Vol 70, No 3 (2015)

Background: The incidence of the postoperative atrial fibrillation (POAF) after open heart surgery is up to 65%. Statin therapy has shown conflicting data in the prevention of the POAF. Objective: Our aim was еo evaluate the role of statin therapy in the primary prevention of AF after CABG. Methods: Group 1 (n =84) included those patients who received no statin therapy and the Group 2 (n =124) included those patients who did receive statin therapy for at least three days prior to the operation and for all days in the postoperative period. WBC count in different periods after surgery and rate of AF were evaluated. The risk of occurrence of postoperative AF was evaluated using the Cox-regression model and odds ratio. Results: A retrospective analysis of 206 medical records of the patients without pre-existing AF after CABG was performed. The rate of AF was 26% in Group 1 and 6.5 % in Group 2 (p =0.0001). On Day 4 after surgery, WBC count was 11 (9;13) in the first group and 9 (7,6;10,2)×10⁹ e/L in the second group (p =0.000001). «Statin use» and «number of grafts» and were found to be statistically meaningful: p =0.002 and p =0.0125 respectively (χ²=28,3; p <0.001). In accordance with the Cox model of regression, the risk of AF was 0.201 for «statin use»; and 2.099 for «number of grafts». Odds ratio was 0.2 (95% CI 0.08–0.5). Conclusion: Statin therapy prior to and after GABG was found to be an effective method of primary prevention of AF in the early postoperative period.

The paper presents results of a comprehensive analysis of the cardiovascular diseases (CVD) situation, both in the global and Russian contexts. It introduces original data illustrating the declining mortality rate from CVD, and the diminishing contribution of these diseases to overall mortality rate — globally and, to a larger extent, in developed countries. The paper also analyses the reasons for continuing CVD epidemic in Russia. Based on factual evidence, it argues that those include insufficient expenditures on treating CVD patients, and critically inadequate funding of prevention programmes. Unsatisfactory use of these funds to subsidise Russian regions (without taking into account their actual needs determined by the CVD mortality rate) only makes the problem worse. Through modelling, «average» efficiency of the Russian health care system in reducing CVD mortality was revealed. The paper describes various scenarios for future development of the Russian CVD situation. In the context of innovation-based scenario, the advantages of technological foresight are analysed; specifically, the authors summarise major S&T development trends in the health sector (using data of the Russian S&T Foresight 2030), which could significantly contribute to stopping the CVD epidemic in Russia.

The article presents a literature review over the last few years devoted to the health status and development peculiarities of children born using assisted reproductive technologies (ART) procedures. The statistics shows an explosive increase in the frequency of ART application as a fertility treatment method. The presented data analysis reflects the perinatal outcomes after ART in children, the frequency of congenital malformations and genetic diseases in this population, possible long-term malconditions and pathologies in children born using ART. The overwhelming majority of investigators consider the adverse effect of ART on a child’s body to be the result of prematurity and multiple pregnancy (transfer multiple embryos followed by partial reduction). It is stated that the widespread introduction of ART may contribute to the vertical transmission of parental infertility factors in the population. The application of ART procedures in some cases is associated with controversial ethical and legal issues (surrogacy, oocyte donation). Further improvements in ART procedures (preimplantation training, medical and genetic diagnosis, reducing the frequency of multiple pregnancy) cannot be stated as an alternative to the general medical and social prevention of reproductive disorders in adolescents and youth.

Background: One of the main difficulties in assessing the effectiveness of etiologic treatment of hypoparathyroidism is absence of its standardized model. Objective: The aim of the study was to develop a method of hypoparathyroidism modeling. Methods: Controlled nonrandomized study was performed on female Wistar rats aged 10 month. Group 1 (n =14) was performed with destruction of parathyroid glands with electrocoagulation; group 2 (n =12) — parathyroidectomy by the developed method. In 3 and 14 days after the surgery the levels of ionized calcium, parathyroid hormone, number of white blood cells, blood leukocyte formula, indicators of immunological tests, histological examination of organs in the area of operations were performed. Statistical analysis was performed using the nonparametric Mann–Whitney-Wilcoxon test. Results: Selection of animals by sex and age criteria, angular skin incision, use of the operating microscope, microsurgical techniques, extirpation of parathyroid glands via resection of thyroid gland with the closure of the wound defect glue appeared to be the distinctive features of the developed method. In 14 days the group 2 showed decrease in ionized calcium (p =0.016), PTH (p =0.094), leucocytes (p =0.004), PI (р =0.003), spontaneous NBT test (р =0,004), induced NBT test (р =0.003) compared with group 1. Histological examination in the group 2 revealed no changes in thyroid gland, thin connective tissue capsule, cavity with a small amount of glue, however, there were determined foci of necrosis with perifocal inflammation in the group 1. Conclusion: Combination of several techniques allowed to simulate metabolic disorders with persistent hypocalcemia as well as lack of mortality in early postoperative period.

Background: Non-drug correction of reparative bone tissue regeneration in different pathological states — one of the most actual problems of modern medicine. Objective: Our aim was to conduct morphological analysis of the influence of electromagnetic radiation of ultra-high frequency and low intensity on reparative osteogenesis and angiogenesis in fracture treatment under transosseous osteosynthesis. Methods: In the experiment conducted on rats we modeled tibial fracture with reposition and fixation of the bone fragments both in control and experimental groups. In the animals of the experimental group the fracture zone was exposed to low intensity electromagnetic radiation of ultra-high frequency. Exposure simulation was performed in the control group. The operated bones were examined using radiography, light and electronic microscopy, X-ray electronic probe microanalysis. Results: It has been established that electromagnetic radiation of ultra-high frequency sessions in fracture treatment stimulate secretory activity and degranulation of mast cells, produce microcirculatory bed vascular permeability increase, endotheliocyte migration phenotype expression, provide endovascular endothelial outgrowth formation, activate reparative osteogenesis and angiogenesis while fracture reparation becomes the one of the primary type. The full periosteal, intermediary and intraosteal bone union was defined in 28 days. Conclusion: Among the therapeutic benefits of electromagnetic radiation of ultra-high frequency in fracture treatment we can detect mast cell secretory activity stimulation and endovascular angiogenesis activation.

Background: Justification of the study direction of public health improving is quite general. But the identification of the most effective indicators of the healthcare system improvement remains unexplored. Objective: Our aim was to determine the interaction between the basic demographic indicators of the region (Smolensk region) and efficacy endpoints of the Healthcare management identified in the study. Methods: The study reviewed the demographic changes of the Smolensk region at present and the forecast for 2015, 2016, 2017. The forecast of demographic and health indicators was based on exponential smoothing models and autoregressive model. Results: The study identified the most appropriate medical and demographic indicators. 1) The ratio of physicians (per 10,000 people in population, the rate maximum was 62 in 2004, in 2015 this figure has fallen to 52, and it is supposed to decrease to 49 by 2017). 2) The overall mortality rate (per 1000 people in population). Reduction of the resident population of the Smolensk region is 8.2 thousand people in annual average. This fact shows a stable depopulation of the region. 3) The average load on the ambulance. It has been found that the increase and decrease of these parameters directly affect the population rate. Conclusion: The study revealed a stable downtrend of average resident population number which confirms the long regional depopulation. It is associated in particular with the lack of stimulation of the health and demographic indicators’ increase including but not limited to inefficient healthcare management arrangements.

Objective: The aim of our study was to compare the changes in the severity of positive, negative and psychopathological PANSS symptoms which occur as an outcome of an attack in schizophrenic patients along with remission formation and the degree of platelet activation in these patients. Methods: Psychometric scale of the Positive and Negative Syndrome Scale (PANSS) and the method of estimation of platelet activation based on the calculation of cells number after elution from the column with sepharose CL-2B were used. Results: The changes in the severity of the disease were estimated using the PANSS scale of chronic schizophrenic patients in remission formation. An increase in platelet activation was determined on the basis of the above described quantitative parameter. Comparison of changes in platelet activation parameter with changes in the disease severity rating detected similar statistically indistinguishable (p >0.05) changes in the severity of positive symptoms and quantitative variable of platelet activation between the 1^st and the 3^rd visits in the period of remission formation. Platelet number after elution from the column during the 3^rd visit was approximately two times less than during the 1^st visit (p =0.002). PANSS positive subscale shows a decrease of the severity of the syndrome by 1.6 times (p <0.0002). In addition the difference between the platelet activation parameter and severity of the negative syndrome was fixed during the 3^rd visit (p <0.034). Conclusion: Similar changes in the severity of positive syndrome and platelet activation parameter were presented from 1^st to 3^rd visit in the remission formation. A distinction was also made between the platelet activation parameter and severity of the negative syndrome was fixed during the 3^rd visit.

Background: One way to increase drug efficacy is to provide a drug delivery transport system to the target organ. A widely used method is to incorporate the drug in a biodegradable polymer composition with forming nanosized drug’s transport forms. Objective: Our aim was to investigate the tissue biodistribution of antibiotic rifabutin transport system based on lactic and glycolic acids copolymer, and to compare it with the pure substance of rifabutin. Methods: These substances were administered to two groups of rats intragastrically in the doses of 10 mg/kg. After a certain period of time, the animals were sacrificed by cervical dislocation. Samples preparation for analysis was carried out of the liquid-liquid extraction. Active substance’s concentrations were measured by high performance liquid chromatography method. Results: The study included 8-week-aged Wistar rats of both sexes weighing 0.22±0.02 kg. Animals were divided into 2 groups. The study group received polymer form of antibiotic, and the comparison group received substance of rifabutin. In intervals of 10 min, 30 min, 1 h, 2 h, 4 h, 7 h, 15 h, 24 h after drug administration liver, lung, spleen, kidney, intestines, stomach, heart and brain were resected respectively. Organs were measured by their weight. The drug was not detected in the brain. Rifabutin was determined in other examined tissues within 10 minutes and the maximum drug concentration in organs was fixed in 1.5–3.5 hours after administration. The rifabutin concentrations defined in the lungs were significantly higher in polymer form (p <0.05). The polymer form’s distribution coefficient was higher in the liver and lungs (15.83 and 10.14 μg/g respectively) in comparison with the substance one. The minimum amount of the active ingredient was observed in the heart (0.02 μg/g). Conclusion: It is shown that the inclusion of the drug in a polymeric form substantially alters its localization in organs and tissues. Extensive biodistribution nanorifabutin in lung tissue, liver and spleen is established.

Objective: Our aim was to identify the most informative clinical and laboratory predictors of chronicity of Ixodes tick-borne borreliosis in the acute phase of the disease based on the «optimal cut-off values» (COV) and the predicted probability of the outcomes. Methods: A retrospective cohort controlled study was carried out. We used the technique of ROC-analysis to estimate the information content of the clinical and laboratory indicators in patients with Ixodes tick-borne borreliosis in the acute phase of the disease with erythemal (n =16), non-erythemal (n =77) forms of Ixodes tickborne borreliosis and co-infection with the tick-borne encephalitis (n =68) for the prediction of the outcomes: recovery or chronization. Results: A retrospective analysis of clinical and laboratory parameters recorded in the acute phase of the disease in 161 patients with chronic Ixodes tick-borne borreliosis. The calculations were performed for the informative clinical and laboratory prognostic predictors of the outcomes for the intervals above and below the COV values are defined probabilities of recovery or chronization of Ixodes tick-borne borreliosis. A general predictor of outcomes for all clinical forms of the disease — the interleukin 8 — was established: the probability of chronization after erythemal form is 100.0% at the level of its production over 107.89 pg/ml (AUC =1.0), after non-erythemal form is 54.63±0.23% at serum concentrations above 94.64 pg/ml (AUC =0.770), after co-infection with the tick-borne encephalitis is 52.69±0.27% at the level of interleukin 8 above 84.96 pg/ml (AUC =0.780). Conclusion: The  results of the study suggest the possibility of predicting the outcomes of infection in the acute phase, which allows to optimize the etiopathogenic therapy of the disease in a timely manner.

First published on the website of the journal "Current Pediatrics". Available at: http://www.spr-journal.ru/ojs/index.php/VSP/about/submissions#authorGuidelines.

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