Vol 7, No 1 (2022)

Aim – to obtain new data on the anatomy of the mandible of a human fetus aged 19–23 weeks.

Material and methods. The object of the study was 40 mandibles of human fetuses of both sexes aged from 19 to 23 weeks. The morphological method (macromicroscopic preparation; the method of saw cuts according to N.I. Pirogov; production of serial histotopograms) and the method of ultrasound scanning by the device VOLUSONS 10, RAB 6 – RS sensor in 2D mode and in the "Skeleton" program (3D mode) were used.

Results. In fetuses aged 19–23 weeks the mandible represents a paired bone connected in the center by a symphysis. According to the shape of the body, it is possible to select wide and short, long and narrow mandibles in a ratio of 2 to 1, respectively 67% and 33%. The length of the alveolar arch is 52.4 ± 5.6 mm (with a range of 45.3–60.2 mm), the angular width is 23.4 ± 1.7 mm (with a range of 19.0–27.8 mm). The height of the branch at the cutting level was equal to 6.2 ± 1.4 mm (with a range of 3.6–9.0 mm). On the anterior surface of the body, one chin opening is determined on both sides, at an average distance of 16.4 mm from the angle of the mandible and at a height of 2.2 mm. On the inner surface of the branch, the opening of the mandible is determined, located at a distance of 3.6 ± 1.1 mm from the angle, 3.2 ± 0.9 mm from the anterior edge of the branch, 4.1 ± 1.2 mm from the posterior edge of the branch. In the second trimester of pregnancy, dental alveoli are determined in the mandibular dental arch of the fetus. Significant sex differences were found for the angle of the mandible (p ≥ 0.05). In girls, the angle was 141.1° ± 10.1, in boys – 129.5° ± 9.4.

Conclusion. The mandible of the fetus at the age of 19–23 weeks is formed and has fetal characteristics. During this period, no significant bilateral differences were revealed, sexual differences start to form.

Aim – to evaluate the severity of tinnitus before and after medical treatment in military personnel exposed to high-intensity noise.

Material and methods. The study involved 14 soldiers with complaints of tinnitus who suffered hearing damage caused by gunshot noise (AK74 gun) during military training without hearing protectors. The tinnitus severity and its dynamics during the treatment by glucocorticosteroids was assessed using the Tinnitus Functional Index (TFI). The Tinnitus Handicap Inventory (THI) was used before the treatment, on the 3rd and 7th days after the treatment.

Results. It was found that the greatest discomfort was caused by the intrusiveness of noise and inability to control it during the day, and the least discomfort was associated with sleep. The changes in the severity of noise on the THI and TFI scales on the third and seventh days after treatment were significantly different, if compared with the pre-treatment results, and had a positive trend. The therapy provided the significant decrease of noise intrusiveness and established the sense of noise control during the day, as well as minimized its effect on relaxation, hearing and quality of life, if compared to the data before treatment.

Conclusion. The TFI and THI scales are recommended for assessing the severity of tinnitus and monitoring the treatment of patients exposed to high-intensity noise. Particular attention should be paid to the use of personal hearing protection equipment when working in conditions of increased level of noise.

Aim – to compare the parameters of bioimpedance analysis of body composition in elderly and old men with polymorbid pathology.

Material and methods. The study involved 123 men aged from 65 to 84 years (mean age 73.7 ± 5.9 years) with polymorbid pathology. The Group 1 included 65 elderly men; the Group 2 consisted of 58 old men.

Results. The study revealed the decrease in strength, mass and muscle function parameters related to aging. The bioimpedance phase angle was lower in the group of old men than in the group of elderly men. The correlations of the phase angle with anthropometric and functional parameters, as well as with body composition were revealed.

Conclusion. The decrease in muscle mass parameters and low phase angle may be associated with degenerative processes in skeletal muscles due to aging and polymorbidity. The bioimpedance analysis of body composition can be used in geriatric practice for the diagnosis of sarcopenia syndrome in elderly and old men.

Aim – to study medical university students’ attitude to water intake as an element of a healthy lifestyle.

Material and methods. 824 students of medical university took part in a survey on their attitude to drinking water. The data obtained were processed using the methods of descriptive, parametric and nonparametric statistics.

Results. The students’ attitude to water consumption corresponds to the current WHO recommendations. Almost all respondents (93.2%) agree that water and its rational consumption have positive impact on human health. 87.3% of the students consume water as a drink, with an average of 1.53±0.02 liters per day. 81.8% of respondents use drinking water to satisfy their thirst. 55.3% of respondents prefer still spring water. 32.9% of respondents pointed to the leading role of the family and traditions in forming a certain attitude to drinking water consumption. The respondents also noted the influence of media reports and advertising (20.0%) and of the immediate environment such as friends, classmates, etc. (19.8%). 51.8% of respondents are ready to replace the drinks they use with drinking water.

Conclusion. The main factors determining the behavior of the majority of students in relation to the rational use of drinking water are age and family (including the presence of medical workers among relatives).

Aim – to develop, using mathematical and statistical analysis of clinical, laboratory and instrumental data, a method for predicting the development of chronic kidney disease (CKD) in patients with hemorrhagic fever with renal syndrome (HFRS).

Material and methods. 244 patients at the age from 18 to 50 years with a confirmed diagnosis of HFRS were examined. Patients were observed in the following periods: oliguric, polyuric, early (30th day of illness) and late (90th and 180th day of illness) convalescence. Clinical, laboratory and instrumental data, including computer photoplethysmography, were evaluated.

Results. Prediction of CKD in patients with HFRS (polyuria period) based on a linear discriminant model is possible with an accuracy index of 92.2%. In subsequent periods, the accuracy index increases: in early convalescence – 98.4%, in late convalescence up to 100%. The following markers were the most informative: RI before ischemia, leukocytes and platelets in the general blood test, total protein and creatinine in the biochemical blood test, GFR calculated using the CKD-EPI and MDRD formulas, daily microalbuminuria, BMI and weight.

Conclusion. A complex of discriminant models for predicting the development of CKD in patients with HFRS at various stages of the disease, including convalescence, with an accuracy index from 92 to 100% has been developed. These models are implemented in the software "Calculator for predicting CKD after HFRS".

Aim – a comprehensive study of disorders of the biomechanics of blood circulation for early diagnostics of atherosclerosis.

Material and methods. The study included 120 people having one of the following risk factors for cardiovascular diseases: smoking, hypertension, Type 1 or Type 2 diabetes. All subjects underwent computer-assisted rheopulmonography, rheovasography, apexcardiography, and direct sphygmography of the major arteries. The functioning of the heart, the arterial wall, the vascular bed of the pulmonary and systemic circulation was evaluated.

Results. Smoking patients mainly had violations of the pulmonary circulation hemodynamics and the biomechanics of the arterial wall of the peripheral arteries due, obviously, to direct damage by nicotine. In patients with arterial hypertension, there was an increase in the work of the myocardium, obviously as a result of the formation of a hyperkinetic type of blood circulation in this disease. Patients with type 1 and type 2 diabetes mellitus were characterized primarily by the development of systolic-diastolic vascular dysfunction, which may be a predictor of the development of angiopathies in the future. In addition, the study of the kinetics of the major arteries revealed violations of the biomechanics of the wall of all vessels under study with risk factors for atherosclerosis. At the same time, it should be noted that more pronounced changes were found in the distal arteries of the muscular type than in the arteries of the muscular-elastic type, which is obviously associated with hemodynamic overloads experienced by peripheral vessels, both as a result of the hydraulic shock that occurs with hyperkinetic type of blood circulation, and the effect of hydrodynamic forces on the vessel wall under the influence of gravity.

Conclusion. Each factor contributes to the development of disorders of cardiovascular biomechanics and hemodynamics. It is necessary to consider changes in the biomechanics of the heart and vascular bed as early manifestations of the circulatory system malfunction with present risk factors for cardiovascular diseases.

The article presents a clinical observation of a patient with ovarian cancer, stage IIIA according to FIGO (International Federation of Obstetrics and Gynecology), after completing the first-line combination therapy for whom we determined the risk of recurrence using a special software.

The early prediction of the ovarian cancer relapse was based on calculated ARRNO index (Assessment of Risk of Relapse of Neoplasm of Ovary). As initial data the following characteristics were inserted into the program: disease stage according to FIGO, tumor differentiation stage (Grade), hystotype, state of residual tissue on ultrasound examination after the treatment, levels of СА-125 before the treatment, levels of НЕ-4 after the treatment. The ARRNO software calculated the individual risk of relapse in 3 limits: low (0 - 0,39), moderate (0,40 - 0,85) and high (0,86 - 1,0).

Conclusion. The special software for assessing the risk of relapse of ovarian neoplasm proved to be simple to operate and allowed to predict the relapse with high probability.

Aim – to assess the accuracy and duration of acetabulum adaptation when using the developed method of installing the acetabular components of the hip joint endoprosthesis.

Material and methods. A method and a special device for its implementation have been developed for adapting of the acetabulum with defects. An experimental study was conducted on 3D printed plastic models of pelvic bones of patients with acetabulum defects of type 2A-3B according to the Paprosky classification. In the main group, pelvic bones were treated using the developed method. The control group used Zimmer (USA) hip endoprosthesis kit cutters as well as standard surgical instruments. The accuracy of the pelvic bone treatment was evaluated by the volume of liquid silicone that was poured into the space between the endoprosthesis component and the pelvic bone. The duration of preparation of the acetabulum for cup implantation was assessed using a stopwatch.

Results. The mean duration of pelvic bone preparation for cup implantation did not differ significantly between the groups (p = 0.7). The average volume of solidified silicone in the space between the cup and the pelvic bone model in the main group was significantly less than in the control group (p = 0.02). This indicates a high accuracy of the acetabulum adaptation. Acetabulum wall damage in control group occurred in 5 cases.

Conclusion. The proposed method and the device for its implementation allow you to prepare the pelvic bone for implantation of a customized cup with high accuracy. Its application can simplify the complex revision operations and reduce their invasiveness.

Aim – to present a new midline approach technique with dissection of the navel and umbilical ring, that allows to reduce the number of postoperative ventral hernias after median laparotomy.

Material and methods. The study involved 230 patients operated using the median approach with the transumbilical technique and with the traditional technique of midline laparotomy with a bypass of the umbilical ring on the left. The observation period lasted from 2016 to 2021.

Results. The observation helped to assess the course of the postoperative period and the long-term outcome in the area of the surgical intervention on the abdominal wall. The advantages of the proposed technique were determined.

Conclusion. When performing an access with a dissection of the umbilical ring, a strict compliance with the sequence of actions of suturing the laparotomic wound is of great importance. For the prevention of postoperative ventral hernias, it is important to combine the methods of access and suturing of the median laparotomic wound.