Vol 8, No 3 (2023)

Aim – to evaluate the qualitative and quantitative morphological characteristics of placentas of pregnant women after in vitro fertilization (IVF) registered in the prenatal period and after birth.

Material and methods. The retrospective study of medical records of pregnant and puerperia women focused on the chorion and placenta parameters registered by ultrasound examinations in the I, II, III trimesters. The patients' inclusion criteria were singleton pregnancy and birth at 37-41 weeks' gestation. The types of assisted reproductive technologies and delivery were not specified in this study. The patients were divided into 2 groups according to their age: 1 Group – I period of adulthood, 2 Group – II period of adulthood. The postpartum placenta morphometry included registration of shape, diameter, weight, thickness of the placenta, the place of attachment and length of the umbilical cord, the type of vessels branching.

Results. 1. The ultrasound characteristics of the placenta anatomy during pregnancy achieved by IVF are generally normal and do not have specific features.

2. The pathological location of the chorion in the uterine cavity in the first trimester of pregnancy is characterized by a risk factor – the older age group.
3. The weight of the placenta during full-term pregnancy after in vitro fertilization is higher than normal, its average area is larger due to a decrease in thickness.
4. A large proportion of pathological (sheath) attachment of the umbilical cord can lead to more frequent complications of pregnancy – acute placental insufficiency.

Aim – to evaluate the correlation between the course of vertebral arteries and veins and the results of calculations of hemodynamic parameters during ultrasound with functional tests.

Material and methods. In the observation, 252 volunteers were examined using Samsung SonoAce R7 and GE Logiq F6 equipment. The hemodynamics was studied at the level of the second segment of the vertebral arteries and veins at rest, when turning, tilting and lifting the head. The results were processed using Microsoft Excel 2007 with subsequent statistical analysis.

Results. 504 vascular complexes were analyzed without taking into account the visualization side. When assessing the arteries, the highest maximum blood flow velocity was registered when lifting the head in women with a rectilinear course of the vessels. In the group of men with non-rectilinear course of vessels, the lowest average blood flow velocity was registered when tilting the head. The highest volume flow was recorded in case of non-rectilinear vascular course in women when lifting the head.

For vertebral veins, the highest indicators of maximum and minimum venous blood flow rates were observed in men with a rectilinear course of vessels when lifting the head. The highest values of the average flow velocity and volume flow were noted in men who had a rectilinear course of the vessels.

The maximum values of the calculated venous volume flow were registered in groups with rectilinear vascular course: in men up to 19.42±14.85 ml/min. (Me – 12.45 ml/min.), in women – 18.52± 15.30 ml/min. (Me – 10.50 ml/min.).

Conclusion. The data obtained by the study contributes to improving the software and analysis of individual changes during patient examination, helps to evaluate the effectiveness of treatment and rehabilitation, as well as to analyze multifactorial models.

Aim – to assess the frequency of disability in instrumental activities of daily living (IADLs) and to analyze its associations with other geriatric syndromes in persons aged ≥65 years.

Material and methods. The study involved 4,308 people (30% male) living in 11 regions of the Russian Federation, aged 65 to 107 years (average age 78 ± 8 years). The majority (60%) of participants were examined in a polyclinic, every fifth – in a hospital (20%) or at home (19%), 1% – in nursing homes. All patients underwent a comprehensive geriatric assessment, including an assessment of instrumental activities of daily living on the Lawton scale.

Results. Among the elderly, a high (54%) prevalence of dependence in IADLs was revealed, and with increasing age, this indicator increased significantly, reaching 82% in people over 85 years old. In patients with disability in IADLs, the frequency of all geriatric syndromes, except orthostatic hypotension, was higher, of which the most common were chronic pain syndrome (90%), frailty (80%), dependence in basic activities of daily living (ADLs) (78%), cognitive impairment (75%), probable depression (63%) and urinary incontinence (54%). One-factor regression analysis showed that the presence of disability in IADLs increases the chances of detecting other geriatric syndromes by 1.6–5.9 times.

Conclusion. The results of the EUCALYPT epidemiological study demonstrate a high prevalence of dependence in IADLs among the Russian population. The study also gives an idea of the relationship of dependence in IADLs with various geriatric syndromes.

Aim – to evaluate the pathogenetic role of T-lymphocytes carrying the natural killer marker CD56 in hemorrhagic fever with renal syndrome (HFRS).

Material and methods. The study group included 65 patients with HFRS receiving the inpatient treatment in the Clinics of SamSMU, and 15 healthy people were chosen for the control group. The following examinations were scheduled for all patients in the different stages of the disease: a clinical blood test, flow cytometry with a given set of monoclonal antibodies, enzyme-linked immunosorbent assay of blood serum to determine the cytokine profile. For statistical analysis we used the SPSS v.23 software.

Results. The percentage of CD3+ CD56+ NKT blood content in comparison with those for cells of innate immunity (neutrophil granulocytes, monocytes, natural killers) and lymphocytes of adaptive immune response, as well as the level of cytokines in the blood serum showed that in polyuric and convalescent periods, the number of these cells significantly increases and remains closely embedded in correlations with other components of the immune system.

Conclusion. A new hypothesis has been proposed to interpret the role of NKT in the development of the immune response in HFRS.

Aim – to develop a mathematical model for the prognosis of ischemic stroke outcome in the acute period of the disease.

Material and methods. The study included 103 patients with ischemic stroke in the carotid basin with existing hemiparesis. The comprehensive examination comprised clinical and anamnestic data, state assessment using clinical scales, brain computed tomography, ultrasound, transcranial magnetic stimulation, evoked potential tests, laboratory blood tests. The patients were examined at admission, at discharge and in 12-24 months after leaving hospital. According to the motor function recovery, the patients were divided into two groups – with favorable and unfavorable outcome. Statistical methods identified the significantly different results in the two groups.

Results. The most significant indicators affecting the prognosis of ischemic stroke were identified.The developed criteria served the basis for a mathematical model using the results of transcranial magnetic stimulation.

Conclusion. The obtained mathematical model can be used to determine the outcome of ischemic stroke in the acute period. Transcranial magnetic stimulation is a method that allows for prognosis of the outcome in early period of stroke.

Aim – to statistically determine the distribution of chronic diseases in the chronology of observations; to show the specifics of methods for testing hypotheses in the quantitative and probabilistic prediction of the prevalence of polypous rhinosinusitis.

Material and methods. The outpatient data for the period of 2017–2021 and quantitative information about the cases with polypous rhinosinusitis as main or concomitant diagnosis registered by medical organizations of 25 districts of the Samara region were used in the study.

Results. The synthesis of the initial data statistics, which amounted to the volume of the numerical expansion of primary indicators in the following ratio: categories 15.8%, counting data 26.3%; quantitative values 21.1%; 26.7% – relative incidence and prevalence data. The rest of the data is the descriptive statistics and indicators in the form of tables of correlation coefficients. For extensions of the synthesized data, distributions were evaluated and hypotheses tested using statistical criteria.

Conclusion. The count of the number of chronic diseases is approximated by the density of atypical distributions. Approximately 58% of samples for diagnoses are not confirmed as obeying the law of distribution. In such a situation, when preparing a forecast for the transition to a time series, it is necessary to solve the problem of obtaining sequences with stationary characteristics. In machine learning, data in predictive calculations must be checked for probabilistic confirmation of the coincidence of related sample parameter distributions. The results of the forecast should be taken as a probabilistic conclusion at the level of an unrejected hypothesis.

Aim – to analyze the survival of patients with localized low and intermediate risk prostate cancer receiving various types of treatment and active surveillance in the Samara region.

Material and methods. The study included 1474 patients with newly diagnosed localized prostate cancer in the Samara region for the period 2010-2016.

Results. In the Samara region, the radical prostatectomy proved to be the most effective treatment method. At the same time, the active surveillance was comparable to other treatment methods in men older than 75 years.

Conclusion. The active surveillance can improve the managing of prostate cancer patients by reducing overtreatment of its clinically insignificant forms, reducing treatment costs and reducing the number of side effects of radical treatment. At the same time, the possibility of radical treatment remains in case of malignant neoplasm progression.

Aim – to evaluate the effect of dry extract of mistletoe leafs on the change of vascular endothelium vasodilation function in rats under conditions of chronic alcohol intoxication.

Material and methods. The chronic alcohol intoxication was modeled in female Wistar rats by course of oral administration of ethanol at the rate of 3g/kg/day. The tested extract and the reference drug – ethylmethylhydroxypyridine succinate were administered per os at a dose of 100 mg/kg. The vasodilation function of the vascular endothelium was assessed by the change in the rate of cerebral blood flow during modification of the endogenous nitric oxide synthesis. The concentration of active forms of endothelial and inducible nitric oxide synthase isofrom was determined by enzyme immunoassay.

Results. The course of the tested extract and the reference drug resulted in an increase in the rate of cerebral blood flow in relation to untreated animals by 48.1% (p<0.05) and 40.2% (p<0.05), respectively. The restoration of endothelium-dependent vasodilation of cerebral vessels was also noted with the administration of the studied extract of white mistletoe and the reference drug. The analysis of changes in the NO-synthase system showed that, when using the tested extract, the concentration of eNOS increased by 76.3% (p<0.05), and iNOS, on the contrary, decreased by 22.1% (p<0.05), which was comparable with the indicators of the group of animals receiving the reference drug.

Conclusion. The use of mistletoe leaf dry extract leads to the restoration of endothelium-dependent vasodilation of cerebral vessels in rats with chronic alcohol intoxication, probably due to the improvement of eNOS-dependent mechanisms of nitric oxide synthesis.

Aim – to implement a comprehensive approach to treatment of patients with tuberculosis in anti-tuberculosis medical organizations.

Material and methods. Fifty-two patients and fourteen employees took part in the study. For psychodiagnostics, we used the "TOBOL" questionnaire, the diagnostics of professional "burnout" by K. Maslach, S. Jackson, the Wheel of Life concept by Paul J. Meyer. The data was analyzed using Mann – Whitney U-test, Wilcoxon signed rank test.

Results. The older patients had a tendency for excessive vigilance and aggressiveness in their attitude to the disease. The harmonious and anosognostic types of attitude to the disease were prevalent in patients with permanent employment. The medical workers demonstrated a high level of emotional burnout. The training aimed at prevention of burnout was the part of the study. After the training, the registered values of emotional exhaustion were reduced by 7 points, the depersonalization score shifted from high to average, the reduction of personal achievements score raised by 5 points.

Conclusion. The age and social status can influence the type of attitude towards tuberculosis. Patients under 40 years of age with permanent employment have a more favorable prognosis of adherence to treatment and persistent clinical cure of tuberculosis. The introduction of an integrated approach to the provision of medical care with the mandatory presence of psychological support is relevant and necessary. This study substantiates the expediency of creating a psychological assistance office in a medical organization.

Purulent arthritis of the sternoclavicular joint requires surgical treatment. The volume of the intervention depends on the degree of the joint's transformation and patient's general condition. The resulting defect of the chest wall tissues requires surgical closure at the reconstructive stage. In case of an extensive defect area with a skin deficiency, it is most advisable to use full-thickness flaps of the latissimus dorsi or pectoralis major muscles.

The article presents a clinical case of a patient operated for purulent arthritis of the sternoclavicular joint. The surgical treatment was planned in two stages. During the first stage, the use of vacuum-assisted dressings demonstrated its effectiveness. The second, reconstructive stage, included plastic surgery for the chest wall defect using a full-thickness flap of the pectoralis major on the thoracic branch of the thoracoacromial artery. The progress of the patient's surgical and general treatment was described in detail.