Vol 74, No 4 (2019)

OBSTETRICS AND GYNAECOLOGY: CURRENT ISSUES
Prediction and management model of preterm birth
Semenov Y.A., Dolgushina V.F., Moskvicheva M.G., Chulkov V.S.
Abstract

Background: It seems relevant to study the contribution of socio-demographic, somatic and obstetric-gynecological factors in the implementation of preterm birth.

Aims: Assessment of the prognostic significance of socio-demographic, obstetric-gynecological and somatic factors in the prediction of preterm birth and associated adverse pregnancy outcomes with subsequent validation of the prognostic model.

Materials and methods: Cohort study with a mixed cohort. A retrospective assessment of socio-demographic factors, harmful habits, obstetric and gynecological pathology, somatic diseases, course and outcomes of pregnancy was carried out with the assessment of the status of newborns in 1246 women with subsequent construction of a predictive model of preterm birth and adverse outcomes of pregnancy using Regression with Optimal Scaling and its prospective validation in 100 women. Results: The most significant predictors, that increase the chance of preterm birth and adverse pregnancy outcomes, were history of premature birth, irregular monitoring during pregnancy, history of pelvic inflammatory disease, smoking, obesity, the onset of sexual activity up to 16 years, cardiovascular and endocrine diseases. Intellectual job reduced the chance of preterm birth and adverse pregnancy outcomes This multivariate predictive model has a diagnostic value. The score of risk factors ≥25 points had a sensitivity of 73%, a specificity of 71%, the area under the ROC curve (AUC) 0.76 (good quality), p<0.001. After stratification of high-risk groups by maternal and perinatal pathology the following list of diagnostic and therapeutic measures is introduced and actively implemented in antenatal clinics. To stratificate this model, we prospectively analyze the course and pregnancy outcomes of 100 women divided into 2 groups: group 1 ― 50 women with preterm delivery, group 2 ― 50 women with term delivery. A total score of 25 and above had 44% of women in group 1 and only 10% of women in group 2 (sensitivity 81.4%, specificity 61.6%, positive predictive value 44%, negative predictive value 90%, positive likelihood ratio 2.2 [1.5−3.0], negative likelihood ratio 0.3 [0.13−0.68]).

Conclusions: We have proposed a model for predicting preterm birth and delivery and perinatal losses using the available characteristics of pregnant women from early pregnancy with moderate indicators of diagnostic value. Further validation of the model in the general population of pregnant women is required.

Annals of the Russian academy of medical sciences. 2019;74(4):221-228
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ANDROLOGY: CURRENT ISSUES
The risk of sperm demage in men with the combined effect of endocrine disruptors
Chigrinets S.V., Brukhin G.V.
Abstract

Background: The most frequent ultrastructural change in sperm cells is nuclear DNA fragmentation. Many authors believe that DNA damage to sperm cells can serve as a diagnostic marker of a negative paternal effect in the pre-implantation period of human development. A number of studies have shown a direct correlation between the high percentage of sperm DNA damage and the frequency of spontaneous abortions. On the other hand, it is known that the damaging effect of endocrine disruptors, for example, triclosan and bisphenol A, is based on their ability to induce oxidative stress, which is considered as one of the factors in cell DNA damage.

Aims: to assess the risk of sperm DNA fragmentation in men with the combined effect of bisphenol A, triclosan and 4-nonylphenol in seminal fluid.

Materials and methods: 84 samples of seminal fluid of men with normo-and patozoospermia were studied. The concentration of bisphenol A, triclosan and 4-nonylphenol in gas was determined by gas chromatography with mass spectrometry (GC-MS). The comparison groups were divided according to the degree of DNA fragmentation of spermatozoa into two groups: the 1st group of patients with DNA fragmentation of spermatozoa <15% (n=18) and the 2nd group ≥15% (n=29). The spermiological study was carried out according to the WHO recommendations (2010) taking into account the assessment of the number of spermatozoa, their motility and morphology, as well as the degree of fragmentation of the sperm DNA.

Results: Bisphenol A was found in 100% of the ejaculate samples with a median concentration of 0.150 ng/ml. Triclosan and 4-nonylphenol were detected in 84.3 and 98.1% of ejaculate samples with a median concentration of 0.11 and 0.16 ng/ml respectively. Comparison groups were statistically significantly distinguished by the concentration of bisphenol A and triclosan — p=0.014; p<0.001 respectively. Triclosan with an increase in concentration in seminal fluid by 0.1 ng/ml increased the chance of development of the degree of DNA fragmentation ≥15% by 2.9 times. The odds ratio of bisphenol A and 4-nonylphenol to DNA damage was not statistically significant. The prognostic model of the joint effect of endocrine disruptors on DNA damage, constructed using multiple logistic regression analysis, was also found to be statistically significant only with respect to the effect of triclosan.

Conclusions: The risk of damage to sperm DNA in men is primarily associated with the effect of triclosan in seminal fluid. At the same time, it is necessary to assume the absence of a synergistic effect of bisphenol A, triclosan and 4-nonylphenol on the DNA damage of spermatozoa in men.

Annals of the Russian academy of medical sciences. 2019;74(4):229-234
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DERMATOLOGY and VENEROLOGY: current issues
Prerequisites for the development of dermatovenerological care, taking into account the implementation of the national project «Health»
Kubanova A.A., Martynov A.A., Vlasova A.V.
Abstract

The article discusses the prerequisites for the development of dermatovenerological assistance in the Russian Federation, taking into account the implementation of the national project «Health». The analysis of the state of the dermatovenerological service in the Russian Federation. Prior to the implementation of the Healthcare project, the authors attempted to justify promising directions for the development of dermatovenereological assistance in the country. Venereology clinics need to be reoriented, in particular, to provide specialized medical care to foreign citizens, as well as the introduction of new types of medical care, in particular, medical rehabilitation, as well as the development of the service component of the main activity. It is assumed that the implementation of priorities in the framework of the main direction of the strategic development of the Russian Federation «Healthcare» for the period up to 2025 will be aimed at solving issues important for health. Systematic work in this direction should ensure an increase in the availability and quality of medical care to the population of the Russian Federation, including in the «dermatovenereology» profile.

Annals of the Russian academy of medical sciences. 2019;74(4):235-244
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CARDIOLOGY AND CARDIOVASCULAR SURGERY: CURRENT ISSUES
Genetic aspects of lone atrial fibrillation in patients without structural heart disease
Golukhova E.Z., Zholbaeva A.Z., Arakelyan M.G., Bulaeva N.I., Minashkin M.M.
Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Among patients with AF the subgroup posessing AF without traditional risk factors is differentiated. Such patients are commonly referred as having “lone AF” and comprise 10–20% of all cases. A number of studies have demonstrated that the background of AF, and in particular lone AF, have a substantial genetic component.

Aims: To evaluate the influence of gene polymorphism to the development of atrial fibrillation in patients without concomitant valvular pathology and coronary artery disease.

Materials and methods: The study included 174 patients with atrial fibrillation and 124 controls without any cardiovascular pathology. All patients were divided into two subgroups: with “lone AF” (n=94) and with concomitant arterial hypertension (n=80). All patients underwent a complex of clinical, instrumental (ECG, echocardiography, computed tomography of the pulmonary veins) and laboratory tests (thyroid hormones, inflammatory markers, fibrosis), as well as genetic analysis (determination of single nucleotide polymorphisms described as AF risk factors in genes AGXT2, PDE4D, SLN, SCN5A, PITX2, PRRX1, ZFHX3, TBX5, CAV1 и HCN4).

Results: For the rare polymorphisms rs12291814 (SLN) and rs137854601 (SCN5A) wasn’t found anyone carrier of the minor allele (C and A, respectively). In the both patient subgroups the minor allele T of rs2200733 in PITX2 (OR=3.18, p<0.0001), minor allele G of rs3903239 in PRRX1, and minor alleles A of 2 polymorphisms rs2106261 and rs7193343 in ZFHX3 gene were revealed as risk factor of AF (OR=2.96, p<0.0001, OR=2.02, p=0.0045, OR=1.64, p=0.04, respectively). We also revealed significant difference between AF and control groups for rs3807989 in CAV1: homozygotic state of minor allele A has a protective effect on the development of arrhythmias (OR=0.39).

Conclusions: We revealed the association between the polymorphisms in genes regulating transcription and the development of atrial fibrillation. These polymorphisms have already described but their frequencies have never investigated in Russian population. But the polymorphisms influence to gene functions stays unclear, although attempts to investigate relationship between genotype and gene expression have been made. When the relationship will be discovered it can help us to modify our approach in treatment to patients with atrial fibrillation.

Annals of the Russian academy of medical sciences. 2019;74(4):245-252
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HEALTH CARE MANAGEMENT: CURRENT ISSUES
The system of unified training of scientific medical personnel of Sechenov university
Morozova O.L., Litvitskiy P.F., Andriutsa N.S., Maltseva L.D., Gribaleva E.O., Emelyanova E.S., Arakelyan A.S.
Abstract

Background: The article describes the issue of theoretical proof and experimental testing of the developed approach to optimization of fostering young generations of scientists and optimizing their individual career path. Aims: The aim of the article was to analyze the efficacy of the program of integration of high school students of medical school classes into the global system of training of young scientists.

Materials and methods: The general scientific methods were used, such as analysis and synthesis, field experiment and social research, which included survey conduction, education and control testing of high school students of medical preprofessional classes.

Results: Authors revealed the efficacy of implemented model of organization of educational process, which was based on the integration of high school students of medical classes into the global system of researchers training and which created a specialized environment for rapid individual professional development.

Conclusions: The conducted research proved the efficacy of the personalized approach to gradual teaching of basic research competencies.

Annals of the Russian academy of medical sciences. 2019;74(4):253-260
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РATHOPHYSIOLOGY: CURRENT ISSUES
The results of medical and psychophysiological examination performed during an arctic world oceanic international flight
Atkov O.Y., Gorokhova S.G., Serikov V.V., Alchinova I.B., Polyakova M.V., Pankova N.N., Karganov M.Y., Baranov V.M.
Abstract

Background: The development of the Arctic region is connected with extreme and strenuous work conditions and transmeridian shifts. The resulting stress changes the functional state of involved professionals irrespective of their age. Successful performance of job tasks depends on individual adaptation, which is an urgent issue to be studied with modern research methods.

Aims: The study was a complex research project on adaptation and changes of cardiovascular and psychophysiological functioning in response to long-term stress associated with rapid climate changes and transmeridian shifts experienced by the participants of the Arctic World Oceanic International Flight «Sever Vash».

Materials and methods: The participants of Sever Vash expedition, which took place in July and August 2018, were examined. According to the design of the study, they underwent a complex laboratory and instrumental assessment before the start and immediately on the finish. Blood parameters, level of DNA damage in blood cells, cardiovascular parameters (heart rate, brachial and aortic blood pressure (BP), subendocardial blood flow etc.), allostatic load index (ALI), and data of psychophysiological tests with work capacity assessment were analyzed.

Results: All participants (7 males, 39−69 y.o.) completed the planned route. The actual duration of the flight was 43 days. Comparative pairwise analysis on the finish revealed an increase of total blood protein (p<0.000), creatinine (p<0.000), bilirubine (p=0.038) and AcAT (p=0.031), and glucose (p<0.000) levels, and shifts in peripheral blood parameters, which are typical for the process of adaptation to the Polar conditions and transmeridian shifts. An increase of DNA damage in white blood cells was found. Average values of hemodynamic parameters were in a normal range; heart rate increased (p<0.000); mean brachial BP (p=0.003) and systolic aortic BP (p=0.001) decreased. Average values of pulse BP and subendocardial blood flow did not change (p<0.05). ALI increased in four pilots; in others, no ALI dynamic was observed. Psychophysiological potential decreased after the flight. The number of errors and omissions of target signal (р≤0.000) increased, attention span and emotional stability deteriorated. Along with this, the mood parameter increased to a maximum level, and risk tolerance level decreased (р<0.001).

Conclusions: Working in Arctic conditions is connected with stress factors and leads to multiple and deep changes required for urgent adaptation. Allostatic load index, which is an integral parameter of strained functioning in extreme conditions, can be a marker of individual adaptation. The achieved functional stability of body systems, particularly the cardiovascular system, ensures an acceptable level of work capacity in the considered conditions.

Annals of the Russian academy of medical sciences. 2019;74(4):261-271
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SURGERY: CURRENT ISSUES
Surgical treatment of hammertoes (literature review)
Bobrov D.S., Shubkina A.A., Lychagin A.V., Slinyakov L.Y., Yakimov L.A.
Abstract

The high prevalence of hammertoe deformity in the population, the effect of this pathology on the ability and the quality of life allow us to consider this pathology as a important medical problem. The most common surgery is arthrodesis of the proximal interphalangeal joint with a Weil-osteotomy. Specific complication is a floating toe, which leads to overload of adjacent toes and metatarsal heads. For to correct the instability of the metatarsophalangeal joint, the flexor to extensor transfer Girdlestone-Taylor can be used. However, the use of this procedure had limitations associated with difficult surgery techniques and below the average cosmetic result of the procedure. In the study of the causes of hammertoe deformity, the conclusion of the importance of the plantar plate of the metatarsophalangeal joint was made. Plantar plate repair leads to the stabilization of the metatarsophalangeal joint, reduces the risk of developing a floating toe, leads to the restoration of the support function and normal biomechanics of movement and foot function. Simultaneously, the plantar plate repair technically complicates surgical treatment. An promising direction of treatment is minimally invasive technologies for correction of hammertoe deformity that can reduce the risk of infectious complications, improve the cosmetic result of the surgery and reduce the risk of postoperative contracture in the joint, the time of the operation and rehabilitation, postoperative pain, emotional stress for the patient. However, the technique this type of surgery is more difficult, it requires a long training of the surgeon. The potential risk of intraoperative damage to various anatomical structures increases, which requires use of special tools during surgery. The choice of the surgical procedures is based on the individual characteristics of the pathological changes in the patient’s foot, the equipment of the operating room and the experience of the surgeon. It is necessary to evaluate the elasticity of the deformity, the stability of the metatarsophalangeal joint, the presence and severity of concomitant overloading metatarsalgia, as well as to take into account the subjective personalized requirements and expectations of the patient.

Annals of the Russian academy of medical sciences. 2019;74(4):272-282
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Study of the influence of vacuum therapy on the wound process in patients with diabetic foot syndrome
Gerasimchuk P.A., Shidlovskyi A.V., Fira D.B., Pavlyshyn A.V.
Abstract

Background: According to the International Diabetes Federation (IDF), the number of patients on diabetes mellitus is now more than 415 million people on Earth, until 2030 it will increase to 439 million, and by 2035 ― will reach 592 million. Throughout life, 4.6−25% of patients with diabetes mellitus develops a diabetic foot syndrome with the formation of wounds, whose treatment, can not yet be considered satisfactory, since in 15−25% of patients are the direct cause of high amputations of the lower limbs. This requires finding new effective methods for treating wound defects in patients with diabetic foot syndrome, one of which can be vacuum wound therapy.

Aims: To study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion.

Materials and methods: The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 2014−2017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area round the wound.

Results: Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p<0.05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization. In patients with ischemic lesions (chronic arterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 70−80 mm Hg, which makes it possible to stop pain during the day. At 2−3 days of the postoperative period, negative pressure is established at standard values.

Conclusions: Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduces the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average (4.3±1.7) bed-days, and patients with ischemic form ― on average (4.1±1.9) bed-days, which has both medical and social significance.

Annals of the Russian academy of medical sciences. 2019;74(4):283-288
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