Vol 5, No 4 (2020)

Human Anatomy

Terminological aspects of morphology of the human perineal body and associated muscles

Chemidronov S.N., Nikolenko V.N., Kolsanov A.V., Suvorova G.N., Kornilov V.D.


Objectives – the terminological analysis of the identification of perineal body and associated muscles according to native and foreign literature.

Material and methods. The literature on human anatomy, topographical anatomy, operative surgery, obstetrics, gynecology, proctology as well as urology was reviewed. We analyzed articles from several peer-reviewed scientific medical journals on the topic of the perineum and pelvic organs diseases.

Results. The review of the literature indicates that most of native authors use the term "centrum tendineum perinei" despite last two international anatomical terminology revisions in 2003 and 2019. At the same time, the foreign authors use the term "perineal body" which is in line with contemporary anatomical terminology.

It was also found that the authors disagree on the terminology and morphology not only of the "centrum tendineum perinei" but also of the muscles that form it.

Science and Innovations in Medicine. 2020;5(4):220-225
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ENT Disorders

Modern technologies of simulation training in practical otorhinolaryngology

Vladimirova T.Y., Davydkin-Gogel M.M., Nasretdinova M.T., Aizenshtadt L.V.


Objectives – to evaluate the realism and usefulness of the model developed by us "The ear simulator for practicing emergency care skills in otorhinolaryngology".

Material and methods. 49 otorhinolaryngologists participated in the study. They performed the initial surgical debridement of the external ear, removal of earlobe atheroma, otoscopy, removal of foreign bodies of the external auditory canal, and paracentesis of the tympanic membrane using the developed simulator. The results were evaluated using a questionnaire on practicing emergency care skills in otorhinolaryngology.

Results. The majority of the specialists (94%) defined the developed ear simulator as an adequate model for training, while 83% considered it possible to use it as a training tool for practicing doctors.

Conclusion. The developed model of the simulator is intended for practical training of students and residents in otiatrics in the scope of performing emergency and urgent manipulations.

Science and Innovations in Medicine. 2020;5(4):226-229
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Cause-and-effect relationships between air pollution and health conditions in population

Berezin I.I., Eliseev Y.Y., Sergeev A.K.


Objectives – to reveal cause-and-effect relationships in the system "air pollution – morbidity of the population" in a large industrial city.

Material and methods. The dynamics of the pollutants concentration, such as formaldehyde and benzopyrene, through the period of 2015–2017 was analyzed in relation to the indicators of the morbidity of the respiratory system in the population of Samara. In particular, the study focused on the ratio of allergic rhinitis and asthma cases and the concentration of the formaldehyde and benzopyrene.

Results. The incidence of respiratory diseases and the general morbidity increased both among children (by 46.7%) and adults (by 11.4%). There was the causal correlation between the effect of benzopyrene on the development of allergic rhinitis and bronchial asthma in children
(r = 0.57 and r = 0.76) and in adults (r = 0.45 and r = 0.51) in Samara. The significant differences between the level of the pollutants and the frequency of the respiratory system diseases were registered in children and adults in different areas of Samara.

Discussion. As a result of the increase of the maximum allowable concentration (MAC) of formaldehyde in atmospheric air, this pollutant has now ceased to be a priority. The revealed negative correlations point to the absence of an adverse effect of formaldehyde on the development of allergic rhinitis and bronchial asthma in both children and adults in Samara.

Conclusion. According to the results of the study, the preventive measures aimed at reducing the impact of main air pollutants on the health of children and adults in Samara were suggested. Their implementation is possible by the immediate informing of the executive authorities to ensure they can make timely management decisions to improve the quality of the environment.

Science and Innovations in Medicine. 2020;5(4):230-234
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Acquired long QT syndrome caused by pseudohypoparathyroidism

Balykova L.A., Samoshkina E.S., Petrushkina Y.A., Zolnikova T.M., Krasnopolskaya A.V., Blohina S.I.


The article presents a review of literature data on the long QT syndrome (LQTS), focusing on the role of secondary factors in the development of this disorder. In particular, it describes in detail pseudohypoparathyroidism – a rare genetically and clinically heterogeneous condition characterized by resistance to parathyroid hormone, often manifested by arrhythmogenic syncope and seizures. A specific clinical case illustrates the necessity to exclude the endocrine and electrolyte abnormalities in syncopal conditions associated with the QT interval prolongation.

Science and Innovations in Medicine. 2020;5(4):235-238
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Diagnostic radiology, radiation therapy

Complex neuroimaging of traumatic brain injury: Magnetic resonance imaging

Yarikov A.V., Lobanov I.A., Leonov V.A., Fraerman A.P., Nikolenko S.V.


Traumatic brain injury is one of the most frequent types of injuries and ranks first among the causes of mortality and disability of the working population. The timely diagnosis of brain damage is one of the ways of improving the quality of emergency neurosurgical treatment of severe traumatic brain injury. Choosing the right diagnostic method allows you to assess the volume, severity of the injury and apply the correct treatment tactics.

This paper describes in detail the special methods of magnetic resonance imaging used in the diagnosis of traumatic brain injury (MR cisternography, perfusion MRI, MR spectroscopy, diffusion-weighted and diffusion tensor MRI). The diagnostic capabilities, advantages and disadvantages of each method are discussed.

Science and Innovations in Medicine. 2020;5(4):239-244
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Diseases of the nervous system

Prediction of ischemic stroke outcome during thrombolytic therapy

Minina Y.D., Kalinin V.A.


The problem of ischemic stroke in the Russian Federation occupies a leading place in the structure of causes of mortality. Among all treatment methods, the systemic thrombolytic therapy with a recombinant tissue plasminogen activator is regarded as the most effective one.

This review focuses on clinical studies of the safety and effectiveness of this type of treatment, as well as on prognostically unfavorable factors inducing the hemorrhagic transformation of ischemic stroke.

Science and Innovations in Medicine. 2020;5(4):245-250
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Public Health and Healthcare

Information and legal background for remote outpatient care for patients with diabetes mellitus during COVID-19 pandemic

Pervyshin N.A., Lebedeva I.V., Lebedeva E.A., Suslin S.A.


Objectives – the in-depth analysis of the informational and legal base for organisation of remote medical care for patients with diabetes mellitus in the context of the COVID-19 pandemic.

Material and methods. Official memoranda of the WHO and the International Labour Organization (ILO), decisions of the Government of the Russian Federation and foreign countries on the use of remote telemedicine counseling in the context of the COVID-19 pandemic were reviewed and analysed.

Results. After reviewing the results of remote telemedicine counseling to provide specialized medical care to patients with diabetes during COVID-19 pandemic on various virtual platforms, we defined the factors limiting the widespread use of this technology. We collected metadata of the results of the original experience of remote consultation of patients with endocrine pathology using the automated workplace of an endocrinologist (AWPE).

Conclusion. In the context of the COVID-19 pandemic, the development and implementation of new promising forms of outpatient work using digital telecommunication technologies is particularly relevant. The use of remote access telemedicine consulting techniques via Automated endocrinologist's workplace for patients with endocrine pathology during the period of self-isolation showed its effectiveness in a pilot study. Its widespread introduction into outpatient practice will not only significantly increase the availability of medical care for patients with diabetes, but also minimize the risk of infection with a new coronavirus for doctors.

Science and Innovations in Medicine. 2020;5(4):251-257
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Endolaryngeal surgery in treatment of early-stage cancer in supraglottic laryngeal region

Stadler V.V., Mahonin A.A., Gabrielyan A.G., Sinotin A.I., Postnikov M.А., Vladimirova T.Y., Kostin D.S.


Objectives – to improve the results of surgical treatment of patients with T1-T2 stages of cancer in the supraglottic and ventricular region by using endolaryngeal resections.

Material and methods. The study was held in Samara Regional Clinical Oncology Center from 2011 to 2016. We analysed 97 case histories of patients diagnosed with stage 0-I laryngeal cancer. The patients were divided into 2 groups depending on the selected organ-preserving method of surgical treatment. The patients of the control group were subjected to open resection of the larynx (laryngofissure). While the patients of the main group received the endolaryngeal resection using an endoscopic rack, a suspension system, a laryngoscope, hard endoscopes of 0, 30, 45 degrees, as well as electrosurgical cutting and endolaryngeal instruments.

Results. The duration of the operation, blood loss, and bed day number was significantly less in patients of the main group in comparison with the control group. Also, the percentage of common complications in the main group was lower in relation to the control group. The three-year relapse-free and overall survival was not significantly different between the study groups.

Conclusion. According to our observations, the endolaryngeal resections in treatment of the initial stages of laryngeal cancer do not impair the results of treatment and do not significantly affect the survival of this category of patients.

Science and Innovations in Medicine. 2020;5(4):258-261
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Traumatology and Orthopedics

Changes of the cytokine profile in patients with traumatic synovitis on the background of ozone therapy

Zakhvatov A.N., Tarasova T.V., Vinogradova A.A., Khaidar D.A., Timoshkin V.O.


Objectives – the cytokine profile research in patients with posttraumatic synovitis during intravenous and intra-articular ozone therapy.

Material and methods. The research involved 69 patients with traumatic knee joint damage complicated by posttraumatic synovitis.

Patients in Group I (35 people) received a traditional treatment. Patients in Group II (34 people) along with the traditional therapy had intravenous injection of 200 ml of ozonated solution of sodium chloride in ozone concentration 2 mg/l once daily for 10 days, and intra-articular injection of 20 ml ozone-oxygen mixture in ozone concentration of 15 mg/l once every second day, in an amount of 5 injections.

During arthroscopy, the lavage of the joint cavity was performed with ozonated saline solution at a concentration of 2.0 mg/l.

The cytokine profile was evaluated by the content of pro-inflammatory cytokines (TNF-á, IL-1â, IL-6, IL-17), regulatory (IL-2), IL-1 receptor antagonist, and anti-inflammatory (IL-4, IL-10) cytokines by solid-phase enzyme immunoassay with peroxidase as an indicator. Statistical analysis of the results was carried out using the Student t-test.

Results. The use of intravenous and intra-articular ozone therapy contributed to synchronous decrease of the levels of pro-inflammatory cytokines with simultaneous reduction of anti-inflammatory mediators of inflammation. TNF-á content decreased by 24.6% (p2<0.001), IL-17 – by 17.3% (p2<0.01), IL-6 – by 20.1% (p2<0.001), IL-1â – by 19.1% (p2<0.001), IL-2 – by 25.7% (p2<0.001), IL-1RА – by 24.4% (p2<0.001), IL-10 – by 21.3%(p2<0.001), IL-4 – by 25.7% (p2<0.001) in comparison to traditional treatment.

Conclusion. The complex ozone therapy led to the decrease of inflammation, which was reflected in the depression dynamics of the studied cytokines. These results allow us to evaluate it as an effective treatment method for post-traumatic synovitis which effectively reduces the secondary posttraumatic alteration of tissue structures.

Science and Innovations in Medicine. 2020;5(4):262-266
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A preoperative planning method for long tubular bone osteosynthesis

Pankratov A.S., Lartsev Y.V., Alayo J.G., Ardatov S.V., Ogurtsov D.A., Rubtsov A.A.


Objectives – the development of a preoperative planning method for long tubular bone osteosynthesis using the contralateral healthy bone.

Material and methods. To justify the usage of the opposite limb’s intact segment model in order to reconstruct the damaged one, their matching in shape and size was analyzed. We built three-dimensional models of the right and left segments of the upper limbs of 20 people and compared them using the Hausdorff distance calculation algorithm. For treatment of a 24-year-old patient with a closed humerus fracture, an individual stereolithographic surgical template with fracture lines was created with the help of computed tomography data of the healthy humerus bone processed by AUTOPLAN EXPERT software. This template was used for pre-bending the plate for osteosynthesis. The plate positioning on the template defined the surgical approach, taking into account the anatomical structures located in the projection of the fracture line and the plate. The technique of "reverse bone reposition" on the prepared plate was applied.

Results. With the help of the created 3D models we revealed the size differences of the symmetrical segments of upper limbs. The greatest difference in the limits was registered in the area of the epiphyses (heads of the humeri) – up to 6.8 mm, and the smallest – throughout the entire diaphysis, less than 1.5 mm. Due to preoperative planning there were no intraoperative and postoperative complications, the installation of the plate and osteosynthesis was convenient. The fracture consolidation took place in 3 months.

Conclusion. The proposed method has a number of advantages. It is possible to make a stereolithographic template even for a seriously damaged bone with a copied fracture line. This allows the surgeon to plan the details of osteosynthesis, to model the plate according to the template, to determine the required length and shape of the surgical approach, thus reducing the surgical risks and injury for the patient.

Science and Innovations in Medicine. 2020;5(4):267-271
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Myxoid adrenal cortical adenoma and isolated adrenal myelolipoma

Lisitsyn A.A., Zemlyanoi V.P., Velikanova L.I., Bekhtereva I.A., Shafigullina Z.R.


Objectives – to reveal the clinical, morphological and hormonal characteristics of patients operated on for isolated adrenal myelolipoma and myxoid adenomas with adrenal myelolipoma.

Material and methods. The study was based on the results of examination of patients operated on for adrenal myelolipoma in the period from 2000 to 2015. During the study, the hormonal activity in patients with isolated and myxoid adrenal myelolipomas was analyzed. A pathomorphological and immunohistochemical study of the removed formations of the adrenal gland was performed. The article presents rare clinical observations of patients undergoing treatment in the clinic of E.E. Eichwald, North-Western State Medical University named after I.I. Mechnikov, with accidentally detected neoplasms, which were a combination of adenoma and myelolipoma of the adrenal gland.

Results. The occurrence of isolated myelolipomas and myxoid adenomas with myelolipoma among incidentalomas was 6.3% and 4.9%, respectively. The average age of patients with adrenal myelolipoma is 54.5 years. The ratio of women to men was 2:1. According to our data, four types of hormonal activity have been identified among myxoid formations of the adrenal gland. Type 1 is associated with Cushing's syndrome, type 2 is associated with Conn's syndrome, type 3 is associated with autonomic cortisol secretion, type 4 has no hormonal activity. Based on the results obtained by high-performance liquid chromatography (HPLC), 11â-hydroxylase deficiency was noted, and according to the study of the urine steroid profile by gas chromatography-mass spectrometry (GCMS), the signs of type 2 11â-hydroxysteroid dehydrogenase deficiency and an increase in 5á-reductase activity in patients with isolated adrenal myelolipoma were obtained.

Conclusion. The combination of adenoma with myelolipoma, as well as of adenoma, myelolipoma and cavernous hemangioma is a rare pathology, the diagnosis of which is based on the pathomorphological examination of the removed tumor. Myelolipoma as a part of adrenal adenoma is an incidentaloma, which can be of different sizes and is accompanied by hormonal dysfunction of the cells of the adrenal cortex. An uncertain intrascopic phenotype and hormonal activity of myxoid formations are the decisive factors in favor of surgical intervention.

Science and Innovations in Medicine. 2020;5(4):272-277
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Efficiency of prognostic scales in assessing patients' condition in severe acute pancreatitis

Makarov I.V., Mustafaev I.A., Kurashev A.V., Budorina L.A., Gerasimov L.V.


Objectives – to compare the predictive efficiency of modern scales used in prognosis of disease severity (APACHE II, SAPS, SOFA, MODS) in patients with severe acute pancreatitis.

Material and methods. 17 patients formed two study groups: Group 1 consisted of 10 survived patients, Group 2 included 7 patients with a fatal outcome. The mortality ratio and the severity of the condition were calculated for all 17 patients, using the scales presented above, at the admission to the ICU and at the moment of transfer to a surgical department. The intensive care procedure and surgical interventions were in line with the clinical recommendations for surgical treatment of severe acute pancreatitis.

Results. The day of ICU admission, Group 1, the average mortality rate on the SAPS scale was 11±0.08%; on the SOFA scale – 27±0.08%; on the MODS scale – 1–2%; on the APACHE II scale – 8.45±0.09%. The day of ICU admission, Group 2, the average mortality rate on the SAPS scale was 5.7±7.11%; on the SOFA scale – 25.14±6.09%; on the MODS scale – 2.4±1.05%; on the APACHE II scale – 12.1±8.49%. The day of patients' transfer from the ICU to the surgical department, Group1, the average mortality rate on the SAPS scale was 8.99±0.10%; on the SOFA scale – 30±0.15%; on the MODS scale – 1–2%; on the APACHE II scale – 14.29±0.08%. The day of patients' transfer from the ICU to the surgical department, Group 2, the average mortality rate on the SAPS scale was 7.7±8.69%; on the SOFA scale – 22±0%; on the MODS scale – 1–2%, on the APACHE II scale – 12.37±9.89%.

According to our data, none of the used prognostic scales could present the real condition of a patient or the mortality prognosis for patients in both groups. By comparison of the average mortality rate calculated for patients of Group 1 and Group 2, we revealed the more unfavorable prognosis for the survived patients than for the patients with lethal outcome.

Conclusion. The objective evaluation of the severity of patient's condition and the prognosis for treatment is not possible with the scales used in the study. Among them, the SAPS and APACHE II scales provided the most precise prognoses for patients' condition.

Science and Innovations in Medicine. 2020;5(4):278-282
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A developed treatment method for superficial and partial thickness localized burns: Clinical and morphological assessment

Tolstov A.V., Novikov I.V., Podsevalova I.V., Voronin A.S., Dydykin S.S., Alipov V.V.


Objectives – to prove the effectiveness of the new developed method of treatment of patients with localized superficial and partial thickness burns (gel and silver coating plus ultraviolet radiation of the wound and magnetic therapy).

Material and methods. The treatment of local burn wound infection was analyzed in 29 patients with I-II degree localized burns during the all phases of the wound healing process. The wound material was obtained in accordance with the requirements of the Guidelines МУ 4.2.2039-05 "The technique of collection and transportation of biomaterials in microbiological laboratories". The material was delivered to the laboratory in test tubes with a transport medium under isothermal conditions at a temperature of 20–22°C within a day after collection.

Results. The tests revealed no significant differences in the studied characteristics between the compared groups (р>0.05, р=0.55, ÷2=3.841).

Conclusion. We consider the developed method of local treatment of superficial and partial thickness localized burns as a rather promising, feasible method having its own significance and intended for the prevention and treatment of local wound infection in all phases of the wound healing process.

Science and Innovations in Medicine. 2020;5(4):283-287
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