in group 1 than in the control group, showing activation of additional motor units: in the external intercostal muscles during the first test, by 31.7% (p = 0.032) and 37.9% (p = 0.044) and by 28.9% (p = 0.048) and 43.1% (p = 0.036) during the second test; and in the sternocleidomastoid muscle during the first test by 66.1% (p = 0.033) and 49.4% (p = 0.043) and by 128.6% (p = 0.032) during the second test.

CONCLUSION: Surface electromyography with loading tests revealed diaphragm fatigue and increased activation of accessory inspiratory muscles in patients with NYHA class II chronic heart failure.

BACKGROUND: Spleen status has been associated with survival in patients with carcinoma, potentially mediated by the effects of immunosuppressive hematopoietic cells in the spleen.

AIM: This study aimed to investigate the composition and quantity of hematopoietic stem-like cells in the spleen and their relationship with hematogenous metastases in patients with varying carcinoma types.

MATERIAL AND METHODS: Forty patients with carcinomas of the stomach, gastroesophageal junction, pancreas, splenic flexure of the colon, sigmoid colon, kidney, ovary, and uterus were examined. The subgroup with hematogenous metastases (15 patients) included 7 cases of gastric cancer, 1 of gastroesophageal junction cancer, 4 of colon cancer, 1 of pancreatic cancer, 1 of renal cancer, and 1 of ovarian cancer. The subgroup without hematogenous metastases (13 patients) comprised 6 cases of gastric cancer, 4 of gastroesophageal junction cancer, 1 of colon cancer, 1 of pancreatic cancer, and 1 of uterine cancer. Formalin-fixed, paraffin-embedded spleen tissue sections were analyzed using multiplex tyramide signal amplification, a modified immunohistochemistry technique, with antibodies to CD45, CD34, CD133, TIE2, VEGFR1, CD90, and CD11b. Data are presented as median (Me) and interquartile range (Q₁–Q₃). Differences between groups were assessed using the Mann–Whitney U test. ROC analysis was employed to evaluate the prognostic significance of the parameters. P < 0.05 indicated significant differences.

RESULTS: Multiparametric analysis of spleen tissue identified 20 phenotypes within the continuum of hematopoietic stem cells and cells with hematopoietic/angiogenic potential, exhibiting phenotypic diversity. Across all carcinoma types, the number of CD45^–CD34⁺CD133^–TIE2^–VEGFR1^– stem-like cells in lymphoid follicles was lower in patients with hematogenous metastases: 43.313 (0.00–85.393) and 110.034 (83.050–197.915), respectively (p = 0.03). The number of stem-like cells with the CD45^–CD34⁺CD133^–TIE2^–VEGFR1^– phenotype was lower in the group of patients with gastric cancer and hematogenous metastases (31.092 [0.000–37.987]) than in the group without hematogenous metastases (119.962 [103.486–258.533]) (p = 0.001). In contrast, the number of hematopoietic progenitor cells with the CD45⁺CD34^–CD133⁺TIE2^–VEGFR1^– phenotype identified in the lymphoid follicle was higher (7901.164 [5705.314–8563.807] vs 4670.894 [3328.607–6473.649]) (p = 0.035), as well as the number of CD45⁺CD34^–CD133⁺TIE2⁺VEGFR1⁺ cells detected in the red pulp of the spleen (131.396 [35.701–167.521] vs 21.524 [6.123–30.117]) (p = 0.02).

CONCLUSION: The number of spleen-derived 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: In vivo analysis of the morphometric parameters of the parotid gland in the context of various cranial shapes is a promising approach, as it enables the systematization of the existing knowledge of the parotid gland anatomy.

AIM: This work aimed to identify the anatomical features of the parotid gland in men with different cranial shapes based on the head computed tomography (CT) and magnetic resonance imaging (MRI) findings.

MATERIAL AND METHODS: A retrospective study was conducted based on the analysis of head CT and MRI findings from 92 men. Based on the cranial shape, the sample was divided into the following groups: dolichocranes (n = 30), mesocranes (n = 32), and brachycranes (n = 30); chamaecranes (n = 19), orthocranes (n = 47), and hypsicranes (n = 26); and tapeinocranes (n = 33), metriocranes (n = 30), and acrocranes (n = 29). Based on the facial shape, three groups were identified: euryenes (n = 29), mesenes (n = 33), and leptenes (n = 40). A morphometric study of the parotid gland was performed, measuring dimensions in three planes and calculating the gland volume using the ultrasonographic method for measuring internal organ vo­lumes. Statistical analysis was performed using nonparametric methods, including the Kruskal–Wallis test, the Mann–Whitney test with Bonferroni correction, and Spearman’s correlation.

RESULTS: The sagittal dimension of the parotid gland in the men increased significantly from brachycranics (4.22 cm on the right, 3.99 cm on the left) to dolichocranics (4.77 cm on the right [p = 0.0001], 4.57 cm on the left [p = 0.0001]). A decrease in the frontal dimension of the gland was observed from brachycranics (3.43 cm on the right, 3.47 cm on the left) to dolichocranics (2.49 cm on the right [p = 0.0001], 2.47 cm on the left [p = 0.0001]). With regard to viscerocranium shapes, a significant diffe­rence in the vertical dimension of the gland was identified (6.12 cm on the right, 6.18 cm on the left in euryenes; 6.98 cm on the right [p < 0.0001], 6.95 cm on the left [p < 0.0001] in leptenes). The frontal dimension decreased significantly from euryenes (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, the sagittal dimension of the parotid gland varies significantly depending on the shape of the neurocranium as determined by the cranial index; the frontal dimension of the gland changes depending on both the neurocranial and viscerocranium shapes.

BACKGROUND: Electron irradiation is one of the most promising modalities for the treatment of malignant colonic neoplasms.

AIM: To evaluate the morphology of apoptosis and proliferation in the colonic epithelium of animals after local fractional electron irradiation at a focal dose of 25 Gy.

MATERIALS AND METHODS: Two groups of Wistar rats were used: group 1, control (n = 10); and group 2, experimental (n = 20). The experimental group was exposed to local electron irradiation at a focal dose of 25 Gy in fractions of 5 Gy on days 1, 3, 5, 7, and 9. Colonic fragments were examined using light microscopy, and immunohistochemical reactions were performed using antibodies to the Ki-67 and caspase-3 antigens. The wall thickness and diameter of the serous mucosal membrane were measured in micrometers. Morphological changes were evaluated using a scoring system. Results were analyzed 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 mucosal hyperemia without significant destructive changes. Furthermore, microscopic examination showed insignificant lesions of the colonic mucosa and decreased goblet cells compared with the control group (63.17% ± 1.87% vs. 21.64% ± 1.37%, respectively; p = 0.009). The number of caspase-3-positive epithelial cells increased (28.7% ± 8.2% vs. 14.5% ± 3.9%, p = 0.027). The proliferative index (Ki-67) in colonic crypts decreased after local fractional electron irradiation at a total focal dose of 25 Gy compared with the control group (11.14% ± 6.23% vs. 19.45% ± 5.12%, p = 0.013).

СONCLUSION: Local fractional electron irradiation of rats at a total focal dose of 25 Gy was found to induce weak degenerative and dystrophic changes in the epithelium and a decrease in goblet cells while preserving regenerative potential 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: Studying the processes of growth and development in the pediatric population is crucial because of the significance of the pre-nosological approach aimed at primary disease prevention.

AIM: This study aimed to provide the constituent entities of the Russian Federation (RF) with normative data on the physical development of children and adolescents aged 7–17 years.

MATERIAL AND METHODS: An analytical investigation was conducted using the large-scale database, Physical Development of Children, Adolescents, and Youth in the Russian Federation, 2000–2021c, which contains 395,956 observations of physical development (body length and body weight measurements) in children, adolescents, and youth from 49 constituent entities of RF. Constituent entities where regional normative data had never been developed or where the last norms were established 15–20 years ago or earlier were emphasized. At least two constituent entities were analyzed in each federal district. Big data processing was performed using machine learning methods on a PostgreSQL database. A web application was developed featuring tabular data display, histogram generation with customizable parameters, and the publication of data on a map of the RF.

RESULTS: At the beginning of the 21st century, specific features of physical development were established among schoolchildren living in various constituent entities of the RF, which allows for the identification of “regional scenarios” that should be considered when developing normative standards. We found that the mean height of 15-year-old boys across the constituent entities ranged from 161.70 ± 0.20 cm in the Kursk Region to 174.55 ± 0.40 cm in the Krasnodar Region (range: 12.85 cm, p = 0.001). In girls, the mean height ranged from 154.60 ± 0.50 cm in the Republic of Tyva to 165.69 ± 0.55 cm in Saint Petersburg (range: 11.09 cm, p = 0.001). The body weight of 15-year-old boys ranged from 50.17 ± 0.70 kg in the Kursk Region to 66.00 ± 0.80 kg in the Khabarovsk Region (range: 15.83 kg, p = 0.001). In girls, the weight ranged from 46.90 ± 0.60 kg in the Chelyabinsk Region to 58.40 ± 0.70 kg in the Khabarovsk Region (range: 8.50 kg, p = 0.001).

CONCLUSION: Forty regional normative standards for the physical development of the pediatric population were developed in a standardized manner, allowing for the consideration of regional characteristics and enabling their practical application in healthcare across the constituent entities of the RF.

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