I.P. Pavlov Russian Medical Biological Herald
ISSN (print): 0204-3475, ISSN (online): 2500-2546 Founders: Ryazan State Medical University, Eco-Vector Editor-in-cheif: Roman E. Kalinin, Doctor of Sc., Full Professor Frequency / Access: 4 issues per year / Hybrid Included in: White List (2nd level), RISC, Scopus
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Immediate and long-term outcomes of repeated endovascular correction of bifurcation lesions of coronary arteries
INTRODUCTION: One of the main factors limiting the effectiveness of percutaneous coronary intervention (PCI) in the long-term follow-up period is in-stent restenosis (ISR). One predictor of its development is the initial bifurcation lesion (BL) of the coronary arteries (CA). Such patients present a particularly complicated group for endovascular treatment. AIM: To compare the results of different treatment methods for patients with coronary heart disease and ISR in the area of CA bifurcation. MATERIALS AND METHODS: A single-center, non-randomized, retrospective study included 105 patients with coronary heart disease with ISR in the area of CA bifurcation, who underwent PCI from 2012 to 2023. Group 1 (n = 40) included patients who underwent repeat revascularization using a one-stent coronary stenting technique, group 2 (n = 32) included patients who underwent revascularization using a two-stent technique, group 3 (n = 33) included patients in whom a non-stent treatment technology was used — application of an antiproliferative drug using drug-eluting balloon catheters. The median follow-up period was 380 [264; 411] days. RESULTS: There were no statistically significant differences in the ISR recurrence rate in all groups, however, there was a tendency for it to increase in groups 2 and 3: 8 (25.0%) in group 2 and 8 (24.2%) in group 3 versus 4 (10.0%) in group 1, p = 0.18. The frequency of myocardial infarction did not differ significantly in patients of the analyzed groups: 2 (5.0%) in group 1, 2 (6.3%) in group 2 and 1 (3.0%) in group 3, p = 0,828. There were also no differences in the proportion of adverse cardiovascular vents between the groups: 6 (15.0%) in group 1, 11 (34.3%) in group 2, and 9 (27.3%) in group 3, p = 0.154. When using a one-stent coronary stenting technique, there was a tendency to reduction of the number of adverse cardiovascular events in the late postoperative period compared to other methods, but it did not reach a statistically significant level: 6 (15.0%) versus 20 (30.7%), p = 0.07. CONCLUSION: Endovascular revascularization in binary ISR of the CA bifurcation zone using a one-stent, two-stent techniques and drug-eluting balloon catheters ensures satisfactory immediate and long-term outcomes with no statistical difference.
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Features of catheterization of the inferior mesenteric artery and its architecture in patients with colorectal cancer according to X-ray contrast angiography data
INTRODUCTION: The anatomy of the celiac trunk and superior mesenteric artery, due to their clinical significance, has been studied quite well both in abdominal surgery and oncology. At the same time, there is much less information about peculiarities of the structure and catheterization of the inferior mesenteric artery (IMA) in angiographic operations, which was the reason for studying this issue. AIM: To study the architecture of the IMA and the peculiarities of its catheterization based on X-ray contrast angiography data. MATERIALS AND METHODS: The study included 20 patients (13 men, 7 women; mean age (56.0 ± 7.0) years) with colorectal cancer and colorectal cancer metastases to regional lymph nodes, who underwent intra-arterial neoadjuvant/adjuvant therapy. X-ray endovascular intervention was performed using a Siemens Artis Zee device. In 10 patients, angiography was performed through the femoral access, in 10 patients — through a puncture of the brachial artery. The identified features of the structure of the IMA, were structured using a modified classification of H. Yada. RESULTS: Type I of the IMA structure according to H. Yada was detected in 70%; type II — in 15%; type III — in 10%; type IV — in 5%. Basic morphometric parameters of the IMA were: diameter — (2.90 ± 0.67) mm, length to the level of separation of the first branch — (29.8 ± 15.9) mm, separation angle — (32.0 ± 7.4)°. The revealed structural features of the inferior mesenteric artery make access through the upper limb using an MPA catheter preferable. CONCLUSION: Four variants of the structure of the IMA circulation according to H. Yada’s classification were confirmed, and its main morphometric parameters were established based on our clinical material. Access through the upper limb using an MPA catheter with the primary visualization of the IMA at the level of the fifth lumbar vertebra with subsequent pulling up and orientating the catheter tip toward the anterior wall of the left semicircle of the aorta is optimal for catheterization of the IMA and its branches.
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Dynamics of the number of myocyte nuclei in muscle portions of arterial and venous homograft walls during long-term preservation
INTRODUCTION: An important issue of use of freshly prepared homograft’s in the reconstructive vascular surgery is the maximal length of their preservation for safe application. Histological examinations are required. AIM: To determine the optimal timing of the use of homograft’s based on the dynamics of the number of myocyte nuclei of muscle portions of arterial and venous homograft walls preserved in RPMI 1640 solution with the addition of gentamicin and fluconazole at a temperature of +4°C. MATERIALS AND METHODS: The study of arterial and venous homograft’s from a posthumous donor was performed in compliance with the rules for collecting organs and tissues. The homograft’s were preserved in RPMI 1640 solution with the addition of gentamicin (400 μg/ml) and fluconazole (20 μg/ml) at a temperature of +4°C. At intervals of 7 days up to 84 days, sections of the arterial and venous grafts were cut out and fixed in formalin. Then glass slides were prepared. A total of 120 arterial and 120 venous samples were studied. The number of myocyte nuclei in 0.01 mm2 muscle portions of the walls was estimated. RESULTS: On day 42, a decrease in the number of myocyte nuclei in arterial homograft’s by 56% was recorded relative to the values of day 7 (p = 0.003), a decrease in the number of myocyte nuclei in venous homograft’s by 55% (p = 0.024); a decrease in nuclei was also recorded at all subsequent control points. CONCLUSION: The optimal period for the use of arterial homograft’s can be considered the period of preservation in RPMI 1640 solution for up to 21 days. Venous homograft’s can be used for up to 42 days, despite the decrease in the number of myocyte nuclei after 35 days, since there is no edema of the venous homograft wall until the end of the 42 day.
Comparative analysis of the results of using mechanical methods of prophylactic hemostasis in endoscopic removal of large polypoid masses of colon mucosa
INTRODUCTION: Bleeding is the most common complication of endoscopic resection of mucous membrane of a hollow organ, which most often accompanies removal of large polypoid masses (PMs). However, currently endoscopic techniques have been developed that allow for effective prevention of this complication. AIM: Comparison of the effectiveness of endoscopic methods of preventing bleeding when removing large PMs of colonic mucosa: prophylactic clipping and prophylactic ligation of polyp stalk. MATERIALS AND METHODS: The study included patients with single pedunculated PMs with a feeding stalk of ≥ 5 mm thickness, located in different parts of the colon. Exclusion criteria were the presence of other large (≥ 10 mm) epithelial masses in the colon, as well as the use of antiplatelet agents and anticoagulants. Patients of group A (n = 32) were planned to undergo bleeding prevention by ligating the PM stalk using an original ligating device, patients of group B (n = 32) by prophylactic clipping of the stalk with a metal endoclip. The time of surgical intervention, intraoperative and immediate postoperative bleeding rate were compared, and technical difficulties in the use of prophylactic hemostasis techniques were recorded. RESULTS: Sixty-one out of sixty-four surgical interventions were performed without technical difficulties. In two cases, prophylactic clipping of the stalk was initially planned, but during the surgical intervention ligation was used due to technical peculiarities of the operation. The average time of surgical intervention using the prophylactic ligation method was (16 ± 3) minutes, using clipping — (12 ± 2) minutes. No bleeding was recorded during surgical interventions and in the immediate postoperative period in any of study cases. CONCLUSION: Both methods provide reliable prophylactic hemostasis, effective in almost 100% of cases. However, the prophylactic clipping method has a number of technical limitations: it should be used with caution when removing a PM with a short or a thick stalk. In these cases, the method of choice for the endoscopist may be the prophylactic ligation.
Prognostic indicators of the development of persisting pleural effusion after video-assisted and open lobectomy for lung cancer
INTRODUCTION: The work is devoted to the problem of predicting the development of persisting pleural effusion (PPE) after lobectomy, which is an important part of modern thoracic surgery, since it concerns the immediate outcomes of surgical treatment of lung cancer. AIM: To determine the frequency of PPE development in the groups of video-assisted thoracoscopic (VATS) and open lobectomy and to determine prognostic indicators of PPE development. MATERIALS AND METHODS: The analysis included patients (n = 78) who underwent open lobectomy with mediastinal lymph node dissection in the period from March 01, 2023 to November 10, 2023 (n = 45; 58%), as well as patients who underwent VATS lobectomy with mediastinal lymph node dissection in the period from January 01, 2022 to January 01, 2024 (n = 33; 42%). In 30 cases, a complication was recorded — PPE. RESULTS: The frequency of PPE in the group of patients with open lobectomy was 22/45 (49%) versus 8/33 (24%) in the group with VATS lobectomy. In patients after VATS, the chest tube was removed earlier compared to those who underwent open lobectomy (p = 0.012). The threshold values were determined for significant prognostic indicators: neutrophil-lymphocyte index on day 4 — 2.11 (p = 0.003), protein in the drainage fluid on day 2 — 14.2 g/l (p = 0.002). CONCLUSION: Patients with VATS lobectomy had a lower incidence and duration of PPE, which, in turn, determined a shorter hospital stay. Multivariate analysis identified prognostic indicators, the excess of threshold values of which is associated with the PPE development: neutrophil-lymphocyte index on day 4 and the amount of protein in the pleural fluid on day 2.
Changes in the amount of matrix metalloproteinases and kynurenines in individuals with diabetic retinopathy, their role in the development of the disease
INTRODUCTION: Diabetic retinopathy (DR) is one of most common chronic complications of diabetes mellitus (DM). The pathogenesis of DR is complex and involves interaction of many molecular mechanisms, and far not all of them have been studied. AIM: To determine the level of matrix metalloproteinases and kynurenines in the blood of patients with type 2 DM (T2DM) with different stages of DR. MATERIALS AND METHODS: Four groups of patients were formed: Group 1 (control) — 21 healthy individuals; Group 2 — 21 patients with prediabetes, Group 3 — 21 patients with T2DM, Group 4 — 63 patients with T2DM and DR. Then patients with DR were divided into groups (n = 21): Group 5 — non-proliferative stage of DR, Group 6 — preproliferative DR, Group 7 — proliferative DR. In the blood serum, the following parameters were determined: the content of metalloproteinases (MMP) types 2 and 9 (MMP-2, MMP-9) by the enzyme immunoassay; in blood plasma — the concentration of kynurenines by the high-performance liquid chromatography. RESULTS: Significant differences were recorded in the studied parameters between healthy individuals and patients with diabetes. Subsequently, the results of patients with different stages of DR were compared with the data of patients with diabetes without vascular complications. In the preproliferative stage of DR, an excess of blood MMP-2 by 87.9% (p = 0.030) and MMP-9 by 37% (p = 0.049) was recorded relative to the individuals with diabetes. In the proliferative stage of DR, the levels of MMP-9 and MMP-2 were higher than those of not only the comparison group, but also the groups of non-proliferative and preproliferative stages of DR. In the preproliferative stage of DR, an increased concentration of 3-hydroxykynurenine was also recorded. The maximum increase in kynurenines was noted in the final stage of DR (p < 0.05 relative to the groups of non-proliferative and preproliferative DR). CONCLUSIONS: In the analyzed groups of individuals, the concentrations of kynurenines increased as the underlying disease progressed. The level of MMP-9 was higher in diabetes mellitus, and in the proliferative stage of DR, the values of MMP-9 and MMP-2 increased.
Peculiarities of the course of acute coronary syndrome in anemia according to the registry of the Regional Vascular Center of the Ryazan Region
INTRODUCTION: Anemia not only negatively affects the course and prognosis of acute coronary syndrome (ACS), but can also influence the choice of treatment. It seems relevant to study the regional features of the course and prognosis of ACS in combination with anemia. AIM: To study the incidence and severity of anemia in patients with ACS, the features of the course and outcomes of ACS in patients with anemia according to the registry of the Regional Vascular Center of the Ryazan Region. MATERIALS AND METHODS: A retrospective analysis of the ACS registry data for 2019 was performed, which included 242 patients: group 1 — patients with anemia (n = 52; 21.5%), group 2 — patients without anemia (n = 190; 78.5%). All analyzed data were obtained from the medical records of the inpatients. RESULTS: Eighty five percent of patients in group 1 had mild, 11% — moderate, and 4% — severe anemia. Patients with ACS in combination with anemia were older (p = 0.0001). There were more women in the anemia group (p < 0.001), these patients more often had a history of myocardial infarction (p < 0.001), stroke (p = 0.03), angina (p = 0.009); they had lower blood pressure (p = 0.002 for systolic and p = 0.0004 for diastolic), glomerular filtration rate (p = 0.0005), left ventricular ejection fraction (p = 0.01). Killip class II heart failure was more often recorded in the presence of anemia (p = 0.009), the risk of in-hospital mortality according to the GRACE scale was also higher in patients with anemia (p < 0.001). Coronary angiography and percutaneous coronary intervention were more often performed in the group with ACS without anemia (p < 0.001 and p = 0.005 respectively). In-hospital mortality in patients with anemia exceeded that in patients without anemia (17.3% versus 7.9%, p = 0.04). Mild anemia was predominant among deceased patients (80.0%). CONCLUSION: According to the ACS registry of the Regional Vascular Center for 2019, anemia was detected in 21.5% of patients, with mild anemia predominating. Patients with ACS and anemia more often had angina pectoris, postinfarction cardiosclerosis and stroke in history, and according to the GRACE scale, a higher risk of hospital mortality. They were less likely to undergo coronary angiography and percutaneous coronary intervention compared to patients with ACS without anemia. Hospital mortality was higher in the ACS group with anemia; among the deceased, mild anemia predominated.
Gender differences in risk factor profiles, structural and functional myocardial characteristics and heart failure biomarkers in urban population aged 35–69 years
INTRODUCTION: Cardiac structure, function and metabolism, as well as the immune system biology significantly differ in men and women. Identification of differences of the myocardial response to the concomitant diseases in women compared to men could provide insight into the mechanisms underlying heart failure (HF) in women and men. AIM: A comparative analysis of the cardiovascular risk profile, structural and functional myocardial parameters and heart failure biomarkers in the population of men and women, and investigation of gender differences in the relationships of these parameters with metabolic syndrome (MS). MATERIALS AND METHODS: The ‘Learn Your Heart’ cross-sectional study data were analyzed on a population sample aged 35–69 years (n = 2,380), of which 989 men (41.5%) and 1,391 women (58.5%). History data (bad habits, diseases) and laboratory data, including high-sensitivity troponin T (hs-TnT) and N-terminal propeptide of the brain natriuretic peptide (NT-proBNP) were used. The presence of MS was determined based on AHA/NHBLI 2009 criteria. Echocardiography was used to evaluate structural and functional parameters with phenotyping of systolic and diastolic dysfunction of the left ventricle (LV). RESULTS: Men were more likely to smoke and have a history of myocardial infarction, while women were more likely to have heart failure and diabetes (p < 0.05 for all). Men had higher triglyceride levels, while women had higher body mass index and low-density lipoprotein cholesterol (all p < 0.05). Ejection fraction and global longitudinal strain (GLS) of the LV, adjusted for bad habits and diseases (heart failure, diabetes, myocardial infarction), had lower values in men, and diastolic dysfunction of the LV was more distinct in women (p < 0.001 for all). The hs-TnT level was higher in men, the frequency of elevated LV filling pressure (E/é) and NT-proBNP concentration exceeded 125 pg/ml in women (all p < 0.05). In women, a stronger negative association was recorded between MS and the é lateral (p = 0.001), é septal (p = 0.003) and GLS (p = 0.013) of the LV. CONCLUSION: In a population sample aged 35–69 years, gender differences in the structural and functional heart characteristics were identified: lower values of ejection fraction and GLS of LV, higher hs-TnT levels in men and higher levels of LV filling pressure (E/é) and NT-proBNP and stronger negative relationships of MS with relaxation parameters (é lateral, é septal) and LV contractility in women.
Pathohistological changes in the granular layer of the dentate gyrus in rats with chronic alcohol intoxication and the possibilities of their pharmacological correction with new derivatives of neuroactive amino acids
INTRODUCTION: Long-term alcohol consumption provokes damage to the central nervous system, in particular the dentate gyrus and hippocampus, leading to a decrease in cognitive functions. In this regard, the search for substances with a neuroprotective effect is relevant. It was previously shown that a derivative of glutamic acid (glufimet) and a derivative of gamma-aminobutyric acid (mefargin) limit anxiety and manifestations of obsessive-compulsive disorder in animals exposed to alcoholization. AIM: Analysis of pathomorphological changes in the granular layer of the dentate gyrus in rats under conditions of chronic alcohol intoxication (CAI) and under the influence of glufimet and mefargin. MATERIALS AND METHODS: The experiments were conducted on female Wistar rats divided into groups: 1 — intact rats; 2 — a control group of animals with CAI, which was modeled by replacing drinking water with 10% ethanol solution for 24 weeks; 3 and 4 — groups of rats, which, after the modeled CAI, were administered glufimet and mefargin respectively, once, intraperitoneally, for 14 days after the cessation of alcoholization; 5 — a group of alcoholized rats that received the comparison drug meldonium. Pathomorphological changes in the granular layer of the dentate gyrus were assessed, and morphometric parameters were calculated. RESULTS: In the granular layer of the dentate gyrus of animals with CAI, areas of significant cellular depletion, a large number of sharply hyperchromic, shrunken neurons, cells with swelling phenomena, ectopic nucleoli and cytoplasmic hyperchromia, and widespread karyocytolysis were observed. Glufimet contributed to the preservation of the cytoarchitecture of the dentate gyrus. Microscopic examination revealed no hypocellular areas, the average area of perikarya and neuronal nuclei was larger than in animals with CAI by 19.6% and 14.2% respectively. The width of the granular layer of the dentate gyrus in rats treated with glufimet after CAI was virtually identical to that in intact group rats. The number of shrunken neurons with hyperchromatosis was 40% lower than in animals with CAI without treatment. Mefargin led to some improvement in the morphology of the dentate gyrus, but to a lesser extent compared to glufimet. CONCLUSION: New derivatives of neuroactive amino acids helped to limit the negative impact of chronic alcohol intoxication on the cytoarchitecture of the dentate gyrus, with the neuroprotective effect more pronounced in glufimet, which may be the basis for developing a drug based on it to prevent the consequences of long-term alcohol consumption.
System analysis of the physiological and psychophysiological determinants of purposeful physical activity and prediction of its effectiveness among students of a medical university
INTRODUCTION: In the field of sports physiology, the need to study the determinants of the effectiveness of various types of physical activity is quite urgent. A variety of physiological and psychophysiological parameters as potential predictors of purposeful physical activity determines the need to search for a new algorithm for system analysis carried out using modern methods of mathematical data processing. In this regard, it is relevant to use artificial neural networks and multifactorial regression analysis in order to solve the stated tasks. AIM: To carry out a system analysis of the individual physiological and psychophysiological determinants of human physical activity in order to predict its effectiveness. MATERIALS AND METHODS: One hundred twenty young men who did not have sports grades and did not regularly attend sports clubs voluntarily participated in the study. The subjects' motivational basis of behavior, basic physical qualities, physiological and psychophysiological parameters were evaluated. Forecasting the direction of performance was carried out using the constructed models of artificial neural network technology and multifactorial regression analysis. RESULTS: Based on the statistical processing of the obtained parameters (division into clusters, rank correlation, neural network modeling, linear regression), an algorithm was created for the correct and reliable identification of the direction of the effectiveness of physical activity when the study participants realized the basic physical characteristics (strength, dexterity, endurance, speed). The study participants were divided into homogeneous clusters: ‘effective in running disciplines’ (70 boys) and ‘effective in strength disciplines’ (50 boys). The models constructed using artificial neural network technology with the involvement of various parameters, allowed identification of the determinants of the effectiveness of physical activity (ROC sensitivity: 75.7, 86.0 and 96.5%). According to the calculated parameters of the regression equation the result was predicted in high-speed quality with an accuracy of 87.9% (p ≤ 0.001), and in power quality with an accuracy of 70.8% (p ≤ 0.004). CONCLUSION: The complex of mathematical and statistical methods of analysis selected in the work can be introduced for identification and system analysis of motor activity of individual physiological and psychophysiological determinants of physical activity to predict its effectiveness in young men.
Experience of transanal endoscopic microsurgery in the treatment of synchronous primary multiple colorectal cancer: a case report
INTRODUCTION: The incidence of primary multiple colorectal cancer ranges from 1% to 8%. In 50% of cases, synchronous malignant tumors are located in different segments of the colon, which requires expanding the scope of the operation to colectomy, colproctectomy or simultaneous resections of different segments of the colon. The article presents a clinical case of a 65-year-old patient with rare and difficult to diagnose synchronous primary multiple colorectal cancer. Simultaneous laparoscopic right hemicolectomy with D2 lymphadenectomy and transanal endoscopic excision of the rectal tumor were performed in the treatment. As a result, it was possible to avoid low anterior resection of the rectum with a ‘switching-off’ stoma, achieve the fastest possible rehabilitation and the absence of complications in the postoperative period. It is worth noting, however, that the transanal stage took 90 minutes with relatively small tumor sizes, which is associated with the stage of mastering the technique and overcoming the learning curve. CONCLUSION: Transanal endomicrosurgery is an effective and safe option for surgical treatment of rectal tumors.
Posterior trifurcation of the internal carotid artery — normal or pathological? (a case report)
INTRODUCTION: Currently, there is no unified classification of variant anatomy of cerebral vessels, which underlies the contradictory character of data on the prevalence and clinical picture of such developmental variants as the posterior trifurcation of the internal carotid artery (ICA). AIM: To present a clinical case of diagnosis and confirm the anatomical norm of the posterior trifurcation of the ICA. The article describes diagnostic search in a 51-year-old female patient with a chronic tension headache. On examination, a fusiform aneurysm of the left ICA was suspected, but it was not confirmed by computed angiography, which detected posterior trifurcation of the ICA. CONCLUSION: The posterior trifurcation of the ICA in the analyzed clinical case is a finding not being a pathological condition. Anatomical differentiation of a complete posterior trifurcation and fusiform aneurysm of the ICA in chronic tension headache postulates the posterior trifurcation of the ICA being a variant of normal structure of the circle of Willis, which is of a principal clinical significance. For the first time the trifurcation of the ICA is presented as ontogenetic resource of the arterial system of the human brain, an ontogenetically determined variant of structure, and not ‘an embryonic type of structure’ of the circle of Willis, preserved due to delayed reduction of the posterior communicating arteries.
Hyperhomocysteinemia and distribution features of allelic polymorphism of folate group genes in patients with malignant neoplasms
INTRODUCTION: Malignant neoplasms (MNs) are currently widespread in the population. The study of the etiology of various tumor diseases is an important field of medical science. In recent years, elevated level of homocysteine (HC) in blood has been shown to be closely associated with cancer, as well as with unfavorable course after surgical interventions and during chemotherapy. AIM: To assess the role of hyperhomocysteinemia (HHC) and polymorphism of folate cycle genes in the development of tumor processes and venous thromboembolic complications (VTEC). MATERIALS AND METHODS: The PubMed and eLibrary.ru databases were searched for publications for the period from January 1, 2005 to December 31, 2024, including abstracts and articles with the results of original studies (primary sources), meta-analyses and reviews (secondary sources), foreign and Russian clinical guidelines (tertiary sources) using the keywords ‘malignant neoplasms’, ‘hyperhomocysteinemia’, ‘folate cycle gene polymorphism’, ‘folic acid’, ‘venous thromboembolic complications’. The role of HHC, folate cycle gene polymorphism in the development of tumor processes and venous thrombosis was analyzed and assessed. RESULTS: This review analyzes the relationship between elevated plasma HC levels and the risk of developing malignant neoplasms of various locations and discusses clinical prospects. The article presents evidence of interaction between allelic polymorphism of folate cycle genes involved in HC metabolism, and the risk of development and course of cancer in humans. The article systematizes data on the role of HHC in the development of VTEC in patients with cancer. CONCLUSION: The content of HC in blood plasma can be used as a potential tumor biomarker for various types of MNs, and HHC can be an important prognostic marker for the course of tumor processes and a risk factor for the development of VTEC. Understanding the effect of HC levels on the growth and proliferation of tumor cells will allow the creation of new promising strategies to combat MNs. Further clinical studies are needed for a more accurate assessment of these positions.
Prevalence of uncomplicated erosive and ulcerative lesions of the upper gastrointestinal tract in patients of a surgical hospital
INTRODUCTION: In the last decade, patients with various surgical pathologies have been demonstrating an increase in uncomplicated erosive and ulcerative lesions (EULs) of the proximal part of the gastrointestinal tract (GIT). Knowledge of the current prevalence of this pathology has both scientific and practical significance. AIM: Assessment of the prevalence of uncomplicated EULs in the upper GIT in a multidisciplinary surgical hospital and analysis of factors that determine the structure of the identified prevalence. MATERIALS AND METHODS: Meta-analysis of 20 clinical studies from eLibrary, PubMed databases from 2010 to 2023 devoted to uncomplicated EULs of GIT, stomach and duodenum. RESULTS: Based on the examination of 4,337 patients (data of domestic literature sources) and 13,024,812 (data of foreign sources), the prevalence of acute erosive and EULs of the upper GIT ranged from 7.4 to 100% and from 1.7 до 100% respectively. High heterogeneity of samples confirms a wide variation of the incidence of the analyzed kind of lesion both in our country and abroad determined by the influence of various factors, specific to both each patient and the profile of a surgical hospital. CONCLUSION: The meta-analysis demonstrates a high range of incidence of uncomplicated acute EULs of the proximal GIT, which requires further clarification of the true prevalence of the pathology under study and of other causes that influence the development of destructive pathological alterations.
Role of mast cell proteases in cardiac damage in new coronavirus infection
INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is the cause of the global pandemic of 2019–2023. Despite the fact that COVID-19 primarily affects the lung tissue, cardiovascular complications are not uncommon both at the height of the disease, and in the post-COVID period. The presence of previous cardiovascular diseases and advanced age of the patient are proven risk factors of adverse outcomes in COVID-19. AIM: Based on the analysis of the current literature sources, to determine the role of mast cell proteases in the pathogenesis of cardiovascular complications of COVID-19. Excessive production of pro-inflammatory cytokines and chemokines by mast cells in the new coronavirus infection conditions the initiation of a severe systemic inflammatory response that affects not only the lung tissue, but also the myocardium. One most significant mechanism of the development of cardiovascular complications in patients with COVID-19 is endothelial dysfunction of the microcirculatory system with the formation of ischemic areas with subsequent local apoptosis of cardiac myocytes. CONCLUSION: Cardiovascular complications of COVID-19 develop primarily due to the damaging effect of proinflammatory cytokines, the production of which is stimulated by proteases of activated mast cells. Because of small amount of published data, additional investigation is required.
On the system of social and hygienic monitoring in the Russian Federation
INTRODUCTION: The review is devoted to social and hygienic monitoring (SHM), a system of monitoring the state of the environment and health of the population, allowing to establish cause-and-effect relationships between them. It is used for all stages of processing data on environmental parameters, socio-economic indicators and medical and demographic characteristics of the population. All regions of the Russian Federation have experience in SHM. Every year, hundreds of thousands of instrumental measurements of human environmental factors are performed as part of its implementation. A huge amount of data has been accumulated at the federal and regional levels, the analysis of which is the basis for making informed decisions in order to improve the sanitary and epidemiological situation and well-being of the population, as well as for the development and implementation of effective measures and activities to eliminate risk factors. Today, the SHM system is provided with modern tools and methods, it is constantly being improved, responding to emerging requests. AIM: To analyze and summarize the regulatory framework and scientific literature on social and hygienic monitoring in order to identify promising areas for its further development. The search for scientific articles was carried out in the eLibrary, Google Scholar, CyberLeninka databases, and regulatory documentation was searched in the TekhExpert system. CONCLUSION: Based on the results of the study, several promising areas for further development of the SHM system can be identified. The urgent tasks include the development of a single document on social and hygienic monitoring, optimization of sampling programs and laboratory tests, and the introduction of molecular genetic monitoring, which will allow for individual multifactorial health risk assessment. In addition, it is necessary to expand interdepartmental interaction and information exchange in order to form a single database of SHM results to solve urgent problems of public health protection.