Vol 24, No 2 (2020)


Effects and clinical outcomes of early initiation of sacubitril/valsartan in patients with chronic heart failure with a low ejection fraction

Kobalava Z.D., Galochkin S.A., Tolkacheva V.V., Bagmanova N.K.


Aim : to evaluate effects and clinical outcomes of early initiation of sacubitril/valsartan in patients with chronic heart failure with a low ejection fraction. Methods : 30 patients admitted to the clinic for an episode of acute heart failure (AHF) II-IV class NYHA and decreased ejection fraction ≤40% (83.3% of men, mean age 66.0 [58.0-76.0] years) were included into the open study. Patients received the first dose of the study drug no later than 6 hours before discharge from the hospital. The period of active treatment was 26 weeks. At week 12 and 26, the number of patients receiving the target dose of 400 mg/day, as well as the dynamics of symptoms and severity of heart failure (HF) were evaluated. During the entire period of the study, safety parameters were investigated in all patients. Results . 70% of patients (n=21) received the target dose by week 2 77,8% (n=21) received the target dose of 200 mg 2 times a day at week 26. The positive effect in the dynamics of symptoms, as well as the severity of HF in the vast majority of patients were observed, a significant reduction in the severity of the main symptoms of HF was achieved, patients moved to a lower class of HF. 3 patients dropped out due to adverse events (1) and serious adverse events (2). 27 (90%) patients completed the program in accordance with the Protocol. Conclusion . Sacubitril/valsartanis is well tolerated, effective and safety drug in patients with CHF and a low ejection fraction.

RUDN Journal of Medicine. 2020;24(2):125-134
pages 125-134 views

Polypathy: searching for etiopathogenetic risks factors

Fus A.V., Podolinny G.I.


The article provides an overview of the literature on the actual problem of diseases - polypathy. The review focuses problematic aspects of comorbid states, the scatter of their definitions, the incidence in different countries according to the international scientific community, the frequency of use of comorbid indices, the influence of racial and ethnicity in polypathies, risk factors for the development of combined diseases both at the level of an individual’s genes and aspects of a person’s lifestyle and the environment, options for their pathogenetic development with examples of nodal chains and their effects (nodules), examples of countries with modified risk factors to reduce mortality according to the approved action plan World Health Organization for the Prevention of Chronic Noncommunicable Diseases. The review focuses on factors contributing to the development of polypathy, in particular connective tissue dysplasia. The problems of diagnosing the external signs of connective tissue dysplasia in comorbid patients according to accepted diagnostic criteria and the frequency of their occurrence abroad and in Russia. An analogy is drawn between the concept of cardiovascular continuum and the development of polypathy in the patient’s body with connective tissue dysplasia of varying severity. There is analyzed the experience of treating patients with comorbid pathology of both the international scientific society of comorbidity (2010) and the Russian recommendations on comorbidity (2016). There is raised the development of COVID-19 in different patients with polypathy in China and other countries.

RUDN Journal of Medicine. 2020;24(2):135-144
pages 135-144 views


Immunohistochemical study of P53 protein expression in different prostate cancer Gleason grading groups

Kudryavtsev G.Y., Kudryavtseva L.V., Mikhaleva L.M., Kudryavtseva Y.Y., Solovyeva N.A., Osipov V.A., Babichenko I.I.


Prostate cancer (PC) remains an urgent public health problem, especially in developed countries. The use of immunohistochemical research methods in addition to the morphological classification of prostate adenocarcinomas allows a more accurate diagnosis and prognosis of the disease. The aim of the study is to identify isoforms of P53 using clones of mouse antibodies (D-07 and Y5; Epitomics, USA) in prostate cancer with different proliferative activity and the degree of malignancy. Materials and Methods: The work included surgical material for prostate resection and prostatectomy, as well as biopsy specimens (56 cases in total). An immunohistochemical study was carried out with the Ki-67 marker, as well as with mouse monoclonal antibodies (D-07 and Y5) to the P53 protein, interacting with its “wild” and mutant isoforms. The significance of the difference in the samples was determined using the Mann-Whitney U-test, correlation relationships were determined using the Spearman coefficient. Results: Expression of P53 upon interaction with antibodies D-07 and Y5 was determined in 56.3% and 39.6%, respectively. A statistically significant direct correlation was found between the severity of P53 expression when interacting with Y5 antibodies and the degree of tumor differentiation (rs = 0.567, p <0.05), as well as between the expression level of this protein and tumor proliferative activity (rs = 0.698, p <0.05). Conclusion: Antibodies of clone D-07, interacting with both wild and mutant isoforms of P53 protein, show positive expression in adenocarcinomas of all degrees. Expression of the mutant P53 protein is most pronounced in low-differentiated carcinomas and correlates with high proliferative activity of tumor cells, which may be associated with a loss in the induction of P53-dependent apoptosis.

RUDN Journal of Medicine. 2020;24(2):145-155
pages 145-155 views


Functional results of surgical treatment of retinal detachment

Ilyukhin O.E., Frolov M.A., Ignatenko K.V.


The article analyzes the state of patients’ visual acuity after successful surgical treatment of retinal detachment. On the basis of gathered data, it was concluded that in case of detachment of the macula only in 50% of cases it is possible to increase visual acuity to 0.4 and higher. Restoration of visual functions continues for at least 6 months after the operation and is determined by the restoration of the structure of the outer segments of the photoreceptor cells. During this time, it is advisable to conduct drug therapy aimed at normalizing blood flow and functional activity of the retina. Visual functions recovery continues for at least 6 months after the operation and is connected with the restored structure of the outer segments of the photoreceptor cells. Important prognostic factors of central vision restoration in the postoperative period are visual acuity before surgery, duration of existence and height of macular detachment. Data on which of the methods of surgical treatment of retinal detachment allows to achieve higher visual acuity are contradictory. There is practically no data on the comparison of the effect on visual acuity of scleral buckling and vitrectomy in the long-term period, in patients with phakic eyes and with artiphakia. On visual acuity after fitting detachment of the macula may affect macular edema, epiretinal membrane formation and retinal folds, and edema of the peripapillary optic nerve head, progressive deterioration of blood flow in the basin of the central retinal artery, short posterior ciliary arteries and ophthalmic artery. It is believed that these factors are significantly more pronounced after scleral buckling than after vitrectomy. Some indicators of optical coherence tomography correlate with visual acuity after surgical treatment of retinal detachment: the state of the articulation line of the external and internal segments of the photoreceptors, as well as the state of the external limiting membrane.

RUDN Journal of Medicine. 2020;24(2):156-162
pages 156-162 views


Low molecular weight bioregulator of bacterial origin in condylomatosis therapy optimization

Abramashvili Y.G., Kolesnikova N.V., Borisova O.Y., Guryanova S.V.


Condylomatosis is a disease characterized by the formation on the surface epithelium of the skin and mucous outgrowths, which can reach significant sizes. The cause of the disease is DNA-containing human papillomavirus (HPV), which have a high affinity for epithelial tissues of the genital organs, esophagus, anal canal and respiratory tract. Clinicians have described various patterns of use of the drug Liсopid in the treatment of condylomatosis. Of interest is the development and further implementation of condylomatosis therapy using a drug based on glucosaminyl muramyl dipeptide in order to correct immunodeficiency states and treat papillomavirus infection. Clinical condylomatosis of the external genitalia is presented. In the study of PCR on HPV, 33 types with a high viral load were detected. Diagnosis: Papillomavirus infection. Condylomas of the external genitalia. The goals of therapy and the treatment regimen: prescribing the drug Liсopid (AO Peptek, Moscow) to activate innate immunity, which allows to get an adequately high immune response at the level of both cellular and humoral local immunity. After the therapy, condylomas of the external genital organs were not found at the examination. The patient notes an improvement, the disappearance of itching. Thus, condylomatosis therapy according to the standard 10 mg Liсopid regimen for 10 days was effective, it contributed to the disappearance of genital warts, the clinical effect persisted for the entire observation period - 3 months. The clinical effectiveness of the drug can be explained by its systemic effect on the correction of immunity through NOD2 receptors.

RUDN Journal of Medicine. 2020;24(2):163-167
pages 163-167 views

Use of modulation interference microscopy in applied immunology

Gizinger O.A., Levkova E.A., Savin S.Z.


Objective: to determine the osmotic resistance of red blood cells using modulation interference microscopy technologies in the light microscopy mode of biological objects to identify the dynamics and determine the possibilities for continuing apitherapy in patients with autoimmune diseases. Methods. Methodological approaches to the use of modulation interference microscopy and computed tomography for the tasks of diagnostic medicine and applied immunology are described. The technology of vital computer dynamic phase metering, special methods for sample preparation of cytoobjects, as well as a computer-aided automated analysis of cytological images were used; recognition algorithms, measurement and identification of micro-objects; methods of statistical data processing. Results. Using the domestic innovative laser microscope MIM340, the osmotic resistance of erythrocytes was estimated using the method of modulation interference microscopy to identify the dynamics and determine the possibilities for continuing apitherapy in patients with rheumatoid arthritis and multiple sclerosis. Using computer methods of cytodiagnostics, new aspects of the functional morphology of living cells were revealed, clinical and morphological parallels were established. It was possible to evaluate the diagnostic and prognostic value of vital cell morphometry in various pathological processes and assess the effectiveness of therapeutic measures. A data bank of graphic images of red blood cells and blood lymphocytes of patients with diseases of the immune system has been created. Findings. The study of the structural features and functional usefulness of circulating blood cells is of great importance in addressing the pathogenesis, diagnosis, assessment of the severity of various pathological conditions and the effectiveness of the therapy. We believe that the study of living cytoobjects using the new method of coherent phase microscopy will provide the most objective data and increase the information content of the analysis, which is undoubtedly an urgent and promising task. The immediate plans include the refinement of mathematical, algorithmic, and software to support decision-making in computer-aided analysis of images of the epidermis and the surface of the dermis in neoplastic processes - malignant skin diseases. It is also necessary to create algorithmic and software tools for computerizing studies of cell models for quantitative and qualitative assessment of the selective accumulation of xenobiotics by laser microscopy.

RUDN Journal of Medicine. 2020;24(2):168-175
pages 168-175 views


Applying of speleoclimatotherapy for improving children’s health and adaptational possibilities

Komissarova O.V., Dorohov E.V.


The article presents the results of the use of speleoclimatotherapy in recreational activities in children of primary school age. In the course of the study, we analyzed indicators of heart rate variability in children depending on the initial vegetative status. In vagotonics and normotonics, there was an increase in the activity of the sympathetic division of the autonomic nervous system, and in sympatotonics, there was a decrease in HRV parameters within the age norm, characteristic of increased activity of the sympathetic division of the autonomic nervous system. Such changes can occur when the adaptive reserves of the child’s body increase. However, when using speleoclimatotherapy during recreational activities, it is necessary to take into account the initial level of vegetative activity of heart rate regulation in children.

RUDN Journal of Medicine. 2020;24(2):176-182
pages 176-182 views

Physiological substantiation for indicators application to evaluate the young students fitness health

Mikhaylova S.V.


To characterize fitness health, defined as the state of the physical well-being of the body, due to the functional state, physical qualities and component composition of the body, assessment methods are needed. The purpose of the study : physiological justification of the choice of indicators for assessing the fitness of students’ health. Methods: the study was conducted according to the results of preventive examinations of 303 students 18-24 years old at the Health Center, including: anthropometry, bio-impedance research and assessment of physical fitness. Results. To assess fitness health, we used an index of the component composition of the body, which characterizes the ratio of components (fat and active cell mass, water content and basic metabolism), which ensures the flow of metabolic processes, maintaining nutritional status, shaping the nature of working capacity and the adaptive potential of the body. The body composition index has the greatest correlation with the level of fitness health. Assessment of physical fitness, necessary when choosing an adequate regime of power and aerobic load, was carried out according to motor tests included in the RWD complex. Using the index method (power index, Skibinskaya index, endurance coefficient), the functional state of the basic life support systems of the body involved in the implementation of motor activity was characterized. Conclusions. The application of the studied indicators for assessing fitness health has a physiological justification and is confirmed by the correlation analysis.

RUDN Journal of Medicine. 2020;24(2):183-190
pages 183-190 views

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