Vol 4, No 3 (2019)

Internal medicine
Free hemoglobin reference intervals detected with hemoglobin-cyanide method on a biochemical automatic analyzer ILAB 300 PLUS
Murygina O.I., Zhukova E.R., Petrova O.V., Nikulina D.M.

Objectives – to evaluate the reference intervals for free hemoglobin concentration with the help of hemoglobin-cyanide method and a biochemical automatic analyzer.

Material and methods. The reference group consisted of 120 healthy men and 120 healthy women from the Astrakhan region aged from 20 to 60 years.

The fulfilment of standard procedures during the pre-analytical pre-laboratory, pre-analytical laboratory, analytical and post-analytical stages of the study ensured the quality control for free hemoglobin evaluation.

Blood samples were taken with cubital vein puncture after applying a tourniquet (for not more than 1 minute), patient in lying position, using two-component blood sampling systems – disposable polypropylene tubes with a blood coagulation activator (Sarstedt, Germany). To obtain blood serum, blood tubes were centrifuged at 2500 rpm during 10 minutes.

The free hemoglobin in blood serum was detected by the hemoglobin-cyanide method using a ILAB 300 PLUS biochemical automatic analyzer (Laboratory Instrumentation, USA).

The data was processed using the software package Statistica 6.0 for Windows (StatSoft Inc, США).

Results. We used the classical approach and followed the strict inclusion and exclusion criteria, recommended by CLSI C 28-A3 guidelines. Gender and age differences in the content of free hemoglobin in blood serum in men and women of the Astrakhan region were not found. The reference interval of free hemoglobin in men and women of the Astrakhan region was evaluated as 0.02–0.84 g/l.

Science and Innovations in Medicine. 2019;4(3):4-7
Gerontology and geriatrics
Modeling of stochastic brain function in artificial intelligence
Volobuev A.N., Pyatin V.F., Romanchuk N.P., Romanchuk P.I., Bulgakova S.V.

Objectives –research of stochastic brain function in respect to creation of artificial intelligence.

Material and methods. Mathematical modeling principles were used for simulation of brain functioning in a stochastic mode.

Results. Two types of brain activity were considered: determinated type, usually modeled using the perceptron, and stochastic type. It is shown, that stochastic brain function modeling is the necessary condition for AI to become capable of creativity, generation of new knowledge. Mathematical modeling of a neural network of the cerebral cortex, consisting of the set of the cyclic neuronal circuits (memory units), was performed for the stochastic mode of brain functioning. Models of "two-dimensional" and "one-dimensional" brain were analyzed. The pattern of excitation in memory units was calculated in the "one-dimensional" brain model.

Conclusion. Relying on the knowledge of the stochastic mode of brain function, a way of creation of AI can be offered. á-rhythm of a patient is a recommended focus of the therapist's attention in diagnostics and treatment of brain disorders. It was noted, that the alpha wave amplitude and frequency could indicate the cognitive, creative and intuitive abilities of a person.

Science and Innovations in Medicine. 2019;4(3):8-14
Polymorphism of C/T-13910 lactase gene and anthropometric data of girls born in Samara
Spiridonova N.V., Sazonova O.V., Bezrukova A.A.

Objectives –to assess the prevalence of C/T-13910 polymorphism of the lactase gene in the population of children in Samara and to identify the relationship with height, body weight and body mass index.

Material and methods. The study included 103 girls aged 3–6 years. Their height and body weight were measured, and buccal samples were taken to genotype lactase activity (determining the C/T-13910 variant).

Results. In girls born and living in Samara, the frequency of allele 13910-T was 48.6%. The СС genotype was detected in 51.4%, the СT genotype in 37.9% and the TT genotype in 10.7%. There was no statistically significant relationship between genotype and body weight and height, but all children with the TT genotype had a height of more than 25 percentiles, the vast majority of overweight and obese girls (91%) had the СС genotype or the СT genotype.

Science and Innovations in Medicine. 2019;4(3):15-18
Infectious diseases
New causative agents of respiratory tract diseases in immunocompromized patients (a review)
Ismatullin D.D., Zolotov M.O., Lyamin A.V., Nikitina T.R., Zheleznova E.A., Zhestkov A.V.

The diseases of the respiratory system occupy one of the leading positions in the range of morbidities among the Russian population, both in adults and children. Partly, it is due to an increase of patients with primary and secondary immunodeficiencies, with anatomical anomalies of the respiratory tract, and other diseases of the bronchopulmonary system.

Classical pathogens, causing the bacterial respiratory diseases, as a rule, are: Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Pseudomonas spp., Staphylococcus spp., as well as other representatives of the Enterobacteriacae family. But each year, the scientific literature presents more and more microorganisms – pathogens of infectious diseases of various localization in humans, the clinical significance of which has long remained poorly understood. These pathogens include representatives of large families of Corynebacteriaceae, Mycobacteriaceae, Nocardiaceae.

Clinical physicians need to consider possible disorders in the immune system in patients with respiratory impairment, as well as a wide range of pathogens affecting the respiratory tract. To manage such patients effectively, the close interaction of pulmonologists, bacteriologists, and allergologists-immunologists is important.

Science and Innovations in Medicine. 2019;4(3):19-24
Diseases of the nervous system
The effectiveness of rehabilitation of patients with multiple sclerosis in virtual reality
Zakharov A.V., Khivintseva E.V., Kolsanov A.V., Voronin A.S.

Objectives – to review the results of the use of virtual reality for the rehabilitation of patients with multiple sclerosis.

Material and methods. А bibliographic review of the PubMed database was conducted using the keywords "multiple sclerosis" and "virtual reality". The review was performed in accordance with the recommendations of the "Preferred Reporting Items for Systematic reviews and Meta-analysis" (PRISMA).

Results. The analysis included 45 articles. Only 10 articles were subjected to final analysis.

Conclusion. Virtual reality is a potentially effective alternative to traditional motor rehabilitation for patients with multiple sclerosis.

Science and Innovations in Medicine. 2019;4(3):25-29
Neurophysiology of motor imagery in neurorehabilitation and BCI technologies
Korovina E.S., Segreeva M.S., Zakharov A.V., Pyatin V.F.

Over the last few decades, motor imagery was in the focus of the researchers' attention as a prototypical example of "embodied cognition", and as a basis for neuro-rehabilitation and brain–computer interfaces. This review reveals the concept of motor imagery, the factors characterizing and influencing this process, its neural correlates, and the possibilities for using in neurorehabilitation and brain–computer interfaces. The article explains some discrepancies and variability in findings from previous studies, that will help to optimize a study design in accordance with the purpose of each study in the future.

Science and Innovations in Medicine. 2019;4(3):30-35
Specifity of complex sensory-motor reaction to relevant stimuli in personalized virtual reality in young people
Segreeva M.S., Korovina E.S., Romanchuk N.P., Alexseeva A.S., Zakharov A.V., Pyatin V.F.

Objectives – to evaluate the latent period of complex sensory-motor reaction (СSMR) to relevant visual stimuli in virtual reality (VR) with personalized and indifferent content.

Material and methods. The study included 10 healthy right-handed males aged 18–19. The selection of subjects in groups was based on two VR scenarios, the content of which reflected (personalized VR) or did not reflect their personal experience (indifferent VR). The latent period of СSMR to relevant visual stimuli was registered using a gamepad and an EEG recording system (BP-010302 BrainAmp Standart 128) in the oddball paradigm. VR scenarios were demonstrated using Oculus Rift CV1 headset. Registration of СSMR in personalized and indifferent VRs was done in three sessions with the interval of 24 hours. Each session lasted 7–8 minutes and included 30–40 СSMR registrations. Igroup Presence Questionnaire (IPQ) was used for subjective evaluation of VR immersiveness. The collected data was processed with IBM SPSS Statistics 22 software.

Results. Statistically significant correlations were registered only in VR with personalized content, between the latent time of СSMR and indexes of spatial presence (0.694522) and a general effect of VR immersiveness (-0.592243). It was noted that latent period of СSMR to relevant visual stimuli in VR is determined by the semantic content: the time of СSMR to relevant stimuli in personalized VR was significantly less, than to those in indifferent VR.

Conclusion. We support the adequacy of the methodology of studying the mechanisms of human voluntary attention with inclusion of personalized scenes in VR content. It is suggested that such methodology is promising for neurorehabilitation of patients with age-related cognitive impairment

Science and Innovations in Medicine. 2019;4(3):36-40
Public health and health service
Evaluation of doctors' level of proficiency, based on self-assessment
Petrova N.G., Gorinshtein V.V.

Objectives – to assess the level of doctors' qualification by means of sociological survey.

Material and methods. The study was conducted in a large city out-patient hospital, where 105 doctors of different specialities were interviewed. The respondents' average age was 44.7±1.9 years; average period of work –16.4±1.8 years. A special questionnaire comprised of 35 questions. The respondents were asked to assess, using a five-point scale, their skills and knowledge of various topics, including special clinical knowledge, prevention, sanitary-epidemiological regimen, psychology, healthcare organization and economics, legal regulation of medical activity. The statistical processing of collected data was performed with the Microsoft Оffice 2016 programs: Microsoft Word, Microsoft Excel.

Results. The average self-assessment score for various aspects ranged from 3.1 to 4.4. The lowest score was registered in the knowledge of public health organization, regulations and healthcare economics. Among the respondents, the maximum self-assessment scores were given by emergency doctors, and the lowest – by therapeutists (general practitioners).

Conclusion. The revealed deficit of knowledge in some aspects (especially in matters of healthcare organization) is a factor that may impede the implementation of one of the basic principles of total quality management – the principle of staff involvement. This requires not only a review of educational programs in medical universities, but also the appropriate adjustment of the programs of postgraduate training, as well as tasks (tests, OSCE stations) performed by doctors of different specialities in the process of their accreditation.

Science and Innovations in Medicine. 2019;4(3):41-45
Process approach to management of patients with proximal femur fracture in city out-patient hospital
Nazarkina I.M., Suslin S.A., Khmelevskikh O.V., Fedoseev M.M., Bratiychuk A.N., Izmalkov S.N.

Objectives – to analyze the results of process approach to managing patients with proximal femur fracture during one year after the injury, in primary health care center.

Materials and methods. We compared the clinical data of patients with proximal femur fracture before the implementation of process management in primary health care and after it. The total number of patients was 233. We used statistical, analytical research methods, as well as organizational modeling.

Results. The active use of process approach in the clinic resulted in statistically significant improvement in patients' complete rehabilitation, reduction of the number of local and general complications, and decrease of mortality rate during the first year after the injury from 35.2% to 8.5%.

Conclusion. At the stage of primary health care, a step-by-step algorithm, which activates the patients effectively by involving a surgeon, a therapist and the patient's relatives in the rehabilitation process, contributes to mortality reduction, improvement of treatment and rehabilitation results.

Science and Innovations in Medicine. 2019;4(3):46-49
Clinical experience of examination of outpatients with diabetes using a formalized protocol
Pervyshin N.A., Lebedeva I.V., Galkin R.A.

Objectives – to improve the quality and efficiency of primary endocrinological care for patients with diabetes mellitus by formalizing outpatient admission and optimizing the professional time of an endocrinologist spent on documentation.

Material and methods. A protocol of examination, developed according to the specifity of care of outpatients with diabetes mellitus, was introduced into practice of endocrinologists. To assess the usability of the protocol, the timing of outpatient admission and the quality control of outpatient medical care was carried out.

Results. The trial of the formalized protocol in clinical settings have confirmed its convenience for doctor's daily work. It does not require extra time for patient registration, while significantly improves the quality of outpatient appointment records, ensures the complete primary medical data recording, eliminates inaccuracies in the formulation of the diagnosis, program of dispensary observation and treatment.

Conclusion. The formalization of the outpatient endocrinologist appointment allows for development of an automated workplace of an endocrinologist with the prospect of its further implementation as a software module for collecting primary medical data in the regional integrated electronic medical record.

Science and Innovations in Medicine. 2019;4(3):50-55
Influence of some of occupational factors on the course of psoriasis in men and women
Mukhamadeeva O.R., Sharafutdinova N.H.

Objectives – to study the influence of workplace factors affecting the course of psoriasis in men and women in Ufa.

Material and methods. 630 patients were assessed for the level of social status, level of education, types of work, the presence of harmful factors, the frequency of requests for medical care, the clinical severity according to Psoriasis Area Severity Index (PASI), the Dermatology Life Quality Index (DLQI), the level of anxiety and depression on the HADS scale.

Results. Among the negative factors that influence the course of the disease, men more often than women noted excessive physical activity, while women more often than men noted hypothermia, noise, chemicals, twice as often vibration and shift work. The same number of respondents of both sexes identified stress and hypodynamia as the leading factors. Women noted the negative influence of the stress factor on the course of psoriasis more distinctly than men (average score 3.9±0.2 and 2.8±0.3, accordingly). The level of anxiety was significantly higher in women (7.5±1.4) than in men (5.7±0.6), while the coefficient of variation in men is one and a half times higher than in women.

Conclusion. It is necessary to plan activities aimed at reducing the level of occupational stress and increasing resistance to stress in women with psoriasis and optimize physical activity to reduce its negative impact on men with psoriasis. A deeper study of triggers in all areas of life, that have a negative impact on the course of the disease, should be continued. The complex action on the triggers through preventive measures will help to increase the effectiveness of drug treatment and improve the quality of life of patients with psoriasis.

Science and Innovations in Medicine. 2019;4(3):56-59
Prognosis of the combination therapy results in patients with synchronous metastases of colorectal cancer
Kozlov S.V., Kaganov O.I., Moryatov A.A., Kozlov A.M., Borisov A.P.

Objectives – to optimize the indications for radiofrequency thermal ablation in patients with synchronous multiple metastases of colorectal cancer to the liver on the basis of prognostic treatment results.

Material and methods. The study group included 78 patients with colorectal cancer with synchronous multiple bilobar liver metastases, who have underwent combined treatment in the period of 2007– 2015, such as cytoreductive surgery removing the primary intestinal tumor in combination with RFA of metastases in the liver, followed by chemotherapy.

Results. A computer program for preoperative risk assessment of disease progression was developed and introduced in clinical practice. It is based on the results of the analysis of the factors, predicting the risk of relapse during the first year after cytoreductive surgery with RFA of synchronous multiple CRC liver metastases.

Conclusion. The index of metastatic liver damage (the product of the sum of the diameters of metastatic liver lesions by their number), the mutational status of the KRAS gene, CEA values are significant factors in predicting the progression of the disease, which can optimize indications for radiofrequency thermal ablation in the treatment of patients with stage IV CRC with synchronous metastases to the liver.

Science and Innovations in Medicine. 2019;4(3):60-64
Relapse of ovarian neoplasm: individual risk assessment algorithm
Savinova A.R., Gataullin I.G.

Objectives – to develop an algorithm for assessing the individual risk of ovarian cancer recurrence.

Material and methods. A retrospective analysis of the results of treatment of patients with ovarian cancer in the period 2010–2015 was carried out. Finally, data of 1103 patients was reinvestigated, ovarian cancer relapse was registered in 907 patients (mean age: 58.7±12 years; interquartile range: 50–68 years). 196 patients with ovarian cancer did not have relapse for the mentioned time period (mean age: 63.1±13.6 years; interquartile range: 53–74 years). In the first stage of investigation, a unifactorial analysis of prognostic factors of ovarian cancer relapse was carried out. In the second stage, the most significant factors were analyzed with the aid of binary regression. As a result, a final formula of the assessment of individual risk of ovarian cancer relapse was developed, which we have named ARRNO (Algorithm of the Assessment of Risk of Relapse of Neoplasm of Ovary).

Results. From 12 prognostic factors, we selected 6 ones with the aid of binary regression: stage, hystotype, tumor differentiation grade, results of post-chemotherapy ultrasound examination, CA 125 pre-treatment levels, HE4 post-treatment levels. The final ARRNO score was developed on the basis of binary regression formula. Depending on the value of ARRNO score the risk could be divided into low (0.00–0.39), moderate (0.40–0.85) and high (0.86–1.00).

Conclusion. The algorithm of the risk assessment of recurrence of ovarian cancer has a high sensitivity and specificity and allows for stratification of patients into groups of high, moderate and low risk. Integration of the ARRNO in the follow-up plan of ovarian cancer patients, after accomplishment of the first-line therapy, could enhance the treatment planning and timely prevention.

Science and Innovations in Medicine. 2019;4(3):65-68
Fruits of Crataegus submollis: study of pharmacological activity of the preparations
Kurkin V.A., Zaitceva E.N., Pravdivtseva O.E., Kurkina A.V., Stenyaeva V.V.

Objectives – to perform a comparative study of the antidepressant action and diuretic activity of liquid extract and decoction of the fruits of Crataegus submollis Sarg.

Material and methods. The study of the antidepressant activity was performed using the behavioral despair test. The diuretic activity of the liquid extract and decoction from the Crataegus submollis fruits at a dose of 100 μl/kg was evaluated in long-term experiments.

Results. The study revealed the impact of the liquid extract of Crataegus submollis fruits, at a dose of 100 μl/kg, on the motion activity of animals: it increased by 45% if compared to the water-alcohol control group, and equivalent to comparator amitriptyline at a threshold dose of 5 mg/kg. While the diuretic activity of the the liquid extract was not registered. At the same time, the decoction of the fruits of Crataegus submollis, at a dose of 100 µl/kg, did not show antidepressant properties, when compared to water control. It was found that animals from the experimental group relative to water control had a statistically significant increase in renal excretion of water, sodium, potassium and creatinine, equivalent to comparators – furosemide at a threshold dose of 1 mg/kg (4 hours experiment), and hydrochlorothiazide at a mean therapeutic dose of 20 mg/kg (24 hours experiment).

Conclusion. The liquid extract from fruits of Crataegus submollis at a dose of 100 μl/kg showed an antidepressant effect, comparable to the effect of amitriptyline at a dose of 5 mg/kg. An expressed stimulating activity on the kidneys excretory function during the 4 and 24 hours of the experiment is characteristic of the decoction from fruits of Crataegus submollis at a dose of 100 μl/kg. The fruits of Crataegus submollis Sarg. are promising medicinal plant raw materials.

Science and Innovations in Medicine. 2019;4(3):69-72

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