Vol 23, No 4 (2019)

SURGERY
Limb Revascularization in Patients with Diabetes Mellitus
Bokeria L.A., Arakelyan V.S., Papitashvili V.G., Tsurtsumiya S.S.
Abstract

The review describes morbidity, mortality and possible complication rates for diabetic patients with peripheral arteries disease. The article demonstrates the modern tendency in the surgical treatment of peripheral arteries atherosclerosis, shows and compares worldwide results of endovascular and open revascularization. The authors have assessed the risk of amputation for patients with diffuse peripheral arteries disease and described basic treatment principals for better chronic ischemic ulcer healing.

RUDN Journal of Medicine. 2019;23(4):349-363
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ONCOLOGY
Immunohistochemical Study of Tumor Cells Proliferative Activity at Different Graduations of Prostate Cancer
Kudryavtsev G.Y., Kudryavtseva L.V., Mikhaleva L.M., Babichenko I.I.
Abstract

Prostate cancer is one of the leading causes of men death in developed countries. Modern diagnostic methods, including a puncture biopsy of the prostate gland, make it possible to verify oncology in the early stages, however, routine studies do not always allow to predict the course of the disease and outcome. The aim of our study was to analyze the clinical, morphological and immunohistochemical features of the proliferative activity of adenocarcinoma cells using the Ki-67 marker, to compare the degree of proliferative activity in tumors of various degrees of malignancy (according to Gleason’s classification), as well as to compare this indicator with the clinical stage of the disease, the level of prostate-specific antigen in the blood, the size of the prostate gland. Materials and Methods: On the basis of the City Clinical Hospital No. 31 and the Veteran Hospital No. 2, paraffin blocks with material obtained as a result of prostate biopsy, transurethral resection, and radical prostatectomy were selected. A morphological and immunohistochemical study of the material with the Ki-67 marker and a quantitative assessment of the degree of proliferative activity were carried out. Data were analyzed using the STATISTICA 10.0 program using estimates of the normality of the data distribution according to the Shapiro-Wilk W-test, the significance of differences was estimated using the Mann-Whitney U-test, and correlation relationships using Spearman’s correlation coefficient. Results: Statistically significant differences in the degree of proliferative activity in groups differing in the degree of differentiation were revealed. A statistically significant direct correlation of moderate severity was revealed when comparing proliferative activity with the degree of differentiation according to the Gleason system (rs = 0.523) and the clinical stage of the disease (rs = 0.646). No statistically significant correlation was found between indicators such as prostate-specific antigen level, age, prostate volume, and proliferative activity index. Conclusion: taking into account the proliferative activity index in addition to clinical and morphological studies helps to diagnose and subsequently predict the course of prostate cancer.

RUDN Journal of Medicine. 2019;23(4):364-372
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Stomatology
Optimization of Dentition Measurements in Orthodontic Practice
Katbeh I., Kosyreva T.F., Tuturov N.S., Birukov A.S.
Abstract

Orthodontic treatment planning is a practice that depends on the accuracy of teeth and dental arches’ size measurement. The purpose of the study is to compare the accuracy and the duration of teeth and dental arches’ measurement, utilizing different approaches from conventional plaster models to virtual 3D models obtained by intraoral and extraoral scanners. Fifteen patients were included in the study (7 males, 8 females, mean age 21.7 ± 0.7 years), with a moderate anterior teeth crowding and class I Angle’s classification of malocclusion. Plaster models, as well as virtual 3D scans were obtained by intraoral and extraoral scanners prior to the orthodontic treatment, crown sizes of incisors, transverse and longitudinal sizes of dentitions, as well as the length of dental arches’ segments were measured, the duration of each measurement was also evaluated. Material and Methods: groups were allocated according to the four different ways the measurements were obtained: 1) biometric measurements on plaster models of the jaws; 2) virtual 3D data of the dentition using intraoral scanner; 3) 3D scanning data of plaster models; 4) 3D scanning data of silicone impressions. Results: The differences between the same type of measurements using a 3D scanner and measurements on plaster models when compared to the same control points in the oral cavity were, on average, 0.3 ± 0.01 mm. The time required to work with plaster models compared to the time taken to obtain virtual models on a 3D scanner was significantly greater, respectively, 15.3 ± 0.7 min. and 5.1 ± 0.2 min. Thus, 3D scanning is the most accurate standardized method for assessing the size of teeth and dental arches with shorter duration of manipulations, although it requires laboratory equipment and certain manual skills.

RUDN Journal of Medicine. 2019;23(4):373-380
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BIOLOGY. EXPERIMENTAL PHYSIOLOGY
Prevalence of Some Gene Polymorphisms Related to Early Pregnancy Loss among Russian Women
Ahmed A.A., Muradian A.A., Azova M.M.
Abstract

Background. A variety of biological processes regulated by differential gene expression are required to maintain a normal gestation and accordingly, the mutations and polymorphisms in such genes may cause miscellaneous biological disorders that eventually result in early pregnancy loss. Many studies reported that aberrant fetal DNA methylation as well as embryonic chromosome abnormalities may lead to impairment of fetal early growth and development. Therefore, we have aimed to genotype several gene polymorphisms might be involved in the above-mentioned biological disorders to screen their prevalence in Russian population. Materials and methods. 81 Russian women without previous history of normal pregnancy or early abortion were recruited into this population study to determine the genotype and allele frequencies through genotyping using RFLP-PCR method for DNMT3B rs2424913, DNMT3B rs1569686, DNMT3A rs7590760, DNMT1 rs2228611, DNMT1 rs8101626, DNMT3L rs2276248, and DNMT3L rs2070565, allele-specific PCR for SYCP3 T657C, and real-time PCR for MTHFR rs1801133, MTHFR rs1801131, MTR rs1805087, and MTRR rs1801394. Results. Minor homozygous genotypes and minor alleles of the polymorphisms DNMT3B rs2424913 (TT: 11.1%, T: 37.05%), DNMT1 rs2228611 (GG: 18.5%, G: 40.75%), and DNMT1 rs8101626 (GG: 16.0%, G: 40.1%) were quite prevalent in Russian women and as frequent as those of the well-studied polymorphisms: MTRR rs1801394 (GG: 27.2%, G: 50.65%), MTHFR rs1801131 (CC: 17.3%, C: 40.15%), and MTHFR rs1801133 (TT: 11.1%, T: 29.0%).The heterozygous genotype of SYCP3 T657C (CT: 12.3%, T: 6.15%) was also quite frequent. Conclusion. Based on our study and literature data, we suggest that DNMT3B rs2424913, DNMT1 rs2228611, DNMT1 rs8101626, and SYCP3 T657C polymorphisms along with the common folate cycle gene polymorphisms can be potential genetic predictors for early pregnancy loss in Russian women.

RUDN Journal of Medicine. 2019;23(4):381-389
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Effect of Long-Term Electrical Spinal Cord Stimulation on Expression of Non-Reciprocal Inhibition α-Motoneurons of Human Skeletal Muscles
Roshchina L.V., Gladchenko D.A., Pivovarova E.A., Chelnokov A.A.
Abstract

It is known, transcutaneous electrical spinal cord stimulation (tESCS) in the T11-T12 level of the thoracic vertebrae increases the power capabilities of the leg agonist muscles. One of the inhibition spinal mechanisms that protects skeletal muscles from excessive force is non-reciprocal inhibition. Taking into account the biological role of non-reciprocal inhibition, the aim of the study was to research the effect of long-term tESCS on expression of non-reciprocal inhibition of soleus muscle α-motorneurons in humans at rest and when holding a weak static force. Materials and methods: the study involved 22 healthy male subjects aged 27 to 35 years. Non-reciprocal inhibition of α-motorneurons was recorded during the 20-minute tESCS in the T11-T12 level of the thoracic vertebrae at rest, in combination with arbitrary muscular effort (5% of MVC) and after its impact. Results: TESCS at rest resulted in the weakening of non-reciprocal inhibition within 20 minutes of exposure and 10 minutes after the end of stimulation. TESCS in combination with arbitrary muscular effort in 5% of the MVC increases the activity of non-reciprocal inhibition for 20 minutes of stimulation and 10 minutes after its end. The proposed physiological mechanisms underlying the effect of long-term tESCS on expression of non-reciprocal inhibition are discussed.

RUDN Journal of Medicine. 2019;23(4):390-396
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Morphology of GFAP-Positive Cells in Male and Female Rats’ Cerebral Cortex during the Cerebral Hypoxia Development according to the Stress Tolerance Level
Chrishtop V.V., Rumyanceva T.A., Pozhilov D.A.
Abstract

Correlation between individual typological features like sex-related characteristics and low initial level of stress resistance and unfavorable prognosis of ischemic brain damage is shown. At the same time, the astrocytes’ participation in neuroplasticity in this disease represents the purpose of the study. The goal was to study the cerebral cortex astrocytes’ morphometric characteristics during the cerebral hypoxia in rats of different sexes with different stress tolerance levels. We performed the study with 72 Wistar rats. According to the Open Field test results all the animals were divided into two subgroups: with high and low level of stress tolerance. Both carotid arteries of the experimental group animals (48 animals) were bandaged. Animals were removed from the experiment at 21, 60 and 90 days after surgery. Glial fibrillary acidic protein (GFAP), a marker of mature astrocytes, was detected on histological sections of the central brain gyrus using primary polyclonal rabbit antibodies. Progressive decrease of the astrocytes’ numerical density and the number of first order processes were obtained during the study. It was less pronounced in animals with high stress tolerance and females. Increase of the processes’ distribution area was reliably detected. Area decreased after 90th day of the experiment. It is concluded that the astrocytes’ alteration develops earlier in animals with high stress tolerance and males, later in females (60 days) and animals with low stress tolerance (90 days).

RUDN Journal of Medicine. 2019;23(4):397-404
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IMMUNOLOGY
Optimization of Therapy of Patient with Genetic Defect Antibody Production
Sizyakina L.P., Andreeva I.I., Petruchik S.V.
Abstract

Development of molecular genetics and immunological diagnostics, disclosure of pathogenesis of various forms of primary immunodeficiency (PID), improvement of therapeutic techniques contributed to the formation of a generation patients with PID older than 18 years. Experience shows that isolated replacement therapy, leading to a reduction in the frequency and severity of reactivation chronic foci of infection, is not able in some cases to fully stabilize the condition of patients, and the use of antibiotics remains inevitable. Interesting is the development and implementation of the concept of combined therapy of PID humoral therapy, the ideology of which is based on the combination of substitution therapy with exposure on the functional potential of the cellular link of the immune system. One of the perspective variants of influence on functions of cellular components of immune is the use of innate immunity receptor agonists. From the position of the specific clinical application deserves the attention medication Likopid (glucosaminilmuramyl dipeptide) - semi-synthetic analogue of muramyldipeptide, minimally biologically active substance peptidoglycan fragment of the cell wall of all known bacteria. Presented clinical case of X-linked agammaglobulinemia. The patient, despite regular replacement therapy with intravenous immunoglobulins with maintaining a pretransfusion IgG level of at least 8 g/l, continued to register episodes of exacerbation of chronic conjunctivitis up to 10 times a year. Application of licopid in addition to IVIG therapy contributed to the improvement quality of life, reducing the frequency of exacerbations, conjunctivitis and duration of use antibiotics. This example illustrates the role of cellular components innate immune response in clinical manifestation of insufficiency humoral link adaptive immunity, and confirms the possibility of additional correction of these parameters to improve the efficiency of the standard substitution therapy.

RUDN Journal of Medicine. 2019;23(4):405-411
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Studying Possibilities of Using Beebread in Medicine with the Follow-Up Development of a Means to Improve Immunity
Shavrina D.I., Nesterova N.V., Nesterova O.V., Birukova N.V., Iaroshenko A.A.
Abstract

In the course of the analysis of scientific literature, the composition of the bee bread containing biologically active substances (arginine, phenylalanine, isoleucine, leucine, lysine, methionine, threonine), mineral salts, trace elements and valuable vitamins that enhance immunity was studied. The complex of reactions recommended by the State Pharmacopoeia of the Russian Federation was used to determine the main groups of biologically active substances characteristic of natural raw materials. As an object of research, bee bread was used. The raw materials were identified: amino acids, hydroxyacids, saponins, flavonoids, tannins, coumarins, pectins. This beekeeping product can be recommended for use in medicine as a perspective drug.

RUDN Journal of Medicine. 2019;23(4):412-417
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SOCIAL HEALTH AND HEALTH PROTECTION
Demographic characteristics of the Moscow region at the beginning of the XXI century
Olenin Y.A., Lebedeva I.V.
Abstract

The socio-economic development of the country and any region is influenced by many factors, among which the most important role belongs to the demographic, in a generalized form representing the demographic situation. The demographic situation is usually understood as the demographic situation, the state of demographic processes, the composition and placement of the population at a certain time in a country or a particular region. Thus, the analysis of the demographic situation is necessary for understanding the main parameters of the population, trends in their dynamics, forecasting the number, demographic structure, demographic behavior of the population. Objective: to conduct a comparative analysis of official statistical data on demographic processes (statics and population dynamics) in the Moscow region (MO) for 2000-2015. Materials and methods: at the first stage, the collection and analysis of information and statistical sources were carried out, requests were sent to the Federal and territorial state statistics services of the Russian Federation (Rosstat, Mosobstat, MIAC MO). At the second stage, the data on demographic processes in the Moscow region were copied from the responses of Rosstat, Mosobstat, MIAC MO and from the websites of relevant organizations. Statistical analysis included calculation of simple arithmetic mean, percentage values, economic and demographic burden on the working population, demographic factors and the efficiency of population growth. Results and conclusions. The population of the Moscow region at the beginning of the XXI century continues to increase, but mainly due to migrants arriving from neighboring regions of the country and abroad. Males constitute 46.2% of the population and females 53.8% (2015). Boys are born more than girls by 6% and this advantage is maintained until the age of 30. And starting from the age of 35, the number of women begins to prevail over the number of men by 3.5%. This trend continues to 75 years and older. Age groups of the region's population are formed according to the regressive type: children - 15.9%; working-age population - 59.8%, and persons older than working age - 24.3% (2015). The economic and demographic burden of children and the elderly on the working population is more than 40%. The birth rate in the region increased by 76.7% from 2000 to 2015 and was higher than in 1990. Analysis of the total fertility rate indicates that in the Moscow region remains mononuclear family type (1-2-child family), ie there is no expanded reproduction of the population. In children, and especially in working age, the mortality rate is higher in men than in women. In men, the mortality rate reaches 41% of the total mortality at the working age. The number of women who died in working age is 4 times less than men. The natural increase in the population of the Moscow region for 15 years of the XXI century has a small but negative value, since the population is decreasing, and the increase in the population is mainly due to high migration.

RUDN Journal of Medicine. 2019;23(4):418-430
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Methods of Forming Humanistic Values in Students of Medical Universities in the Process of Learning a Discipline “Internal Diseases”
Alekseev M.V., Fomina K.A., Makoeva L.D., Tebloev K.I., Arkad’eva G.V.
Abstract

Аctuality: the article deals with the actual problem of spiritual and moral education of students in medical schools. Aim: design of practical classes and original tasks for medical students aimed at the formation of general cultural and professional competencies. Materials and methods: the innovative method of organization and practical training on the discipline “Internal diseases” is offered. The study included 123 students (64 and 59 in the experimental and control groups, respectively). Results: in the experimental group, the average score for the lesson according to the results of the final test control was 89%, in the control group - only 78%, and the overall level of knowledge increased by 9% compared to the control. Conclusion: the effectiveness of the proposed method of training is confirmed by the results of the pedagogical experiment and contributes to the formation of General cultural and professional competencies.

RUDN Journal of Medicine. 2019;23(4):431-441
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