Vol 6, No 1 (2021)

Human Anatomy

Variability of the level of portal vein formation registered by computed tomography

Kolsanov A.V., Myakotnykh M.N., Tolstov A.V., Mironov A.A.


Objectives – to study the variability of the level of portal vein formation in relation to the spinal column according to computed tomography data.

Material and methods. The study evaluated the results of 100 multispiral (multislice) computed tomography (MSCT) scans of the abdominal organs done in the period of 2018-2019 and collected in the archive of the Clinics of the Samara State Medical University. For mathematical modeling and the creation of three-dimensional models of the vascular bed, we used the plug-ins in the software "Luch" and "Avtoplan" that made it possible to obtain the three-dimensional models based on MSCT data. The level of portal vein formation relative to the spinal column was studied.

Results. The level of portal portal vein formation relative to the spinal column varied from the lower edge of the twelfth thoracic vertebra (ThXII) to the upper edge of the second lumbar vertebra (LII). Most often, the portal vein was formed at the level of the middle of the first thoracic vertebra body (LI). This level of portal vein formation was detected in 23% of cases. In 64% of cases, the portal vein was formed at the level of the right edge of the vertebra.

Science and Innovations in Medicine. 2021;6(1):4-8
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ENT Disorders

Macroscopic anatomy of the fetal nasal cavity

Lutsai E.D., Anikin M.I., Murtazina N.I., Naidenova S.I., Anisimov A.V., Kirksova L.S., Neprokina A.V.


Objectives – to describe the macromicroscopic anatomy of the nasal cavity in the intermediate fetal period of human ontogenesis.

Material and methods. The object of the study was horizontal histotopograms of the nose of 15 fetuses of both genders at the age of 19–22 weeks of the intermediate fetal period of ontogenesis. The study used the method of macromicroscopic preparation, the modified method of saw cuts according to N.I. Pirogov, and the histotopographic method.

Results. On the horizontal histotopographic sections the external nose was shaped like a triangle. The structures of the external nose were covered with skin soldered to the underlying tissues. In soft tissues, there was a large accumulation of arterial and venous vessels, nerves, and glands. In the intermediate fetal period, the nasal passages had the shape of a triangle, with the base turned to the nasal part of the pharynx.

It was found that the anterior-posterior size of the nasal septum in fetuses of the intermediate fetal period was 14.05±4.34 mm, with a range of fluctuations from 5.75 to 19.85 mm. The anterior-posterior size of the nasal septum in female fetuses was greater than the anterior-posterior size of the septum of male fetuses. The value of the width of the nasal septum was the maximum in the lower third, and reached up to 2.54±0.67 mm. The narrowest part of the nasal septum was its middle third, the value was 1.63±0.47 mm. The areas of the nasal passages had no bilateral differences.

Conclusion. In the intermediate fetal period there is the establishment of qualitative and quantitative macromicroscopic anatomy of the nasal cavity. All the main structures are determined: the nasal septum, nasal conchs, mucosa, and blood vessels. Sexual differences begin to form, and there are no bilateral differences. Quantitative characteristics of the structures of the nasal cavity in fetuses can serve as a justification for early surgical intervention in choanal atresia.

Science and Innovations in Medicine. 2021;6(1):9-13
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Assessment of the necessary conditions for robot-assisted surgery in the nasal cavity

Mareev O.V., Mareev G.O., Tsymbal D.D., Afonina O.I.


Objectives - to determine the necessary conditions for performing robot-assisted operations in the nasal cavity.

Material and methods. We have investigated the movement of an endoscope in space by measurements based on high-resolution computed tomography (CT) data. A total of 50 CT scans of the paranasal sinuses were used for this purpose. The tomograms were randomly selected from among the patients of the ENT clinic of the Saratov State Medical University. The main parameters characterizing the movement of the endoscope in the nasal cavity under the conditions set by us are the magnitude of its linear displacement from the entry point and the angle of its deviation, measured in three planes - frontal, sagittal and horizontal, provided that the planes of these sections pass through the entry point during various operations. To control these measurements, we detected the displacements of the endoscope in space using an optical tracking system we made, as well as specialized software designed specifically for the purpose of optical tracking. With the help of this device, measurements were carried out on the skulls and their models, the silicone model for endoscopic examination K. Storz 723128, as well as during real endoscopic operations on the paranasal sinuses. All studies were combined into groups according to the standard protocols of endoscopic operations performed endonasally: “Anterior ethmoidotomy”, “Posterior ethmoidotomy”, “Frontotomy”, “Sinusotomy”, “Sphenotomy”, “Adenotomy”.

Results. The main characteristics of the movement of the endoscope in the nasal cavity at a given entry point in the nostril area were established - its maximum linear and angular displacement during various types of FESS interventions for adults.

The results obtained by us can serve as the main criteria for the development of a specialized robot assistant that holds and moves the endoscope in space during FESS.

Science and Innovations in Medicine. 2021;6(1):14-19
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Interdisciplinary approach in audiology – an experience of pediatric amplification

Tufatulin G.S., Koroleva I.V., Korkunova M.S.


Objectives – to develop an algorithm for the interaction between an audiologist and speech-language therapist in initial amplification for hearing impaired children.

Material and methods. 219 children with hearing impairments aged from 2 months to 16 years were divided into 2 groups. The experimental group consisted of children who got a special course of medical, psychological and pedagogical rehabilitation at the stage of initial fitting, based on the new algorithm of interdisciplinary interaction between an audiologist and a speech-language therapist. The control group included children with traditional procedure of hearing aids’ fitting, in which the audiologist did not interact with the speech therapist.

Results. The algorithm for the interaction of an audiologist and speech-language therapist included 3 stages of hearing aids fitting (preparation, initial fitting, adaptation and fine tuning of hearing aids). The tasks of each specialist at these stages were identified, including the parents’ involvement in the process of fitting. The exchange of information between specialists was organised by a developed protocol. The algorithm was implemented in a special course of medical-psychological-pedagogical rehabilitation in the Center of Pediatric Audiology.

It was found that in 1 month after the primary fitting among children who underwent this course, the significantly larger number of children used the hearing aids for more than 8 hours a day and reached the integral criterion of effective hearing aids’ fitting, if compared to the control group. These children also took less time to adjust their hearing aid settings during the repeated fitting sessions.

Conclusion. A structured interdisciplinary interaction between an audiologist and speech-language therapist at the stage of initial amplification significantly increases the effectiveness of medical technology for restoring hearing function in children.

Science and Innovations in Medicine. 2021;6(1):20-24
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Recurrent paratonsillitis of odontogenic origin

Chechko A.N., Vladimirova T.Y.


The recurrent paratonsillitis caused by medium dental caries is an extremely rare condition. Patients with this pathology are admitted to otorhinolaryngological departments and in most cases they do not actively present odontogenic complaints. Currently, the algorithm for the mandatory examination of patients with paratonsillitis does not include an examination by a dentist.

This article presents a clinical case of recurrent paratonsillitis in a 22-year-old man. His admission due to this condition was the third during the year. The disease proceeded without signs of affection of the palatine tonsils. In this regard, the patient was examined according to clinical recommendations using additional research methods to verify the source of infection. To exclude the formation of peritonsillar abscess, the non-invasive diagnostic methods were used - transoral ultrasound of peritonsillar tissues.

This examination revealed an abnormal arrangement of the external carotid artery branches. This circumstance determined the choice of treatment tactics, excluding the use of relaxing incisions in the peritonsillar area. A laboratory study of saliva determined the activity of á-amylase, pH value was measured to exclude an inflammation of the salivary glands. An additional examination revealed the odontogenic etiology of paratonsillitis.

Science and Innovations in Medicine. 2021;6(1):25-28
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Meta-prebiotics: a new way to control the intestinal microbiota

Кrylova I.А., Kupaev V.I., Lyamin А.V., Ismatullin D.D.


Objectives – to analyze the quality and quantity of the intestinal microflora of relatively healthy people and/or of those who did not visit a doctor in the last 3 months, before and 1 month after taking a meta-prebiotic complex containing dietary fiber (inulin) and oligosaccharides (oligofructose).

Material and methods. We examined the individuals who considered themselves healthy and/or did not consult a doctor during the past 3 months. To detect the presence of dyspeptic complaints, the clinical data were collected. 114 people with different suboptimal status and non-specific dyspeptic complaints were chosen for the study and underwent the clinical examination for the degree of gut microbiota imbalance before taking the meta-prebiotic complex. 78 people followed the course of the meta-prebiotic and were examined after 1 month after the start.

Results. We have obtained new data on intestinal biocenosis at various suboptimal status in relatively healthy people: the total number of bacteria is insufficient. When using a meta-prebiotic complex containing inulin and oligofructose, the composition of the intestinal microflora was improved due to the decreased cases of detection of opportunistic enterobacteria and other gram-negative microorganisms.

Conclusion. The significance of studying the intestinal microbiotic complex in patients with the increased suboptimal health status is proved, and the earlier active screening of this category of patients is recommended.

Science and Innovations in Medicine. 2021;6(1):29-32
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Quality of milk consumed in Samara region: An analysis of milk physical and chemical characteristics

Sazonova O.V., Gorbachev D.O., Borodina L.М., Gavryushin M.Y., Synbulatov I.V., Minko O.V.


Objectives – an analysis of physical and chemical indicators of milk quality produced under the most popular brands in the Samara region.

Material and methods. The study was selective and prospective, focused on the physical and chemical indices of milk quality. The sampling was based on the results of the assessment of the frequency of consumption of various brands of milk by the population of the Samara region. The analysis included five samples of milk of different brands, purchased in the retail food store chain, and assessed their various physical and chemical indicators. All measurements were performed in accordance with the regulatory documentation.

Results. Only 1/3 part of respondents (32.6%) included milk in their daily diet. All five milk samples subjected to physical and chemical examination met the requirements of the current regulatory documentation. However, in assessing the nutritional value of the samples by mineral composition, it was found that the actual content of phosphorus and calcium is significantly lower than the values of the corresponding indicators set out in the handbook "Chemical composition and calorie content of Russian food products" that is used as a guide by nutrition specialists.

Conclusion. Milk purchased in the food store chain met the safety requirements for physical and chemical indicators. The reduced level of milk consumption among the population of the Samara region requires management decisions. The actual chemical composition of this product, which has regional and seasonal characteristics, should be taken into account in the development of diets for defined population groups.

Science and Innovations in Medicine. 2021;6(1):33-38
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Infectious diseases

Opportunity of early detection of hemorrhagic fever with renal syndrome

Stulova M.V., Konstantinov D.Y., Nedugov G.V., Popova L.L., Lyubushkina A.V., Kudryashov A.P.


Objectives – to develop a method of early differential diagnosis of the hemorrhagic fever with renal syndrome (in 3 days after the onset) from other infectious and non-infectious diseases on the basis of mathematical-statistical analysis of clinical, functional and instrumental data.

Material and methods. The study presented a complex clinical, functional and ultrasound examinations of 276 patients with various infectious and non-infectious diseases performed within 4 or 5 days from the onset of the disease.

Results. Based on the discriminant analysis of the obtained data, a discriminant model for early differential diagnosis of hemorrhagic fever with renal syndrome was developed.

Conclusion. The accuracy index of the differential diagnosis of HFRS using the developed discriminant model is 96%.

Science and Innovations in Medicine. 2021;6(1):39-44
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Modeling of restenosis of main arteries after the intravascular stenting interventions

Germanova O.A., Germanov V.A., Shchukin Y.V., Germanov A.V., Piskunov M.V., Burmistrov A.E., Yusupov R.Y., Galati G.


Objectives – to study the mechanism of restenosis after the intra-arterial stenting using the original device for modeling of intra-arterial blood flow.

Material and methods. To perform the experiment, we have created the original device simulating the intra-arterial blood flow. A glass tube of rotameter was the imitation of the arterial vessel. The closed system was filled with the liquid imitating blood, specifically the solution of glycerin the same viscosity as the human blood plasma. Using our original model of intra-artetial blood flow, we were able to study the intra-arterial hemodynamics under different conditions of cardiovascular system functioning, including arrhythmias.

Results. In extrasystolic arrhythmia, during the spread of the first post-extrasystolic wave, we observed the intensive impact of pressure wave (the indicator was the silk thread) on the vessel walls with forming of reflected and standing waves. Putting the piezo crystal probe of pressure inside the tube, we verified our observations. The increase of pressure during the spread of the first post-extrasystolic wave in multiple measurements had a mean value of 160% in comparison with the pressure during the regular heart rhythm.

Conclusion. The hydraulic shock appears during the spread of the first post-extrasystolic wave in the arterial vessel. Its effect on hemodynamics grows in case of the frequent extrasystoles and allorhythmia. The mechanical impact of hydraulic shock in extrasystoles can be the starting point of the restenosis onset and progressing in the intra-arterial stent.

Science and Innovations in Medicine. 2021;6(1):45-49
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Risk factors of cardiovascular diseases in students of Samara State Medical University on MMM-18 registry data

Rubanenko A.O., Rubanenko O.A., Dyachkov V.A., Shchukin Y.V., Ivanov K.M.


Objectives – to evaluate the occurrence of the main cardiovascular risk factors in medical students.

Material and methods. The MMM-18 registry included 177 students of Samara State Medical University with mean age of 21.0 years. All the students filled in a survey form anonymously, where they stated their age, gender, height and weight, smoking status (yes or no), alcohol consumption (never, once a week, regularly) and also known cardiovascular diseases (coronary heart disease, stroke) and diabetes mellitus.

Results and Discussion. The study confirmed the important role of conventional cardiovascular risk factors such as smoking, high body mass index, elevated blood pressure. These findings support the necessity of periodical screening of medical students in order to timely detect and correct the above-mentioned risk factors.

Science and Innovations in Medicine. 2021;6(1):50-53
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New groups of hypolipidemic drugs based on inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9). Part 1

Chaulin A.M., Svechkov N.A., Duplyakov D.V.


The hypolipidemic therapy is one of the essential components for the management of patients with cardiovascular diseases (CVD). In this regard, the main task of modern research is to find new targets for creating additional effective groups of lipid-lowering drugs. In 2003, a Canadian and French research team led by N. Seidah and M. Abifadel discovered a new enzyme, proprotein convertase subtilisin-kexin type 9 (PCSK9), which plays an important role in lipid metabolism.

The main mechanism of action of PCSK9 is to regulate the density of low-density lipoprotein receptors (LDLR) in the cell membrane of hepatocytes. The increased activity of PCSK9 significantly accelerates the degradation of LDLR and leads to an increase in the concentration of atherogenic classes of lipoproteins – the low-density lipoproteins (LDL). A reduced activity of PCSK9, on the contrary, is accompanied by a decrease in the concentration of LDL and a decrease in the risk of developing atherosclerosis and CVD. The second, recently discovered and less studied, mechanism of the protearogenic action of PCSK9 is the enhancement of inflammatory processes in the atherosclerotic plaque. Given this unfavorable contribution of PCSK9 to the development and progression of atherosclerosis and CVD, the main task of the researchers was to develop drugs that inhibit this enzyme. To date, several new drug groups have been developed that target the biosynthesis steps and the function of PCSK9.

In this article, we will focus in detail on the discussion of the mechanisms of action and effectiveness of the following groups of lipid-lowering drugs: anti-PCSK9 monoclonal antibodies (alirocumab, evolocumab), small interfering ribonucleic acids (incliciran) and antisense nucleotides.

Science and Innovations in Medicine. 2021;6(1):54-60
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Public health, organization and sociology of health

Features of social and hygienic characteristics in families with women of late reproductive age, raising children after ART

Kuzmichev K.A., Tyumina O.V., Chertukhina O.B., Sapunkova Y.A., Konovalov O.E.


Objectives – to study the social and hygienic characteristics of families of women of late reproductive age (LRA) who are raising children, conceived by assisted reproductive technology (ART) in Samara region.

Material and methods. In the study, 500 women of late reproductive age (LRA) and their children took part using the "pair of copies" method: the main group included women of LRA giving birth with ART (n=250), the control group – LRA women giving birth without ART (n=250). The average age of mothers at the time of birth was 39.11±0.5 years in the main group and 36.95±0.76 years in the control group. The social and hygienic examination involved the data collection from children's medical records and interviewing mothers with the help of specially designed questionnaires that included questions on medical activity and social factors.

Results. The main and control groups presented the differences in the medical activity. The families with children born after ART showed a more attentive attitude to the child's health, strict adherence to the recommendations of the doctor in case of illness, and observance of the daily routine. However, in terms of social adaptation and physical development, the children born after ART are inferior to those in the control group: they spend less time outdoors and, as a rule, do not attend additional study groups or sports sections.

Science and Innovations in Medicine. 2021;6(1):61-65
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Structure of navigation information as a criterion of efficient visualization of a lean hospital

Kurmangulov A.A., Isakova D.N., Brynza N.S.


Objectives – to determine the main types of structuring information of navigation systems in medical organizations of the Russian Federation and evaluate their compliance with the principles of lean production.

Material and methods. A structural analysis of the types of information presentation in navigation systems was based on the publications selected from the E-library, Medline, Scopus, PubMed and the Cochrane Library databases. The research process included the use of research methods for law, historical, descriptive-analytical methods, content analysis.

Results. The structuring of navigation information can be done according to numerological, architectural, routing, alphabetical, structural, functional and combined principles. The optimal choice of the principle of organizing information should depend on how detailed the navigation system is, on the analysis of the architectural solutions used for a medical organization and on the calculation of navigation objects. It is possible to increase the efficiency of structuring navigational information using an appropriate color scheme, infographic and compositional solutions. When improving the navigation systems of medical institutions as a part of lean hospital management, it is necessary to audit all available navigation elements to determine the principle of structuring the information.

Conclusion. The effective visualization of a medical institution is the provision of clear and understandable navigational information. One of the most effective methods to systematize the navigation information is its structuring.

Science and Innovations in Medicine. 2021;6(1):66-72
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