Vol 24, No 1 (2020)

SURGERY. UROLOGY
Current issues of pathogenesis, diagnostic visualization and methods of treatment Peyronie’s disease
Kasenova B.G., Notov I.K., Verdiev R.V., Volobuev D.I., Aliev U.M., Mikailova S.E., Erkovich A.A., Tulupov A.A., Satinov A.V.
Abstract

This paper presents current survey data on the epidemiology, etiopathogenesis, diagnostic imaging, conservative and surgical methods of the treatment for Peyronie’s disease. The review of literature ends with a conclusion that there is no single point of view on causes and mechanisms of this disease. Particular theories of etiopathogenesis were observed: anatomical, autoimmune, genetic, oxidative stress theories and TGF-β impact role. Early diagnosis is necessary to achieve optimal effects of the treatment. Sonography with or without cavernosography are recommended as routine diagnostic visualization methods. Magnetic resonance imaging also could be used according to the indications. Morphometric penile evaluation could be performed with different modern methods; quantitative assessment has a particular role. In addition, comparative characteristics of diagnostic imaging methods were described. Among nonsurgical therapeutic methods, we spotted peroral, injection and shock wave therapy. Peroral therapy does not impact plaque size and penile curvature and should be used only in active phase to stabilize the process. Shock wave therapy does not affect plaque size as well, but has a positive effect on pain syndrome and erectile function. Injection therapy with collagenase clostridium histolyticum is the most effective method among nonsurgical ones. Main surgical techniques such as plication, grafting, penile prosthesis placement and also rehabilitation in postoperative period were observed in this review. Surgery maintains to be golden standard in Peyronie’s disease and is performed in patients with stable phase, as well as in patients with severe deformity and with drug-refractory condition.

RUDN Journal of Medicine. 2020;24(1):9-25
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TRAUMATOLOGY
Analysis of the vascular abnormalities of the patients with ankle joint mild osteoarthritis
Mombekov A.O., Karpovich N.I., Dogotar O.A., Dergunov A.V., Zagorodnyi N.B.
Abstract

The vascular factor is one of the leading pathogenesis factors in the formation of ankle joint osteoarthritis. Dystrophic and sclerotic changes in the joint tissues develop as a result of blood flow decrease. These mechanisms understanding will allow to plan treatment and rehabilitation measures, as well as predict and prevent complications. The purpose of the work is to study hemodynamic parameters in the main lower leg arteries of the in patients in follow-up period of mild ankle joint osteoarthritis. Two groups of patients were examined. The first group - 82 patients with mild ankle joint osteoarthritis in the follow-up period (10 years) and the second group - control (healthy) group of 58 people without ankle joint osteoarthritis. Duplex scan of the main lower leg arteries was performed to all the patients. The state of arteries and hemodynamic parameters were evaluated. Excell and STATISTICA 10.0 programs were used for statistical data processing. In patients with follow-up of mild ankle joint osteoarthritis, the diameter of the arteries did not differ from the control group. In patients with mild ankle joint osteoarthritis the thickness of the Intima-media complex in the lower leg arteries and walls pulsation were significantly higher than those in patients of the control group (p <0.05). Analysis of hemodynamic parameters in patients with ankle joint osteoarthritis revealed an increase in the linear velocity of blood flow with a further tendency to normalization and even decrease in the follow-up compared with the control group. Signs of perfusion difficulty that accompanied the development of high blood pressure syndrome in the lower leg arteries were observed in 122 (67.0%) patients, and the signs of perfusion difficulty were bilateral in most of the cases (86.9%). Stenosis, deformation and arteries tortuosity were noted in 22% of patients with ankle joint osteoarthritis. Thus, mild ankle joint osteoarthritis is accompanied by blood flow changes in the form of inadequate perfusion and high-pressure syndrome in the lower leg arteries, which can cause secondary injuries and requires higher attention when selecting treatment and rehabilitation actions.

RUDN Journal of Medicine. 2020;24(1):26-37
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Stomatology
Comparative analysis of the application of virtual and mechanical articulators in functional diagnostics
Chkhikvadze T.V., Roschin E.M., Bekreev V.V.
Abstract

The paper presents the results of examination of patients with articulation disorders of the lower jaw caused by internal pathology of the TMJ. The purpose of the presented work: to study the effectiveness of the use of mechanical and virtual articulators in the functional diagnosis of patients with internal TMJ disorders. All patients underwent comprehensive clinical and instrumental examination including cone-beam computed tomography (CT) and axiographic examination (optical axiograph Dentograf Prosystom, Russia). CBCT was used to assess the state of the TMJ and determine the individual ratio of jaw and joint models. When axiography was recorded and analyzed articular trajectories of the lower jaw. In the first group of patients dynamic occlusion was evaluated using a mechanical articulator, in the second group a virtual articulator was used. It was revealed that the use of mechanical articulators in functional diagnostics to assess dynamic occlusion is limited and does not allow to obtain individualized patient data, their efficiency was 75%. The use of virtual articulators allows to evaluate the dynamic occlusion during opening and closing of the mouth, protrusion and laterotrusion, as well as the continuous movement of the lower jaw with the registration of all possible dental contacts. Due to the combination of CT data of the patient’s head and virtual models, the highest accuracy of placing models in the virtual articulator in accordance with the individual characteristics of patients was achieved.

RUDN Journal of Medicine. 2020;24(1):38-51
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Microbial flora of dentin of remote wisdom teeth
Sidorenko V.O., Panin A.M., Tsitsiashvili A.M., Podporin M.S.
Abstract

The aim of our study was to study the microbial flora of autodentin of removed wisdom teeth and compare it with the microbial flora of the oral cavity in order to determineits safe use as graft for thereplacement of defects of the alveolar bone. Relevance. The dental dentin is close in organic and mineral composition to human bone tissue. A bone autograft is considered the “gold standard” for ridge augmentation. However, a bone autograft graft increases the morbidity of reconstructive operations, requiring the formation of a donor zone, which increases the feeling of discomfort and the patient’s rehabilitation time. Increases the risk of intra- and postoperative complications. Materials and methods. A group of patients with wisdom teeth to be removed had smears taken from the mucous membrane in the area of the extracted teeth. After that, the teeth were removed, crushed using a bone mill manually, or reduced to thin plates, placed in nutrient media and sent for microbiological examination. Conclusions. According to the microbiological study, the microflora of the oral cavity and the microbial flora of the extracted teeth were identical, only quantitative indicators differed.

RUDN Journal of Medicine. 2020;24(1):52-60
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The risks of injection anesthesia in dentistry
Bogaevskaya O.Y., Sokhov S.T.
Abstract

The article intends to study the risks of performing injection anesthesia for dentists experiencing chronic fatigue syndrome. Materials and methods used: The survey was conducted from August to November 2019 at various dental clinics of Moscow, with 308 dentists having filled in the questionnaire. Information source: The “Questionnaire on Assessing Injection Security and Chronic Fatigue Syndrome” was offered to dentists from clinics representing different types of ownership and contained 88 questions. Results: 97,14% of the respondents were feeling anxious while performing local anesthesia, yet, regrettably, 14,28% of them had to refer the patient to a dental surgeon for this procedure. 17,14% (n=53) of the 308 respondents noted that they had to confront the patient’s general condition worsening significantly due to a local anesthetic injection prior to the start of dental treatment. The mistakes made mostly had to do with anesthetic choice (26,73%), needle choice (12%), and needle breakage (3,78%). 17,14 per cent of dentists had the experience of confronting grave, even fatal outcomes of anesthesia. The majority of dentists (74,29%) work from 41,2 to 57,7 hours weekly. The risk of developing chronic fatigue syndrome was assessed as high in 11,43% of all cases. Conclusion: Given the absence of prophylaxis in 45,71% of cases related to anesthetic injection and the increased concentration of vasoconstrictor in the anesthetic in 88,57% of all instances, keeping records of complications caused by injection anesthesia is recommended.

RUDN Journal of Medicine. 2020;24(1):61-68
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The use of various types of autografts in the bone grafting of the alveolar process
Makeev A.V., Topolnitsky O.Z., Fedotov R.N.
Abstract

Relevance. Fixing a cleft alveolar process is one of the most complicated problems in pediatric maxillofacial surgery. The difficulty lies in the fact that bone grafting of the alveolar process directly affects the growth of the upper jaw, the difficulty of performing surgery, as well as trying to form a sufficient amount of bone regenerate, while it is necessary to restore the anatomical integrity of the alveolar process for subsequent orthodontic treatment or dental implantation. Purpose: To review the literature on the use of autografts from various donor areas in patients with congenital cleft upper lip, alveolar process, hard and soft palate. Materials and methods: A literature review of the data was carried out using the electronic databases “Medline”, “Pubmed”, “Kibeleninka”. The key words in the search were: bone plastic, cleft alveolar process. The selection criteria were the articles in English and Russian containing clinical studies on the use of various types of grafts in bone grafting of the alveolar process cleft. Results: The sources of literature on the use of various autografts for bone grafting of the alveolar outgrowth in children with cleft lip and palate were analyzed. Currently, most authors are inclined to use an iliac crest autograft in surgery. Conclusion: Although more than a century has passed since the first alveolar cleft bone graft surgery was performed, the choice of bone material is still unresolved - due to the severity of complications, the impossibility of taking a sufficient amount of bone material, as well as a high percentage of material resorption, because even with the use of iliac crest bone, the volume of transplant resorption can be over 40%.

RUDN Journal of Medicine. 2020;24(1):69-74
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EXPERIMENTAL PHYSIOLOGY
The effect of transcranial electrostimulation on the frontal crust of students during a psychoemotional stress
Kade A.H., Ahejak-Naguze C.K., Durov V.V., Kashina Y.V., Tacenko E.G., Penzhoyan A.G., Nikitin R.V., Abushkevich V.G.
Abstract

Relevance: transcranial electrical stimulation has an anti-stress effect in humans. One of the possible mechanisms is due to changes in the functional state of the frontal region of the cerebral cortex.The aim: to evaluate the dynamics of tractography of the frontal region of the human cerebral cortex during psychoemotional stress before and after transcranial electrical stimulation. Materials and methods: Observations were performed on 26 conditionally healthy young men. Students assessed the level of stress resistance by N.N. Kirsheva, N.V. Ryabchikova and heart rate variability in the test period. Brain MRI was performed on a high-field tomograph (magnetic field strength 3 T) from General Electric (USA), followed by software processing and tractography. 16 subjects (main group) underwent transcranial electrical stimulation (TES) therapy. TES therapy was performed using the TRANSAIR-02 apparatus with monopolar impulses. Sessions were held in the evening from 18 to 22 hours every other day. The course consisted of 5 sessions of 30 minutes, the current strength was from 2.0 to 3.0 mA After a course of TES therapy, MRI of the brain and tractography were repeated. In the comparison group (10 people), TES therapy was not performed, but MRI and tractography were similarly repeated. The tractograms compared the area of the tracts in the frontal region of the cerebral cortex in both groups, as well as before and after TES therapy. For statistical analysis of the results of the study used the program: “STATISTICA 10”. Results: On the tractograms of the frontal cortex of the brain, in students experiencing stress due to the training load in the crediting period, the tract area on the tractogram was 7.9 ± 0.4 cm2. After 5 sessions of transcranial electrical stimulation, the level of stress resistance increased. On the tractograms of the frontal cortex, the area of the tracts increased and amounted to 13.4 ± 0.5 cm2.The conclusion: After transcranial electrical stimulation, when psychoemotional stress is removed, students restore paths in the frontal region of the cerebral cortex

RUDN Journal of Medicine. 2020;24(1):75-84
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Cellular structure of thymus in drug-induced deficiency of magnesium
Chuchkova N.N., Smetanina M.V., Kormilina N.V., Kanunnikova O.M., Pazinenko K.A.
Abstract

The timeliness of the work is due to the prevalence of magnesium deficiency associated with the use of drugs that contribute to the excretion of magnesium from the body. The aim of the work is to elucidate the cell-mediated reaction of the thymus to magnesium deficiency caused by the administration of furosemide. Magnesium deficiency was modeled by intraperitoneal administration of furosemide to experimental rats. The amount of magnesium and sodium in the blood and thymus tissue was determined by inductively coupled plasma atomic emission spectrometry, the cell composition of the thymus was evaluated on histological sections. It is shown that at furosemide load the amount of magnesium decreases in the blood, but increases in the tissue of the thymus gland. The areas of the structural zones of the thymus (subcapsular zone, cortex, medulla), their percentage; cortical/medullary ratio were calculated. Cell density, lymphocyte count large, medium and small lymphocytes, reticular epithelial cells, macrophages, mast cells, apoptotic cells, thymic corpuscle were counted in each structural zone per unit area (100 μ2). In experimental animals the amount of magnesium in the blood decreases, but in the thymus tissue increases, there is leukocytosis and lymphocytosis, eosinophilia. Revealed histo- and cytostructural morphological rearrangements indicate a change in the functional activity of the gland. It was shown that the furosemide-induce deficiency of magnesium the area of the medulla increases, the number of macrophages and apoptotic elements increases; without affecting on the mast cells, but their secretory activity increases. There are size thymic corpuscle and the number of cells in them increases. Thus, the furosemide load is accompanied by magnesium imbalance, proinflammatory changes induce, is accompanied by a proapoptotic action and stimulates the starting of a macrophage reaction and degranulation of mastocytes in the thymus.

RUDN Journal of Medicine. 2020;24(1):85-92
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PHYSIOLOGY. EXPERIMENTAL PHYSIOLOGY
State of the antioxidant protection system of rat liver in ischemia and reperfusion
Popov K.A., Bykov I.M., Tsymbalyuk I.Y., Denisova Y.E., Stolyarova A.N., Azimov E.A., Shurygina L.A.
Abstract

Purpose: determination of the state of the antioxidant protection system of the cytosolic fraction and suspension of rat liver mitochondria after experimental ischemia and reperfusion. Materials and methods: the study was conducted using white mature rats, divided into 3 groups: the control group (n = 15); The 2nd group of animals (n = 15), from which the liver was taken after 15 minutes of liver ischemia; the 3rd group of rats (n = 15), from which the liver was taken after a 15-minute reperfusion period, followed by a 15-minute ischemic period. Mitochondrial suspension and cytosolic fraction were isolated from liver tissue. Results: the obtained research results showed the presence of certain pathobiochemical changes in the suspension of mitochondria and the cytosolic fraction after ischemia or reperfusion. In the mitochondrial suspension during the reperfusion period it was found an adaptive increase in the activity of glutathione peroxidase by 39% and glutathione reductase by 61%. In the cytosolic fraction, it was the most remarkable increase of the total antioxidant capacity by 38% already during ischemia and a progressive decrease in the level of reduced glutathione form by 26% in ischemic and 55% in reperfusion period. The change in the state of the antioxidant system occurred against the background of an increase in the number of products of oxidative modifications of biomolecules by 40% during ischemia and 2.2 times after reperfusion. Conclusion: The results indicate the need to develop not only a mitochondria-oriented correction of oxidative disorders, but also active support for the components of the cytosol, which provide the main accumulation of free radical damage products and their subsequent removal from the cell, which is essential for survival.

RUDN Journal of Medicine. 2020;24(1):93-104
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IMMUNOLOGY
Significance of pathogenicity factors in initiation of immune response in Helicobacter pylori infection
Matveeva L.V., Kapkaeva R.H., Chudajkin A.N., Novikova L.V.
Abstract

Helicobacter pylori is a unique microorganism capable of long-term colonization of the gastric mucosa, induction of the inflammatory process, antigenic mimicry and immune evasia. Flagella proteins, adhesins, invasive and aggressive enzymes, cytotoxin-associated protein, vacuolating cytotoxin can have a damaging effect on stomach epithelial cells. Recognition of molecular patterns of Helicobacter pylori by stomach cell receptors initiates activation of adapter proteins, protein kinases and transcription factors, leading to the production of proinflammatory cytokines, infiltration by neutrophilic granulocytes, absorption and killing of microorganisms by phagocytes with presentation of antigens to lymphocytes, while the activity and completeness of phagocytosis remain at a low level. Activation of CD8+-, CD16+- lymphocytes is accompanied by cytotoxic effect on both Helicobacter pylori and epithelial cells of the gastric mucosa. Weak immunogenicity of Helicobacter pylori antigens limits the production of anti-Helicobacter antibodies. Thus, activation of immune factors, in most cases, does not lead to complete elimination of the pathogen, but can aggravate the pathomorphological changes of the gastric epithelium.

RUDN Journal of Medicine. 2020;24(1):105-113
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