Vol 9, No 3 (2024)

Aim – to identify a correlation between the somatotype of a patient with liver cirrhosis and changes in the composition of the intestinal microbiota.

Material and methods. The study included 46 patients diagnosed with liver cirrhosis of various etiologies. The somatotype of the patients was determined using a bioimpedance analyzer of body composition (ABC-01 "Medass"). The intestinal microbiota was analyzed once by 16s rRNA sequencing. The processing of the received data was carried out using the program “Statistica".

Results. Among 46 patients diagnosed with liver cirrhosis, the majority (26 patients) had a mesoendomorphic somatotype, 14 patients were representatives of endomesomorphs. The predominance of representatives of the genera Streptococcus (p-value = 0.02), Campylobacter (p-value = 0.049) and Holdemanella (p-value = 0.048) was statistically significant in the group of endomesomorphs, while bacteria from the genera Klebsiella (p-value = 0.01) and Gammaproteobacteria (p-value = 0.048) prevailed in the group of mesoendomorphs (p-value = 0.02). Taxa of the intestinal microbiota of Pyramidobacter were expressed in patients with the endomorphic somatotype (p-value = 0.016).

Aim – to identify the features of the use of various morphological methods, their informative value, advantages and disadvantages in studying the topographic anatomy of organs and structures of the fetal pelvis of the fetus.

Material and methods. The study was carried out on the material of 100 human fetuses of both sexes using classical morphological methods (macromicropreparation, the method of cutting according to N.I. Pirogov, histotopographic method).

Results. Macromicroscopic dissection in the study of pelvic organs in prenatal ontogenesis makes it possible to determine the position of organs and structures, their course and direction, symmetry with respect to paired organs. Dissection makes it possible to identify vascular and nerve structures, which is necessary when interpreting data obtained using other methods. Dissection does not allow to determine the skeletotopy of the organs and structures of the pelvis, their relative position relative to each other and bone structures, the relationship with the walls of the pelvic cavity.

The use of the method of cutting according to N.I. Pirogov and the histotopographic method made it possible to describe of all horizontal sections from the LIII level to the subcutaneous floor of the perineum, as well as clinically important sagittal and frontal sections, was given. These methods allow us to define the skeletotopy of the organ, its relationship with the walls of the pelvic cavity, to study the ratio of the volume of the occupied organ in the cavity, as well as measure distances. The histotopographic method makes it possible to study in detail the internal structure, microtopography of organs and neurovascular complexes of the pelvis. This is the most informative method when studying the perineum. The article presents photographs of preparations demonstrating the features of the topographic anatomy of the fetal pelvis.

Conclusions. It is possible to study in detail the topographic anatomy of the fetal pelvis, as well as to give a detailed description of the skeletotopy and syntopy of each organ only when using the complex of morphological methods presented. Using this approach, the data obtained will be useful to specialists of prenatal diagnostics, as well as during fetal operations.

Aim – to develop an applied prognostic calculator for the rate of progression of CKD in elderly patients with type 2 diabetes, which makes it possible to identify a group of high rate of GFR reduction in conditions of routine outpatient admission.

Material and methods. 69 clinical indicators were studied, the interrelationships and significance of differences in parameters in the groups identified according to the original diagnostic parameter, the glomerular filtration rate reduction index with a threshold value of 3.83 ml/min/1.73 m² per year, above which the rate of progression of CKD was considered high.

Results. By using regression analysis, significant factors for the prognostic calculator were identified: the duration of diabetes and insulin therapy, concomitant diagnosis of obesity, pulse in the ankle artery, severe stage of polyneuropathy, risk group IV of hypertension, treatment with sulfonylureas, the number of antihypertensive drugs taken. When evaluating the information capacity and predictive ability of the calculator, the area under the AUC ROC curve was 0.89 (0.80; 0.99) p < 0.001, which characterizes the quality of the diagnostic technique as high.

Conclusion. The presented calculator gives the doctor the opportunity to identify a group of patients with the risk of rapid progression of CKD directly on an outpatient basis.

Aim – to determine additional risks of developing arterial thrombotic and thromboembolic complications in bradysystolic AF and substantiate the results using modeling of intra-arterial hemodynamics.

Material and methods. A single-center prospective study involving 252 patients: 146 in the main group, 106 in the control group. The main group was divided into 2 subgroups: 1A subgroup RR ECG interval <1.5 seconds; 2B subgroup RR≥1.5 seconds. A comprehensive examination of the patients was carried out. The second stage is prospective comprising an analysis of the development of arterial thrombotic and thromboembolic complications over 1 year. Experimental modeling was carried out using the “Device for simulating intra-arterial circulation”.

Results. Thrombotic and thromboembolic complications were more common in subgroup 1B (OR=8.287 (2.287; 30.040); z=3.219; p=0.001). When analyzing the main parameters of the hemodynamics of the main arteries, the first pulse wave, coming after a long pause of 1.5 seconds or more in AF, was accompanied by a statistically significant increase in all of analyzed parameters. In the experiment, when simulating AF, the intensity of the mechanical impact of the free end of the thread on the wall of the rotameter was maximum when the pause between pulse waves was 1.5 seconds or more (9.70 ± 2.52 mm). At this moment, the piezocrystalline pressure sensor recorded the maximum increase in pressure inside the rotameter tube by an average of 56%.

Conclusions. Bradysystole in AF is associated with a significantly higher likelihood of developing long-term thromboembolic events. The first pulse wave, coming after a long pause between ventricular contractions during AF, leads to a significant increase in the main parameters of the hemodynamics of the main arteries (linear velocity of blood flow, volumetric blood flow). When monitoring heart rate in AF, it is necessary to avoid bradysystole with pauses between ventricular contractions of 1.5 seconds or more, due to a higher risk of stroke, myocardial infarction, and distal arterial embolism in other vascular regions.

Aim – assessment of the effectiveness of complex therapy to reduce the development of early cardiovascular complications.

Materials and methods. Information from medical histories and outpatient follow-up cards of 139 patients with invasive breast cancer was analyzed: in the G.V. Bondar Republican Cancer Center 64 patients (main and control groups); as an additional comparison group, the study included 75 patients of the Samara Regional Clinical Oncology Dispensary. Patients in the control group (33 people) and the Samara Regional Clinical Oncology Dispensary group (75 people) received standard therapy (RUSSCO, recommendations, 2023): doxorubicin 60 mg/m² IV on day 1 + cyclophosphamide 600 mg/m² IV on day 1 Day 4 – 4 courses. In 31 patients of the main observation group, in addition to similar drug treatment, in order to prevent the development of early cardiovascular complications, the method was used, which included 7 courses before the start of 1 cycle of chemotherapy + 3 courses of interval normobaric hypoxic therapy (INHT) before the start of each subsequent cycle of chemotherapy.

Results. When analyzing the total effectiveness of treatment between the groups of patients, statistically significant differences were obtained: the control and main groups were compared (χ²=5.4, p=0.03), the group of the Samara Regional Clinical Oncology Dispensary group and the main group (χ²=3.45, p=0.076).

Conclusions. Hypoxic therapy significantly affects the quality of life of patients. For all indicators reflecting quality of life, traditional treatment was inferior to combination drug therapy with INHT.

The study of the extraesophageal reflux effect on the middle ear structures in adults is of considerable interest. The mechanism of formation of gastroesophageal reflux disease associated otitis media is closely related to such concepts as nasopharyngeal reflux and laryngopharyngeal reflux.

The article presents an analysis of the medical literature focusing on the mechanisms of development of inflammation mechanisms in the middle ear cavity affected by the gastric contents. The article uses publications in such scientific databases as PubMed, eLIBRARY, Science Direct, Research Gate, dated from 1990 to 2024.

A detailed understanding of pathophysiological mechanisms affecting formation of the middle ear cavity inflammation under the influence of extraesophageal reflux has been obtained. Major scientific studies confirm that gastroesophageal reflux disease acts as a risk factor for the middle ear cavity inflammation formation.

The review article presents the analysis of current organ-preserving surgical treatment methods for chondral defects of the knee joint from the standpoint of their pathogenesis. We systematized and provided comparative characteristics of the methods of joint-preserving surgical treatment of patients of this category with a critical analysis of various types of operations used for full-thickness and penetrating hyaline cartilage defects. Mosaic chondroplasty, one of the leading methods of surgical treatment for III- and IV-degrees defects (according to the ICRS classification), was considered in detail. The indications, contraindications and conditions for performing mosaic autoplasty of the articular surfaces of the knee joint were analyzed using the historical retrospective and the results of current research. We outlined several debatable provisions and problems of using the classical version of mosaic chondroplasty in case of destructive-dystrophic genesis of the osteochondral defect. The dogmatic approaches to chondroplasty were raised for discussion, as we consider them requiring critical revision.

The authors presented a detailed description of the developed new methods of mosaic chondroplasty relying on the current understanding of the pathogenesis of the knee osteoarthritis and osteonecrosis, as well as the role of the subchondral bone in the development of both these conditions and associated articular cartilage defects. The surgical instruments developed by the authors for the new methods of chondroplasty were described.

The use of robotic systems has long gone beyond experimental medicine. More than 200 thousand operations per year are carried out with the use of just the most popular robotic complex Da Vinci. Further development of robotics will contribute to improvement of quality and accuracy of surgical interventions. Even now, it enables reduction of postoperative complications to almost zero. This review presents the analysis of the results of introducing robots into surgery. An overview of the data presented in PubMed, Cochrane Library, Science Direct and eLIBRARY was performed.