Vol 22, No 3 (2018)

SURGERY. ANDROLOGY
CHOICE OF MESH IMPLANTS FOR LICHTENSTEIN PLASTIC OF MALE IN REPRODUCTIVE AGE
Klimov A.E., Popov V.S., Barchudarov A.A., Yuriy A.V.
Abstract

The article deals with the impact of polypropylene and polyester mesh implants on the sexual function of men of reproductive age after the plastic surgery of the inguinal canal in the Lichtenstein technique. For an adequate comparison of groups of patients with established polypropylene and polyester implants, an algorithm for their examination was developed. For a comprehensive assessment of sexual function in the study, it is divided into two components. Fertility of 155 patients was assessed through the analysis of spermiological studies performed in young patients with inguinal hernia. The possible reason of the immunological form of sterility, against the background of established reticular endoprostheses, a spermiological study in each patient was supplemented with a Mar-test in order to search for antisperm antibodies. To assess the copulative component of sexual function, patients of both groups were questioned according to the questionnaire “International Index of Erectile Function, Version 5” (ICEF 5). After statistical processing of the data based on the developed algorithm, no statistically significant differences between the groups of patients with established polypropylene and polyester implants were revealed. However, in one patient in the group where polypropylene mesh endoprostheses were used, changes in the spermiological analysis taken after the operative allowance, which can speak of a sharp decrease in the quality of the ejaculate, up to the development of sterility, are revealed. Also, this patient recorded a decrease below the ICEF 5. The results of the study, conclusions were drawn and recommendations were given to practicing surgeons about the possibility of using polypropylene and polyester reticular endoprostheses in plastics of the posterior wall of the inguinal canal in men of reproductive age.

RUDN Journal of Medicine. 2018;22(3):249-257
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THE CHOICE OF IMPLANT FOR HERNIOPLASTY OF POSTOPERATIVE VENTRAL HERNIAS
Protasov A.V., Kalyakanova I.O., Kaitova Z.S.
Abstract

According to the literature, up to 50% of laparotomies end with herniation. Therefore, postoperative ventral hernias will not lose their relevance for a long time. The appearance of non-tension hernioplasty by means with synthetic implants helped to solve some issues of hernia: the frequency of relapses in the late postoperative period significantly decreased. However, the number of the complications associated with suppuration of postoperative wounds and seroma in the early postoperative period increased. This leads in the increase of number days of hospital treatment, the need for antibiotic therapy, and accordingly the cost of treatment. In this regard, new types of implants that have the necessary biocompatibility properties are constantly being developed. Also, implants with the possibility of self-griping to the tissues have become more and more relevant in recent years. Self-gripping implants are not only convenient for the operating surgeon - reducing the time of operation, but also don’t cause of the chronic pain in the area of operation. However, the problem of surgical treatment of postoperative ventral hernias remains unresolved. The aim of study was to improve the quality of life of patients with postoperative ventral hernias. Was surgery with implants ProgripTM 65 patients. Patients were divided into two groups, taking into account the use of standard implant shape and simulated. The frequencies of surgical complications, duration of surgery and inpatient treatment were compared. The relapse developed in 14.7% and 3.2% of cases, respectively. There were no other significant complications. Conclusion: the simulated implant is anatomically correct and reduces the risk of detachment of the implant from the tissue during stretching.

RUDN Journal of Medicine. 2018;22(3):258-264
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DISTRUPTION OF SPERMATOGENESIS. MORPHOLOGICAL ASPECTS
Kulchenko N.G.
Abstract

At the beginning of the 21st century there is a decline in quality of reproductive health of men around the world. In structure of sterile marriage the men's factor of infertility is found out in approximately 40-50% of cases. A little studied question of male infertility is the question of quantity and quality of gametes in convoluted seminiferous tubules. Aim: to study morphological (quantitative and qualitative) changes of a seminiferous epithelium of patients with male infertility. Materials and Methods: 264 patients with male infertility have been examined. Patients with an obstructive form of infertility, with diseases sexually transmitted, with varicocele, with the revealed genetic and immunological factors of infertility have not been included in the research. Patients with a heavy form of pathospermia (n = 112) were taken a testis biopsy before the ICSI cycle (Intra Cytoplasmic Sperm Injection). Further a condition of the seminiferous epithelium of a testis was estimated with the use of light microscopy. Results: Hypoplasy of a seminiferous epithelium was revealed around 34 (30,5%) men, subtotal aplasia of a seminiferous epithelium - around 59 (52,6%) patients, Sertoli Cell-only syndrome - around 12 (10,7%) and tubular atrophy of convoluted seminiferous tubules - around 7 (6,2% ) patients. Conclusions: The morphological research of testis gives the opportunity to define the extent of pathological process at all stages of a spermatogenesis. Only on the basis of studying of features of a spermatogenesis of the specific patient it is possible to make an algorithm of further personal medical and rehabilitation actions.

RUDN Journal of Medicine. 2018;22(3):265-271
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EPIDEMIOLOGY OF AGE-RELATED ANDROGEN DEFICIENCY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA
Chumakov P.I., Marchenko L.A., Kravchenko I.V.
Abstract

Every fourth patient at the age of 50 years, every third patient at the age of 60 years, every second man at the age of 70 years and almost everyone (90%) older than 80 years have Benign prostatic hyperplasia (BPH). Lower urinary tract symptoms developing against the background of BPH are often connected both with manifestations of the hyperplasia of a prostate, and with the age androgenic deficiency (AAD). Aim: To determine the frequency of emergence of age androgenic deficiency of patients with Benign prostatic hyperplasia (BPH). Materials and Methods: 180 patients with clinical signs of Benign prostatic hyperplasia have been examined. All patients were conducted with standard clinical examination: survey, measurement of International prostate symptom score (IPSS), assessment of quality of life (QOL). The research of the androgenic status of patients included clinical assessment of deficiency of androgens with the use of the standard international questionnaire: “The questionnaire of Aging Males’ Symptoms” (AMS) and hormonal blood test with determination of level of the general testosterone, follicle-stimulating and luteinizing hormones. Results: There were 118 patients with the low level of the general testosterone (Tgen) (67,7%) of all people. An average level of Tgen was 8,74 ± 0,9 nmol/l. In group of patients with low testosterone the GPA (grade point average) on a scale of AMS was 47,3 ± 9,1. Patients with BPH and AAD frequently have the accompanying pathology which is generally presented in such diseases as arterial hypertension, a metabolic syndrome, coronary heart disease, diabetes of the II type, anurolithic disease. Conclusions: Monitoring of the Tgen level is necessary for patients with BPH. Considering the high risk of a combination of BPH with the deficiency of testosterone it is necessary to include in the standard scheme of inspection the hormonal blood test with determination of the Tgen level.

RUDN Journal of Medicine. 2018;22(3):272-278
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SELECTION OF METHODS OF COMBINED GERNIOPLASTICS EXTENSIVE MEDIAN HERNIAS TAKING INTO ACCOUNT THE DYSPLASIA OF CONNECTING TISSUE
Railianu R.I., Botezatu A.A., Podoliniy G.I., Kryzhanovsky V.A.
Abstract

For the purpose of improvement of results of treatment of extensive median hernias in the choice of ways of the combined hernioplasty at a stage of an electromyography ball assessment of the stigmata of a dysplasia of a connecting tissue, influence of a mesenchymal failure on contractility of abdominal muscles and data of program diagnostics of a collagen found at survey in microscopic preparations of a skin and aponeurosis at 95 surgical patients is introduced. In group 25 (26,4%) of patients with clinically significant level of a dysplasia depression of electroactivity of rectus muscles for 24,7% and the lateral group of the abdominal muscles - for 22,8% is revealed. The microscopy of sites of an aponeurosis among them taped depression of density of laying of a collagen to 31,7% and augmentation of intensity of its staining twice. As a result of the undertaken improvement the way of surgical treatment of median hernias of the extensive sizes which use in clinical practice allows to reduce a share of a dysplasia of a connecting tissue among the reasons of a recurrence of a disease is developed.

RUDN Journal of Medicine. 2018;22(3):279-287
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ALLERGOLOGY. DERMATOLOGY
ALLERGEN IMMUNOTHERAPY: EFFICACY, PERSISTENCE, CONSISTENCY, AND COST EFFECTIVENESS
Wallace D.
Abstract
Although allergen immunotherapy (AIT) has been used for the treatment of allergic rhinitis (AR), allergic conjunctivitis, asthma, stinging insect hypersensitivity, and atopic dermatitis for over 100 years, it has been slow to gain universal acceptance. With the publication of the “World Health Organization Position Paper, Allergen Immunotherapy” in 1998 which summarized the scientific evidence for the efficacy and long-term benefit of this therapy, it has become an accepted and respected modality of treatment. In this review there are discussed following topics of allergen immunotherapy: the reasons for recommending AIT, mechanism of action, subcutaneous and sublingual methods of application, duration, adherence and cost effectiveness. It is necessary to support, not blame, the patient for nonadherence as it is the responsibility of the patient, the physician, and the health-care system to create an environment in which the patient can be adherent. Nonadherence is multifactorial in most every patient and the physician must address all of the factors if adherence is to be improved. The greatest challenge is taking the time to create an individualized patient-tailored strategy to improve adherence, as one size does not fit all. Adherence is dynamic and selecting the best time to start AIT and assuring that there is close follow-up through AIT years of treatment is essential. The patient who is persistent and consistent in year one of AIT may not continue to be so in year three without added encouragement and support. The health-care systems and professional organizations need to help train physicians and their staff both in efficient and accurate ways to assess nonadherence and in implementing interventions to optimize adherence. The multidisciplinary approach to treating this disease of nonadherence will require the involvement of all healthcare professionals, researchers, professional organizations, insurance companies, and policy-makers.
RUDN Journal of Medicine. 2018;22(3):288-301
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SEVERE ASTHMA IN CHILDREN
Stroikova T.R., Bashkina O.A., Mizernitskiy Y.L., Seliverstova E.N.
Abstract

The definition of severe asthma is based on the criteria for clinical control, the treatment received, as well as the response to therapy, the assessment of future risk. In severe bronchial asthma, control can be achieved only at the highest possible level of therapy, namely, in treatment corresponding to the 4th or 5th stage. The article highlights the features of the clinical phenotype of severe bronchial asthma in children. Purpose: to identify the predictors of severe phenotype in children, the analysis of clinical and anamnestic features, to study the dynamics of disease control. Materials and methods: a group of patients with different degrees of severity of bronchial asthma aged 3 to 12 years, both sexes, was studied. The clinical aspects of the disease, the dynamics of control over bronchial asthma have been studied. Functional tests were carried out: examination of the function of external respiration, pyclofometry. Data of a specific allergic diagnosis (skin tests with non-bacterial allergens, detection of specific IgE antibodies), self-monitoring tests were studied. Statistical methods used a nonparametric method, a c2 distribution, a Pearson test, using conjugacy tables. Results and discussion: the family female phenotype is a predictor of severe bronchial asthma in patients in this group. The severity of the disease on the background of therapy for five years in a group of patients was revised only in a third of children. With this phenotype, partial control over the disease was achieved. The ineffectiveness of control is associated with the presence of a comorbid background: the pathology of the nervous system, the gastrointestinal tract, endocrine disorders. The severe phenotype of bronchial asthma, independently of age debut, was significantly less frequent than in the case of moderate disease.

RUDN Journal of Medicine. 2018;22(3):302-307
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CLINICAL AND DIAGNOSTIC VALUE OF THE DETERMINANTION OF FRACTALKINE IN ATOPIC DERMATITIS OF CHILDREN
Ben M.M., Yanchevskaya E.Y., Mesnyankina O.A.
Abstract

In recent years there has been an increase in the incidence of atopic dermatitis in children. However, despite numerous studies, still remains the problem of objective laboratory diagnosis of this disease, and, respectively, rational pharmacotherapy. Aim. The aim of the study was to improve the diagnostics of allergic skin diseases in children. Materials and methods: the study included 135 children with atopic dermatitis and 29 children in the control group. Clinical and laboratory examination of patients was carried out in accordance with the standards of diagnosis of atopic dermatitis. Additionally, we determined the level fractalkine in blood serum using enzyme immunoassay kit for the quantitative determination fractalkine in biological fluids. Results. For most patients with Ad were a characteristic increase in the level fractalkine in blood serum depending on the severity of the disease. The highest concentrations of the studied CC chemokine is characteristic of severe process. Conclusions. Definition fractalkine in the serum can be used as an indicator of the severity of the pathological process and predicting its future course.

RUDN Journal of Medicine. 2018;22(3):308-313
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SOCIAL HEALTH AND HEALTH PROTECTION
CATEGORY OF MARKETING OF RELATIONS IN MEDICAL ORGANIZATIONS
Abramov A.Y., Kicha D.I., Rukodainiy O.V.
Abstract

The need for intensification of health care, raises the issue of improving the efficiency of medical organizations. The article analyzes the current management technology: “marketing relationships in medical organizations”. The aim of the research was to find the correct “definition of the concept and professional fullness” of the content of relationship marketing in medical organizations. The authors defined the marketing of relations in medical organizations as “the relationship (mutual relation) of the subjects of medical care at the level of “doctor-patient”, “administration-personnel”, “relations between medical organizations and counterparts”, in order to improve the efficiency of activities and the quality of medical care, patients and medical personnel. The results are obtained on the basis of a comparative analysis of scientific literature data and authors’ own research. In the formulation of the research, methods of content analysis of bibliographic data, the sociological method and the authors’ own experience were used. Based on the results of the research, the role of the individual characteristics of patients (gender, age, occupation, relationship to the composition of patients, transport accessibility, organization of admission) in the formation of relations between consumers and providers of medical services is shown. In conclusion, based on the results of the study, the development of marketing relationships at the level of medical organizations of different ownership forms and the need to improve marketing of communications, social networks and distant forms of work with potential and real patients are justified. Conceptual bases of the marketing relationship concept in medical organizations of different ownership forms have been developed.

RUDN Journal of Medicine. 2018;22(3):314-321
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IMMUNOLOGY. INFECTIOUS PATHOLOGY
HUMAN GRANULOCYTOTROPIC ANAPLASMOSIS
Klimova Y.A., Polovinkina N.A., Konnov V.V., Konnov D.S.
Abstract

Natural focal tick-borne infections are widespread in the world and are characterized by a great etiologic diversity. Human granulocytotropic anaplasmosis (HGA), also transmitted by the bite of ticks became relevant in the last century of detection not only in animals but also in humans. The review provides an overview of the incidence of HGA in Russia and in the world, the prevalence of the habitat of mites, the diversity of reservoirs and sources of infection, mechanisms and pathways of transmission of the pathogen Anaplasma phagocytophilum and its biological features. The links and stages of the disease pathogenesis are considered in detail. Scientific data on the clinical course of the disease, the frequency and diversity of various symptoms of the disease, the issues of laboratory and differential diagnosis of anaplasmosis and its place in the nosological structure in patients with fever of unknown origin are discussed. At the same time, choosing a method of laboratory diagnostics it is necessary to take into account that molecular-genetic method (polymerase chain reaction PCR-diagnosis) allows to confirm the diagnosis quickly, while serological methods of research in a greater degree - to put a retrospective diagnosis. The article presents current data on the treatment of disease and methods of HGA prevention and also presents the results of the authors’ own observations based on the survey of 63 patients. The analysis of Moscow residents treatment about sucking mites is carried out and summarized the incidence of infections transmitted by ixode mites. For the diagnosis of HGA and other tick-borne fever used a technique called polymerase chain reaction. It has been revealed that in Moscow, lime borreliosis occupies a leading place among mites associated with infections 60%, and the share of granulocytic anaplasmosis of a person is only 5% of patients. However, the study of ticks for the presence of HGA pathogens and other natural focal tick infections is carried out in insufficient volume (less than 30%), which should be considered in clinical and laboratory differential diagnosis, as well as preventive measures.

RUDN Journal of Medicine. 2018;22(3):322-331
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REMODELING OF THE TRANSFORMED PHENOTYPE OF CD16+CD32+CD11b+ NEUTROPHILIC GRANULOCYTES OF PATIENTS WITH ATYPICAL CHRONIC BACTERIAL INFECTION IN VITRO
Chudilova G.A., Nesterova I.V., Lomtatidze L.V., Kovaleva S.V., Rusinova T.V.
Abstract

The research has shown that the functional state of neutrophilic granulocytes (NG) is determined by the state of NG subpopulation phenotype composition in evaluating the simultaneous expression of CD16, CD32, CD11b membrane markers with considering the density of expressed molecules. The change in NG subpopulations phenotype indicates active or defective inclusion of NG in the immune response in inflammation. Various inducers of endo- and exogenous nature activate NG and promote translocation from cytoplasmic granules and vesicles or expression to the surface cytoplasmic membrane of receptor molecules. In this regard, our interest was in studying the expression peculiarities of CD16, CD32, CD11b NG receptors in patients with atypically occurring bacterial infections (chronic sinusitis) and the possibility of remodeling the NG phenotype under the influence of glucosaminylmuramyl dipeptide (GMDP) and IFNγ in vitro. Subjects of this study were blood samples of patients with chronic sinusitis and conditionally healthy individuals. Flow rate cytometry at CYTOMICS FC500 (Beckman Coulter, USA) was used to evaluate the % NGs expressing CD16, CD32, CD11b, and the fluorescence intensity of these molecules (MFI) before and after incubation with the test substances. Flow cytometry (CYTOMICS FC500, Beckman Coulter, USA) were used to evaluate amount (%) of NGs expressing CD16, CD32, CD11b and mean fluorescence intensity of these molecules (MFI) before and after incubation with the test substances. The studies showed that in patients with chronic sinusitis with persistent recurrent course the presence is characterized by transformed phenotype CD16dimCD32midCD11bbr of CD16+CD32+CD11b+NG subpopulation. We have shown that the revealed changes in the level of expression of trigger membrane receptors do not allow NG to fully engage in inflammatory process and to realize its effector and regulatory functions. Under the influence of GMDP and IFNγ regulatory molecules was demonstrated high mobilization capacity of the studied NGs for functionally significant membrane receptors in realization of various functions.

RUDN Journal of Medicine. 2018;22(3):332-339
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EMERGENCY PROPHYLAXIS OF EXPERIMENTAL MELIOIDOSIS USING SYNTHETIC IMMUNOMODULATORS AND HETEROLOGOUS VACCINES
Khabarova I.A., Zhukova S.I., Rotov K.A., Snatenkov E.A., Toporkov A.V., Viktorov D.V.
Abstract

Melioidosis is a particularly dangerous infection caused by Burkholderia pseudomallei , against which a vaccine has not yet been created. In this regard, the development of effective treatment regimens and emergency prevention of melioidosis is very relevant. To improve the effectiveness of emergency prophylaxis of melioidosis, synthetic peptides (bestim, imunofan) and thiopoietin preparation glutoxim were used when combined with the antibiotic doxycycline. In addition, in experiments on white mice, the ability of heterologous vaccines (plague and tularemia), used in the emergency prevention mode, to increase the resistance of animals to melioidosis infection was assessed. It was shown that the most effective was imunofan, which, when combined with doxycycline, increased by 20% the survival rate of 5LD50 Burkholderia pseudomallei infection and significantly increased the average life span of mice infected with 5-12 LD50 (p < 0.05). The efficiency of use for stimulation of non-specific resistance to melioidosis of a heterologous plague vaccine EV, once administered 1 day prior to infection, protected 90% of mice from 6 LD50 Burkholderia pseudomallei and 60% - with an increase in the infectious dose of the pathogen of melioidosis up to 15 LD50. The same level of protection from melioidosis was provided by a 3 day course of antibiotic therapy with doxycycline. It was concluded that the tularemia vaccine is not suitable for immunostimulation in melioidosis due to its high residual virulence and reactogenicity.

RUDN Journal of Medicine. 2018;22(3):340-350
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