Preview

Сибирский научный медицинский журнал

Advanced search
Vol 41, No 1 (2021)
View or download the full issue PDF (Russian)

DISCUSSION

4-15 920
Abstract
Numerous publications on stem cells and cell therapies have appeared last time. Topics discussed in the literature include the differentiation of exogenous SC into various cell lineages, the replacement of senescent, dysfunctional, and damaged cells. However, in vitro differentiation with the expression of certain markers does not prove replacement of functioning cells in vivo. The application of cell therapies in cardiovascular, hepatic, neurodegenerative diseases, osteoarthritis and diabetes mellitus is discussed in this article. Recent data on COVID-19 are overviewed. Some publications exaggerate successes of cell therapies without giving due consideration to potential adverse effects. In recent years there has been a global expansion of stem cell treatments. In conclusion, therapeutic methods with unproven effects should be applied within the framework of high-quality scientific research shielded from conflicts of interest.
16-32 473
Abstract
The main purpose of the article is to discuss the effectiveness of cell therapy. We have analyzed as example the areas trends in clinical trials to determine the effectiveness of cell therapy. The conceptual approaches to cell therapy application, results of clinical trials, identified problems have been discussed in the paper.

REVIEWS

33-43 665
Abstract
The C-peptide is a fragment of proinsulin, the cleavage of which forms active insulin. In recent years, new evidence has emerged indicating that C-peptide is involved not only in the processing of insulin in the secretory granules of pancreatic β-cells, but also has an important regulatory effect on the functions of many organs and tissues. C-peptide mediates physiological effects through signaling pathways by binding to a specific receptor on the cell membrane. Intracellular signaling occurs through the G-protein and Ca2+- dependent pathways, which leads to the activation and increased expression of endothelial nitric oxide synthase, Na+/K+-ATPase, and important transcription factors involved in apoptosis, anti-inflammatory and other intracellular defense mechanisms. One of the most important physiological effects of C-peptide is the regulation and modification of insulin signaling mechanisms. The nature of the effect of C-peptide on the insulin signaling system depends on the concentration of insulin. It is assumed that under conditions of low insulin levels, the C-peptide receptor binds to Gi/o-proteins and leads to increased activation of processes induced by insulin. In this case, the C-peptide acts as insulin-mimetic peptide. Under high insulin conditions, the C-peptide receptor binds to Gq/11-proteins and leads to activation of protein kinase C with subsequent weakening of insulin-related signaling cascades. This review presents new facts indicating the participation of C-peptide in the regulation of the insulin signaling system.
44-49 837
Abstract
The development of complications as a result of neurosurgical operations is an urgent problem nowadays. Various approaches to the classification of complications are presented in the literature. They are based on the nature of the complications, the time of development, the duration of the neurological deficit, the direct connection of the complications with the surgical intervention, methods of their treatment, etc. On the average, the complication rate ranges from 5 to 28 %. In brain operations, the risk of complications is higher than in spinal surgery. The reasons for their development are various and are associated with surgical intervention, the course of the postoperative period, the somatic status of the patient before surgery and the initial pathology that required surgical treatment. From 7 to 24 % of patients require readmission within 30 days after discharge from the hospital due to complications. There are infectious, thromboembolic complications and the appearance or growth of a neurological deficit. The development of complications is associated with a deterioration in the quality of treatment, an increased risk of patient disability and death.

BIOMEDICINE

50-59 341
Abstract
Extramammary Paget’s disease (EMPD) is a rather rare variant of adenocarcinoma, most often localized in the anogenital area or perineum. The aim of our study was to determine the prognostic significance of histological variants of primary EMPD in relation to the risk of tumor recurrence. Material and methods. 202 samples of primary EMPD were taken from 158 patients. Sections stained with hematoxylin and eosin were examined. Results and discussion. 23 patients (14.6 %) had recurrent EMPD. The study revealed that «glandular», «pigmented», «signet ring», «acantholytic» morphological variants of EMPD, as well as syringocystadenocarcinoma papilliferum in situ–like changes and the presence in the dermis of structures similar to eccrine syringoma, are associated with the development of disease recurrence. Conclusion. The «signet-ring» and «pigment» morphological variants of EMPD have the highest predictor value in relation to the risk of disease recurrence. The «signet ring-cell» variant of primary EMPD is the only one that influences the time of the first recurrence of the disease.
60-68 243
Abstract
Introduction. We have developed the aminoacid trace element composition «tritarg». The positive effects of tritarg in case of alcohol intoxication were revealed (it prevents the development of amino acid imbalance in the thymus and spleen), a favorable effect is shown when combined with cyclophosphamide (it prevents the decrease in the number of leukocytes in the blood and increases the phagocytic activity of neutrophils). The aim of the work was to analyze the effect of the course introduction of the «tritarg» composition (arginine, taurine, tryptophan and zinc aspartate) on the processes of utilization of amino acids, their primary metabolism in the liver, as well as transformation during passage through the liver. Material and methods. The experiment was conducted on outbred rats weighing 120–140 g. Animals were injected intragastrically for 10 days with tritarg at a dose of 500 mg/kg, 24 hours after the last tritarg administration – once intragastrically infezol 40 at a dose of 20 ml/kg. The animals were decapitated 10 minutes or 45 minutes after infezol 40 administration. Free amino acid content in blood plasma was measured by reverse phase HPLC. Results and discussion. 10 minutes after a single intragastric administration of Infezol40 in the blood plasma of animals that were previously treated with tritarg for 10 days, the total content of amino acids and their nitrogencontaining derivatives increased, the total number of proteinogenic amino acids, essential amino acids, branched-chain amino acids, aromatic amino acids, the ratio arginine/citrulline. The introduction of a mixture of amino acids. 45 minutes after the administration of Infezol 40 in the blood plasma of animals previously treated with tritarg for 10 days, the structure of the pool of amino acids did not differ from the control group. Consequently, the course administration to animals of the amino acid-microelement composition «tritarg» has a multilateral effect on the metabolism as a whole, which becomes apparent with the introduction of a test dose of a full-component aminosol. Conclusion. Thus, we assume that the observed differences in the change in the pool of free amino acids in the experimental groups are due to the fact that course administration of the «tritarg» minisol, including amino acids arginine, tryptophan and taurine, as well as the trace mineral zinc significantly affect the metabolism, proliferative activity and secretion of enzymes.
69-80 380
Abstract
Aim of the study was to investigate the immunogenetic characteristics of the potential donors of hematopoietic stem cells recruited in the North Caucasus and the distribution features of HLA alleles and multilocus haplotypes. Material and methods. Next Generation Sequencing technology was used to identify HLA-A, -B, -C, -DRB1 and -DQB1 alleles from 2663 unrelated bone marrow volunteers living in the Chechen Republic, Stavropol region, Republic of Dagestan. Mass parallel sequencing was performed using the MiSeq™ System («Illumina Inc.», USA). HLA allele and haplotype frequencies were estimated via maximum-likelihood analysis from genotypic data through an expectationmaximization (EM) algorithm for unknown gametic phase using Arlequin v. 3.5.2.2. Results and discussion. In studied population, 47 HLA-A, 77 HLA-B, 39 HLA-C, 54 HLA-DRB1, 22 HLA-DQB1 alleles were selected. Thirteenth alleles, HLA-A*02:01, HLA-A*01:01, HLA-B*13:02, HLA-B*51:01, HLA-C*06:02, HLA-C*04:01, HLA-C*07:02, HLADRB1*07:01, HLA-DRB1*13:01, HLA-DQB1*03:01, HLA-DQB1*02:02, HLA-DQB1*06:03, DQB1*03:02 exhibit frequencies over 10 %. The highest frequency extended haplotype HLA-A*02:01-B*13:02-C*06:02-DRB1*07:01DQB1*02:02, was observed frequencies of 4,5 %. Routine HLA typing allowed us to define 13 new HLA alleles.
81-90 293
Abstract
Background. Atherosclerosis is frequently accompanied by an extensive calcification, yet the mechanisms behind its initiation and progression remain obscure. In particular, there is unclear whether large mineral deposits grow concentrically or by merging of microcalcifications. Aim of the study was to investigate calcium phosphate maturation during atherosclerotic calcification employing an elemental analysis approach. Material and methods. We collected 20 calcified atherosclerotic plaques excised during carotid endarterectomy. After being fixed in formalin and postfixed in osmium tetroxide, plaques were dehydrated and stained in uranyl acetate with the subsequent embedding into epoxy resin, grinding, polishing, and lead citrate counterstaining. Upon the sputter coating with carbon, we visualised the plaque microanatomy by means of backscattered scanning electron microscopy. Elemental analysis was carried out using energy-dispersive X-ray spectroscopy in the backscattered mode at high vacuum and 20 kV voltage. The analysis was performed at 11 radial points within the calcium deposit and 4 control points at ascending distance from the deposit. Results. Calcium to phosphate ratio differed between the calcium deposits in distinct plaques and also within the same plaque. We found a statistically significant correlation between calcium to phosphate ratio in the center and periphery of the calcium deposit. Areas with distinct electron density had different calcium to phosphate ratio; however, there was no clear correlation between these parameters. Conclusion. Correlation of calcium to phosphate ratio in the center and periphery of the calcium deposit suggests that its maturation develops from the center to the periphery rather than by merging of neighboring calcium deposits.

CLINICAL MEDICINE

91-99 667
Abstract
Multimorbidity is an urgent problem of modern medicine, associated with a greater severity and more serious prognosis of diseases, a large number of complications, difficulty and the high cost of diagnosis and treatment. The study of the quality of life of patients with multimorbidity is necessary for the competent distribution of health resources. Aim of the study was to investigate the effect of transnozologic multimorbidity (TMM) on the components of quality of life (QoL) in patients of a therapeutic clinic. Material and methods. A total of 116 patients, men and women aged 20 to 75 years were examined at the clinic of the Federal Research Center for Fundamental and Translational Medicine in Novosibirsk. TMM was evaluated by the average number of nosologies corresponding to the three-digit classification of ICD-10. Assessment of QoL indicators was carried out using the validated questionnaire SF-36. To assess the number and severity of chronic diseases in the structure of TMM, the CIRS (Cumulative Illness Rating Scale) system was used. Results. Depending on the severity of TMM, 3 groups of patients were formed – with low (n = 42), medium (n = 52) and high TMM (n = 22). A comparative analysis of indicators of QoL, as well as TMM structure in 3 groups was carried out. A comparative analysis showed a significant decrease in the level of physical functioning (by 27 %), physical and mental health components (by 26.3 % and 15.8 %, respectively), and the integral indicator of quality of life (by 19.2 %) in patients with a high level TMM, compared with patients with low TMM. Correlation analysis confirmed the presence of a statistically significant relationship between an increase in TP and a decrease in the main indicators of QoL. Conclusion. An increase in the degree of TMM in patients is significantly associated with a decrease in the main indicators of QoL.
100-108 326
Abstract
Clinical recommendations for cardiac resynchronization therapy (CRT) were based on the results of large multicenter studies. However, patients with congestive heart failure (CHF) in real clinical practice differ from the cohort included in randomized trials. Aim of the study was to evaluate the clinical and demographic characteristics of patients with CHF and implanted devices for CRT in real clinical practice according to the local register of implanted cardiac devices and to compare local cohort with patients included in large clinical trials and registers. Material and methods: The study enrolled 218 patients (83 % men, 17 % women) with CHF implanted with CRT devices from January 2003 to December 2018. Results and discussion: When compared to large studies and registers local cohort was significantly younger (75,9 % of patients were younger than 65 age), the mean age was 57,2 ± 10,5 years. NYHA functional class was lower and left ventricular ejection fraction was higher. However, the distribution of comorbidity was higher, 65 % of patients had ≥3 comorbid conditions. Atrial fibrillation (AF) was observed more frequently (38.5 %). Conclusion: Our data demonstrate significant differences between real clinical cohort and cohort of patients included in large multicenter studies. These differences may significantly affect the effectiveness of CRT both positively (lower age, lower NYHA) and negatively (high distribution of AF and other comorbidities). This explains the need for randomized control CRT studies in Russia and the creation of local registers of CRT devices.
109-116 297
Abstract
The developed computer program for choosing the tactics of treating patients with gastro duodenal ulcerous bleeding (GDUB) combined with various forms of coronary heart disease to the fullest extent meets demands not only practical emergency medicine, but modern evidence-based medicine. The presented case of clinical observation serves the clear illustration of this issue, which convincingly indicates that use of the developed computer program to choose the tactics of treating patients with GDUB combined with various forms of coronary heart disease allows us not only to accurately establish the clinical diagnosis, but also to choose the most appropriate treatment tactic.

PREVENTIVE MEDICINE

117-123 267
Abstract
Introduction. Tobacco smoking is one of the main and independent risk factors for cardiovascular disease developing. Despite the fact that the main effects of tobacco use on human health are well known, the annual number of smokers on the planet is still growing. The aim of the study was to study the twenty-year dynamics of the prevalence of tobacco smoking among women aged 25–64 in the open population of a moderately urbanized city of Western Siberia. Material and methods. Within the regional program for monitoring the epidemiological situation in relation to the risk of developing CVD in 1996 and 2016. Two simultaneous epidemiological studies were carried out among persons from the Central Administrative District of Tyumen – a sample of 1000 women aged 25–64 years. The yield was 81.3 % (n = 813) in 1996, and 70.3 % (n = 703) in 2010. The prevalence of tobacco smoking was determined using a questionnaire developed in the former USSR by the Institute of Preventive Cardiology of the Academy of Medical Sciences (now FSBI «NIMTs TPM» of the Ministry of Health of Russia) as part of the implementation of the Cooperative Study on Multifactorial Prevention of cardiac ischemia. Results and its discussion. According to the results of 20-year monitoring among women aged 25–64 years of the open population of a medium-urbanized city of Western Siberia, an increase in the prevalence of tobacco smoking was established (23.1 % – 31.2 %, p = 0.0036). The highest prevalence of tobacco smoking was found in women in the third decade of life, a significant increase in the indicator during the 20-year monitoring of the open population - in the fourth to sixth decades of life. The established patterns in the dynamics of the increase in the prevalence of tobacco smoking among women aged 25–64 years in the open population of a mediumurbanized city of Western Siberia were determined by an increase in the proportion of women who smoke irregularly (11.4 % – 20.1 %, p = 0.0000) and who started smoking (27.7 % – 37.6 %, p = 0,0000). 20-year monitoring of the open population of a medium-urbanized city of Western Siberia showed some positive trends in the decrease in regular tobacco smoking among women in the third decade of life (25.1 % – 13.5 %, p = 0.0187). Conclusion. Thus, in the open population of a moderately urbanized city of Western Siberia over the period of 20-year monitoring among women aged 25–64 years, a negative epidemiological situation was established in terms of the dynamics of the prevalence of tobacco smoking due to the growth of irregular tobacco smoking and those who started smoking. Positive trends in the Tyumen population are determined by a decrease in the prevalence of regular tobacco smoking in one age group of 25–34 years.
124-129 553
Abstract
This article describes the main issues and problems that arise in the process of implementing long-term home care and maintaining the quality of life of elderly people who are in conditions of forced self-isolation. The aim of the work is to identify factors that have a negative impact on the provision of a decent quality of life by long-term home care professionals for the elderly in conditions of self-isolation. The research material was official statistics and the results of scientific research by Russian scientists. The main research methods used were the method of theoretical scientific analysis, the method of systematization, interpretation, and the method of generalization of the activities of medical and social services that provide long-term care for the elderly at home. The analysis showed that the forced self-isolation of the elderly, caused by the presence of acute respiratory viral infections, leads to a number of negative consequences, which together can worsen both the physical and mental state of a person, which ultimately will lead to a decrease in the quality of life. The result of this study was to identify such problems that exist in the practice of long-term care for older people who are in conditions of forced self-isolation, such as: the problem of quality control of services, imperfection of methods and technologies used to work with older people to ensure a decent quality of life in conditions of forced self-isolation and limited social contacts. Based on the results of the study, some measures have been proposed that will resolve the existing problems in a relatively short time.

HEALTHCARE MANAGEMENT

130-139 455
Abstract
Over the past two decades, the availability of medical personnel in Russia’s healthcare sector has continued to deteriorate. Over the period from 2000 to 2018, it decreased by about 11 % for both doctors and specialists with secondary medical education. This is due to several reasons: the rejection of the previously existing system of training and saturation of the industry with specialists, the unsuccessful optimization of the country’s health system, the lack of attention of the authorities to young professionals, the creation of favorable conditions for them to live and work, etc. An important role is played by insufficient work on career guidance, including in medical specialties with students of General education organizations and the reluctance of medical workers to do this. The article provides recommendations for the organization of career guidance among high school students, describes the forms in which it can be carried out. This includes specialized medical classes, clubs for studying the basics of medical knowledge, and volunteering. The experience of the regional clinical hospital, which for 5 years has been supervising a specialized medical class, 78–96 % of whose graduates have chosen the medical profession is of considerable interest. Teachers of the Novosibirsk Medical College actively work with General education organizations, and therefore the competition among applicants is from 2 people per place in the specialty «Nurse» to 12–14 in the specialties «Pharmacy» and «Orthopedic dentistry». The effectiveness of career guidance largely depends on how systematically and methodically it is carried out. To successfully conduct it, you need to organize a three-level system: career guidance office (level I), career guidance point (level II), career guidance center (level III). The joint work of representatives of General education and medical organizations, medical schools, will help to ensure that school graduates will come to medicine, confident in the correctness of their chosen profession. After graduation, they will return to their native land, to their familiar environment, and with a high degree of probability will remain there forever.
140-148 244
Abstract
Aim of the study was to investigate and compare the levels, structure, dynamics of indicators of morbidity complicating the course of pregnancy in the Irkutsk and Amur regions for the period 2008–2018. Material and methods. We used the databases of the Federal State Statistics Service and Medical Information Analytical Centers of the Irkutsk and Amur regions. To assess the trend of time series, we used one-way linear regression analysis. Time was independent variable. Results. Leading in the frequency of diseases of pregnant women: anemia, diseases of the genitourinary system, diseases of the circulatory system, thyroid disease. The highest incidence rates were recorded in the Amur Region. Trends in prevalence were noted in such forms as venous complications in pregnant women, diabetes mellitus. The prevalence of diseases of the genitourinary system, diseases of the thyroid gland, diseases of the circulatory system showed a downward trend. Conclusion. In the Amur region, the incidence of pregnant women was higher than the average Russian level and the level in the Irkutsk region in such forms as diseases of the genitourinary system, thyroid disease and circulatory system diseases. In all objects, there has been a tendency to an increase in the prevalence of venous complications, diabetes mellitus and thyroid diseases. The reason for this could be a crisis in the socioeconomic sphere, as well as an increase in the level of diagnosis.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2410-2512 (Print)
ISSN 2410-2520 (Online)