Home – Home – Jornals – Siberian Scientific Medical Journal 2020 number 3

The evidences in favor of efficiency of shock-wave in ischemic heart disease therapy are originated mainly from small, uncontrolled observational studies. The experiments have relatively short duration. The shock-wave therapy benefits for ischemic heart disease have been explained by heightened myocardial perfusion and angiogenesis attributed among others to activation of vascular endothelial growth factors of the VEGF group. The role of VEGF in heart diseases and atherosclerosis is ambivalent; along with potential benefit it may contribute to fibrosis. A shock wave induces tissue cavitation and shear stress to membranes. The vulnerability of cardiac muscle cells under conditions of ischemia is increased. Additional damage may contribute to the cell loss. Reported effects of shock-wave treatment may be transient and reactive in their nature. Clinical improvements in humans are caused, at least in part, by the placebo effect. Placebo therapy is beneficial for some patients; however, placebo must be harmless by definition. In conclusion, animal experiments with a longer follow-up are needed prior to the initiation of clinical research with large cohorts of patients. However, some possible late outcomes such as increased vascularization of atherosclerotic plaques and their instability cannot be reliably reproduced in experiments. A promising approach to the evaluation of net harm or benefit could be lifelong animal experiments with comparisons of average life span between test and control groups.

In vivo tumor models created in various mouse strains play an important role in studies on antitumor therapies. An adequately selected model allows one to sufficiently assess the significance of the effect of the studied substance on molecular targets, its effect on the growth and viability of the tumor, and also to reveal a therapeutic window between the effectiveness of treatment and toxicity. An appropriately selected model allows an adequate assessment of the significance of the effect of the studied substance on molecular targets, the model’s effect on the growth and viability of the tumor, and also detection of a therapeutic window between the treatment effectiveness and toxicity. Xenografts of human tumors transplanted to immunodeficient mice are one of the most popular models for studying tumorigenesis and antitumor effects. Immunodeficiency of animal recipients is the prerequisite to prevent the rejection of tumor material from another biological species. A large number of different mouse strains have been developed, with varying severity of immune system defects and with various phenotypic and genotypic characteristics. The choice of an animal strain for a model creation depends on the research tasks. The success of an experiment directly depends on choosing the correct strain of experimental animals.

The aim of the research was to study the effect of photoperiodism disturbances on platelet aggregation activity. Material and methods. The experiment was conducted in two stages in 5 groups of male rats: the control group and four experimental groups. At the first stage, the animals were exposed to 24 h/day continuous light (24L:0D) for 10 and 21 days. In the second stage, animals after 10 and 21 days of round-the-clock lighting were returned to natural lighting for a period of 21 days to study the reversibility of changes. Animals were withdrawn from the experiment by intramuscular injection based on body weight of drugs for anesthesia (telazol, xylanite). Blood sampling was performed by puncture of the right heart. The functional activity of platelets was determined no later than 3 hours after the collection of blood. Results and discussion. The results of the experiment indicate a direct effect of light desynchronosis on the increase in platelet aggregation ability, while it was noted that the degree of increase in aggregation activity and reversibility of changes directly depend on the duration of round-the-clock lighting. So, a 10-day stay of animals in conditions of abnormal lighting leads to an increase in aggregation indices, which remain at a high level even when animals return to normal conditions. In animals that were under round-the-clock illumination for 21 days, a more pronounced increase in platelet aggregation values relative to animals on day 10 was noted. In this regard, it can be argued that circadian rhythm disturbances provoke the development of microvasculature disorders.

Objective. The aim of research was to evaluate experimentally the feasibility of using of control methods of safety indicators of leukoreduced platelet concentrates (CPl). Material and methods. The analysis of 14 leukoreduced platelet concentrates samples was performed. Platelet count was estimated in a 2-grid Goryaev’s camera using a «Mikmed-1» light microscope and conductometry with hydrodynamic focusing on an «XT-4000i» hematology analyzer. To determine the residual number of leukocytes, we used the laser flow cytofluorimetry method by «FACS Canto II» analyzer. The pH was measured by the potentiometric method by a pH-millivoltmeter «pH-150M». The feasibility of applying safety performance monitoring techniques was assessed based on the basis of coefficient of variation (CV) . Results and discussion. The maximum CV value when calculating the platelet count in the Goryaev’s camera was 18,6 %; conductometry method - 2,8 %. CV when determining the residual number of leukocytes by laser flow cytofluorimetry did not exceed 17,5 %. The CV of the method for determining pH by potentiometric method was 0,4 %. Conclusion. To control the platelet count, a unified method of counting in a 2-grid Goryaev’s camera and conductometry method with hydrodynamic focusing on hematology analyzer are recommended. Laser flow cytofluorimetry should be used to determine the residual number of leukocytes. The maximum CV values were taken as the assigned convergence characteristics: for the unified counting method - not more than 18,6 %, for the conductometry method - not more than 2,8 %, for laser flow cytofluorimetry - not more than 17,5 %, for potentiometry - not more than 0,4 %.

Aim of the study was to investigate the morphological features of neurons of the parietal cortex and hippocampus of rats with subtotal cerebral ischemia (SACI) during administration of omega-3 polyunsaturated fatty acids (omega-3 PUFA). Materials and methods. The experiments were performed on 24 white outbred male rats. Surgical interventions were carried out under conditions of intravenous thiopental anesthesia (40-50 mg/kg). Acute SACI was modeled by bilateral ligation of the common carotid arteries. The animals of the main group ( n = 6, SACI + omega-3 PUFA) received intragastric injections of omega-3 PUFA preparation at a dose of 5 mg/kg body weight prior to ischemia for a week. In the comparison group ( n = 6, SACI), the drug was not used; the control ( n = 6) was sham operated animals, which were incised without skin ligation. Animals were decapitated after 60 minutes of ischemia. In rats, morphological changes in the neurons of the parietal cortex and the CA1 field of the hippocampus were studied. For morphometric and histochemical studies, animals were quickly removed after decapitation of the brain, pieces of the anterior cortex of the cerebral hemispheres were fixed in Carnoy fluid. Serial paraffin sections were stained with 0.1 % toluidine blue according to the Nissl method. Statistical hypothesis testing was performed using the Kruskal-Wallis ANOVA test. Results and discussion. The morphological and functional disorders in the parietal cortex and hippocampus have been revealed in animals of both experimental groups. The appointment of omega-3 did not significantly affect the size and shape of neurons in both the parietal cortex and the hippocampus. In the hippocampus, the administration of omega-3 polyunsaturated fatty acids resulted in a decrease in the number of hyperchromic shriveled neurons (by 20%) and an increase in hyperchromic neurons by 31 %. The number of shadow cells in this section did not differ from the indices of the control group. In the parietal cortex, no corrective effect was noted. Conclusions. Thus, subtotal cerebral ischemia leads to the development of morphofunctional disorders of the cerebral cortex. Administration of omega-3 had a positive effect on the state of rat hippocampal neurons, reducing the number of degenerative forms of neurons. The data obtained can serve as the basis for the search for new approaches to the treatment of acute ischemic stroke, which is one of the urgent problems of experimental and clinical neurology.

We report a case of a 47-years old woman presented to our department with the diagnosis of Chiari I malformation and extensive hydrosyringomyelia. Her main complains were severe headache and chronic pain syndrome in the left side of her breast and left arm. Magnetic resonance imaging (MRI) showed alterations suggestive of the presence of intracranial hypotension (IH), that was confirmed by measurement of cerebrospinal fluid (CSF) opening pressure and then CSF venous fistula was detected by computed tomography myelography (CTM). She was successfully surgically treated which leaded to the regression of the clinical symptoms and radiological alterations. Nevertheless, during her recovery after surgery she had an episode of recurrent left arm pain, which was interpreted as secondary cervical spine degeneration consequence. MRI confirmed C5-C6 disc herniation and transforaminal epidural injection of local anesthetic and corticosteroid solutions was performed. A week later she already felt significant improvement as her pain syndrome regressed a lot. IH should be considered in the differential diagnosis of headache and sagging brainstem and tonsils with cord syrinx on MRI and should not be misinterpreted as Chiari malformation. At the same time, transforaminal epidural injection appears to be an effective tool in modern neurosurgical practice allowing to determine the reason and accurate radiculopathy level.

Aim of the study was the development of treatment and diagnostic algorithm for iatrogenic vascular aneurysms and their surgical treatment. Material and methods. The paper presents an analysis of the treatment results of 19 patients (15 men - 78.9 % and 4 women - 21.1 %) with iatrogenic vascular damages and their consequences. The method of endovascular complete vascular occlusion was used for the patients treatment. Results. The following methods were used for surgical treatment: vascular ligation - 3 cases, side seam - 6; plastic surgery was performed on the vessels of 4 patients (autovenous, homovenous or synthetic prosthetics) with the use of endovascular full vascular occlusion. The following methods were used after the aneurysm removal: lateral suture - 6 (31.5 %); circular seam - 1 (5.2 %); dressing - 4 (21 %); autovenous shunting - 2 (10.5 %); extraanatomical shunting - 1 (5.2 %); homovenous bypass surgery - 1 (5.2 %); Z-shaped seams - 1 (5.2 %); Palm’s оperation - 1 (5.2 %). The following complications were observed after the operation: vascular thrombosis - 1, arrosive bleeding - 1 patient. There were no forced amputations and deceased patients. In the postoperative period of 16 (84.2 %) patients, wound healing was primary; 3 (15.8 %) healing occurred by secondary intention. Conclusion The proposed diagnostic and treatment algorithm improves the efficiency of surgical treatment of iatrogenic aneurysms by the method of endovascular complete vascular occlusion and obtains good results.

There have been multiple scientific publications reporting of cases and post-hoc analysis of relationship between the prostaglandin analogues (PA) use and postoperative macular edema development in patients underwent cataract surgery. The purpose of research is to compare effects of different groups of antihypertensive drugs on condition of central retina in patients with primary open-angle glaucoma (POAG) after phacoemulsification of cataract (PC) and combined surgeries for cataract and glaucoma. Material and methods. Analysis was carried out with data on 36 patients (49 eyes) underwent the cataract surgery on the top of POAG: group I - 12 patients (15 eyes) who were receiving antihypertensive therapy of PA before and after PC; group II - 10 patients (11 eyes) who were receiving PA therapy prior to combined surgery for cataract and glaucoma (PA were cancelled during postoperative period); group III - 14 patients (25 eyes) who were receiving antihypertensive therapy of any drug group excluding PA before and after PC. Results. The thickness in central retina of all 3 groups` patients was comparable both before and after the surgery, differences were statistically insignificant. Cross-group measurement results were also statistically insignificant. Conclusion. Findings of the study have not identified any convincing evidence that would support a change of antihypertensive drugs against POAG as a preparation for cataract surgery and during early postoperative period to reduce the risk of macular edema. The use of prostaglandins analogs does not result in conspicuous changes in thickness of macula zone of retina during postoperative period.

Hypernatremia along with septic complications is the most frequent and dangerous complication in patients with severe burn trauma. The intravenous infusion of hypoosmolar solutions is considered to be a common tactic in overcoming critical hypernatremia, although the safety and effectiveness of this approach is questioned. The aim of the work was to clarify the pathogenesis of hypernatremia and define the tactic for its correction in the acute period of severe burn trauma. Material and Methods. The retrospective study included 82 adult patients treated in the ICU of the Burn Trauma Center of Novosibirsk Regional Clinical Hospital between 2015-2018 years. There were patients both with partial thickness burns TBSA >40 % or with full thickness burns TBSA 20 % with or without the thermoinhalation trauma. Results. Hypernatremia (serum Na > 150 mmol/L) usually occurred 4-6 days after a severe burn injury. This complication was detected in 27 % of patients. Cortisol serum levels were at the upper limit of the norm, meantime the serum concentration of aldosterone was significantly increased on 3rd day after trauma. Based on the obtained data, hypernatremia was corrected using enteral rehydration (oral water up to 20-30 ml/kg/day), Spironolactone (200-300 mg/day), intravenous titration of furosemide in small doses (60-100 mg/day). Permanent renal replacement therapy started when a patient›s serum sodium level was greater than 160-163 mmol/L. Conclusion. Significant increase of the serum aldosterone concentration in patients with severe burn trauma was noted by the 3 day, so the use of spironolactone should begin in these terms. Titrated intravenous introduction of furosemide in small doses (60-100 mg/day) allows removing sodium without adverse effects. In addition, the use of additional enteral rehydration is necessary.

Aim of the study was to investigate the results of endoscopic diagnostics and peroral operative endoscopy in subepithelial esophageal tumors. Material and methods. Data of 21 patients underwent flexible endoscopic interventions for subepithelial esophageal tumors (SET) from 2016 till 2019 were analyzed. Main endoscopic methods to reveal and characterize tumors preoperatively are examination in white light, narrow light spectrum imaging, radial endoscopic ultrasonographic scanning. Tumors from 8 till 40 mm in maximal dimension removed by endoscopic mucosal resection (2 tumors in 1 patient), tunnel dissection (13 cases) or endoscopic submucosal dissection (7 cases). The additional endoscopic ultrasonography was demanded intraoperatively in 2 cases of difficult tumor location and blurry visualization. Results and discussion. Subepithelial esophageal tumors are mainly diagnosed occasionally in patients without symptoms related to tumor. Suspicion of the tumor was based on routine esophagogastroduodenoscopy. Following endoscopic ultrasonography of planned esophageal segment allowed rejecting or confirming the lesion (21 patients), evaluating its echoscopic structure, size, growth direction, intramural location and connection to wall layers to make an assumption related to tumor morphology, to plan way of tumor removal. We choose interventions in depends on combination of available tumor features. Technical success of endoscopic interventions with use of flexible endoscope under this approach is noted in all the patients. So endoscopic methods are important for primary and detailed diagnostics and also effective for operative treatment in cases of appropriate indications.

Severe climatic conditions adversely affect the human reproductive function; there is evidence of earlier aging of the endocrine system in residents of the northern territories. However, there is insufficient data on the content of androgens and estrogens in postmenopausal women of the North. This determined the aim of the work - to study the characteristics of the content of sex hormones in fertile and postmenopausal women in the Arctic zone of the Russian Federation. Material and methods. In the period of increasing daylight hours, there were examined 60 residents of the Yamal-Nenets Autonomous District of the reproductive ( n = 33) and postmenopausal ( n = 27) periods. The serum luteinizing, follicle-stimulating hormones, progesterone, dehydroepiandrosterone sulfate, dihydrotestosterone, androstenedione, total and free fractions of testosterone, estrogen, estrone, sex-hormone-binding globulin were determined by immunoassay analysis using sets of «Khema-Medica» (Russia), Alkor-Bio (Russia), DRG (Germany). The research results were statistically processed using application software package STATISTIC 10.0. Results. There were shown high median values of progesterone (2.41 nmol/L) and dihydrotestosterone (191.02 pg/ml) in postmenopausal women, as well as increased concentrations of sex-hormone-binding globulin in both fertile (170.66 nmol/L) and postmenopausal (154.84 nmol/L) women. At the same time, free testosterone levels are slightly reduced, especially in postmenopausal women (0.50 pg/ml). Conclusion. The revealed features of the hormonal profile of women living in high latitudes may be an unfavorable factor for the development of various metabolic disorders.

To diagnose hereditary spherocytosis (HS), an osmotic resistance test is used to assess the severity of hemolysis in a series of hypotonic sodium chloride solutions, which demands intensive and time consuming workload and has low sensitivity and specificity. New methods for evaluating osmotic resistance based on flow cytometry were proposed, but they are not sufficiently standardized. Objective: development and testing of the method for determining the osmotic resistance of red blood cells (RBCs) using flow cytometry in patients with HS. Material and methods. In 2017-2019, 33 patients with HS and 30 children in the control group were examined. The method included the study of blood preparations in phosphate-buffered saline (PBS) and their serial dilutions in distilled water using flow cytometry, both in fresh blood and after 24-hour incubation. The proportion of preserved (not hemolized) RBCs was evaluated. As reference intervals, 5 and 95 percentiles of the control group indicators were used. Results and discussion. Among people with HS, before incubation, pathological changes in at least two dilutions were detected in 81.8 % of patients; after incubation, pathological changes were detected additionally in 4 out of 6 patients. Diagnostic sensitivity of the test is 93.9 %, specificity 83.3 %, positive and negative predictive values 86.1 and 92.6 %, respectively. It was found that the method with proposed reference intervals allows evaluating the osmotic resistance of erythrocytes fast and objectively, and can be used for differential diagnosis in hereditary spherocytosis.

Aim of the study was to investigate rates of mortality from the alcohol-related reasons among the population of the Republic of Buryatia and their dynamics during 2013-2017 for assessment of efficiency of the preventive actions directed to decrease in prevalence of scales of alcoholism. Material and methods. Medical statistics presented in official publications of the Rosstat and the Republican Medical Information and Analytical Center of the Ministry of Health of the Republic of Buryatia were used as an empirical base. Mortality rates are calculated on the average annual population. Results and discussion. 2974 persons died from the alcohol-associated reasons in the Republic during 2013-2017 according to Buryatstat. The rate of mortality decreased by 11.98 % on 100 thousand population (from 60.30 to 53.85). That exceeds similar indicators in the Far Eastern Federal District (further the FEFD) by 1.76 times, Siberian Federal District (further the SFD) by 1.52 times and the Russian Federation by 1.45 times. According to this indicator the Republic of Buryatia takes the 2nd rank place after Transbaikal region among 11 subjects included into the FEFD since 03.11.2018. Conclusions. Mortality indicator from the alcohol-associated reasons is one of the most informative indicators for assessment of the territories social and economic development and wellbeing. The decrease in mortality from the alcohol-associated reasons and volumes of alcoholic products consumption per caput is noted in recent years in the Republic. At the same time, the problem of increase in rates of growth of the mortality value from the alcohol-associated reasons among female population of working-age, living in rural areas allerts. Territories of risk with the high level of population alcoholic mortality and relating to «the most drinking», geographically being most far off from the capital of the Republic are revealed.

Objectives. The paper aims was forming the first health-related quality of life population indicators using EQ-5D-3L survey that represents the Russian population by gender and age, as well as by the attained level of education. Material and methods . For compiling population indicators, we use the EQ-5D-3L questionnaire. The study was conducted on the adult Russian population aged 18 to 75 years. A representative sample was 12616 respondents. Results. 59.3 % of the sample is in good health (profile 11111). The proportion of respondents reporting any health problems increases with age. The average score on a 100-point visual analogue scale is 72.4 (standard deviation 18,1; 95 per cent confidence interval from 72,1 to 72,7). Men, on average, tend to assess their health higher than women. However there are no statistically significant differences in health scores among educational groups, taking into account gender and age data. Conclusions. Comparison of health-related quality of life estimations with normative population data allows us to track differences in health between population groups, as well as to analyze the health status and progress in treating patients. The Russian health-related quality indicators from EQ-5D-3L survey are similar to the Hungary population indices, as well as to many European countries, the USA, and Argentina for age cohorts under 45 years of age. For the cohorts of respondents older than 45 years, Russian estimations are much lower than in other countries. This evidence confirms that borrowing scales from other countries for converting EQ-5D-3L values into a preference EQ-5D-3L index is not acceptable for Russian patients, especially for the elderly.