Vol 77, No 2 (2022)

Background. Disorders in the production of neuroendocrine peptides in the digestive tract can cause changes in, intestinal motility and the formation of visceral hypersensitivity, characteristic of patients with irritable bowel syndrome (IBS). From this standpoint, of particular interest is the study of the role of a number of major endocrine cells (EC) of the colon, secreting motilin, vasoactive intestinal polypeptide, and somatostatin, in IBS. Aims — to evaluate the density of ECs with different hormonal activities that secrete motilin, vasoactive intestinal polypeptide and somatostatin in the mucosa of the sigmoid colon in patients with IBS that occurs with constipation and diarrhea. Materials and methods. 85 patients with IBS were examined. The first group included 44 patients with diarrhea (IBSd), the second group included 41 patients with constipation (IBSc). The comparison group consisted of 36 practically healthy people. The diagnosis of IBS was based on the Rome IV criteria. Patients and healthy people were examined according to a single program, including clinical, instrumental (colonoscopy, ultrasound examination of the abdominal organs), laboratory (clinical blood test, feces for calprotectin and antibodies to gliadin in the presence of diarrhea), morphological and immunohistochemical methods. Results. The clinical picture of IBS corresponded to the classical manifestations of this pathology. Among patients with IBSc, there was a more frequent feeling of incomplete emptying of the intestine after defecation, compared with patients with IBSd (p < 0.05). Among patients with IBSd, there was a statistically significant increase in the number of ECs producing motilin and vasoactive intestinal polypeptide, as well as a lower density of ECs secreting somatostatin, compared with the control group (p < 0.05). In the IBSc group, there was a decrease in the number of ECs producing motilin, vasoactive intestinal polypeptide and an increase in the number of ECs producing somatostatin, compared with the control group (p < 0.05). Conclusions. An increase in the number of cells producing motilin, vasoactive intestinal polypeptide and a decrease in the number of cells observed for the production of somatostatin in the mucosa of the sigmoid colon is characteristic of the manifestation of IBSd. At the same time, an increase in ECs secreting motilin, vasoactive intestinal polypeptide and an increase in cellular elements producing somatostatin reveals manifestations of IBSс.

Spinal muscular atrophy is one of the most severe hereditary neuromuscular diseases and one of the main causes of infant mortality caused by hereditary diseases. Being a monogenic disease, SMA is characterized by a wide range of phenotypes, which are based on the influence of genetic modifiers of the disease. These modifiers determine the development of a more severe or milder form of the disease and can act as potential targets of disease therapy. To date, there are three certified drugs for the treatment of SMA, the action of two of them is directed at the transcript of the main modifier of the disease — the SMN2 gene. With the advent of effective therapy, the issue of screening newborns for the purpose of early detection of patients and the beginning of treatment of SMA at the presymptomatic phase to achieve maximum effectiveness of drugs becomes relevant. In addition to neonatal screening, population screening plays an important role, which may result in a decrease in the frequency of births of children with SMA.

Background. The SARS-CoV-2 pandemic has set new challenges for the radiological community: early diagnosis of interstitial pneumonia, estimation of its severity, and dynamics. Computed tomography has become the method of choice for assessing lung tissue in COVID-19 patients, which is due to the low sensitivity of radiography in detecting a decrease in airiness by the “ground glass opacity” type. The criteria for assessing visual signs of lung tissue damage often have a degree of subjectivity, and the conclusion based on them affects the patient’s management tactics. Aims — to determine the inter- and intra-expert consistency in the assessment of the percentage of lesions and the CT stage of COVID-19 pneumonia among experts-radiologists with different experience, to analyze the level of precision depending on the prevalence of the lesion and other factors. Materials and methods. The research analyzed CT scans of 221 patients with confirmed SARS-CoV-2 by PCR. Patients with additional lung pathology and some patients with lesions up to 50% were excluded to create a uniform degree sample of 100 patients. Four expert radiologists determined the percentage of lung damage and the CT stages. The results of the expert assessment are analyzed using the methods of classical descriptive statistics and the analysis of intra-and inter-expert consistency. Results. The correlation of the level of lung damage, when evaluating intra-expert convergence (after 6 months), as a percentage between the first and second reading was R = 0.86 (p < 0.05) for expert 1 (high level of training), R = 0.84 (p < 0.05) for expert 2 (high level of training). Within the expert agreement, Kappa (for K-degree) was 0.54 for expert 1 and 0.46 for expert 2, which corresponds to a moderate level of consistency. When assessing inter-expert convergence, the connectivity between the level of lung damage as a percentage between experts 1 and 2 (high level of training) was R = 0.87 (p < 0.05), between experts 3 and 4 (low level of training) —R = 0.78 (p < 0.05). The measure of inter-expert agreement Kappa was 0.51 for experts 1 and 2 and 0.56 for experts 3 and 4. The average assessment of experts in the sample varied up to 4.5%, and when analyzing the differences in expert opinions, the difference varied evenly, both in the degree of increase and decrease in the volume of the lesion. Conclusions. In spite of the high level of correlation in the assessment of the percentage of lesion, the convergence of the Cap on the CT degree was moderate, not significantly differing from the degree of expert training. More often, differences in the level of damage are observed in “non-classical” patterns: “reverse halo”, curvilinear lines, etc. The difference in opinions doesn’t represent a systematic error. Hereby the expert assessment of the volume of lung damage “empirically” has a moderate, insufficient level of reliability.

Background. The number of patients (pts) with diffuse lesions among coronary artery bypass grafting (CABG) candidates has increased; they are expected to have worse results. Complex reconstructions, such as coronary endarterectomy (CEAE) and prolonged anastomoses with arteries less than 1.5mm in diameter, are being used more often. There is no sufficient evidence data and accepted guidelines for surgical treatment of this most complicated category of pts. Aim — to evaluate the effectiveness of CABG with and without endarterectomy in pts with diffuse lesion and compare it with standard CABG in pts with local lesion. Materials and methods. In 2010–2017 CABG were performed in 2.927 pts. 1276 had diffuse coronary artery disease and in 154 cases the surgeon was forced to perform CEAE. After excluding 38 pts with comorbidities, the study group was formed (group 1, n = 116). We selected 2 equally large control groups with propensity score matching: from pts with diffuse lesion operated without CEAE (group 2, n = 116) and pts with local lesion operated as standard (group 3, n = 116). Cardiopulmonary bypass and microsurgical techniques were used. Hospital and long-term (up to 8 years; median follow-up of 60 (42; 74) months results were compared. The endpoints were all-cause and cardiac mortality, myocardial infarction (MI), angina recurrence and repeated revascularization. Results. In group 1 the frequency of perioperative MI was significantly higher compared to groups 2 and 3 (6.9% vs 0.7 and 0.7% resp, p < 0.05) Hospital mortality was comparable in groups (p = 0.444). In the long-term period, the angina recurrence frequency was insignificantly lower in both control groups compared with the study group (p = 0.418). Autovenous grafts had significantly more dysfunctions compared with the internal thoracic artery grafts in symptomatic pts (57.5 versus 12.1%, p < 0.05; odds ratio OR = 9.82; 95% CI: 3.24–29.79). Also the severity of the “target” coronary artery lesion > 4 points scaled by the “diffuse lesion index” were more frequent cause of graft dysfunction in this group (60.9 versus 41.6%; p < 0.05; OR = 2.13; 95% CI: 1.13–4.24). Conclusion. Coronary endarterectomy is related to the high risk of perioperative myocardial infraction, while do not significantly increase the hospital mortality and adverse events in the long-term period. It should be considered to use coronary endarterectomy when there is no other option for surgery. The using of other adjunctive techniques demonstrate high efficiency in patients with diffuse lesions of the coronary arteries, comparable to surgery in patients with local lesion.

Asthma is a chronic, heterogeneous inflammatory disease with a high variability of the flow caused by the trigger influence of genetic and environmental factors. The heterogeneity of asthma indicates the involvement of many components in the mechanism of the inflammation of the respiratory tract. Currently, the microbiotic concept of the pathogenesis of respiratory system diseases is studied, based on the existence of a bilateral relationship between the microflora lungs and the intestines. The key mechanism of these relationships is free fatty acids performing signal and regulatory functions in the body. The medium-chain and long-chain free fatty acids are synthesized by de novo or enter the body as a result of consumption of fats, while the short-chain free fatty acids are formed in the intestine as a result of partial digestion of soluble fibre. The mechanism connecting the free fatty acids and inflammatory reactions includes activation of their receptors (Free Fatty Acid Receptor, FFAR) expressed on the cells of the gastrointestinal and respiratory tract, as well as on immune cells. If the role of the medium-chain and long-chain fatty acids receptors (FFAR1, FFAR4) and their ligands in the pathogenesis of asthma is actively studied, the value of the short-chain receptors (FFAR2, FFAR3) only begins to attract the attention of researchers in connection with the emergence of numerous data on the interconnection of the respiratory microbiome paths and intestines and its possible role in the induction of broncho-pulmonary complications. This review includes modern knowledge of the microbiotic concept of asthma, the basic information about the nomenclature, metabolism and transport of the free fatty acids, the value of the individual classes of the free fatty acids in the regulation of immune processes is normal and at bronchopulmonary pathology. The latest data of the FFAR receptors are systematized, features of their activation and expression, the intended role of FFAR2 and FFAR3 in the development and asthma therapy. It is discussed that gastrointestinal microbiota correction can reduce the activity of chronic inflammation of the respiratory tract at asthma.

Today autografts are considered to be an optimal material for bone grafting. However, the collection of material and it’s clinical use is associated with several serious drawbacks, and therefore, in reconstructive surgery, a search for alternative treatment approaches is being conducted. A bone transplant from another person (allo-osteoplasty) is the most natural and logical option for replacing an autobone. Since 1965, allogeneic implants of a partially demineralized bone matrix combining osteoinductive and osteoconductive action have been used in clinical practice. However, the clinical results of the use of this material turned out to be ambiguous, which is due, first of all, to the significant variability of the osteoplastic potential of its various samples. For this reason, in clinical practice, sometimes preference is given to samples of non-demineralized allobone, which retain it’s structure longer. In this paper, we consider factors affecting the osteoinductive activity of a partially demineralized bone matrix, related both to the technological issues of its preparation and to the clinical conditions of use. Issues of the possible improvement of this material were discussed with a view to its further use in medical practice.

Rationale. Tobacco smoking remains a serious health risk factor both in the world and in Russia. Special attention is paid to the protection of young generations from exposure to smoking and the harmful effects of tobacco. The purpose of the study — based on a comparative analysis of the dynamics of tobacco smoking among rural adolescents in 2001-2017, to assess the changes that have occurred and justify proposals to reduce smoking among minors. Materials and methods. A sample of adolescents in each subject of the Russian Federation was formed by multi-stage selection: typological, random and continuous examination. In 2001–2002, 16 743 rural teenagers (7468 boys and 9275 girls) were interviewed, in 2016–2017 18 222 teenagers (8208 boys and 10 014 girls). Statistical development of materials was carried out using the computer program “Risk Factors” (AnkProc). Results. During the period from 2001–2002 to 2016–2017, the prevalence of smoking among boys decreased by 2.7 times, and among girls — by 3 times. The number of boys who smoked remained higher than the number of girls who smoked (by 2 times). The proportion of teenagers who smoked based on the emerging addiction (“like”, “out of habit”, “I can’t quit”) I grew up among both boys and girls. During the period under review, the predominant motive of the first smoking test, both boys and girls, remained “curiosity”. The age interval of initiation to tobacco smoking has not changed either (from 10 years to 17 years inclusive). The peak of initiation to smoking in 2001–2002, and in 2016–2001 boys accounted for up to 10 years inclusive, and among girls — for 13–14 years. In 2016–2017, hookah smoking became popular among rural teenagers. The prevalence rates of hookah smoking were 13.5 per 100 boys and 10.3 per 100 girls. 55.7% of boys and 44.9% of girls smoked hookah with tobacco. Hookah smoking was primarily addressed by teenagers who did not smoke (62.0% of boys and 76.0% of girls). Among hookah smokers, 34.3% of boys and 21.2% of girls smoked tobacco products weekly. Conclusion. A comparative analysis showed a significant decrease in the prevalence of smoking among rural adolescent schoolchildren in the Russian Federation.