Vol 23, No 3 (2019)

Diverse Mechanisms of Allergen Specific Immunotherapy
Cevhertas L., Akdis M.

Allergen immunotherapy (AIT) is widely used to establish a tolerant immune response and it is currently the only disease modifying treatment. There are different routes to administer the allergen, including subcutaneous, sublingual, intralymphatic, epicutaneous, intradermal, and oral and local nasal allergen immunotherapy. Although the optimal administration route depends on the type of allergen, some patients remain unresponsive and so it is important to predict the outcome before and during treatment. Therefore, there is a need to identify candidate prognostic markers for allergen immunotherapy. Herein, we discuss the recent literature on the molecular mechanisms of AIT.

RUDN Journal of Medicine. 2019;23(3):233-249
Changes in Serum Levels of Growth Factors in Chronic Gastritis
Matveeva L.V., Mosina L.M., Stenina M.A.

Chronic inflammation, contributing to atrophy of the gastric epithelium, can develop in the induction of Helicobacter pylori and other microorganisms secretion of cytokines by cells of the gastric mucosa, including growth factors. Violation of the processes of repair of the gastric mucosa in terms of immune and microbiotic imbalance is the basis of ulcer and carcinogenesis. The aim of the study was to determine the serum level and diagnostic value of growth factors in exacerbation of chronic gastritis. Materials and methods . With informed consent in 122 patients with exacerbation of chronic gastritis and 40 healthy volunteers, sampling of gastrobioptates with esophagogastroduodenoscopy (for histological and microbiological examination), 5 ml of venous blood with serum separation (for enzyme immunoassay of serum levels of growth factors) was performed. Results . The amount of granulocyte-macrophage colony stimulating factor, erythropoietin, vascular endothelial growth factor (VEGF) in the serum of patients with atrophic gastritis exceeded the values of healthy individuals, were directly related to the degree and stage of gastritis, Helicobacter pylori infection, and among themselves. The greatest diagnostic value in atrophy gastric epithelial was determined in VEGF (sensitivity - 95,9%, specificity - 48,98%, criterion more 225 pg/ml, AUC 0,654, p = 0,0072). Conclusion. Determination of serum growth factors, especially VEGF, with exacerbation of chronic gastritis is diagnostically valuable, should be used for early diagnosis of atrophy of the gastric epithelium.

RUDN Journal of Medicine. 2019;23(3):250-256
Results of Conversion Osteosynthesis in Treatment of Patients with Long Bone Fractures
Alsmadi Y.M., Zagorodniy N.V., Solod E.I., Lazarev A.F., Abdulkhabirov M.A., Ananyin D.A., Petrovskiy R.A.

Аbctract. Treatment of long bones fractures of the extremities has a particular relevance in modern traumatology due to their high frequency, as well as a large number of deaths in patients with polytrauma. It is dangerous to perform an urgent final osteosynthesis in severe patients because of the possibility of shock and the deterioration of the condition of the injured. Therefore, the principle of Damage control with urgent fixation of damaged segments by external fixation and their subsequent replacement (converse) to intramedullary osteosynthesis had a particular relevance in the treatment of patients with long bones fractures. Purpose: Improving treatment outcomes for patients with long bones fractures. Materials and methods. In the present study, a retrospective analysis of using conversion osteosynthesis in the treatment of 120 patients with long bones extremities fractures in a multidisciplinary hospital was carried out. For a better analysis of the results of treatment, we divided the patients into two groups: The first group 44 patients with fractures of the long bones with polytrauma according to the ISS severity scale> 17. The second group consists of 76 patients with closed isolated unstable comminuted fractures of the long bones with severe post-traumatic edema, who have a high risk of significant trauma of soft tissues. Results. The most optimal time for conversion osteosynthesis to patients with polytrauma was 7-12 days, which prevented the occurrence of traumatic shock; and for patients with closed isolated unstable fractures of long bones with significant of post-traumatic edema for conversion osteosynthesis, the optimal time was 3-7 days after injury, which prevented the occurrence of inflammatory complications in the postoperative period. Conclusion. The study confirmed the feasibility of conversion osteosynthesis in the treatment of patients with diaphyseal fractures. The use of the technique of transferring the fixation of fragments by the external fixation device to the internal osteosynthesis (conversion) contributed to a reduction in the duration of inpatient treatment of patients with fractures of the long bones.

RUDN Journal of Medicine. 2019;23(3):257-270
Searching for the Optimal Predictors’ Model for Occlusion of the Femoral-popliteal and Femoral-tibial bypasses
Kasyanov B.V.

Risk factors affecting the patency of shunts after infrainguinal reconstructions have been known for a long time. But so far, no effective model has been proposed, that allows to predict in a particular patient at what time and with what combination of risk factors bypass occlusion will occur. A statistical analysis of the risk factors for occlusion of such bypasses was made and developed a reliable prognostic model based on the regression function. A retrospective analysis of 136 cases of femoral-popliteal bypasses and femoral-tibial bypasses was carried out at the Department of Vascular Surgery of the Orel Regional Clinical Hospital from 2008 till 2018. Statistical data analysis was performed using Spearman’s rank correlation, binary logistic regression, ROC-curve and Kaplan-Meier survival graphs using IBM SPSS Statistics 22. A correlation was found between almost all analyzed factors and primary permeability. Based on the logistic regression, a reliable model of a combination of ischemia, superficial femoral artery patency, diabetes history, pre-operative INR data and hemoglobin level, with high prognostic significance, specificity, sensitivity and informativeness, was compiled. The constructed Kaplan-Meier survival graphs showed the dependence of the degree of ischemia and trophic disorders, history of diabetes, and the use of clopidogrel, atorvastatin / rozuvastatin, pentoxifylline, actovegin in the postoperative period from the primary patency over the time. To the patients, who have occlusion risk factors proposed in the developed model, should prolonged atorvastatin/rosuvastatin, clopidogrel, pentoxifylline, actovegin intake (more than 1 year, ideally for life) first be advised, and also they should appoint a periodic preventive examination of a vascular surgeon after 1 month, 3 months, 6 months, 1 year and 2 years after surgery with an ultrasound scan of the lower limb arteries and a bypass, as well as a complete blood count analysis (leukocytes and platelets).

RUDN Journal of Medicine. 2019;23(3):271-282
Obstetrics and Gynecology
Endometriosis as a Reason of Intraabdominal Bleeding in Pregnancy. Clinical Case
Revzoeva Y.A., Shakurova E.Y.

The article defines the significance and relevance of the problem of endometriosis during pregnancy. 10% of women in the reproductive period have different localization of endometriosis. 25% of pregnancies with endometriosis are complicated by preterm labor. The article presents a clinical case of intra-abdominal bleeding in a 28-year-old pregnant woman with retrocervical endometriosis at gestation age of 32 weeks and 6 days. The article covers the results of examination and special diagnostic procedures of intra-abdominal bleeding in pregnant women with retrocervical endometriosis. The main diagnostic methods were the study of past medical history, ultrasound examination, and laboratory tests. Due to their infrequency during pregnancy internal bleedings present difficulties in their diagnosis. Ultrasound reliably revealed a large amount of fluid in the abdominal cavity and small pelvis and excluded the presence of intrauterine bleeding. Clinical and laboratory tests indicated the severity of the patient's condition. Symptoms of moderate fetal distress were also identified. Therefore, a decision was made about an emergency delivery by the cesarean section followed by an abdominal revision. During the cesarean section, 500 ml of blood in the form of dark blood clots was found in the abdominal cavity. The condition of the premature newborn was in conformity with his gestational age. The source of bleeding were the of endometriosis on the back wall of the uterus. These focuses most likely caused hemoperitoneum. The revision of the abdominal cavity did not find any other foci of bleeding. The postoperative period was uneventful. The article provides general guidelines for the management of pregnant women with severe forms of endometriosis.

RUDN Journal of Medicine. 2019;23(3):283-289
Management of Rheumatic Heart Diseases in Burundi
Ndirahisha E., Baransaka E., Nyandwi J., Bukuru H., Muserebanyi C., Nimburanira M., Nyandwi R.

Background: The surgical management of rheumatic heart disease (RHD) in Burundi is almost impossible because of the absence of the technical plateau. Aim: To describe the therapeutic and evolutionary aspects of RHD in Burundi. Patients and methods: This is a retrospective and analytical study of patients' records in surgical indication and/or operated for RHD by facilitation of “Maison du Bon Samaritain du Burundi (MBSB)” from February 2015 to February 2017. Results: Among 89 patients consulting for RHD, 45 (50.56%) were operated. The average age of the patients was 25 years. Females predominated with 64.04% of cases. The age of most of patients was between 4 and 40 years with 74 cases (83.14%). All patients had been received at the heart failure stage including 83 (93.25%) at stage III or IV according to the New York Heart Association (NYHA) classification. The ejection fraction was ≤ 50% in 61 patients (68.53%). Pulmonary arterial hypertension was recorded in 79 patients (88.76%). On chest X-ray, cardiomegaly was found in 85 patients (95.50%). Electrical abnormalities were dominated by dilatation of the left atrium in 48 cases (53.93%). Isolated valvular lesions were the most numerous with 67 cases (75.28%). The operative management was mainly valvular replacement (93.47%) with an operative success of 100% six months after the intervention. Conclusion: The diagnosis of RHD was late. Young people were more vulnerable. The postoperative prognosis at six months was good.

RUDN Journal of Medicine. 2019;23(3):290-296
Development Features of the Endogenous Intoxication During Experimental Obstruction of the Urinary Tracts
Akimenko M.A., Kolmakova T.S., Oksenjuk O.S., Kalmykova Y.A., Smirnova O.B.

The purpose of the study: is to establish the characteristics of the development of endogenous intoxication during experimental obstruction of the urinary tract. Materials and methods: to achieve this goal, one control and three experimental groups of animals were formed, in which blood was taken from the marginal ear vein on the 3rd, 7th, 14th and 21st day of the experiment. The following parameters were determined in blood serum: urea, creatinine, total protein and albumin. The level of endogenous intoxication was assessed by the indicators of medium-mass molecules, circulating immune complexes and malon dialdehyde. Results: statistical analysis of blood biochemical parameters and endogenous intoxication markers confirm the link between modern biomarkers of renal injury and morphological changes in the tissues of obstructive and compensatory organs. Conclusion: our findings point to the overstress adaptation mechanisms, the development of oxidative stress and exhibit a high level of endogenous intoxication, resulting in structural and metabolic changes in the affected and in the contralateral kidney.

RUDN Journal of Medicine. 2019;23(3):297-307
Gender Features of Formation of Purposeful Human Behavior when Playing Images with Different Performance
Merkulova M.A., Akulina M.V., Lapkin M.M.

The article is devoted to the study of gender features of the formation of the system organization of purposeful human activity in the reproduction of visual images. The role of feedback on the results of activity in the formation of different success of purposeful behavior of subjects of different sexes with different personal psychodynamic properties in the reproduction of visual images was studied. The paper shows that the enrichment of feedback channels on the results of the activities of the subjects of different sexes formed a new organization of purposeful behavior, reflected in a certain configuration of correlations between the indicators of mathematical analysis of heart rate and statistical characteristics of targeted activity in the reproduction of visual images. One of the possible reasons for the restructuring of targeted activities in subjects divided into groups by gender is a certain combination of their psychodynamic characteristics.

RUDN Journal of Medicine. 2019;23(3):308-317
Morphological Features of the Burn Wound of Skin at Rats Against the Background of Correction by Stimulators of the Reparation of Tissues
Azhikova A.K., Fedorova N.N., Zhuravleva G.F.

In article morphological features of skin of rats in the conditions of burn influence of skin without use of medicines and against the background of correction are studied by pharmaceuticals. A research objective was studying of morphological features of skin wounds of rats in the conditions of a thermal trauma and against the background of their correction was stimulators of a reparation of tissues. Materials and methods. As an object of a research served exemplars of the defective skin of non-linear rats males ( n = 50) excised from a zone of a thermal trauma in interscapular area of a back. The thermal burn of skin was caused imposing of a copper subject. Beginning from first day after a trauma put appliques of stimulators of a reparation of tissues daily during the entire period of an experiment. Results. Thermal influence led to development of the significant degenerative and dystrophic changes in skin. Restitution of a burn wound of skin of rats proceeded as the delayed partial reparative regeneration which is followed by the destructive phenomen and formation of cicatricial tissues. Conclusion. Application of stimulators of a reparation of tissues (cream Spacatel, spray D-pantenol) as means of correction of wound defects of skin promoted delay of the destructive processes within a false skin, a derma and a hypodermic fatty tissue, to an adhesion of a zone of damage (formation of tissues of skin and a cuticularization of a wound), in comparison with a case of correction of burn wounds of skin appliques of extraction alcoolique by Calendulae. Positive takes of our research prove effectiveness of their application in dermatologic and traumatology practice.

RUDN Journal of Medicine. 2019;23(3):318-327
Mathematical Modelling and Prediction in Infectious Disease Epidemiology
Yanchevskaya E.Y., Mesnyankina O.A.

Mathematical modeling of diseases is an urgent problem in the modern world. More and more researchers are turning to mathematical models to predict a particular disease, as they help the most correct and accurate study of changes in certain processes occurring in society. Mathematical modeling is indispensable in certain areas of medicine, where real experiments are impossible or difficult, for example, in epidemiology. The article is devoted to the historical aspects of studying the possibilities of mathematical modeling in medicine. The review demonstrates the main stages of development, achievements and prospects of this direction.

RUDN Journal of Medicine. 2019;23(3):328-334

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