Vol 103, No 3 (2022)

Aim. To determine subpopulations of lymphocytes in exudate in atopic dermatitis.

Material and methods. The study included 80 patients with atopic dermatitis according to predetermined inclusion and exclusion criteria, who were under dispensary supervision at the Regional Dermatovenerologic Dispensary (Chita) from 2018 to 2021. Two groups (adolescents and adults) and two subgroups (patients with limited and widespread lesions) were formed. Skin exudate sampling was carried out during the period of exacerbation of the disease. The control group consisted of 30 practically healthy volunteers undergoing a medical examination at the same dispensary, having primary health records and meeting the inclusion criteria for the study. Lymphocyte phenotypes were determined in skin exudate by flow cytofluorometry. Statistical analysis was performed using Microsoft Excel, IBM SPSS Statistics version 25.0, and the Shapiro–Wilk test, Mann–Whitney and Wilcoxon U-test, Kruskal–Wallis nonparametric analysis of variance were used. The data were presented by median and interquartile intervals — Me (25%; 75%). The critical indicator of the significance level of the differences was p <0.05.

Results. In the exudate of practically healthy volunteers, obtained by the “skin window” method, no subpopulations of lymphocytes were detected. In the skin exudate of adolescents with limited lesions, the content of lymphocytes was 149.00 (129.75; 157.75) cells/μl, T-lymphocytes (CD3+CD19–) — 109.5 (96.25; 113.75) cells/μl, among them 48.95% active, T-helpers — 42.5 (39.25; 57.50) cells/μl, natural killers (CD3+CD16+CD56+) — 38.50 (36.25; 41.00) cells/μl, however, with the widespread process, the level of lymphocytes increased by 11% (p1=0.002), T-helpers — by 45%, natural killers — by 27%, T-lymphocytes up to 125.00 (110.5;135.75) cells/μl (p1=0.00001). These indicators in adults and the level of cytotoxic T-lymphocytes (CD3+CD8+) in adolescents and adults had no significant differences. The number of T-NK-killers (CD3+CD16+CD56+) in adolescents was higher with a widespread process — 23.00 (11.75; 29.75) cells/μl (p1=0.0001), in adults with a limited process — 18.00 (10.25; 20.75) cells/μl (p2=0.0001). The number of NKCD8+ (CD3–CD16+CD56+CD8+) in adolescents with limited dermatosis was 22.50 (18.25; 26.00) cells/μl, with widespread dermatosis — 1.6 times more (p1=0.0001), in adults with a limited process — 29.50 (25.25; 33.75) cells/μl, with widespread — 27% less (p1=0.0001).

Conclusion. In the skin exudate in atopic dermatitis, cytotoxic T-lymphocytes, T-NK-killers, natural killers, CD8-positive NK-killers are detected.

Background. Breast cancer in many cases becomes the main cause of deterioration in the quality of life of patients due to the presence of severe postoperative asymmetry.Аim. To compare immediate and long-term results, quality of life indicators and cost-effectiveness in the treatment of patients diagnosed with breast cancer using an endoprosthesis and lipofilling reconstruction.

Material and methods. A prospective study of the treatment results of 72 patients diagnosed with breast cancer was carried out. Patients in the control group (n=40) underwent subcutaneous mastectomy with endoprosthesis plastics. Patients of the main group (n=32) underwent subcutaneous mastectomy with primary reconstruction by lipofilling. The calculation of indicators characterizing the efficiency of the use of hospital beds of a medical institution was carried out, the number of cases and days of temporary disability was calculated, an analysis of economic costs was made based on the tariff for a completed case of treatment of the disease. All statistical analyzes were performed using the Statistica 10.0 software. The study established a significance test of p <0.05.

Results. In the compared groups, the immediate results of surgical treatment did not differ statistically significantly (p=0.973), while the quality of life in patients after subcutaneous mastectomy with plastic lipofilling was significantly higher on the social functioning scale (0.004) than after reconstruction with the use of an endoprosthesis. When using the method of reconstruction with the use of lipofilling, it was possible to statistically significantly reduce the length of stay of patients in the hospital.

Conclusion. The use of lipofilling as a new method of reconstruction in patients diagnosed with breast cancer allows maintaining significantly high quality of life indicators on the scale of social functioning in comparison with the group of patients who underwent reconstruction with an endoprosthesis, and also makes it possible to significantly reduce the economic costs of treating patients.

Background. Infectious inflammatory complications that occur in women after caesarean section may affect the length of hospital stay. Timely drug therapy plays a major role in preventing the development of complications in the postoperative period.

Aim. To conduct a comparative pharmacoepidemiological analysis of antibiotics use and evaluate the surgery outcomes (on the part of the puerperal and the newborn) in women delivered by caesarean section.

Material and methods. A retrospective analysis of 1025 birth histories of women after planned and emergency caesarean section with a detailed assessment of the antibiotics use in two time periods with a 10-year interval: in 2007–2009 (first period, n=523) and in 2016–2017 (second period, n=502) was carried out. The operation outcomes, the length of hospital stay, the duration of antibiotics use were studied. The significance of differences in relative indicators was assessed by Pearson (χ2).

Results. The frequency of prescribing antibiotics in monotherapy for planned and emergency cesarean section in both time periods did not differ (p=0.858; p=0.726). There were more cases of using two antibiotics at the same time in the first period, both for planned (88 cases, 35.5%) and for emergency surgery (93 cases, 34%; p=0.001). Combinations of three antibiotics were used more frequently in the first period than in the second. The increase in body temperature after surgery (>37.5 °C) was statistically indistinguishable in two periods. The duration of hospital stay with primary antibiotic therapy in the first period was 6 bed-days, with primary antibiotic prophylaxis in the second period — 4 bed-days. Exacerbation of urinary tract infections during emergency and planned caesarean section was diagnosed 4 and 5 times more often in the first period than in the second. Outcome on the part of the newborn — an Apgar score of less than 7 points was more common with emergency intervention in the second period (10%) than in the first (3.5%; p=0.003).

Conclusion. In the first studied time period (2007–2009), with combined antibiotic therapy after caesarean section, a longer stay of women in the hospital, a higher frequency of urinary tract exacerbations in puerperas, and a better assessment of the condition of newborns according to the Apgar score were registered, compared with these indicators in the second time period (in 2016–2017), when antibiotic prophylaxis was predominantly used.

Background. The clinical manifestations of ulcerative colitis are heterogeneous and may change over time. The main problem at present is the search for non-invasive diagnostic markers to assess the activity and severity of an attack in patients with ulcerative colitis.

Aim. Comparative evaluation of the diagnostic significance of serum and fecal biomarkers depending on the severity of an attack of ulcerative colitis.

Material and methods. 178 patients with ulcerative colitis were divided into 4 groups depending on the presence and severity of the attack, the control group included 40 patients with irritable bowel syndrome. The cytokine profile (interleukins-1, -2, -4, -6, -10, -17, tumor necrosis factor α) and the concentration of fecal markers (lactoferrin, calprotectin, neopterin) were determined, the clinical activity index (CAI) and scores according to Mayo scale were assessed. Dispersion, correlation and ROC analysis were used. The indicators are presented as M (SD) for parametric distribution and as Me (25–75) for non-parametric distribution. Differences were considered statistically significant at p <0.05.

Results. Patients with ulcerative colitis showed a statistically significant correlation of Mayo scores with the CAI index (r=0.815, p=0.001), interleukin-6 (r=0.598, p=0.001), interleukin-17 (r=0.587, p=0.005 ), tumor necrosis factor α (r=0.701, p=0.001), fecal calprotectin (r=0.881, p=0.001), lactoferrin (r=0.799, p=0.001), neopterin (r=0.791, p=0.001). Statistically significant correlations between CAI and interleukin-6 (r=0.525, p=0.001), interleukin-17 (r=0.587, p=0.005), tumor necrosis factor α (r=0.624, p=0.001), fecal calprotectin (r=0.831, p=0.001), lactoferrin (r=0.672, p=0.005), neopterin (r=0.765, p=0.002) were found. Cut-off points for serum markers in predicting endoscopically active disease were as follows: interleukin-6 — 9.6 pg/ml, interleukin-17 — 6.6 pg/ml, tumor necrosis factor α — 7.6 pg/ml; cut-off points for fecal markers: calprotectin, 78.6 µg/g; lactoferrin — 765 μg/g; neopterin — 79.5 μg/g.

Conclusion. A higher diagnostic significance of the use of fecal biomarkers compared to serum biomarkers, as well as the advantages of fecal calprotectin in terms of sensitivity and specificity among all the indicators we studied were revealed.

Background. The regulation of the central dopaminergic system under the influence of chronic stress is disturbed, however, the dynamics of changes in the dopamine receptors expression in the periphery remains poorly understood.

Aim. Evaluation of the different models of chronic stress influence on changes in the relative level of dopamine receptor gene expression in peripheral blood cells of rats during immobilization and intense physical activity.

Material and methods. For 270 days on 88 Wistar rats, the study on the effect of different models of chronic stress on the change in the relative level of Drd1–5 genes expression was performed in four groups: the first control group; the second group was subjected to intensive physical activity in the “Forced swimming with a load” test (7-minute swimming with a load of 8% of body weight 2 times a week); the third group experienced daily 90-minute immobilization for 14 days; the fourth group had combined exposure of physical activity and immobilization. The relative level of dopamine receptor gene expression was determined by real-time polymerase chain reaction after 90, 180, and 270 days of the experiment in peripheral blood cells of the tail vein. The calculation of the relative level of gene expression was carried out based on the Livak method (2–ΔΔCt); the assessment of the difference significance — using a two-sample t-test for independent samples.

Results. The analysis of the relative level of genes encoding D1-type dopamine receptors expression showed that a decrease in the Drd1 gene expression level after 90 days of the experiment was detected only in male rats from immobilization stress and control groups [RQ 0.35 (p=0.003) and 0.21 (p=0.002), respectively], while in males from other groups and females, the activity of this gene did not change significantly throughout the course of the experiment. The relative expression level of Drd5 gene changed only in female rats. In females subjected to intense physical activity, the level of this gene expression increased almost 4 times (RQ 3.82, p=0.005) 90 days after the start of the experiment, and in females of the control group, the transcriptional activity of the gene decreased 4 times after 180 days of the experiment (RQ 0.25, p=0.015). When assessing changes in the activity of genes encoding D2-type receptors for the Drd3 and Drd4 genes, a significant increase in the relative expression level was revealed in all experimental groups, both in males and females, on the 180th day of exposure to stress factors. At the same time, activation of both genes was occurred after 90 days in the control group only in females and persisted up to another 90 days, after which it returned to the initial level. Expression of the Drd2 gene wasn't detected in rat blood cells.

Conclusion. The relative level of expression of D1- and D2-like receptor genes in rat peripheral blood cells depends on the type of chronic stress and has pronounced sexual dimorphism.

Background. Knowledge of the anatomical features of the left atrium walls will minimize complications during the “Cox-Maze” surgery.

Aim. To clarify common features and local anatomical specificities of the anterosuperior, lateral and inferior walls of the left atrial body of the heart of an adult.

Material and methods. From 60 preparations of the hearts of men and women aged 35–89 years who died from non-cardiac causes, 61 histotopograms and 180 anatomical sections of the left atrium walls were made. A stereoscopic microscope (×4.7–15 magnification), a histological microscope (×40 magnification), and an image recognition program were used. Nonparametric dispersion, correlation, one-way regression analysis were applied. The significance of differences was assessed by the Mann–Whitney U-test. The results were presented as medians.

Results. Anatomical markers of the anterosuperior wall were a compact group of transverse myocardial fibers (anterior interatrial Bachmann bundle) and a thinned section of the lower third of the medial half of the wall. A feature of the lateral wall was a group of oblique myocardial fibers (left lateral ridge). The inferior wall was characterized by well-developed subepicardial tissue. Anteroposterior wall in the medial area (5130 µm) and lateral wall (5243 µm) were thin. The epicardium with subepicardial tissue in the medial part of the inferior wall was thicker (4750 µm) than in the lateral (2651 µm) and anterosuperior (2535 µm) walls. The myocardium of the anteroposterior wall (2714 µm) was thicker than the myocardium of both the lateral (2213 µm) and inferior wall in its central (1947 µm) and lateral (1913 µm) sections. The median thickness of the endocardium of different walls varied from 335 to 426 µm. The wall thickness in the upper third mostly depended primarily on the myocardium thickness, and in the inferior third on the epicardium and subepicardial tissue thickness.

Conclusion. For the walls of the left atrium, their thickening towards the coronary sulcus was common due to the subepicardial adipose tissue. The peculiarities were the differences of the left atrium walls in thickness and their unique pattern of myocardial anatomy.

Diseases of the cardiovascular system keeps the lead among the main causes of invalidity, disability and mortality of the population. There is a steady increase in cardiovascular diseases, that is why the identification of new markers, that would allow calculating the risks of complications and associated pathological conditions, is one of the most important tasks of modern fundamental and applied medicine. The paper presents current information on the relationship between the qualitative and quantitative characteristics of mitochondrial DNA with the risk of organ failure. The reasons for the body's immune response to the mitochondrial DNA presence outside the cell are considered. The question of mitochondrial DNAs role in the pathogenesis of cardiovascular pathology and inflammatory processes is highlighted. Contradictory information about the change in the amount of freely circulating mitochondrial DNA during the development of organ failure was revealed. However, all authors agree that the number of mitochondrial DNA copies indicates disorders associated with the provision of vital functions of cells, organs and tissues. The study shows that the level of freely circulating mitochondrial DNA in blood plasma, which is currently used to predict the development of complications and mortality in a number of different diseases, is a promising nonspecific marker of cytolytic processes. A comprehensive study of cytological, biochemical and molecular biological indicators at various (especially at early) stages of organ failure development, as well as during the cardiovascular diseases establishment, will provide new important information about the cellular mechanisms of disease pathogenesis and will form the basis for the development of early diagnostic markers and new therapeutic schemes.

Ovarian cancer is the sixth most common cancer in women. The overall 5-year survival rate for ovarian cancer is approximately 40% due to the fact that most cases are diagnosed at late stages. Detection of ovarian cancer at the earliest possible stages is a public health priority. The article provides a review of existing scientific data regarding the early detection and screening of ovarian cancer, based on an analysis of publications in international electronic databases. Screening strategies are most effective for detecting diseases in their early stages, but at the moment there is no standard instrumental method that could be recommended as a screening examination for detecting ovarian cancer at an early stage. In this regard, most researchers have switched to the field of biomarkers and their combinations. Currently, more than 200 tumor markers, which are produced with varying intensity in ovarian cancer, have been proposed, but only two of them, CA-125 and HE4, have been tested in clinical experience. The article highlights the role of new tumor markers, multimarker panels, longitudinal algorithms in the early diagnosis of ovarian cancer. Most of the studies on the early diagnosis of ovarian cancer is aimed at searching for new biomarkers or developing multimodal algorithms that include both tumor markers, free deoxyribonucleic acid, and ultrasound of the pelvic organs. However, there are still no convincing data on mortality reduction based on randomized controlled trials, which stops doctors from including one or another strategy for the early diagnosis of ovarian cancer in national protocols and/or recommendations as a screening examination.

Childhood obesity is an acute problem in the European Region, including countries participating in the World Health Organization's European Childhood Obesity Surveillance Initiative. According to their data, the proportion of overweight children reaches 43%. Overweight and obesity, as well as related diseases, are largely preventable. For this reason, the prevention of childhood obesity should be given top priority. Adolescence obesity has reached epidemic proportions worldwide, with the prevalence of complicated obesity increasing at least fourfold over the past 35 years. Most obese adolescents also have excess body fat mass in adulthood, which increases the risk of obesity-related complications, such as type 2 diabetes and cardiovascular disease, and negatively affects social and psychological health. In modern conditions the prevention of the overweight and obesity formation among schoolchildren is not systemic: no attention is paid to the identification of possible risk factors, no unified approaches exist among specialists of various levels to the methodology for preventing the overweight and obesity formation, rational hygienic measures for preventing obesity are not always implemented, the causes of late diagnostics of overweight and obesity among schoolchildren by pediatricians are not fully analyzed, the motivation of children and parents to change their lifestyle in order to fight overweight are not sufficiently studied. The systemic implementation of such preventive measures could help to reduce the number of overweight schoolchildren and improve the health of the child population.

Lemierre's syndrome is a clinical variant of sepsis characterized by a combination of an infectious process in the oropharynx with thrombosis of the internal jugular vein and metastatic septic foci. Currently, Lemierre's syndrome is a rare pathology, almost a “forgotten disease”. The article describes a case of Lemierre's syndrome, in which the course of acute tonsillopharyngitis in a 20-year-old female patient was complicated by thrombosis of the left internal jugular vein and metastasis of septic foci in the lungs. The process was accompanied by a systemic inflammatory reaction and thrombocytopenia. The microorganism from the blood was not isolated. In crops from the oropharynx, Klebsiella pneumonia was found. The treatment included antibiotic therapy with ceftriaxone and azithromycin, the administration of glucose-salt solutions, the use of anticoagulants, and local antiseptic treatment of the oral cavity. Body temperature returned to normal on the 3rd day of hospitalization, inflammatory changes were jugulated after 9 days. The patient was discharged home on the 12th day of hospitalization in a satisfactory condition. Lemierre's syndrome is still a life-threatening condition, no matter how or by what it was caused. For this reason, early diagnosis and antibiotic therapy are critical to a favorable outcome of the syndrome.

Background. Removal of calculi in salivary stone disease is one of the urgent problems of maxillofacial surgery and surgical dentistry due to the complexity of the manipulation, the trauma of the technique and the frequent development of complications.

Aim. Improvement of the treatment results of patients with salivary stone disease by using our developed method of minimally invasive removal of calculi located in any part of the excretory duct of the submandibular and/or parotid salivary glands, under constant ultrasound visualization of the intervention.

Material and methods. The study included patients diagnosed with salivary stone disease (10 people: 9 male and 1 female aged 18–50 years, mean age 44.2±1.25 years). The methodology was as follows. An ultrasonic sensor was brought in from the side of the skin, and the location of the calculus in the gland duct was determined. Next, a needle with a diameter of 0.3 cm with a mandrin was inserted percutaneously through a puncture into the duct of the salivary gland to the distal surface of the calculus, and it was advanced with the help of a needle as far as possible towards the mouth of the excretory duct. Then the needle was removed, leaving a mandrel in the duct, with which the calculus was fixed in a new position. After bougienage of the excretory duct, Dormia’s basket was introduced into it, and the calculus was captured and removed. The manipulations were performed under constant ultrasound imaging.

Results. The use of the technique developed by us for minimally invasive removal of a calculus with a diameter of up to 5 mm, located in any part of the excretory duct of the submandibular and/or parotid salivary glands, under constant ultrasound visualization of the intervention course, made it possible to achieve a positive result in all 10 patients included in clinical observations.

Conclusion. The minimally invasive technique for removing calculi from the excretory ducts of the salivary glands under constant ultrasound imaging developed by us makes it possible to facilitate manipulation, its visibility and accuracy, as well as atraumaticity and prevention of complications.

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Bruschettini M, Hassan K-O, Romantsik O, Banzi R, Calevo MG, Moresco L. Interventions for the management of transient tachypnoea of the newborn — an overview of systematic reviews. Cochrane Database of Syste­matic Reviews. 2022. Issue 2. Art. No.: CD013563. DOI: 10.1002/14651858.CD013563.pub2.

This publication is a reprint of an article by Prof. I.V. Domrachev “To the replacement of extensive skull defects”, published in the Kazan Medical Journal in 1922. Reprinting is carried out in preparation for the celebration of the 150th anniversary of the first issue of the Kazan Doctors' Society Diaries, the assignee of which is the Kazan Medical Journal. Original publication: Domrachev IV. To the replacement of extensive skull defects. Kazan Medical Journal. 1922;18(3):61–68. DOI: 10.17816/kazmj79147.

This letter was written by V.N. Oslopov and Yu.S. Mishanina regarding the reprinted in the Kazan Medical Journal article by S.S. Zimnitsky “What is our method of functional diagnosis of the kidneys and what does it allow?”, published in 1922.