Vol 8, No 1 (2023)

Human Anatomy

Topographic anatomy of two-piece orbitozygomatic, modified orbitozygomatic and transzygomatic approaches: A comparative analysis of neurosurgical options

Melchenko S.A., Cherekaev V.A., Sufianov A.A., Nikolenko V.N., Golodnev G.E., Shumeiko T.S., Gizatullin M.R., Golbin D.A., Lasunin N.V., Shelyagin I.S., Surikov A.A., Senko I.V.


Aim – to measure and compare the vertical and horizontal angles of attack on different intracranial surgical targets provided by the transzygomatic, modified orbitozygomatic and classic two-piece orbitozygomatic approaches, to determine the most optimal approaches to different surgical targets.

Material and methods. The study was conducted on 8 sides of en bloc specimens of human head and neck. The marking was performed with BrainLAB Kolibri navigational station (Germany) to highlight the surgical landmarks and measure the angles. The dissection was started macroscopically with standard instruments and photographic fixation of every stage of the approach. The craniotomy was performed with Stryker high speed drill (USA). After that, the microscopic stage was carried out with the ZEISS OPMI Vario/S88 surgical microscope (Germany). On each side, the following steps were completed: soft tissues dissection, cutting the zygomatic arch, fronto-temporal craniotomy, orbitozygomatic osteotomy, opening of the dura mater and dissection of structures of the cranial base, measurement of angles of attack with their apex located on skull base structures

Results. The angles of attack on different intracranial surgical targets were measured and compared for two-piece orbitozygomatic, modified orbitozygomatic and transzygomatic approaches.

Conclusion. The two-piece orbitozygomatic craniotomy is the most universal and optimal to approach the basilar artery bifurcation and lesions located in both anterior and middle cranial fossae. However, to minimize the surgical trauma and the risks of complications when exposing exclusively anterior cranial fossa, the modified orbitozygomatic approach is more adequate. When the lesion is small and located exclusively in middle cranial fossa, performing the transzygomatic approach is recommended.

Science and Innovations in Medicine. 2023;8(1):4-12
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Topographic and anatomical relationships of the lower jaw and auricle in human prenatal ontogenesis

Neprokina A.V., Lutsai E.D.


Aim – to describe the topographic and anatomical relationships of the fetal lower jaw and auricle in the mid-gestation period.

Material and methods. The 110 mandibles of human fetuses of the second trimester were selected for the study and divided into groups by sex and age. The morphological techniques and the method of ultrasound scanning were used to determine the topographic relationships of the lower jaw and the fetal ear, the location of the central part of the auricle relative to the lower jaw (the line connecting the gnathion point and the external occipital protuberance) at different age periods.

Results. During the mid-gestation period, with the growth of the fetus, the auricle normally shifts upward relative to the mandible. At the beginning of the study period, the auricle is located just below the angle of the lower jaw. Its central part (C) is below the line (AB) connecting the gnathion point and the external occipital protuberance. The perpendicular from the conditional center of the auricle to the line AB is half the diameter of the auricle 3.7 ± 1.1 mm. In the second age group, the auricle is located at the level of the branch and angle of the lower jaw Its conditional center (C) is below the line AB and is ¼ of the diameter of the auricle 3.1 ± 0.8 mm. By the end of the mid-gestation period, the auricle is displaced to the level of the processes of the lower jaw above the notch. Its central part is above line AB, the perpendicular from point C to line AB is 6.1 ± 1.4 mm.

Conclusion. The deviations in the formation of the topographic and anatomical relationships of the lower jaw and auricle of the fetus from 14 to 27 weeks of gestation can be additional criteria for the development of congenital fetal pathology and require the fetoabnormal alertness.

Science and Innovations in Medicine. 2023;8(1):13-16
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Morphological features of the mucous membrane of the isthmus of the fallopian tubes in the elderly and senile women

Snigireva S.V., Balandina I.A., Balandin A.A.


Aim – to determine the age-related morphological features of the isthmus of fallopian tubes of parous elderly and senile women in comparison with women in early adulthood.

Material and methods. For the morphological study, 79 parous women were divided into 3 groups: Group I included 26 women of early adulthood (aged from 22 to 35), Group II included 28 elderly women (aged from 57 to 74), Group III included 25 senile women (aged from 75 to 88). The histological, micrometric and statistical methods were used in the study. The preparations were stained with hematoxylin and eosin. The thickness of the mucous membrane of the isthmus of fallopian tubes was measured.

Results. The mucous membrane of the isthmus in the old and senile age is characterized by thickened folds located close to each other, forming a narrowing of the uterine tube lumen. From the early adulthood to old age, the thickness of the uterine tube mucosa in the isthmus area was decreasing by 9.1% in the right tube and by 9.2% in the left tube. In the interval from the old age to senile age, the thickness of the right fallopian tube mucosa was decreasing by 4.7% and that of the left fallopian tube – by 4.5% (p<0.01). There was a tendency for asymmetry in the thickness of the mucous membrane in the isthmus area with predominant parameters in the right fallopian tube in all age groups under the study (p>0.05).

Conclusion. The results obtained during the study allow us to expand the previously available information on the age-related restructuring of the female reproductive system organs. This information may provide the basis for various kinds of "anti-age" and clinical research.

Science and Innovations in Medicine. 2023;8(1):17-21
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Perception of the body image and its influence on the development of maladaptive eating behaviors in sports university students

Davletova N.С., Tafeeva E.A.


Aim – to assess the body image perception and its influence on the development of maladaptive eating behavior (MEB) among students of a sports university.

Material and methods. A survey was conducted among 768 students using a self-image questionnaire (SIQ) and an Eating Behavior Assessment Scale (EBAS).

Results. 43.2±5.1% of sportswomen and 42.9±10.8% of sportsmen of complex coordination sports had a pronounced degree of appearance dissatisfaction (AD). The AD level was assessed as "slight dissatisfaction" in most students of other sports and non-athletes (in 50.9±6.7% of athletes of cyclic sports, 37.5±6.1% of wrestlers, 38.8±4.02% of sports games athletes (SGA), 38.2 ± 6.5% of male non-athletes, 40.6 ±8.7% of female wrestlers). In 31.6±4.8% of the female SGA and in 31.7±4.2% women non-athletes we observed "moderate dissatisfaction". The AD level correlated with the presence of clinical manifestations of MEB (r=0.5, p<0.001) and with the presence of psychological traits and behavioral stereotypes characteristic of people with MEB (r=0.279, p<0.001).

Conclusion. A distorted perception of one's own body, namely dissatisfaction with one's appearance, was related with the presence of the MEB symptoms in the students of the sports university. The self-image questionnaire (SIQ) can be used as a screening method to determine the risk group for developing MEB at the prenosological stage. The ranking of sports by the number of athletes with pronounced appearance dissatisfaction can be used to determine the order of development of targeted preventive measures, taking into account the specifics of the sport, the characteristics of the training process and competitive stages.

Science and Innovations in Medicine. 2023;8(1):22-28
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The management of patients aged 90 years and older with ST-segment elevation myocardial infarction

Duplyakova P.D., Pavlova T.V., Khokhlunov S.M., Duplyakov D.V.


Aim – to study in-hospital outcomes in patients with ST-segment elevation myocardial infarction (STEMI) in the age group over 90 years old, depending on the treatment tactics.

Material and methods. For the period of January, 2017 - December, 2020, in total 72 patients aged ≥ 90 were hospitalized in Samara Regional Clinical Cardiology Dispensary with STEMI: mean age 91.8 years (90-96), among them 49 women (68%). Patients were divided into two groups depending on the chosen treatment strategy. Group 1 included patients (n = 13) who underwent coronary angiography and primary percutaneous coronary intervention (pPCI), mean age 90.6 (90-91) years, 8 women (61.5%). Group 2 included patients who received coronary angiography and conservative treatment (n = 5) and only conservative treatment (n = 54), mean age 91.9 (91-96) years, 41 women (69.5%).

Results. In terms of the incidence of pulmonary edema and cardiogenic shock, both groups were comparable, no statistically significant differences were found. In-hospital mortality among STEMI patients aged 90 years and older was higher in the conservative treatment group than in the invasive group (45.8% vs. 7.7%) (OR 10.12; 95% CI (1.24–82 .96)).

Conclusion. The results obtained in our study may indicate the advantage of the invasive strategy in the treatment of patients with STEMI over the age of 90 years. Further prospective studies based on the principles of evidence-based medicine are required.

Science and Innovations in Medicine. 2023;8(1):29-33
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Clinical and diagnostic significance of plasminogen activator inhibitor type 1 in the early development of coronary heart disease

Nurillaeva N.M., Khasanova N.A., Zokirova M.B.


Aim – to determine the quantitative content of the tissue plasminogen activator inhibitor type 1 (PAI-1) and to determine its relationship with risk factors for coronary artery disease.

Material and methods. The study included 67 male and female patients (36 men and 31 women) with coronary artery disease (CAD) and stable angina classes II-IV with the presence of hypertension. The mean age of the patients was 60.2±0.76 years. In all patients, clinical and anamnestic data were collected during the examination. For pain assessment, we used a verbal scale. We registered the anthropometric data and body mass index. Biochemical and instrumental methods of research were used according to the standards for diagnosing CAD. We assessed the occurrence of risk factors in patients included in the study. A complex of general clinical laboratory and instrumental tests was used, as well as the method of enzyme immunoassay ELISA, which determined the level of PAI-1, platelet aggregation activity, renin, aldosterone, cortisol and endothelin.

Results. The group of patients demonstrated a reliable elevation of PAI-1 plasma level. Compared with practically healthy people, the level of this biomarker was 1.6 times higher in patients with coronary artery disease. A significant elevation of PAI-1 level indicates an increased risk of endothelial and hemostasiological disorders in patients, which, in turn, increases the risk of thrombogenic complications. The study revealed the correlation of PAI-1 protein in CAD patients with such risk factors as mixed anxiety-depressive disorder, smoking, hypertension, obesity, and hypercholesterolemia.

Science and Innovations in Medicine. 2023;8(1):34-38
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Occupational medicine

Professional burnout of medical workers in the era of the COVID-19 pandemic as a risk factor for mental health

Sazonova O.V., Gavryushin M.Y., Kuvshinova N.Y., Ostryakova N.A., Babanov S.A.


The paper presents an analysis of the literature on the problem of professional burnout syndrome in medical workers, presented in the Scientific Electronic Library (eLibrary), as well as in the English-language text database of medical and biological publications PubMed.

The novel coronavirus infection pandemic is associated with many factors contributing to formation and development of professional burnout in medical workers. The risk factors are: high workload, lack of PPE, threat and risk of contracting a new coronavirus infection, social isolation, insufficiency (at the first stage) of accumulated knowledge about the new little-studied disease.

Science and Innovations in Medicine. 2023;8(1):39-44
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Public health, organization and sociology of health

Telemedicine in practical dermatovenerology

Vasiliev-Stupalsky E.A., Izmalkov N.S.


Aim – to evaluate the effectiveness of providing specialized dermatovenerological care using remote telemedicine consultations to patients of the Samara region with chronic dermatoses: psoriasis, atopic dermatitis, eczema.

Material and methods. We performed a comparative analysis of telemedicine consultations in real time in 53 adult patients with confirmed clinical diagnoses who were on inpatient and outpatient treatment. The results were evaluated by the duration of clinical remission and indicators of the Dermatology Life Quality Index (DLQI) 12 months after the start of treatment.The telemedicine consultations were conducted in the Unified Medical Information and Analytical System of the Samara Region (EMIAS) using the integrated video conferencing service (VCS) TrueConf version 7.5.

Results. We noted the clinical effectiveness of telemedicine consultations in patients with chronic recurrent dermatoses. The duration of clinical remission significantly increased from 3.1 ± 0.7 months to 5.7 ± 0.4 months (p < 0.05). In the comparison group, this indicator did not significantly differ (p = 0.05) from the initial one (3.2 ± 0.1 months and 3.3 ± 0.6 months). According to the results of the telemedicine consultations, the DLQ index had improved by an average of 45.1% and amounted to 12.4 ± 1.8 points from the initial 22.6 ± 1.6 points (p < 0.05). The treatment compliance increased in 58.5% of patients (31 people), of which 81% (25 people) were rural residents. The remote counseling increases the availability of the medical care and satisfaction of dermatovenerological patients of the Samara region with the medical care provided.

Science and Innovations in Medicine. 2023;8(1):45-49
pages 45-49 views


Determination of the probability of hearing loss in persons exposed to the noise of small arms

Kuznetsov M.S., Dvoryanchikov V.V., Logatkin S.M., Golovanov A.E.


Aim – to analyze the indicators of distortion-product otoacoustic emissions (DPOAE) in persons exposed to the noise of small arms and, on the basis of the most significant of them, to determine the probability of developing hearing loss.

Material and methods. We examined 30 male volunteer shooters (60 ears) aged from 19 to 30 years. The shooters fired 30 shots from the AK74M in short bursts (2-3 shots in a burst) at targets when performing shooting exercises from three positions: from the knee, standing and lying down, in a free acoustic field without the use of personal protective equipment of the hearing organ. All participants were examined for distortion-product otoacoustic emissions (DPOAE) before and after firing from small arms. The method of binary logistic regression was used to develop a predictive model.

Results. A mathematical model has been developed to assess the probability of developing hearing loss according to the indicators of DPOAE before exposure to the noise of small arms. This model, with a standard classification threshold of p = 0.5, has an accuracy of 83.3%, sensitivity of 79.0%, specificity of 88.0%. According to the results of the ROC analysis for the resulting model, the area under the characteristic curve was equal to 0.924 (0.834;1.0), which indicates the excellent quality of the mathematical model.

Conclusion. The most significant were the signal/noise indicator (dB) at a frequency of 4.2 kHz on the left and the level of otoacoustic emission (dB) at a frequency of 4.2 kHz on the left before noise exposure. These indicators, as well as the age of the shooter, allow us to assess the probability of developing hearing loss.

Science and Innovations in Medicine. 2023;8(1):50-55
pages 50-55 views

Traumatology and Orthopedics

Combined therapy for contractures of the hand joints

Fasakhov R.R., Bogov A.A., Zhuravlev M.R.


Aim – to study the effectiveness of the combined treatment of contractures of proximal interphalangeal joint.

Material and methods. The study included 30 patients with a diagnosis of post-traumatic mixed contracture of the proximal interphalangeal joint. The patients were divided into 3 groups. In the first group, the patients were administered a combined treatment, including the arthrolysis of the joint, the imposition of a dynamic distraction apparatus, the injection of hyaluronic acid preparations and platelet-rich plasma. The second group of patients underwent the arthrolysis of the joint and the application of the apparatus. The third group underwent only arthrolysis.

Results. The results of the study indicated the effectiveness of all three methods of treatment. However, in the first group where the combined treatment was used, the registered improvement in the angles of joint function and a decrease in pain were significant, which ultimately led to better functional indices of the hand and a shorter treatment period.

Science and Innovations in Medicine. 2023;8(1):56-59
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Assessment of naphazoline effect on erythrocyte superoxide dismutase activity in rats under experimental modeling of acute radiation sickness

Ivanov V.S., Seleznev A.B., Raguzin E.V., Ivchenko E.V., Pechurina T.B., Ivanov I.M., Glushenko D.D., Glushakov R.V.


Aim – to assess the activity of superoxide dismutase in erythrocytes of rats after a single intramuscular injection of naphazoline in radiofrequency dose and in experimental simulation of acute radiation sickness.

Material and methods. The activity of erythrocytes superoxide dismutase (SOD) after single intramuscular injection of nafazoline in experimental modeling of acute radiation sickness was investigated. The pharmacological properties and mechanisms of radioprotective action of nafazoline were clarified based on the dynamics of activity of erythrocytes SOD in intact and irradiated animals with the dose of 7,4 Gy.

Results. The superoxide dismutase activity was found to increase significantly 60 min after single intramuscular administration of nafazolin at a dose of 5 mg/kg. Under experimental conditions of acute radiation disease modeling, a decrease in superoxide dismutase activity was observed within the first hour after exposure, evidencing the direct involvement of the antioxidant system components in the inactivation of free-radical reaction products.

Conclusion. The radioprotective properties of naphazoline may be due not only to reduction of oxygen delivery to the cells of radiosensitive tissues and inhibition of their metabolism by effect on α2-adreno- and imidazoline receptors, but also by activation of antioxidant system links.

Science and Innovations in Medicine. 2023;8(1):60-65
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Experience in the treatment of patients with ACTH-independent macronodular bilateral adrenal hyperplasia

Lisitcyn A.A., Zemlyanoi V.P., Shustov S.B., Velikanova L.I., Nesvit E.M.


Aim – to determine the optimal tactics for the examination and treatment of patients with macronadular bilateral adrenal hyperplasia.

Material and methods. The study included 11 patients with macronodular bilateral adrenal hyperplasia (main group). To compare biochemical parameters, the results of 26 healthy people were studied (control group).

Results. The patients with macronodular bilateral adrenal hyperplasia were characterized by deficiency of 11β-hydroxylase, 21-hydroxylase, 11β-hydroxysteroid dehydrogenase type 2 and increased activity of 5β-reductase compared with the control group. The optimal treatment for these patients is unilateral adrenalectomy. A comparative selective blood sampling from the central veins of the adrenals is necessary to select the side of intervention in patients with bilateral macronodular adrenal hyperplasia with ACTH-independent Cushing's syndrome.

Conclusion. The first step in the treatment of patients with bilateral macronodular adrenal hyperplasia with ACTH-independent Cushing's syndrome is unilateral adrenalectomy, which reduces the risk of developing adrenal insufficiency and subsequent hormone replacement therapy.

Science and Innovations in Medicine. 2023;8(1):66-71
pages 66-71 views

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