Vol 75, No 1 (2020)


Possibilities of application of regenerative technologies in gynecology

Denisova J.V., Mandra E.V., Lyundup A.V., Sulina Y.Y., Aleksandrov L.S., Ischenko А.А., Ischenko А.I., Beregovykh V.V.


The article presents a review of publications devoted to the use of regenerative technologies in the treatment of gynecological pathologies. The authors describe possible ways to solve these problems by analyzing the experimental studies conducted in the world. Identified the main indications for tissue engineering: Asherman’s syndrome, primary ovarian failure, infertility caused by chemotherapy, a “niche” in the uterus, endometrial pathology (endometriosis, endometrial problems, etc.), cervical pathology, female genital tract abnormalities, pelvic organ prolapse. The results of clinical trials of cell therapy aimed at treating infertility caused by Asherman syndrome and primary ovarian failure, female genital tract abnormalities, as well as such rare pathology as a “niche” of the uterus. At the preclinical stage, in addition to the above, considered cellular therapy of cervical pathologies, endometrial diseases and pelvic organ prolapse. Eximined cell cultures and the level of their influence on the regeneration of the female reproductive system structures, presented the biological scaffolds that stimulate the growth of stem cells, their effectiveness and shortcomings are covered.

Annals of the Russian academy of medical sciences. 2020;75(1):4-17
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Surgical correction of prolapse of anterior wall of the vagina and cervix using titanium mesh implants

Ishchenko A.I., Aleksandrov L.S., Ishchenko A.A., Kazantsev A.A., Khokhlova I.D., Dzhibladze T.A., Gorbenko O.Y., Chuschkov Y.V., Zuev V.M., Manevskaya Y.B., Uschkova A.D.


Background: Regardless of a variety of surgical techniques and hi-tech materials for pelvic prolapse treatment, there is no decrease in the disease recurrences.

Aims: Evaluation of the efficacy of the developed method of surgical correction of II–IV degree colpoptosis anterior combined with II–III degree “C”-prolapse with the use of titanium mesh implants in reproductive, pre- and postmenopausal female patients.

Methods: Female patients (group I, n = 25) with colpoptosis anterior and cervical prolapse were examined and operated on according to the developed know-how technique with the use of titanium mesh implants. Evaluation of the efficacy of surgical correction of the disease was performed using questioning, pelvic exam with Valsalva manoeuvre, transvaginal and transperineal ultrasound, pelvis MRI. The findings were compared with the result of surgical treatment of 46 (group II) and 32 (group III) female patients operated on without the use of titanium implants. After surgical treatment according to the three-stage surgical program that provides for multifocal fixation of anatomical formations with the use of titanium implants, the case follow-up was performed in 3−21 months.

Results: Questioning the patients in group I demonstrated their satisfaction with the surgical treatment results that positively affected the quality of life, mood, and contributed to an increase in sexual activity and community commitment. Check-up showed that the surgical correction of prolapse was completely preserved in the patients of group I during 18−21 months. Pelvic exam at rest and with Valsalva manoeuvre, transvaginal and transperineal ultrasound, pelvis MRI did not reveal any significant extrusion of the pelvic organs or titanium implants. No mesh-associated complications were observed during the follow-up. Recurrence of genital prolapse was diagnosed in 12 (26%) patients of group II, mesh-associated complications were detected in 6 (18.8%) women of group III.

Conclusions: The preserving three-stage surgical program, developed by us, contributed to optimize the results of surgical treatment, decrease the rate of the disease recurrence, and reduce the risk of the development of mesh-associated complications.

Annals of the Russian academy of medical sciences. 2020;75(1):18-26
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The pathomorphosis of inflammatory bowel diseases

Maev I.V., Shelygin Y.A., Skalinskaya M.I., Veselov A.V., Skazyvaeva E.V., Rasmagina I.A., Komarova D.A., Bakulin I.G.


Inflammatory bowel diseases (IBD) are immune-mediated diseases and usually manifest at a young age. They are requires in a long-term treatment or surgery with a high probability of surgical intervention. IBDs are accompanied by a decrease in working capacity, impaired quality of life and social disadaptation. However, timely diagnosis with using modern diagnostic methods, the use of evidence-based immunosuppressive and biological therapy significantly changed the pathomorphosis of this disease. But despite the achievements of the pharmacotherapy, the incidence and prevalence of IBD are still increasing, a demand for surgery remains both for Crohn`s disease and ulcerative colitis throughout all the period of illness. At the same time there is a trend towards the variability of symptoms, mismatch of the clinical symptoms with the real severity of inflammation, increase of a number of patients with extraintestinal manifestations and resistance to induction and maintenance therapies. In addition to this, the observation of this group of patients is complicated due to the difficulty of the early diagnosis and differential analysis of IBD, the need of early induction treatment according to the guidelines and the lack of adherence to the therapy.

Annals of the Russian academy of medical sciences. 2020;75(1):27-35
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Varicose veins: on the verge of discovering the cause?

Zolotukhin I.A., Porembskaya O.Y., Smetanina M.A., Sazhin A.V., Filipenko M.L., Kirienko A.I.


Varicose veins of the lower limbs are one of the most common and wide-spread pathology all around the world. What triggers the specific changes in a vein wall still remains unclear as well as what happens in the layers of the vein wall after the disease starts. The aim of the article is to analyze published data and results of researches on epidemiology, genetics, cellular and molecular mechanisms underlying varicose veins pathogenesis. It is now commonly accepted that vein wall changes in patients with varicose veins result from vein-specific inflammation. This process includes leukocytes adhesion to venous endothelium with their subsequent migration into the vein wall and surrounding tissues. Activated leukocytes express a number of molecules that lead to vein wall remodeling and dilation. Comprehensive assessment of the epidemiological data on the prevalence of varicose veins and risk factors, of the findings from genetic studies, of data on molecular-cell interactions as well as results of various surgical interventions in patients with varicose veins, shows that remodeling is a reversible process that can be stopped and reversed by different stimuli including some chemical substances. For the first time in the literature, the authors assume that varicose veins can be successfully cured pharmacologically with no surgical interventions needed.

Annals of the Russian academy of medical sciences. 2020;75(1):36-45
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What is better for a patient with stable coronary artery disease — bypass surgery or percutaneous coronary intervention?

Sokolova N.Y., Golukhova E.Z.


Background: The main methods of treating patients with stable coronary artery disease (CAD) are myocardial revascularization with coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI). These are two fundamentally different in technique and volume of surgical interventions; PCI is associated with rapid rehabilitation of the patient, and only CABG demonstrated effective in survival benefit.

Aims: Comparison of the long-term results of myocardial revascularization with CABG and PCI in patients with stable CAD.

Methods: The results of a prospective one-center cohort study of 369 patients with stable CAD are presented, the average age is 60.1 ± 5.4 years. Patients were randomized into 2 groups by the «Heart Team»: CABG (n = 196) and PCI (n = 173). In each group, subgroups were identified depending on the severity of the coronary lesion, and the CABG group was also separately studied in according to CABG technique ― beating-heart (off-pump) and with cardiopulmonary bypass (on-pump). The average follow-up was 54.3 ± 7 months. The main outcomes of the study were major adverse cardiac and cerebral events (MACCE): death from all causes, cardiac mortality, nonfatal myocardial infarction (MI), nonfatal stroke and repeated coronary revascularization.

Results: Over the 5-year follow-up period, no differences were found between the CABG and PCI groups with a low complexity of coronary artery lesions (SYNTAX Score 14.2 ± 4.8) in terms of survival, cardiac mortality, nonfatal MI and stroke, and the need for repeated myocardial revascularization. Patients with stenosis of the left main coronary artery (LMCA) and/or multivascular CA disease (SYNTAX Score 25.8 ± 5.0) in the long-term follow-up after CABG and PCI did not differ in MACCE, but the CABG group demonstrated a significant advantage in repeated myocardial revascularization. No significant differences were found in any study endpoint in patients after CABG on-pump versus off-pump.

Conclusions: Our study demonstrates the advantage of CABG in patients with stable CAD with stenosis of the LMCA and/or multivascular CA disease, and which CABG technique should depends on the comorbidity of the patient, the experience of the surgeon and the surgical center.

Annals of the Russian academy of medical sciences. 2020;75(1):46-53
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A meta-analysis of prospective studies comparing the results of laminoplasty and laminectomy with instrumental fixation in the surgical treatment of patients with multilevel degenerative cervical spine diseases

Byvaltsev V.A., Kalinin A.A., Aliev M.A., Shepelev V.V., Yusupov B.R., Aglakov B.M.


Background: Dorsal decompressive-stabilizing techniques — laminotomy with laminoplasty (LP) and laminectomy with instrumental fixation (LF) are effective methods for surgical treatment of patients with multi-level degenerative diseases of the cervical spine. At the same time, there is currently no priority in determining the optimal method for posterior decompression and stabilization.

Aim: conduct a comparative analysis of intraoperative parameters, clinical outcomes, radiological results and complications of LP and LF in the treatment of patients with multilevel degenerative diseases of the cervical spine.

Methods: A meta-analysis of prospective cohort clinical trials was carried out, the primary sources were searched using the databases PubMed, CNKI, eLibrary and the Cochrane Library, published until March 2019, which compared the results of applying the LP and LF methods in the treatment of patients with multilevel degenerative diseases of the cervical spine. For dichotomous variables, the relative risk and the 95% confidence interval were calculated; in turn, for the continuous variables, the standardized difference of the mean values and their 95% confidence intervals were used, using random effect models and a fixed effect.

Resuts: The meta-analysis included 6 prospective clinical trials, one of which was a randomized controlled trial. In total, the results of surgical treatment of 493 patients with multilevel degenerative diseases of the cervical spine were evaluated. In the group of drugs, statistically significantly smaller parameters of the duration of surgical intervention were verified (p < 0.00001). At the same time, comparable parameters of cervical lordosis after surgery, the level of pain in the cervical spine, functional status according to NDI and JOA after surgery, the frequency of perioperative complications (p = 0.17, p = 0.05, p = 0.94, p = 0.96, p = 0.24, respectively).

Conclusions: A meta-analysis showed that the functional outcomes of LP and LF, as well as instrumental results in the treatment of multilevel degenerative diseases of the cervical spine, are not clinically significant. In this case, the LP technique can be performed in a shorter period of time compared with LF.

Annals of the Russian academy of medical sciences. 2020;75(1):54-68
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Implementation of clinical decision support system for anticoagulant prescribing for patients with deep vein thrombosis

Chernov A.A., Kleymenova E.B., Sychev D.A., Yashina L.P., Nigmatkulova M.D., Otdelenov V.A., Yashina L.P.


Background: Physician’s adherence to recommendations for appropriate antithrombotic therapy of venous thromboembolism (VTE) can reduce the risk of recurrent VTE, pulmonary hypertension, bleeding and other adverse events. Clinical decision support systems (CDSS) are shown to increase physician’s adherence to clinical guidelines.

Aims: To assess effectivenes and safety of CDSS for anticoagulant prescribing for inhospital patients with VTE.

Methods: A prospective cohort study was conducted in a Moscow general hospital from 06.30.2017 to 06.23.2018 to compare physician’s compliance with clinical guidelines for DVT anticoagulant therapy, the rate of drug errors and direct costs of anticoagulant therapy before and after CDSS implementation (55 patients in control group and 49 in experimental group).

Results: The rate of anticoagulant prescribing for patients with DVT did not alter significantly after CDSS implementation (96% compared with 91% before CDSS), but physicians’ compliance with recommendations on anticoagulant dosage increased from 32.7% to 73.5% (p = 0.0003) with corresponding decrease in the rate of anticoagulant prescribing errors from 1.35 to 0.65 per 1 patient (p = 0.0005). The length of stay and hemorrhagic complication rate did not differ between control and experimental groups. LMWH replacement with new oral anticoagulants has reduced the cost of anticoagulant therapy for 1 patient from 11.800 rubles (IQR = 7000) to 5.430 rubles (IQR = 5700) (p < 0.005).

Conclusions: СDSS can increase physician’s adherence to recommended anticoagulant therapy for patients with DVT: to prevent unreasonable under-/overdosing or prolongation of anticoagulant therapy. CDSS for DVT drug therapy can be economically feasible.

Annals of the Russian academy of medical sciences. 2020;75(1):69-76
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Clinical and epidemiological features of papillomavirus infection manifestations on the example of cervical cancer and genital warts

Briko N.I., Sekacheva M.I., Lopukhov P.D., Kobzev G.S., Kaprin A.D., Novikova E.G., Trushina O.I., Khaldin A.A., Maleev V.V.


Background: Cervical cancer and genital warts (GWs) are some of the most common manifestations of human papillomavirus infection (HPV). These lesions cause significant damage to the reproductive health of the population, which leads to increased attention to the prevention of HPV infection among various population groups.

Aims: To determine the clinical and epidemiological features of the HPV manifestations by the example of cervical cancer and genital warts.

Methods: A retrospective analysis of anamnestic information of 115 women with an established diagnosis of cervical cancer and 177 patients with an established diagnosis of GWs was performed. The clinical and epidemiological characteristics of patients with diagnoses of GWs and cervical cancer were based on the development of outpatient admission cards and inpatient histories, as well as test data for HPV.

Results: HPV 16 was the most common HPV type among patients with GWs and cervical cancer ― it was detected in 37.6% of cases. Also the most frequently encountered: HPV 6/18/11/31/51/52. In 43.2% cases of HPV detection, two or more types were detected at once, the most common combinations: HPV16 and HPV18, HPV6 and HPV16, HPV6 and HPV11. Analysis of the frequency of screening for cervical cancer and visits to the gynecologist for 5 years before establishing the diagnosis showed that among those who did not screen for cervical cancer, the risk of diagnosing stage II–IV was 5.2 times higher than among individuals who underwent cervical screening 2 years ago, or once a year for the last five years. Among patients with GWs who had 2 or more sexual partners for 1 year, 13.5% of patients regularly used barrier contraception methods (condoms) during sexual contact, not regularly ― 61.5%, did not use them at all ― 25.0%.

Conclusions: Identifying the clinical and epidemiological features of HPV infection should contribute to the development of new and optimize existing prevention programs for a wide range of HPV-associated diseases.

Annals of the Russian academy of medical sciences. 2020;75(1):77-82
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Obstetric and perinatal care units functioning during the COVID-19 pandemic

Di Renzo G., Makatsariya A.D., Tsibizova V.I., Capanna F., Rasero B., Komlichenko E.V., Pervunina T.M., Khizroeva J.K., Bitsadze V.O., Shkoda A.S.


The rapid spread of COVID-19 and the large number of cases put a significant burden on the health systems of any developed country. Specialists in natural disasters and military medicine should be involved in the provision of medical care and observance of anti-epidemic measures. In some countries, including Italy, they were involved only after the situation was dramatically worsening with many clinical units and hospitals overloaded by infected patients. To curb the spread of COVID-19, most countries declared a state of emergency, and unprecedented measures have been taken to strengthen quarantine in suspected or positive symptomatic subjects. Nevertheless, the crisis associated with the unexpectedly global scale and tragedy of the pandemic and the inconsistency of actions of both society and individuals and specialized medical services, lead to insufficient effectiveness of the measures taken in a number of regions. In the present day, it is vital for every person to change its mindset ― relying on personal responsibility to comply with all recommendations of quarantine and anti-epidemic measures, and to reorganize departments and resources of medical institutions at all levels in order to withstand the spread of infection and at the same time provide all those in need with the necessary and appropriate medical care. Particular attention should be paid to the obstetric care service, given that even in “normal” times, the obstetric hospital is an area of increased responsibility for the life and health of mother and child and future mankind. Fulfillment of existing orders, instructions of national and regional committees, international and national protocols and clinical protocols should undoubtedly lead to a positive result, but this requires additional training of medical personnel at all levels. The purpose of this review is to propose quick key strategies for reassessing the maternity and neonatal wards/ hospitals based on the experience of health systems and organizations which faced the spread of this new coronavirus; this advice may be applied along with binding tight instructions in obstetric hospitals in order to proactively respond to a likely wave of growth in COVID-19.

Annals of the Russian academy of medical sciences. 2020;75(1):83-92
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