Vol 95, No 1 (2014)
- Year: 2014
- Articles: 34
- URL: https://journal-vniispk.ru/kazanmedj/issue/view/104
Metabolomic research in medicine
Abstract
The paper covers the questions of metabolomic research in medicine. The central idea of metabolomics is to identify the specific biomarkers in biological samples for diagnosis of a number of conditions. The biomarkers include volatile organic compounds - metabolites isolated from various tissues and biological fluids (blood, urine, sputum, exhaled air). Main methods of separation and identification of volatile organic compounds (gas chromatography, mass spectrometry, nuclear magnetic resonance spectroscopy) applied in metabolomics, are reviewed. Mass spectrometry and nuclear magnetic resonance spectroscopy are compared as the main methods of volatile metabolites detection. The method of solid phase microextraction, used for sample preparation, is described. The paper reviews laboratory research results aimed at the detection of cancer, chronic infections and inherited diseases biomarkers. The qualitative characteristics of biological sample metabolome taken from patients with different diseases are discussed. Besides, special attention is paid to the possible use of metabolomics in experimental medicine. The results of volatile metabolome changes in cell culture in vitro depending on the additives to nutrient media, β-carotene volatile decomposition products as suspected carcinogens, volatile organic compounds emitted at vertebrates decay are described. In addition, the method of two-dimensional gas chromatography aimed to increase the sensitivity and specificity of metabolomics tests is portrayed. The presented approach adds to early diagnosis of a number of diseases.
Kazan medical journal. 2014;95(1):1-6
1-6
Theoretical and clinical medicine
Male reproductive status after the classical inguinal hernia repair
Abstract
Aim. To determine the male reproductive status 18-20 years after classic unilateral herniotomy performed in childhood. Methods. Newsletters were sent to 127 patients, of whom 12 (9.45 %) responded. Male patients were invited for examination, including physical examination spermography with mixed agglutination reaction (MAR)-test, scrotum Doppler ultrasonography, prostate ultrasonography. Complete list of abovementioned examinations was performed in 10 male patients, representing 7.87% of the total number of respondents. 10 volunteers who had no medical history of inguinal hernia surgery were tested as a comparison group. Results. Sclerotic changes manifesting as testicular calcification were found in 4 (3.15%) patients who underwent inguinal hernioplasty surgery. No such findings were registered in volunteers who had no inguinal hernia surgery. Besides, 4 patients developed unilateral testicular hypotrophy of the hernia side, accompanied by an increased resistance index of parenchymal vessels in 75% of cases, which indirectly explains the causes of pathological changes in sperm. Considering small number of examined patients, the study had not enough power to state that hernioplasty surgery had the negative impact on male reproductive function; hence, it should be noted that in 7 cases alterations in the semen analysis were found, and 3 patients were infertile. These changes are likely to be related to technical defects of classic inguinal hernioplasty surgery performed in childhood. Conclusion. It is necessary to revise the use of classic inguinal hernioplasty and herniorrhaphy surgery performed in male children.
Kazan medical journal. 2014;95(1):7-11
7-11
Very premature babies and west’s syndrome
Abstract
Aim. To compare the prevalence of West’s syndrome in very preterm babies and in babies with prematurity of 1-2 degrees. Methods. Both retrospective and prospective study including 241 preterm babies who received out-patient or in-patient aid for different neurological disorders. Inclusion criteria for the first group were diagnosis of a neurological disorder, gestational age less than 31 weeks and birth weight not exceeding 1500 grams. Inclusion criteria for the second group were diagnosis of a neurological disorder, gestational age of 32-37 weeks and birth weight ranging from 1501 to 2500 grams. Results. Severe central nervous system damage, including such conditions as spastic quadriplegia (126 out of 157 1 stgroup babies, 80.3%, and 40 out of 84 2 ndgroup babies, 47.6%, р <0.001), developmental delay of cognitive functions (123 out of 157 1 stgroup babies, 78.3%, and 40 out of 84 1 stgroup babies, 47.6%, р <0,001) were more common in the first group. West’s syndrome was diagnosed in 22 (14%) of cases in 1 stgroup, in 3 (3.6%) of cases in 2 ndgroup (HR=4.4, 95% CI [1.28; 15.16], χ 2=6.42, р=0.01). In 21 (95.5%) of West’s syndrome cases, modified hypsarrhythmia was diagnosed by video electroencephalogram monitoring. Severe cerebral hypoxia of higher degrees, periventricular leukomalacia and hypoplasia of the corpus callosum were more common in 1 stgroup babies. Conclusion. Our study showed that the prevalence of West’s syndrome in very premature infants with neurological disorders was 4.4 times higher compared to babies with prematurity of 1-2 degrees. There was an association between West’s syndrome in preterm babies and such cerebral disorders as severe cerebral hypoxia of 3 rddegree, periventricular leukomalacia and hypoplasia of the corpus callosum.
Kazan medical journal. 2014;95(1):11-18
11-18
Secondary premature loss of baby teeth in children who had seek for the orthodontic aid
Abstract
Aim. To study the prevalence and structure of secondary premature loss of baby teeth in children of various ages who had seek for orthodontic aid. Methods. 998 medical charts of children aged from 3 to 10 years who were present at the department of pediatric stomatology seeking for orthodontic aid from 2003 to 2012. Groups of children were gender and age-matched. The analysis of prevalence and structure of prematurely extracted temporary teeth was performed. Results. Premature loss of temporary teeth was revealed in 312 (31.27%) out of 998 children who had seek for orthodontic aid. During the period of the temporary bite formation (3-6 years), the number of extracted deciduous incisors and molar teeth increased twice, single cases of deciduous canine teeth loss were revealed. During the mixed bite period, every 4th and/or 5th child had defects of baby tooth arches. Molars, mainly first molars, were the temporary teeth that were extracted more often. Significant increase in prevalence of a secondary premature loss of baby teeth (up to 27.91%), mainly at the lower jaw, was noticed during the period of the eruption of closely located permanent incisor teeth. Combined defects of frontal and lateral areas of temporary tooth arches were revealed in some children. Conclusion. Prevalence of a secondary premature loss of baby teeth in children of Krasnodar Krai who had seek for the orthodontic help, reached 31.27%. Upper incisors, first molar teeth, lower canines and their combination prevailed among the prematurely extracted temporary teeth. No gender differences in prevalence, structure and localization of prematurely extracted teeth according to quadrants of tooth arches were revealed.
Kazan medical journal. 2014;95(1):19-22
19-22
Bond strength of restoration materials used for dental ceramics repair
Abstract
Aim. To assess the bond strength of composite material to ceramic surface of metal-ceramic-fixed dental prosthesis depending on the type of restoration systems used for chipped porcelain restorations. Methods. Bond strength of restoration material to porcelain coating surface were studied according to ISO 10477 issued at 01.10.2004. The surface of the ceramic-metal plates was polished by different methods depending on the restoration system used. Restorative material was applied using a template. Prepared samples were placed in a testing machine and loaded at a constant crosshead speed of 1±0.3 mm/min before separation, the load F at break was registered by an automatic recorder. Results. Similar bond strength results were revealed for restoration systems not requiring acid pickling of porcelain surface («Cimara», «Ceramic Repair») and restoration system including 9.5% hydrofluoric acid «Porcelain etch & silane»: 17.993, 17.774 and 17.896 MPa respectively. Bond strength was much higher (25.278 MPa) if restoration system with 4% hydrofluoric acid was used. «Vertise™ Flow» restorative single-component material also provided significant bond strength - 24.315 MPa. Conclusion. The study showed the possibility of using a single-component restorative material to repair chipped porcelain tile coating metal-ceramic-fixed dental prostheses. For longer life of chipped porcelain tile coating restoration of dental prostheses, the use of restoration systems including 4% hydrofluoric acid is recommended.
Kazan medical journal. 2014;95(1):22-25
22-25
Diagnosing breast cancer based on radiotracer uptake at planar scintigraphy
Abstract
Aim. To study the radiotracer uptake at breast planar scintigraphy using a special gamma camera for breast cancer detection. Methods. The study included 120 women aged 53±9 years. Breast planar scintigraphy was carried out by BSGI (Breast Specific Gamma Imaging) method using DILON 6800 gamma camera with 99mTc-methoxyisobutylisonitrile ( 99mTc-MIBI) as radiotracer. All scintigraphy results were further confirmed by cytological and morphological verification of biological material. Results. According to nature and intensity of radiotracer accumulation in the breast, all examined patients were divided to three groups. Of 120 women, a homogeneous breast structure with no lesions was detected in 34. In 32 patients, a heterogeneous breast structure with zones of low and medium radiotracer accumulation was revealed, indicating benign breast disease. In 54 women, heterogeneous breast structure with high and ultra-high focal radiotracer uptake was found. In 36 cases, a benign disease was diagnosed, and in 18 (33%) of 54 cases, the scintigraphy results showed breast cancer, which was confirmed by the results of morphological verification of postoperative material. Breast planar scintigraphy by BSGI allowed to reveal the breast cancer, including small tumors (less than 1 cm) as focuses of 99mTc-MIBI accumulation. Sensitivity of breast planar scintigraphy in diagnosing breast cancer was 95%, specificity - 98%. Conclusion. High informative values of breast planar scintigraphy by BSGI allows to use this diagnostic method as a component of a diagnostic algorithm for breast cancer early detection.
Kazan medical journal. 2014;95(1):25-31
25-31
The use of phosphodiesterase type 5 (pde-5) inhibitors in treatment of erectile dysfunction in patients with diabetes mellitus of different age groups
Abstract
Aim. To study the effect of phosphodiesterase type 5 inhibitors used to treat the erectile dysfunction in patients of different age groups with concomitant diabetes mellitus. Methods. The study included 293 patients with diabetes mellitus type I and II aged 17-60 years, with duration of diabetes varying from 6 months to 29 years, duration of erectile dysfunction - from 6 months to 12 years. To diagnose the erectile dysfunction, an international index of erectile function, together with routine and special methods were used. Patients were administered phosphodiesterase type 5 inhibitors: sildenafil, taladafil and vardenafil. The control group included men with the erectile dysfunction without diabetes. To identify the male hypogonadism, patients were examined depending on the age group: 18-29 years, 30-39 years, 40-49 years, 50-59 years. Patiens were tested for sex hormones level, male ageing questionnaires were administered. Results. The increased rate of hypogonadism (from 12.5 to 54%) was associated with older age in patients with diabetes mellitus. The androgen status index in patients with diabetes mellitus, according to the Aging Males’ Symptoms rating scale, was 37.1±1.4 points. Phosphodiesterase type 5 inhibitors were more effective in younger age groups (57.1-91.7%) compared to older (36.8-67.3%). When comparing the study drugs, vardenafil showed better effect and relatively few side effects. Conclusion. Androgen deficiency, developing with increasing age is accompanied by a decrease in phosphodiesterase type 5 inhibitors efficiency. The use of small doses of these drugs corresponding the circadian rhythm of testosterone in males with normal testosterone blood level has the same effect as large doses.
Kazan medical journal. 2014;95(1):31-35
31-35
Non-alcoholic fatty liver disease in patients with chronic viral hepatitis
Abstract
Aim. To estimate the prevalence of non-acloholic fatty liver disease in patients with chronic hepatitis B, and the association of non-acloholic fatty liver disease with the biochemical, virological and metabolic faсtors. Methods. 53 patients with chronic hepatitis B observed in the regional hospital of infective diseases, Stavropol, at 2008-2012, were included. Patients were distributed to 2 groups according to the results of liver biopsies: group I - patients with hepatosteatosis (>5%) and group II - no signs of steatosis (≤5%). Anthropometric, histological, biochemical, virological, and metabolic determinants were compared. Results. Of 53 patients, 18 (34%) liver biopsies had signs of steatosis. Patients with steatosis (group I), compared with group II, were older (43±13 vs 34.5±10.9 years, р=0.015), had higher body mass index (30±5.3 vs 22.9±4.3 kg/m 2, р=0.015), higher level of triglycerides (1.6±0.8 vs 1.06±0.7 mmol/l, р=0.014), higher level of cholesterol (5.6±0.7 vs 4.97±0.9 mmol/l, р=0.012), and higher serum insulin (13±7.9 vs 8.2±3 mkME/l, р=0.002) and leptin levels (16.2±15.6 vs 6.5±5.2 ng/ml, р=0.001). The values of HOMA (Homeostasis Model Assessment) and QUICKI (quantitative insulin sensitivity check index) indices corresponded to insulin resistance (НОМА 2.9±1.8 and 1.9±0.8, р=0.007; QUICKI 0.33±0.02 and 0.35±0.03, р=0.014). There were no differences in histological activity scores by Knodell and fibrosis scores by METAVIR scale between the groups. No reliable differences in virological parameters (viral load and HBeAg status) were obtained. Conclusion. Non-alcoholic fatty liver disease is observed in one-third of patients with hepatitis B and is associated with host metabolic factors, which correspond to the parameters of metabolic syndrome.
Kazan medical journal. 2014;95(1):35-41
35-41
The functional state of the endothelium in patients with viral hepatitis and liver cirrhosis
Abstract
Aim. To study the functional state of endothelium in patients with chronic viral hepatitis and liver cirrhosis and impact of left and right ventricle diastolic malfunction and pulmonary hypertension on endothelial function. Methods. 74 patients with chronic viral hepatitis (group 1), 62 patients with cirrhosis (group 2) and 17 healthy volunteers were examined. Doppler echocardiography and brachial artery ultrasonography with endothelium-dependent vasodilation measurement were performed. Results. Endothelium-dependent vasodilatation was reduced in patients of the 1 stgroup (6.2%), and of the 2 ndgroup (2.2%) compared to the controls (13.8%, р <0.05). Sensitivity coefficient for the brachial artery was measured as 0.31 (0.19; 0.35) in patients with chronic viral hepatitis, 0.25 (0.09; 0.35) in patients with cirrhosis compared to 1.27 (0.72; 1.29) in control group, demonstrating the marked endothelial dysfunction in patients of the 1 stand 2 ndgroups (р <0.05). Moderate pulmonary hypertension was accompanied by a more pronounced endothelium-dependent vasodilation impairment in both groups (р <0.05). In patients with viral hepatitis, endothelial malfunction was less common (62%) compared with patients with liver cirrhosis (85%, p=0.002). Presence of left and right ventricle diastolic malfunction did not influence the endothelial function. Conclusion. In patients with viral hepatitis and cirrhosis, endothelium-dependent vasodilatation is affected depending on the severity of the disease and increased if pulmonary hypertension was present. Presence of left and right ventricle diastolic malfunction did not influence the endothelial function.
Kazan medical journal. 2014;95(1):41-45
41-45
Comparative analysis of dural reconstruction methods in open brain surgery for prevention of postoperative cerebrospinal fluid leakage
Abstract
Aim. A comparative evaluation of dural reconstruction results using different material: patient’s own tissues (periosteal fragments, m. temporalis fascia or fascia lata), dural graft implants, collagen matrix, as well as evaluation of adhesive compositions effect for dural sutures sealing. Methods. Results of different types of dural reconstruction used in 243 patients operated between 2009 and 2012 were analyzed. Additional materials were required to complete dural reconstruction in 91 cases. Three patient groups were formed depending on the type of plastic material: patient’s own tissues, artificial materials and collagen matrix without suture fixation. In first two groups, sutures fixed plastic material, adhesive compositions or collagen materials were used as sealant in some cases. Effect in postoperative cerebrospinal fluid leakage preventing was assessed for different plastic materials, as well as for additional dural sealants. Results. Cerebrospinal fluid leakage frequency was similar (p >0.05) regardless of the type of plactic material (patient’s own tissues, dural graft implants, collagen matrix) use and was assessed as 26.2, 29.0 and 27.8% accordingly. In subgroups where sutures between dura mater and graft were additionally strengthened by adhesive compositions or collagen stripes, cerebrospinal fluid leakage rate (23.3%) was lower (p <0.05) compared to subgroups without sealant (44.4%). Conclusion. The type of plastic material does not matter for effective cerebrospinal fluid leakage prevention. Additional sealing of recovered dura mater reduces the risk of postoperative cerebrospinal fluid leakage.
Kazan medical journal. 2014;95(1):45-49
45-49
Clinical and criminological characteristics of patients with organic mental disorders who had repeatedly committed socially dangerous acts
Abstract
Aim. To perform the comparative analysis of clinical and criminological characteristics of patients with organic mental disorders who had repeatedly committed socially dangerous acts. Methods. 79 patients with diagnosed organic mental disorders who had committed socially dangerous acts, declared insane by the court and underwent compulsory treatment determined by the court as out-patients or in general or specialized mental hospital. Patients who had repeated socially dangerous acts after treatment, were included in the group A (19 patients), patients who had not committed any socially dangerous act after treatment, were included in the group B (60 patients). Results. Patients with organic delusional disorder (21 vs 11.6%) and non-psychotic organic disorders (10.5 vs 5%) were more commonly seen in group A compared to group B. The share of patients with dementia was higher in group B (23.3 vs 5.2%). 8 (42.1%) patients of group A were never prosecuted before, compared to 40 (66.7%) patients from group B. Some crimes were registered only in patients who repeatedly committed crimes: sexual crimes - 1 (5.2%), crimes against administrative order - 2 (10.5%), crimes against public security 5.2% (patient was convicted in illicit firearms manufacturing). Psychopathy-like syndrome was the leading syndrome in patients who committed a socially dangerous act in both A and B groups: 11 (57.9%) and 33 (55%) cases respectively. Hallucinatory delusion was diagnosed in 7 (36.8%) of group A patients and in 17 (28.3%) of group B patients. Majority of the group A patients had further committed only one crime after treatment - 11 (57.9%), 5 (26.3%) committed 2-3 crimes, 3 (15.8%) patients - over 3 crimes. The time gap between the first and further compulsory treatment was between 1 and 3 years in most of the cases (11 patients, 57.9%). 4 (21%) patients were readmitted for repeated compulsory treatment within 1 year, 3 (15.8%) were readmitted from 3 to 5 years and 1 (5.3%) from 5 to 8 years after the initial treatment. Conclusion. There are a number of factors influencing the criminal behavior and re-committing socially dangerous acts in future. Despite the small sample size, it should be noted that patients with dementia do not repeat socially dangerous acts.
Kazan medical journal. 2014;95(1):49-54
49-54
Influence of some hormones and collagen metabolism on gastroesophageal reflux disease pathogenesis in children
Abstract
Aim. To study the collagen metabolism and secretion of hormones, and estimate their association in gastroesophageal reflux disease (GERD). Methods. 62 children with gastroesophageal reflux disease were examined. Control group included 32 children. Insulin and cortisol blood levels were determined by electro-chemiluminescence immunoassay (ECLIA), gastrin and somatostatin blood levels were determined by ELISA. Hydroxyproline and sialic acids levels were measured in gastric juice. Results. Esophageal mucosa lesions of different stages were diagnosed in all children with GERD: 36 (58%) children had I stage of esophagitis, 24 (38.7 %) children - II stage, 2 (3.2%) children - III stage. It was revealed that children with GERD demonstrated increased collagen breakdown level in esophageal and gastric mucosa, confirmed by high free hydroxyproline levels (29.6±3.2 μmol/L; p <0,05) and peptin-associated hydroxyproline (25.5±2.1 μmol /L; p <0.01). This collagen breakdown might be possible due to high cortisol level (389±15.5 nmol/L versus 204.4±12.1 nmol/L in control group, р <0.05). Increased insulin level (28.5±3.2 μU/ml vs 9.3±2.5 μU/ml; р <0,05) in patients with GERD might be a compensatory reaction to catabolic processes. Increased level of somatostatin (0.457±0.14 nmol/L; р <0.001) associated with low levels of gastrin (7.2±1.4 nmol/L) was discovered in children with GERD aged 9-12 years. On the contrary, children older than 12 years demonstrated high gastrin levels (18.72±3.2 nmol/L) associated with low levels of somatostatin (0.129±0.09 nmol/L). Conclusion. Influence of cortisol increased blood level on mucosa results in disbalance between aggressive and protective gastroduodenal factors in children with GERD, resulting in collagen breakdown. Increased insulin level signs the stimulation of the protective and adaptation mechanisms in children with GERD.
Kazan medical journal. 2014;95(1):54-58
54-58
Experimental medicine
Effects of triphenyltetradecylphosphonium bromide and tributylhexadecylphosphonium bromide on cellular permeability in patients with hereditary cellular membrane hyperpermeability
Abstract
Aim. Comparative analysis of effects of novel biologically active agents: triphenyltetradecylphosphonium bromide and tributylhexadecylphosphonium bromide on cell membrane permeability for sodium by determination of of Na +-Li +-countertransport speed in erythrocyte membrane at patients with genetically determined high membrane permeability for sodium. Methods. Blood samples of 8 healthy volunteers who were classified as persons belonging to IV population quartile according to Na +-Li +-counter-transport speed in erythrocyte membrane, i.e. persons with high membrane permeability, were studied. Effects of different concentrations of triphenyltetradecylphosphonium bromide and tributylhexadecylphosphonium bromide (known by antibacterial and antifungal action) on Na +-Li +-counter-transport speed in erythrocyte membrane in vitro according to the method proposed by M. Canessa et al. Results. Effect of triphenyltetradecylphosphonium bromide (С 14) and tributylhexadecylphosphonium bromide (С 16) on cell membrane permeability for sodium depends on the genetically determined baseline cell membrane state. С 14reduced the erythrocyte membrane permeability for sodium in studied patients belonging to IV quartile of Na +-Li +-counter-transport speed if administered in a concentration of 0.05 μm. C 16increased membrane permeability for sodium in the same group if administered in concentrations of 0.001 and 0.005 μm. Thus, tributylhexadecylphosphonium bromide is better suitable for designing a drug with antibacterial and antifungal action for patients belonging to IV quartile of Na +-Li +-counter-transport speed, if Na +-Li +-counter-transport speed reduction is wanted. If Na +-Li +-counter-transport speed increase is wanted, triphenyltetradecylphosphonium bromide is better suitable. Conclusion. Cand Csubstances affect cell membrane permeability for sodium in patients with genetically determined high membrane permeability for sodium.
Kazan medical journal. 2014;95(1):59-62
59-62
Reviews
Laser doppler flowmetry for human blood microcirculation assessment
Abstract
The prevention and treatment of various microcirculation disorders are one of the most important problems of medical practice. The difficulties of studying the microcirculation are related to the blood vessels small size and extensive branching within organ tissues. At present, various methods of microcirculation assessment using the laser Doppler flowmetry are applied in active clinical practice in our country. The review covers the main methods of laser Doppler flowmetry used for the diagnosis of various microcirculation disorders. The method is based on the determination of tissue blood perfusion by measuring the Doppler frequency shift while tissue is illuminated by a laser beam, followed by the registration of the reflected radiation from moving and stationary tissue components. Microcirculatory oscillation rhythm plays an important role, especially in early diagnosis of many diseases. The loss of certain types of oscillations at laser Doppler flowmetry is interpreted as «spectral narrowing» and serves as a diagnostic criterion for microcirculation deregulation, which is directly related to decreased blood perfusion and tissue hypotrophy. The use of amplitude-frequency analysis of blood flow oscillations can non-invasively evaluate the impact of the various components of microvascular tone, allowing to calculate an index of neurogenic and myogenic tone and bypass index. The amplitude-frequency analysis of the laser Doppler flowmetry spectrum uses normalized parameters determining the maximum amplitude of the blood flow oscillation in different bands, as well as their ratio - microcirculation effectiveness index. Hyperemic, spastic, spastic-atonic, structural and degenerative, congestive and stasic forms of various microcirculation disorders are marked out. Each of these microcirculatory disorders is characterized by a certain ratio of structural and functional changes and changes in blood velocity, as well as impaired barrier function. The main principles of the microcirculatory disorders are described.
Kazan medical journal. 2014;95(1):63-69
63-69
Pathogenetic features of the hepatobiliary system damage in patients with metabolic syndrome
Abstract
A review of articles covering the modern views on the hepatobiliary system damage features in patients with clinical manifestations of metabolic syndrome. 196 original papers published over the last 6 years were found using PubMed, MEDLINE, E-library databases, from which 50 articles were picked out for the review. Considering high prevalence of metabolic syndrome, the studied problem seems important. The influence of obesity and associated insulin resistance at launching the systemic inflammation leading to activation of immunological cascade resulting in terget organs damage in such patients is highlighted. The pathogenesis of liver, gall bladder and bile ducts damage at presence of metabolic disorders is outlined. The role of inflammatory and anti-inflammatory cytokines in liver tissue damage is described. Based on the data of literature review and own data, it was shown that the lipid metabolism alterations are associated with liver functional damage, and liver in patients with metabolic syndrome is not only participating in atherogenic dislipoproteinemia development, but also damaged as the target organ. It was revealed that the key link in the gall bladder pathology in patients with metabolic syndrome is the lipid metabolism alterations that lead to the excess cholesterol bile excretion and cholesterol monohydrate crystals sedimentation. It was also shown that the functionally affected hepatocytes produce imperfect bile micelles with high cholesterol and low phospholipid levels, increasing the bile lithogenicity. High bile cholesterol level stimulating the mucin secretion by gall bladder wall, which is the important component of bile sediment and increases the bile crystalloids aggregation.
Kazan medical journal. 2014;95(1):70-74
70-74
Extracorporal methods for liver failure treatment
Abstract
A mortality rate in patients with liver failure remains high. Currently the main causes for liver failure are viral hepatitis and alcoholic liver disease. As a result of liver detoxification malfunction a number of complications, including hepatic encephalopathy, hepatorenal syndrome, circulatory disorders develop. Different types of extracorporeal therapies and their combination are used to treat the liver failure for a long time. Figuratively, extracorporeal liver support systems can be divided into two groups: biological and non-biological. Biological methods are based on the use of isolated hepatocytes suspension. Non-biological methods include dialysis, hemofiltration, plasma exchange, hemosorption, Molecular Adsorbent Recirculating System (MARS) and fractionated plasma separation and adsorption (FPSA or Prometheus). Modern technologies allowed to combine liver support systems into a whole and to create an additional method of liver failure treatment — Molecular Adsorbent Recirculating System (MARS). Currently, MARS is a promising trend of liver failure treatment, as it allows support the liver function for a long time until restored or an optimal donor will be found.
Kazan medical journal. 2014;95(1):75-79
75-79
Clinical and immunological studies of periodontal inflammatory complications at orthodontic treatment using fixed appliances
Abstract
The review of clinical and immunologic studies of periodontal inflammatory diseases is presented. At present, the most effective tools for treatment of malocclusions are fixed orthodontic appliances (dental braces), but the use of fixed appliances complicates the oral hygiene, predisposes to periodontal and gum inflammation. The rate of complications diagnosed during orthodontic treatment stays high. The principles of periodontal inflammatory diseases (gingivitis, periodontitis) treatment are closely related with the causes and mechanisms of periodontal inflammation. Patients who receive orthodontic treatment using braces should be treated as a group with a high risk for inflammatory periodontal diseases. The orthodontic devices stimulate the directed reorganization of periodontal structures achieving optimal aesthetic and functional standards. Physiology of periodontium restructuring is largely determined by the local and general health before, during and after the orthodontic treatment. This article surveys the mechanisms of periodontal damage, highlighting the important role of immune response. So far, only anecdotal descriptions of immune response on the stages of orthodontic treatment are published.
Kazan medical journal. 2014;95(1):80-82
80-82
Analysis of visual perception features by corneal reflex components examination
Abstract
The article surveys the data of experimental studies in which the corneal reflex was used in the analysis of the visual perception process. Visual perception largely depends on the physiological characteristics of the human visual system, both individual and general. Blinking performs a number of functions, one of which is protection, including protection from unpleasant or undesired information. Blinking is closely related to the processes of concentration and disinterest. Blinking while watching a video is synchronized in single person and in a group of people watching the same video fragment. Blinking synchronization depends on the video plot; background video does not cause synchronization. Blinking synchronization is not gender specified. A longer duration of blinking is associated with a significant increase of the intervals between blinks. Accounting for these features of visual perception will allow to coordinate the work with video in several ways. First of all, it is an analysis of the reaction by monitoring the blinks while watching the video. Such analysis should contain a detailed and comprehensive decoding including electrophysiological, psychological and psychophysiological tools. Thus, the analysis of visual perception by studying the corneal reflex components requires an interdisciplinary approach and should be targeted to getting the results usable both for further studies of psychological features and principles of human visual perception and for further creation of most effectively perceived video.
Kazan medical journal. 2014;95(1):82-86
82-86
Prospects of using P2 receptors agonists and antagonists as drug substances
Abstract
P2 receptors are detected in different tissues and organs, which makes them a potential target of pharmacological action. A number of studies confirming the maturity of purinergic theory are currently published. Literature review focuses on P2 receptors characteristics, their main current agonists and antagonists, as well as on the possibilities of pharmacological action on these receptors. The most important studies addressing new chemical compounds important for studying P2 receptors and also compounds with potential for medical use are analyzed. Data on current successes of P2 receptors pharmacology and introduction of P2Y receptors antagonists into clinical practice are presented. Over the last decades a certain progress was observed in studying P2 receptors agonists and antagonists. There is a growing interest to pathophysiology and therapeutic potential of purinergic neurotransmission. Nevertheless, there is a need for developing new compounds acting selectively to these receptors both in vivo and in vitro. Despite the large number of P2 receptors agonists and antagonists, most of them have certain drawbacks, including incomplete of non-selective antagonism, or significant effect on ecto-ATPase activity. Thus, studying P2 receptors to find novel compounds acting on these receptors is of significant clinical value. Apparently, this trend of developing novel drugs — P2 receptors agonists and antagonists — is particularly promising.
Kazan medical journal. 2014;95(1):86-90
86-90
Healthcare mangement
Mathematical model for predicting the length of hospital stay after performing high-tech operations for arrhythmia correction
Abstract
Aim. To create a mathematical model for predicting the length of post-operative treatment after performing high-tech surgeries for arrhythmia treatment. Methods. To predict the in-patient treatment duration after performing high-tech surgeries for arrhythmia treatment, the data set was checked for normality of sample variance distribution and for variability, discriminant function analysis, variability analysis, Kolmogorov-Smirnov test, crosstab Pearson’s chi-squared test were performed. Normally distributed quantitative parameters are presented as M±m (m - standard error). Cross-sectional prospective study including the data of 345 patients aged 20 to 88 years (males 42.0%, females 58.0%) who underwent high-tech surgeries for arrhythmia treatment, was performed for modeling. Results. It was found that the main category of patients who require surgery for cardiac arrhythmia treatment were women aged 61 to 75 years (mean 68±7 years). Pacemaker implantation was the most common surgery type (47.0%, 162 patients), followed by radiofrequency ablation (31.0%, 107 patients) and encircling pulmonary veins isolation (22.0%, 76 patients). It was also found that the presence of postoperative complications after implantation of the pacemaker directly influencing treatment duration, increasing it almost twice fold (to an average of 14.2±5.1 days compared to 7.4±1.2 days in patients without complications, p=0.02). Statistical analysis allowed to identify five levels characterizing the duration of in-patient post-operative management. An automated software module for risk assessment in patients admitted for high-tech surgeries for arrhythmia treatment was created basing on the results of the study. The precision of the model reached 87% (mean value 84.7%). Conclusion. An automated software module for predicting the length of in-patient post-operative treatment allows to stratify the risk of post-surgical complications for patients and shows the influence of those risks on the use of hospital beds, medical aid management and funding of high-tech surgeries by obligatory health insurance funds.
Kazan medical journal. 2014;95(1):91-94
91-94
Patient satisfaction as a quality criterion of paid ophthalmologic aid
Abstract
Aim. Conduct a questionnaire survey of in private clinic patients to study the problems of ophthalmologic aid quality. Methods. The survey included 108 patients who filled in a specially designed questionnaire. Typological and variation analysis was performed, relative and mean statistical values were calculated; statistical significance of revealed differences was checked. Results. When choosing a private clinic, young people often rely on advertising, while the older patients - on the opinion of relatives and friends. Patients seek for paid services because they believe in a higher healthcare, with 59.3% of respondents believe that the quality of care is improved if they pay. Services of paid clinics are quite affordable for the majority of the interviewed patients (proposed service cost is moderate, transport accessibility, travelling time and admission queue time are quite acceptable). Generally, consumers gave a positive assessment of the clinic staff and its activities as a whole: the relationship with the doctor was characterized as trustful, attentive and respectful, involving a complete understanding of patient’s problems by the medical staff. Most respondents (92.6%) find their physician a specialist of high qualification. The main reasons for dissatisfaction with paid medical services are discrepancy between price and quality, low treatment effect, which is closely coupled with the staff competence and incorrect behavior of health workers. Conclusion. The conducted survey showed high satisfaction with medical services provided in a private clinic.
Kazan medical journal. 2014;95(1):95-99
95-99
Risk factors of urolithiasis in Gusar and Khachmaz districts of Azerbaijan Republic
Abstract
Aim. To assess the risk factors, gender, age and social features of patients with urolithiasis who live in the northern regions of Azerbaijan. Methods. Patients with urolithiasis who live in the northern regions of Azerbaijan and were admitted to the Central Hospitals of Gusar and Khachmaz districts (113 and 81 patients respectively) were included in the study. In Gusar district, 70 (61.95%) male patients and 43 (38.05%) female patients were included, in Khachmaz region, 51 (62.96%) male and 30 (37.04%) female patients were included. Results. In Gusar district, urolithiasis was most commonly found in patients aged from 16 to 30 years and from 41 to 50 years. In Khachmaz district, the highest prevalence of urolithiasis was registered in people aged from 41 to 50 years. In Gusar district, urolithiasis was more common in patient groups with body mass index of 25-29.9 kg/m 2and 30-34.9 kg/m 2. In Khachmaz district, urolithiasis was diagnosed mainly in patients with body mass index of 25-29.9 kg/m 2and 18.5-24.9 kg/m 2; in female patients - mainly in patients with body mass index of 25-29.9 kg/m 2and 30-34.9 kg/m 2). In both districts, urolithiasis mainly occurred in unemployed and white collars. Conclusion. Overweight, aged and elderly, unemployed and white collars are patient categories with highest risk for urolithiasis, which should be considered at prevention.
Kazan medical journal. 2014;95(1):100-103
100-103
Social pediatrics: scientometric analysis
Abstract
Aim. To identify trends of further development, priorities, challenges and vectors of further research in social pediatrics. Methods. Interpretive content analysis of dissertations in the field of public health and healthcare for the period from 1991 to 2012 was performed. 4194 items were analyzed. Results. At the first stage of the research, it was found that 14.8% of public health dissertations presented during the research period addressed pediatric problems. The next stage included qualitative and quantitative analysis of top-priority topics of social pediatrics in public health dissertations. The analysis of social pediatrics areas included the following categories: (1) studies of social (psychosocial) determinants of children’s health; (2) studies of health condition of children and adolescents in a stressful situation; (3) organization of medical and social aid to children. Studies of social (psychosocial) determinants of children’s health were the most common (35.9 %). Studies of health status of vulnerable children and adolescents had a share of 15% of all studies. 7.6% of studies were devoted to pediatric medical and social aid organization. Conclusion. It is important to facilitate the research in social pediatrics to optimize the scientific data and improve pediatric medical and social aid.
Kazan medical journal. 2014;95(1):103-107
103-107
Sports medicine and rehabilitation
Actual aspects of studying athlete’s body composition
Abstract
The review of the literature presents the existing methods of the body composition estimation, including the area of their use and information they provide, the role of the body composition monitoring in athletes, as well as the main factors influencing the body composition, are outlined. Over time, in professional sports there is a trend of the significant improvement of the results, sophistication of the technical sporting programs, leading to tougher training and competition, resulting in morphological changes of the athletes’ body composition. Thus, the importance of the athletes’ body composition assessment increases. Athletes’ body composition monitoring allows to assess the athletes’ health and physical fitness, allowing to adjust the training. The development of the new methods, changes in basic principles and the possibilities of determining body composition, which today have become more accurate and reliable, is an important step towards the proper athlete’s health support and enhancing the performance. Currently, there are a lot of methods of tissue body composition assessment at different levels of organization (elemental, molecular, cellular, tissue and organ levels, whole body level). However, despite the variety of existing methods, each of them has a number of advantages and disadvantages for use in sports practice. Therefore, to choose the proper body composition assessment method, it is necessary to focus on research objectives, as well as the accessibility and availability of the research method. Introduction of new technologies and examination methods allows increasing the specificity and promptness of the body composition estimation, but the novel methods are high-cost, needs standardization and validation to be widely used in common practice.
Kazan medical journal. 2014;95(1):108-111
108-111
Assistance to the practicing physician
Two-staged surgical treatment of hip septic arthritis
Abstract
Hip arthritis (coxitis) is the inflammatory process in the hip, requiring complicated and lengthy treatment. At some cases it is associated with serious complications, up to patient’s disability due to the femoral head destruction. The treatment goal is to halt inflammation for further hip arthroplasty and functional rehabilitation. Arthroplasty is performed using the commercially available cement antibiotic-impregnated articulating spacers. The article reviews a number of clinical examples of two-staged surgical treatment of hip septic arthritis using articulating spacers with further hip arthroplasty. Experts, including native specialists, in the periodicals and clinical practice question the effectiveness of two-staged treatment. The experience of effective use of commercially available bone cement antibiotic-impregnated articulating spacers is presented. The method allows to halt the inflammation, to avoid the significant femoral shortening and acetabulum filling by scar tissue, to preserve hip function and provides the patient an opportunity to move with a partial load on the operated limb while waiting for the arthroplasty, as well as improves the conditions for hip implant consolidation. After suppressing the inflammation, the described method, providing a moderate load on the affected bone, enhances the bone mineral density increase both of femur and acetabulum. Two-staged treatment of septic coxitis decreases the risk for infective complications after the total hip replacement.
Kazan medical journal. 2014;95(1):112-115
112-115
Clinical observations
Traumatic amputation of penis
Abstract
7 patients with penile traumas (4 - with penile fracture, 2 - degloving penile injury, 1 - traumatic amputation of the penis) were observed in the department of urology of the Municipal Hospital №5, Naberezhnye Chelny, Russia from 2009 to 2013. The penile trauma, regardless of its cause, is the major physical and mental trauma for the patient. It causes psychological distress, and impacts the subsequent quality of life in males. In domestic and foreign literature, there are few reports about the traumatic amputation of the penis as suicidal attempt in mental patients. At the presented case, patient himself performed the traumatic amputation to remove the strangulating ring. The patient used a metal ring to increase erection, after the coitus it caused the pathologic erection, and patient could not remove it. To decrease the edema, the patient cut the penile skin, but did not reckon the knife sharpness and the force, and performed the traumatic amputation of penis; the stump was thrown away by the patient. The described case can be distinguished because of the rare trauma mechanism in mentally healthy patient.
Kazan medical journal. 2014;95(1):116-117
116-117
Stent retriever for iatrogenic cerebral thromboembolism treatment
Abstract
Thromboembolism is one of the dangerous complications of cerebrovascular endovascular surgeries, often resulting in severe disabilities. A clinical case of using stent retriever for treating iatrogenic cerebral thromboembolism occurred as a complication of diagnostic cerebral angiography is presented. Patient M., 49 years, was admitted in the department of neurology with referral diagnosis of subarachnoid hematoma. No pathologic changes of intracranial arteries were revealed on multi-spiral computed tomography, so cerebral angiography was administered. After administration of heparin (100 U/kg), selective cerebral angiography of all the intracranial vascular beds was performed using a diagnostic cerebral catheter with some technical difficulties. After the intervention was finished, the patient developed non-focal neurological symptoms, left-sided hemianopsia. Angiography of posterior circulation system was repeated immediately, left posterior cerebral artery occlusion was found. Stent retriever was used to restore the intracranial blood flow. An intracranial stent retriever Solitaire (EV3) was delivered to the occlusion and deployed with exposition of 5 minutes and further removal. Control angiography showed complete restoration of the intracranial blood flow without signs of distal embolism. The neurologic deficit had completely resolved during first 24 hours after the surgery. The presented clinical case illustrates the effect of stent retriever use to to restore the intracranial blood flow and stresses the need for such devices availability in departments performing cerebral surgeries in patients with cerebrovascular diseases.
Kazan medical journal. 2014;95(1):118-120
118-120
History of medicine
Sanitary and hygienic situation in educational institution and its influence on student’s protests at the turn of the XX century (on the example of the kazan theological seminary)
Abstract
In 1899 in the Kazan Theological Seminary the wave of student’s protests arose. Uproar were extreme forms and were accompanied by a window shattering, furniture crash and threats to authorities. Shortly before this, the Seminary rector, archimandrite Kirill (Lopatin) submitted the report to the Kazan archbishop Arseny (Bryantsev) in which he described difficult sanitary and hygienic situation of seminary and that it negatively affects the educational process. The document reveals a heavy student life: extreme overcrowding, lack of rooms, high humidity and lack of fresh air. As a special problem, absence of own bath was mentioned, forcing students to visit city baths, that led to increase of number of contagious diseases cases. The petition of the seminary students, handed over to the Kazan archbishop, confirmed that radical moods of pupils were motivated by worsening sanitary conditions in educational institution. However, despite recommendations of the bishop to the Seminary Board to find a solution of the problems rising, no efforts were made due to different reasons. The commission appointed for investigation of incidents, consisted of teachers, but didn’t include a medical worker, that indirectly indicates authorities’ formalistic approach to the problem. On the other hand, the considerable fault in sanitary and hygienic situation deterioration in Seminary lays on students, who by the end of the XIX century were not yet aware of simple sanitary rules importance.
Kazan medical journal. 2014;95(1):121-123
121-123
The main directions of zemstvo healthcare development in Kazan governorate in XIX century
Abstract
The Zemstvo reform has set a start of changes in a number of spheres of the country’s life, including health-care. The development of zemstvo healthcare in Kazan Governorate took the way of increasing the number of healthcare workers and consolidating the healthcare facilities network. Kazan Governorate zemstvo managed to create a promoted healthcare in conditions of scarce resources and lack of medical professionals. At this period, a new form of medical and sanitary attendance — medical district — was created, replacing the old patrolling system. One of the advantages of zemstvo healthcare was introduction of free drug supplies. At the end of XIX century, a developed network of pharmacies was established. Almost in all uyezds of Kazan Governorate, medical depots were functioning, providing local pharmacies with the required medicines. At the beginning of zemstvo healthcare functioning, obstetrics was singled out as a separate branch of medicine. In XIX century, special maternity beds appeared in a number of zemstvo healthcare units. At the beginning of XX century, special maternity ward for obstetric aid appeared in zemstvo hospitals, maternity clinics opened. By the early XX century, a rural healthcare system, its legal groundwork, operations and funding were established. As a result of zemstvo self-government institutions functioning, an extensive network of uyezd hospitals, paramedic stations was established, providing medical aid to rural population; stationary zonal system of medical aid was created.
Kazan medical journal. 2014;95(1):124-127
124-127
Discussions
Psychological characteristics of patients with missing teeth at initial contact and after orthopedic treatment
Abstract
Aim. To study the influence of dental diseases and results of their treatment on patient’s psychological profile. Methods. 40 patients with hard teeth tissues and dentition defects at the esthetic zone aged from 30 to 57 years were included in the study. Control group consisted of 25 people not requiring dental treatment. A new method of determining patient’s psychological subtype, offered by A. Anuashvili and based on computer analysis of the patient’s photographs, allowing totally avoid the subjectivity of a diagnosis. Results. Analysis of emotional stress level in patients before the dental procedures showed that it was significantly higher in males compared to females (73.6±0.86 vs 57.9±0.93% respectively, р <0,01). It was also found that 60% of all patients had unstable aspects of psychological subtype regardless of gender. In the control group, only minor changes of psychoemotional state between two examinations were registered, allowing to conclude that psychoemotional state without strong stimuli is quite stable. The use of the video-computed psychoanalysis method can help a dentist to assess the patient’s psychoemotional status when patient is seeking for dental aid, and to communicate better considering the patient’s psychological subtype, as well as to control psychoemotional state during and after the treatment. Conclusion. Missing teeth not only impair chewing, but also deteriorate patient’s psychoemotional state, leading to worse quality of life.
Kazan medical journal. 2014;95(1):128-130
128-130
Jubilees
Life journey and scientific heritage of professor M.B. Vurgaft (to the 100th anniversary)
Abstract
In 2013 it is 100th birthday anniversary of M.B. Vurgaft - world known scientist, one of the founders of the aqueous humour production and drainage examination by compression tests and tonometry in a normal eye and in glaucoma patients. Moisey Bencionovich Vurgaft, professor, PhD, headed the department of ophthalmology of Kazan State Institution for Post-Graduate Medical Education, later renamed to Kazan State Medical Academy. The student of outstanding scientists - academician V.P. Filatov and professor S.F. Kalf, M.B. Vurgaft has devoted all his life to studying one of the leading problems of ophthalmology - glaucoma. He was the first in The Soviet Union who has started to study the eye fluid flow, and developed original and easily assessable study methods that are still important nowadays. A new direction of scientific research of the department targeted on glaucoma studies was formed under the guidance of M.B. Vurgaft. Moisey Bencionovich had always tried to link the scientific research with the needs of healthcare practice. He was an outstanding diagnostician, clinician and ophthalmic surgeon. Professor M.B. Vurgaft had always shared his experience and had mentored a number of outgoing students, who are currently working all over the country. He is the author of over 140 academic papers, 6 textbooks, several patents covering various questions of ophthalmology. Using the scientific data, originally gained by M.B. Vurgaft, 16 master and 6 doctoral degrees (PhDs) were completed in different institutions of CIS, Bulgaria and Hungary. During 13 years he was an eternal head of the Tatarstan Scientific Society of Ophthalmologists, an honoured member of All-Russia and Soviet Union Scientific Society of Ophthalmologists, member of the expert board of the Central (awarded with the order of Lenin) Institution for Post-Graduate Medical Education of the responsible for the development of post-graduate educational programs in ophthalmology, member of the of surgical faculty of Kazan State Institution for Post-Graduate Medical Education.
Kazan medical journal. 2014;95(1):131-136
131-136
K 100-letiyu so dnya rozhdeniya professora Abruy Khusainovny Khamidullinoy
Kazan medical journal. 2014;95(1):137-138
137-138
Dotsentu Roze Genad'evne Al'bekovoy — 85 let
Kazan medical journal. 2014;95(1):139-140
139-140
Book review
Na kn.: Fedorov I.V., Malkov I.S., Dubrovin V.N. Laparoskopicheskaya khirurgiya, ginekologiya i urologiya. - M.: Dom knigi, 2013. - 436 s.
Kazan medical journal. 2014;95(1):141-142
141-142